Once the need for resuscitation has been established and attended to if necessary, the person with a suspected spinal cord injury has to be appropriately immobilised.
For the first aider or untrained bystander, this may entail only the positioning of the head in the neutral position and then maintaining it there until more professional help arrives.
This is accomplished with manual inline support, which is to say holding the head using your hands so that it does not move relative to the body.
This may be all that is able to be done at this stage but represents a significant action in preventing further damage through inadvertent movement of the person prior to a higher level of care being present.
For those trained in its application, a cervical or C collar is then placed to prevent movement of the head and neck. This is a semi-rigid plastic device which can be adjusted to fit different sized and shaped people.
In the past, soft foam collars were used which offer no restriction of movement and have little place in modern first response practice. The only thing that can possibly be said is that they may serve to alert other people to the fact that an injury is present, but this can also be interpreted as an insignificant injury that is being treated with what amounts to a cushioning device.
A spineboard is a long, rigid device used for lifting and carrying an injured person. Spinal boards come in many different types and they can be made of a variety of materials. Typically they are fibreglass, carbon fibre or plastic, though aluminium and wood are also used.
A minimum of four straps which can be tightened over the person are required to ensure adequate immobilisation. A spineboard should not be used without the straps except when sliding an injured person out of an enclosed space or vehicle (in this circumstance it is being used as for rescue or extrication).
Some spineboard are in a single piece, whilst others that can be scooped under the injured person (or scissored at one end) have locking mechanisms which can be opened and closed to allow the spineboard to be split into two.
Extrication devices are short spineboards which have straps attached and often an inbuilt head immobilisation device as well.
A vacuum mattress is a whole-body bean bag mattress that can have the air removed by a pump from within it, leaving a harder outside shell which conforms to the injured person’s shape. It is ideally used when an injured person is going to spend a long time during the process of transport as it diminishes the potential for pressure over bony prominences whilst lying in the supine (face upwards) position.
The other important piece of equipment used to help mobilise the injured person is the head immobilisation device or “headbed“. This device has a base plate which is strapped to the underlying spineboard, and typically two blocks of foam which are placed on either side of the injured persons head. Velcro or adhesive straps are then placed over the top of these blocks to hold the head in position.
If the entire head neck and body are appropriately immobilised in this fashion, and the straps tightened to ensure no movement has occurred during the fitting process, it is then appropriate to remove the first responder’s hands from providing manual inline support, as the injured person is effectively “packaged” and can be transported knowing that inappropriate movement has been restricted and in most cases eliminated.
There are arguments in the medical literature about the efficacy of collars, spineboards and head immobilisation devices, however from basic principles of fracture management (splinting theinjured body part at, above and below the level of injury) it seems logical to utilise these devices. Naturally it is important to ensure they are properly applied as they can then provide a more secure method of transporting a injured person. The alternative is requiring a first responder to stay at the head of the injured person and apply manual in line support for what may be a great deal of time (from a few minutes to several hours in some cases) and maintain vigilance whilst moving the injured person, loading them into and out of an ambulance and accompanying all the way into a hospital.