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London Ambulance service training order.
Adult Spinal Immobilisation Guidlines
The indications for rigid spinal immobilisation will be given by the history of the accident and evidence from 'mechanism of injury'., together with clinical signs/symptoms suggesting the possibility of damage to the spine.
Spinal immobilisation should always be applied in the following groups of patients.
where the mechanism of injury raises the possibility of spinal damage.
where there is pain arising from the spine, or tenderness of the spine.
Where there are neurological signs related to spinal injury (including loss of ,or reduced feelings to extremities)
Where a patient presents with a significant injury and there is an altered level of consciousness or intoxication (whether from drugs or alcohol), or injuries that may distract from a spinal injury.
Note: The use for spinal immobilisation is mandatory in all unconscious injured patients.
Cervical collars must under no circumstances be used in isolation,. Collars must be used with other immobilisation equipment/devices. Collars must also be measured against patient for correct size
LAS Unofficial note: Do not transport any patient in sitting position with collar. Do not transport any recumbent patient with just a collar, must be used with blocks or rolled blanked if not available, secured taped with full immobilisation. A No-Neck fits all is not correct. Size your patient correctly and apply appropriate collar.
Long Boards (Spinal board), Ortho stretchers
In cases of spinal injury that require extrication from a vehicle, the long spinal board should continue to be used in conjunction with collar, KED/RED. In cases where no extrication is necessary, the patient may removed from scene following immobilisation using a collar and ortho stretcher. The patient must be secured using straps and head blocks secured with tape if necessary. The patent may be left on the ortho' stretcher during transport. Once at the hospital then the ortho may be removed.
It is emphasised that with any suspicion of spinal injury, the default position should be the application of a cervical collar and spinal/ortho' stretcher. This is essential in dealing with patients who may reasonably be suspected of having sustained a spinal injury and who are;
Unconscious
presenting with reduced levels of consciousness due to any cause
Or are presenting with a significant distracting injury.
There is evidence however, that collars are being applied unnecessarily in conscious car occupants after a low velocity impact (20mph or less). Spinal immobilisation may not be required for car occupants when all the following circumstances are found together.
The impact was 20mph or less
There is minimal damage to the vehicle
The person is young and normally fit.
There is no compliant of neck pain.
There is no spasm of the neck
There is no spinal tenderness
In the above circumstances spinal immobilisation may not be required. If in any doubt then immobilisation should be used.
All patients being treated for spinal injury should also be administered 100% O2 as this helps to reduce spinal swelling.
It is emphasised that the above guidelines are intended for adults only. Further guidelines for children will be issued in due course
