Safety First: Cervical Spine Trauma

 


Study Notes:

  1. 1.If the MOI suggests a possible C-spine, we need to stabilize the C-spine so that it doesn’t move.

  2. 2.It is possible to ‘clear’ the C-spine in the field, but we don’t do that at this point in the call.  Instead, if there is any doubt, we immobilize (for now) and later in the call we use the protocol to determine if we need to continue immobilization.

  3. 3.If we decide to continue immobilization later in the call, we’ll protect the spine more securely.  For now we are just going to hold the patient’s head in place so that it doesn’t move.

  4. 4.Usually it is the paramedic acting in the ‘second’ role that immobilizes the c-spine.

  5. 5.On these calls, our first words to the patient are often ‘Don’t move, don’t turn your head’.

  6. 6.If this is an MCI, we use the ‘T’ to remind us to do triage (and not c-spine immobilization).

“T is for Trauma to the cervical spine”

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“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

“Oh my achin’ neck!’

In this next step you are about to talk to your patient for the first time, and to put your hands on them as well.  I’m going to assume that you know all about how paramedics work in teams.  (If you don’t know all about this, you might want to read this first).

As humans, we have a fragile design flaw.  We have a huge head, attached by a thin column to the rest of our body. 

Our necks.

This means that whenever a strong force pushes our heads, or pushes our bodies, there is a danger of our necks being injured or broken.

In medical language, we refer to our necks as the “cervical” portion of our spinal column, and we always shorten this when we are speaking to calling it our 'C-spine'. 

(We don't say 'necks'... if you do, you'll sound like a rookie.)

The problem with our necks - I mean our C-spine! (ack!) - is that if they are broken and we move them, we risk breaking them more and injuring our spinal cord, which runs in a column inside our cervical spine bones. 

If we injure our spinal cord too much we might become paralyzed, even to the point of losing the ability to breath on our own.

This means that, as a rescuer, you have to take exceptionally gentle care of anyone who is (as we say) 'a possible C-spine'.

At this point in the call we are - for the first time - actually engaging with the patient and speaking to them.  So it is quite common for the very first words we say to people to be 'Don't move. Don't turn your head' - even before we introduce ourselves.

If the MOI suggests a possible C-spine, then we have to protect the C-spine for our patients. 

There are two ways we can do this.  Usually it is the ‘second’ (often the medic with lower training) who places both of their hands on either side of the patients head and gently supports their head in that position. This keeps the ‘attendant’ (the other medic) free to interview the patient and perform other medical care.  We don't try to move the head, or carry the entire weight of it, we just hold it and make sure that the patient doesn't move it around at all, and possibly injure their spinal cord. 

We act like a brace.

If the patient is lying on the ground, then the second can use their knees, instead of their hands, to immobilize the patients C-spine.  Why would they use their knees instead of their hands?

Because that lets the second keep their hands free so that they can do some of the other things that need to get done, like dealing with possible airway complications, or doing more of a physical assessment on the patient. 

But that comes later, for now, just know that using your knees is a handy way to immobilize the C-spine of someone on the ground.

OK ... I know it's not a perfect mnemonic, but how does 'T' stand for 'C-spine'? ( I hear you ask)

What we're trying to do is protect a C-spine that has undergone Trauma.  The T stands for trauma - but in this case its trauma specifically to the C-spine.

So, let's review.  At this point in the call we have taken our BSI precautions (Safety), we've done a scene assessment (F), we've assessed either the MOI or NOI of the incident (I) we've noted the number of patients (R) and sent for help if we think we might possibly need it (S). If the MOI suggests a possible C-spine, we've approached the patient, told them not to move, and the second has entered quickly to immobilize the C-spine (T). 

However, we’re not quite done yet.  The ‘T’ in this step can stand for something else.  If we earlier noted that there are more patients than there are rescuers then we are not going to bother dealing with one patient at this point - even if we suspect that have a broken neck.  Instead, we are going to concentrate of finding all of the patients and prioritizing them all in order, from the most sick to the least sick (without really treating them yet).  Sorting patients out like this is called ‘triage’ (which comes from the French word meaning ‘to sort’).  So if this is a multi-casualty incident, we use the ‘T’ to remind us to do triage, instead of to immobilize any one patient’s C-spine.

We've done our 'Safety F.I.R.S.T.'  Good job!

Now what? ...