Most often when someone is acting as an immediate responder (regular person who is trained in first aid, but who is not an lifeguard/EMT/nurse), they are responding to a minor, non-life threatening injury. Think small cut, twisted ankle, burn in the kitchen or the run of the mill workplace injury. But, what about when you come across some of those more severe incidents? The car accident, the diving board, the "kid wasn't looking where they were running at the playground and now we have a head injury" injury. What if you come across someone who is unresponsive and you don't know what's wrong with them? Because these kind of scenarios are brought up weekly in our courses, this week I wanted to take a moment and touch on spinal injuries.
For those of you who think this isn't important, or wont apply to you. Did you know that a vehicle accident at just 20MPH can cause whiplash and/or an accompanying head injury? What about a fall from any distance greater than the person's height, a fall onto your butt which transfers force to the spine, any fall landing on the head or spine, or any excessive extension or rotation (such as tumbling down a hill while skiing without your ski's releasing) is all that it could take for you to receive a life altering spinal injury? It doesn't take much, and honestly, most of us have probably suffered a minor spinal injury at one point or another in our lives. So lets get into it.
Checking for Spinal Injuries
First things first,
a person who is found unconscious should always be treated as an assumed spinal injury.
If you are unsure as to how an injured person became unresponsive, you must assume a spinal injury first. This is especially true if there is evidence of suspected trauma such as an assault, vehicle accident or fall.
- Keep the person still, do not move the person unless you or the person is in immediate danger.
- Manually stabilize their head while you form your initial impression and make up a game plan.
- If the person is responsive, help them to remain clam
- Look listen and feel for signs and symptoms of spinal injury, including
Spinal pain/discomfort to the touch
Altered sensation at the extremities (loss of sensation, cold to the touch, weakness/inability to move, tingling)
Respiratory difficulty
Loss of bowel/bladder control
Providing Care
When providing care to spinal injury victims your number one priority is your ABC's. (which stands for Airway, Breathing, and Circulation) These are the things that are required for living, so they should be given priority. As previously mentioned, your next immediate priority should be to immediately immobilize the neck and spine through manual stabilization.
Airway and Breathing
- To maintain an open airway, utilize the jaw-thrust technique as opposed to the head-tilt, chin lift
- Immobilize the head and neck and only remove a helmet if it is restricting breathing or your ability to provide rescue breaths
- Verify the person is breathing and perform frequent checks to ensure their condition doesn't change.
Circulation
- Frequently check the extremities for color, temperature, and sensation
- During your frequent assessments, make sure to keep checking the persons pulse, look to maintain a pulse rate above 60 BPM for adults, anything less and 911 should be updated immediately.
Pulse checks can be made in these locations, utilizing 2 fingers and never your thumb. I recommend the carotid artery or the brachial junction.
What if I have to move the person or use an AED?
Movement of a person with a spinal injury is super not recommended. However, sometimes it simply cannot be avoided. Think scenarios where the scene is or becomes unsafe, needing to use an AED in a location where there is metal or standing water, or the injury happened in an isolated area (the woods) resulting in long term care while waiting for extrication or assistance.
If you MUST move a person with a known or suspected spinal injury you should be VERY proficient and practice the techniques often. For AED pad placement, try the log roll technique
If you are alone, you can also use the technique shown below. Stabilize the head and neck between your forearms/elbows, stay as low to the ground as possible, and with your hands inside the persons armpits drag the person to safety.
Regardless of which technique you use:
- Always maintain control over the head and neck, preventing any and all movement.
- Do everything possible to keep the spin in a straight line.
- Take it slow. Slow is smooth, smooth is fast.
- Make a plan for movement, make sure your path is clear, make your movement slowly and deliberately.
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