Spinal Management Certificate Learner Guide v2.1 May 2017
Acknowledgements Surf Life Saving Australia (SLSA) would like to acknowledge all of the volunteers, contractors and staff members who contributed their time and expertise to support the development of this resource. 2017 Surf Life Saving Australia Ltd This work is copyright, but permission is given to SLSA trainers and assessors to make copies for use within their own training environment. This permission does not extend to making copies for use outside the immediate training environment for which they are made, or the making of copies for hire or resale to third parties. For permission outside these guidelines, please contact: Surf Life Saving Australia Locked Bag 1010, Rosebery NSW 2018 Ph: (02) 9215 8000 Fax: (02) 9215 8180 info@slsa.asn.au All resources developed by SLSA are reviewed regularly and updated as required. Feedback can be supplied to SLSA at any time by calling or writing using the details above. Version v2.1 May 2017 Spinal Management Certificate Learner Guide v2.1 May 2017 Page 2 of 20
Contents Acknowledgements 2 Course Introduction 4 Course outcomes... 4 SLSA award entry requirements... 4 What you need to complete this course... 4 Topic 1 Spinal Cord Injuries 5 The musculoskeletal system... 5 The spinal cord... 6 Common causes of spinal cord injury (SCI)... 6 Mechanisms of injury... 7 Classification and level of injury... 8 Signs and symptoms... 9 Topic 2 - Managing a Spinal Cord Injury 10 Manual immobilisation... 11 When a walk-up victim needs assistance... 12 Log roll... 14 Strapping... 16 Extricating a victim... 16 Stabilisation and retrieval in an aquatic environment... 16 Victim handover... 18 Assessment Information 19 Assessment Task 1: Written questions... 19 Assessment Task 2: Practical scenarios... 19 Appendices 20 Appendix 1 List of figures... 20 Spinal Management Certificate Learner Guide v2.1 May 2017 Page 3 of 20
Course Introduction This course is designed to address the need to identify and manage victims with suspected spinal cord injuries in the aquatic environment. Course outcomes By the end of this course you will be able to: identify victims with a suspected spinal cord injury manage victims with a suspected spinal cord injury. SLSA award entry requirements To commence training for the SLSA Spinal Management Certificate you must meet the following award entry requirements: be at least 15 years of age on the date of final assessment be proficient in one of the following SLSA awards: - Bronze Medallion OR - First Aid. hold one of the following units of competency: - HLTFA211A or HLTAID002 Provide basic emergency life support OR - HLTAID003 Provide first aid. Prerequisites There are no prerequisites for the SLSA Spinal Management Certificate. What you need to complete this course this Learner Guide a copy of the Spinal Management Assessment Portfolio access to appropriate equipment to practice with any equipment you need for working in the water (e.g. swimmers, shorts, rash shirt, stinger suit, wet suit) to retrieve a victim with a suspected spinal injury Spinal Management Certificate Learner Guide v2.1 May 2017 Page 4 of 20
Topic 1 Spinal Cord Injuries This topic covers injuries that can occur to the spinal column and/or cord, and describes how to treat a victim with a suspected spinal injury. Severe injuries of the spine are rare. Minor neck and back injuries however, are very common and are responsible for a large amount of lost time from work. The majority of people who sustain a back/ spinal injury will recover and return to their previous level of activity. However, some suffer ongoing pain, limitation of movement and an impaired quality of life for some time, even permanently, after the injury. The musculoskeletal system The skeletal system consists of a rigid framework of bones (206 in the adult) that perform many functions. They: provide structural support for the body protect vital body organs (e.g. brain, heart, lungs) provide an anchor for muscle tendons, allowing joint movement are an important site for the production of blood cells provide a mineral (e.g. calcium) reservoir for the body. The bones of the skeleton are connected by a series of joints. Some joints permit virtually no movement (e.g. the bones of the skull), while others are designed to permit movement (e.g. the shoulder, elbow, hip, and knee joints). Joints are held in place by fibrous bands called ligaments. Generally, the greater the range of movement, the less stable the joint, so the shoulder joint, which allows a great range of movement, is prone to dislocation because of this. Muscles are attached to bones via tendons. Contraction and relaxation of muscles allows movement of the bones, thereby enabling the body to move. The skeleton consists of the: skull, which encloses and protects the brain the lower jaw, or mandible, which is joined to the skull spine, or vertebral column, which surrounds and protects the spinal cord rib cage, which protects the lungs and heart bones of the upper limbs pelvis bones of the lower limbs. Figure 1 - The musculoskeletal system The most common musculoskeletal injuries seen by first responders are: sprains (overstretched ligaments) strains (overstretched muscles and tendons) fractures (broken bones) dislocations (joints out of normal position). Spinal Management Certificate Learner Guide v2.1 May 2017 Page 5 of 20
The spinal cord The spinal cord is a collection of nervous tissue connecting the brain to the body. The spinal cord is surrounded for most of its length by the bones (vertebrae) that form the spine, and which protect the soft spinal cord from injury. The cord runs through the oval shaped opening in each vertebra (see Figure 2). The vertebrae are stacked on top of one another and are separated by spongy discs that act as shock absorbers between each vertebra. The spinal cord is divided into four (4) sections: cervical, thoracic, lumbar and sacral. There are 31 pairs of spinal nerves that connect with the spinal cord through nerve roots, which extend from the spinal cord from either side of the spinal column. Each spinal nerve relates to a different section of the body. Figure 2 - Spinal cord and spine The spinal nerves are: 8 in the cervical vertebrae 12 in the thoracic vertebrae 5 in the lumbar vertebrae 5 in the sacral vertebrae.. For example, the pair of spinal nerves connecting with the spinal cord in the region of the C2 vertebra travels to the head and neck, while the spinal nerves attaching to the cord in the region of the L4 vertebra run to specific muscles in the legs and specific areas of skin in the calves. Figure 3 indicates where the spinal cord nerves extend to in the body, and shows the relationship between the nerves and the vertebrae. Figure 3 - Spinal nerves Common causes of spinal cord injury (SCI) Each year in Australia, between 300 and 400 people sustain traumatic spinal cord injuries; mostly as a result of car accidents and falls. If a vertebra is broken and a piece of the broken bone presses into the spinal cord, the cord will be injured. The cord can also be injured if the vertebrae, which are normally held in place by strong ligaments and muscles, are pushed or pulled out of alignment, even if they are not fractured. Figure 4 shows a broken vertebra pressing on the spinal cord (the broken vertebra is shown cut in half to reveal the spinal cord). Spinal injuries in aquatic based activities usually occur in the cervical (neck) section of the spine as a result of a traumatic force, such as diving into shallow water. Water-based spinal cord injuries account for less than 10% of the total number of spinal cord injuries per year in Australia. This equates to less than 30 spinal cord injuries occurring in water-based environments in Australia every year. (Source: Norton L 2010. Spinal cord injury, Australia 2007-08. Cat. no. INJCAT 128. Canberra: AIHW. Viewed 23 June 2016 http://www.aihw.gov.au/publication-detail/?id=6442468335 ). Figure 4 - Spinal cord injuries Spinal Management Certificate Learner Guide v2.1 May 2017 Page 6 of 20
Mechanisms of injury The mechanism of injury is the exchange of forces that result in an injury. For example, in a motor vehicle accident, the mechanism of injury is the process by which forces are exchanged between the vehicle and what is struck: the victim and the vehicle s interior, and the various tissues and organs as they collide with each other within the body. When being assessed for spinal injury approximately only 50% of victims show recognised symptoms or signs of spinal damage. Therefore, it is important that if a spinal injury is suspected that the victim is managed accordingly. The five (5) main mechanisms seen in spinal cord injuries are: 1. Hyperextension injuries Occur when the head is sharply thrust back and the spine is arched backwards beyond its normal limit (see Figure 5) Most commonly seen in the upper cervical section of the spinal cord when there is nothing to restrain the head Thoracic and lumbar hyperextension is less common but often results in fractures Common causes of hyperextension injuries are: motor vehicle accidents (whiplash) shallow water diving accidents falling face down whilst climbing stairs. Figure 5 - Hyperextension 2. Hyperflexion injuries Occur when the spine is arched forward beyond its normal limit (see Figure 6) Injuries to the cervical segment occur when the head is pushed forward until the chin makes contact with the chest, fracturing the vertebrae at the front of the cervical spine and tearing the supporting ligaments Common causes of hyperflexion injuries are: whiplash falling down stairs during a football/rugby tackle and/or scrum. Figure 6 - Hyperflexion 3. Compression injuries Occur when the spinal cord is compressed following impact, often resulting in injuries to the cervical or thoracic spine (see Figure 7) The weight of the body is driven against the head by sudden, excessive compression Often causes a burst vertebral body Common causes of compression injuries are: diving injuries hitting the windscreen in a car accident jumping from a height and landing feet first a heavy object falling on the head. Figure 7 - Compression Spinal Management Certificate Learner Guide v2.1 May 2017 Page 7 of 20
4. Distraction injuries Occur when the spinal cord is overstretched, or pulled apart (see Figure 8) Common causes of distraction injuries are: suicide by hanging gunshot wounds to the chest, back and abdomen playground injuries to children football/rugby tackles gymnastics. Figure 8 - Distraction 5. Rotation injuries Occur when the head and body rotate in opposite directions (see Figure 9) Results in twisting of the muscle, ligaments, vertebrae and/or spinal cord Common causes of rotation injuries are: motor vehicle injuries ejection from a motor vehicle. Figure 9 - Rotation Classification and level of injury Spinal cord injuries are classified as complete or incomplete depending on how much of the cord width is damaged. Complete injuries Complete spinal cord injury is the term used to describe damage to the spinal cord that is absolute. It causes complete and permanent loss of ability to send sensory and motor nerve impulses and, therefore, complete and usually permanent loss of function below the level of the injury. Incomplete injuries Incomplete spinal cord injury is the term used to describe partial damage to the spinal cord. With an incomplete lesion, some motor and sensory function remains. People with an incomplete injury may have feeling, but little or no movement. Others may have movement and little or no feeling. Incomplete spinal injuries differ from one (1) person to another because the amount of damage to each person s nerve fibres is different. 67% of spinal cord injuries in Australia are classed as incomplete. Good management of a victim with an incomplete spinal cord injury will minimise the chance of causing more damage which may further reduce spinal cord function. Level of a spinal cord injury The level of the SCI refers to the vertebra that the injury is closest to. For example, an injury to the spinal cord at the level of the sixth cervical vertebra would be referred to as a C6 injury (C for cervical). When the spinal cord is injured, the brain s ability to communicate with the body below the level of the injury may be reduced or lost. When that happens, the part of the body affected will not function normally. See Figure 10 for more detail. Spinal Management Certificate Learner Guide v2.1 May 2017 Page 8 of 20
The closer to the head the spinal cord injury is, the greater the area of the body that may be affected. For example, a person with a T10 injury (at the level of the tenth thoracic vertebra, in the lower middle back) may lose use of the legs (paraplegia) but the arms will not be affected. A person with a C4 injury (at the level of the fourth cervical vertebra, which is in the middle of the neck) may lose use of the legs and arms (referred to as tetraplegia or quadriplegia). This damage causes an impairment or loss of motor or sensory function in the cervical segments of the spinal cord affecting the trunk and all four (4) limbs. Signs and symptoms The signs and symptoms of an SCI depend on two (2) factors: the location of the injury the extent of the injury complete or incomplete. Figure 10 - Level of Injury The more acute the sign or symptom, the more urgent the need to transport/evacuate the victim to a specialist medical facility. Signs suggesting SCI Breathing difficulties Loss or altered level of consciousness Loss of function in hands, fingers, feet or toes Loss of bladder or bowel control Neck or head in abnormal position Dilated pupils Fluid leaking from the ears Abnormal blood pressure Profuse bleeding from the head Abrasions or bruising to the head or forehead Shock (fast heart rate) Spinal shock (slow heart rate) Priapism (erection) in males Increased muscle tone Symptoms suggesting SCI Back or neck pain (often intense) Tingling, numbness or lack of feeling in lower or upper limbs Feeling of pins and needles Headache or dizziness Nausea NOTE The motionless and unresponsive victim should be treated according to DRSABCD. Spinal Management Certificate Learner Guide v2.1 May 2017 Page 9 of 20
Topic 2 - Managing a Spinal Cord Injury This topic will cover the first aid management of a suspected spinal injury. First aid management focuses on ensuring that the victim is immobilised until handover to paramedic care is organised. The victim may stop breathing, go into shock or have other injuries that require first aid management at the same time. NOTE A primary assessment DRSABCD - should be conducted to ascertain the safety of the area and the nature of the victim s condition. Hazards may be obvious or hidden, or may develop, so rescuers should remain alert. Always: call for an ambulance as soon as possible manage the victim s airway manage the spine. Victims should only be moved where it is absolutely necessary to extricate them from danger (e.g. incoming tide, rocky terrain that an ambulance cannot reach) or to perform essential first aid (e.g. CPR). The minimum equipment to be used when extricating a victim with a suspected spinal injury should be a spinal board with strapping to secure the victim on the board. Once the victim has been extricated, strapping should be immediately removed and the victim taken off the spinal board and made as comfortable as possible lying on the sand or ground with a minimum amount of movement of the spine. Unconscious victims An unresponsive, breathing victim with a suspected spinal injury should be placed in the lateral position, to maintain an adequate airway. The victim should be: turned onto their side using the log roll technique handled gently, with no twisting or forward movement of the head and spine rolled with spinal alignment maintained. Conscious victims A conscious victim with a suspected spinal injury should be instructed to remain still and not move their head. Reassure the victim and constantly monitor the victim s condition. If the victim loses consciousness or starts to regurgitate/vomit, immediately roll the victim into the lateral position according to the log roll procedure and recommence primary assessment. Where the victim approaches the first responder on foot, the victim should be instructed to lower themselves carefully to the ground while keeping their head still. If the victim has difficulty lowering themselves to the ground, you may assist them with some support. If they really struggle to get to the ground, the spinal board may be used to assist them. Figure 11 - Conscious victim lowering themselves to ground Spinal Management Certificate Learner Guide v2.1 May 2017 Page 10 of 20
NOTE There are a number of training videos available in the Members Portal covering some of the techniques used to manage a victim with a suspected spinal injury. These include: extricating a conscious victim from the water the log roll technique assisting a walk-up victim with and without using the spinal board. Infants and children When treating a victim younger than eight (8) years old, the anatomical differences between child and adult victims must be considered. The younger child or infant has a relatively large head in proportion to its body. In the supine position (lying face up) the enlarged head can be pushed forward into a hyper-flexed position, thus narrowing the airway and elongating the cervical section of the spine. In cases of suspected spinal injury in children, the placement of padding under the child or infant s torso (shoulder to hip) will assist in aligning the victim s head in the neutral position (see Figure 12). Figure 12 - Infant with support Manual immobilisation The first step a first responder should take when attending a suspected spinal incident is the manual immobilisation of the victim s head and neck in the neutral position. Typically the first responder will offer manual stabilisation from behind the victim. When approaching a suspected spinal injury victim, the first responder should approach front on to minimise any movement of the head and neck. Approaching from the side or the back of the person will normally result in that person turning to look at the first responder to listen and talk, resulting in unnecessary head/neck movement. If there are other first responders present, it is useful that one (1) person maintains eye contact with the victim by standing in front of them and providing suitable explanations about what is happening. When manually immobilising a victim s head, the first responder should: 1. Spread their fingers across the side of the victim s head to obtain maximum contact (see Figure 13) 2. Stabilise their hands by resting their elbows firmly on the ground (if in supine position), or 3. Stabilise their hands by locking their elbows in place 4. Align the victim s head in the neutral position, remembering contraindications. Figure 13 - Hold the victim s head This grip can be used to stabilise the victim s head when standing or lying down. Manual stabilisation can also be achieved using the vice grip or trapezius grip techniques. Spinal Management Certificate Learner Guide v2.1 May 2017 Page 11 of 20
Vice grip Alternatively, the head can be stabilised from the side using the vice grip technique (see Figure 14). The first responder should: 1. Clasp the back of the victim s head with one (1) hand and position the forearm so that it is lying against the victim s spine take care not to push the head forward 2. Grip the victim s jaw with the other hand and position the forearm down the victim s chest 3. Squeeze the forearms together to create a vice that supports the neck and head. Care must be taken to ensure that pressure is not applied to the soft tissue part of the neck and that the victim s head is not pushed backwards out of the neutral position. The vice grip is most often used to stabilise a victim s head in water. Figure 14 - Vice grip Trapezius grip The trapezius grip is used to support the supine victim s head and neck. This is achieved as follows: 1. Grip the upper trapezius muscle between the thumb and fingers a shown in Figure 15 2. Support the head between the forearms (using a vice-like grip along the side of the head). When a walk-up victim needs assistance If a walk-up victim with a suspected spinal injury has difficulty lowering themselves to the ground with a minimum amount of assistance, the following technique is the preferred method for immobilisation. It is recommended that a minimum of five (5) first responders perform this procedure. The victim s head must be stabilised first, and the person who is supporting the head is in charge. This is the same technique that is in the Bronze Medallion. 1. First responder one (1) reassure the victim and tell them that you are going to move behind them and place your hands on their head to immobilise it (see Figure 16) maintain and support the head in the neutral position take charge of the actions and instruct the other first responders on what to do Figure 15 - Trapezius grip 2. First responder two (2) insert the spinal board on an angle between the victim s spine and first responder one s arms, ensuring that the board is placed as close as possible to the victim s heels bring the board to the upright position between first responder one (1) and the victim s back (if the standing victim feels faint, rest them against the spinal board) Figure 16 - Reassure the victim Spinal Management Certificate Learner Guide v2.1 May 2017 Page 12 of 20
3. First responders two (2) and three (3) take up a position on either side of the victim grip the spinal board at the top with one (1) hand pass the other hand under the victim s armpit and grip the spinal board Figure 17 - Position board behind victim 4. First responder four (4) and five (5) stand next to first responders two (2) and three (3) on either side of the victim take a hold of the spinal board as close as you can to the top get ready to assist with lowering the victim to the ground Figure 18 - Taking hold of spinal board 5. All First responders on the command of the first responder controlling the head of the victim commence slowly and smoothly lowering the spinal board and victim to the ground remove the victim from the spinal board using the log roll technique (outlined on the following page) offer constant reassurance during this process and keep the victim informed about what is being done monitor the victim s vital signs and condition until medical help arrives Keep the victim protected from the elements (e.g. use an umbrella to shade the victim s face from the sun, a space blanket or dry towel to keep them warm). Figure 19 - Lowering the victim on spinal board Spinal Management Certificate Learner Guide v2.1 May 2017 Page 13 of 20
Stabilising a walk-up victim with two first responders and a bystander In this example two (2) first responders call upon a bystander to assist in managing the victim. 1. First responder one (1) reassure the victim and advise them that you are going to take control of their head by standing behind them and placing your hands on either side of their head maintain and support the head in the neutral position 2. First responder two (2) seek assistance from a bystander. Explain to the bystander that you need them to help you position the spinal board behind the victim and then lower the victim to the ground let the victim know you are going to slip a spinal board behind them slip the spinal board in behind the victim 3. First responder two (2) and assistant take up a position on either side of the victim grip the spinal board at the top with one hand pass the other hand under the victim s armpit and grip the spinal board 4. First responder one (1) continue to calm the victim and your assistant talk the assistant through the next steps 5. everyone together slowly lower the spinal board and victim to the ground talk the victim and the bystander through the log roll to remove the victim from the board. Log roll The log roll is an accepted method to: turn a victim onto their side to allow the placement or removal of a spinal board place the unresponsive breathing victim in the lateral position clear a blocked airway or if the victim vomits. If a victim needs to be moved or turned, their head, trunk and toes should be kept in a straight line at all times during the manoeuvre. A log roll is best performed using four (4) to six (6) first responders; however modified versions using two (2) or three (3) people can still be successfully performed. When performing a log roll, the victim s arms are positioned down each side of their torso with their hands against their body. Spinal Management Certificate Learner Guide v2.1 May 2017 Page 14 of 20
The steps to perform a four-person log roll are: 1. First responder one (1), positioned behind the victim manually stabilise the victim s head with both hands 2. First responder two (2), positioned at the chest reach across the victim, securely grasp the shoulder and upper to mid-thigh 3. First responder three (3), positioned at the pelvis reach across the victim and securely grasp the upper arm and mid to low thigh (this may vary depending on the size of the victim) they can also secure the victim s legs by grasping both trouser ankles Figure 20 - Four-person log roll 4. All together first responder one (1) coordinates the movement, while all first responders perform a coordinated roll of the victim towards the first responders, ensuring that head and spine stability is maintained at all times. 5. First responder four (4) Treat victim as required e.g. clear airway, remove or place spinal board 6. All First responders carefully return the victim to the supine position and treat as required (e.g. CPR or reassurance) by rolling them the other way. Remember to ensure: clear communication at all times effective head management and alignment smooth and slow transitions in all movements. Figure 21 - Clearing the airway Log roll with fewer than four first responders Regardless of the number of first responders available, the steps in performing a log roll are basically the same as for a four-person roll. It is vital that there is always someone maintaining stability of the victim s head. Variations for three (3) first responders: first responder one (1) maintains head support first responder two (2) and three (3) on each side of the victim first responder two (2), with one (1) hand on the victim s opposite shoulder and one (1) hand on the victim s opposite hip, rolls the victim towards them first responder three (3) provides assistance as the victim requires (e.g. clearing the airway, removing or placing spinal board). Figure 22 - Three-person log roll Spinal Management Certificate Learner Guide v2.1 May 2017 Page 15 of 20
Strapping A spinal board placed under the victim can be used by first responders should it be necessary to extricate the person. Strapping should be used to adequately immobilise the victim prior to moving. There are a variety of different straps that may be used. You should familiarise yourself with the ones used at your club. To stabilise the victim for extrication, immobilisation strapping should be fitted over the victim s body and secured to the spinal board (see Figure23). Medical guidelines generally advise that the chest strap should be secured first, followed by the hip and foot strap. As a precaution first responders should always check the strapping manufacturer s instructions about how straps should be applied). Once all straps have been fitted, the first responder should check the security of the victim, and adjust the straps as required. First responders must maintain spinal alignment and head immobilisation until victim handover. Strapping has been shown to restrict breathing and should be loosened if compromising the victim. It is important that the first responder constantly reassures the victim and monitors for discomfort, breathing difficulties and vomiting. Figure 23 - Strapping Strapping should only be applied if the victim is being extricated from danger to a location where medical personnel can assess them, and should be removed immediately after extrication is complete. Extricating a victim Once the victim is secured to the spinal board, they are ready to be extricated. 1. The victim can be given oxygen therapy, if necessary 2. Plan a coordinated lift the first responder positioned at the head of the victim is in charge of the lift/movement 3. Use safe lifting practices, maintaining head stabilisation 4. Extricate victim to desired location, feet first, maintaining head stabilisation and ensuring that the board stays level 5. Continue to monitor victim s condition. Points to remember: avoid lifting one (1) end of the board higher than the other keep the board horizontal, or the head higher on stairs or on an incline do not slide the spinal board across the ground or surface; it may catch and jolt the victim ensure that hair, jewellery and clothing is clear and cannot catch against surfaces or become caught in the first responders hands, straps, etc. use safe lifting practices and lift in a coordinated manner carrying the victim feet first allows the first responder supporting the head to walk in a forward direction. Stabilisation and retrieval in an aquatic environment Spinal injuries can occur as a result of people diving into shallow water where rocks, sandbanks or foreign objects are present. Spinal injuries in the aquatic environment have the added complication of possible drowning. Managing suspected spinal injuries in the aquatic environment is no different from on land managing the victim s airway and breathing is the first priority while immobilising the head and body as much as possible. Spinal Management Certificate Learner Guide v2.1 May 2017 Page 16 of 20
NOTE All non-responsive victims should be removed from the water immediately, as carefully as possible, for further assessment of their airway. In the surf zone, it is highly recommended to position a conscious victim with their face towards the shore, and with the first responder s body between the oncoming waves and the victim. This will assist in protecting the victim from the waves as well as keeping the victim s body aligned. If the surf is too large to effectively stabilise the victim and keep their airway clear from waves, you will need to remove them from the water and treat them on the beach. Successful removal of a victim from a pool or shallow water location will require a minimum of three (3) first responders. When approaching the victim, the first responder should move cautiously towards the victim. If a victim is face-down, they can be turned to a face-up position by: vice grip roll-over, or extended arm roll-over. Vice grip roll-over The vice grip discussed on p. 12 can be adapted for use in the water as follows: 1. Adopt vice grip (see Figure 24) 2. While maintaining the vice grip a. move under the victim and roll the victim into a face up position (see Figure 25) b. take care not to raise the victim out of the water; this may cause movement of the spine. c. as the victim is turned, move forward to create a corkscrew effect to keep the roll smooth d. the first responder will end up on the opposite side of the victim (see Figure26) 3. Stabilise the victim on their back and monitor. Effective grip is obtained by maintaining support to the head and spine without depressing the soft neck tissue. Where a suspected spinal injury victim is found facing up, a vice grip may be used to support the victim s head and spine until further assistance arrives. The vice grip roll should only be performed when the first responder is in sufficiently deep water to be able to fully submerge underneath the victim. Figure 24 - Adopt vice grip Figure 25 - Move under victim Figure 26 - End result Spinal Management Certificate Learner Guide v2.1 May 2017 Page 17 of 20
Extended arm rollover Where the water depth is too shallow to perform an effective vice grip roll, the extended arm rollover can be utilised: 1. First responder one (1) call/signal for assistance slowly manoeuvre the victim s arms alongside their head, grasping the upper arms firmly to immobilise the head and spine, and support the head by placing your thumbs on the victim s head as you hold their arms in place maintain this grip and move forwards (corkscrew), at the same time rolling the victim towards you until they are in a face up position support the victim with one (1) arm under their head grasp the opposite upper arm and pull the victim towards you (see Figure 27) Figure 27 - Extended arms 2. First responder two (2) support the victim s hips with both hands (see Figure 28) slowly raise the hips in line with the surface of the water Alternatively, a flotation aid (e.g. rescue tube) may be placed under the victim s legs to assist in supporting the victim in horizontal alignment Figure 28 - Raise the victim s hips After stabilising the victim s head, a spinal board can be moved into place under the victim, into position to support the spine (see Figure 29). In coordinated stages, move the victim and the board carefully to the water s edge (see Figure 30) Log roll victim off spinal board Maintain dialogue and ensure the victim is reassured and kept protected from the elements Ensure that head stabilisation is always maintained First responder positions may change throughout the process Figure 29 - Position the spinal board Victim handover When the ambulance services arrive on the scene, they will want to know: What happened? What signs and symptoms have been observed or reported? What treatment has been given? Ambulance services may use different techniques to manage the victim, including putting a rigid or soft spinal collar on the victim. Always follow the instructions given by ambulance personnel. Figure 30 - Remove the victim from the water Spinal Management Certificate Learner Guide v2.1 May 2017 Page 18 of 20
Assessment Information There are two (2) assessment tasks required to complete the SLSA Spinal Management course. Assessment Task 1: Written questions Complete all the written questions in the separate assessment portfolio. Assessment Task 2: Practical scenarios Participate in at least three (3) scenarios, taking responsibility for the management of a victim s head in at least one (1) case. Spinal Management Certificate Learner Guide v2.1 May 2017 Page 19 of 20
Appendices Appendix 1 List of figures Figure 1 The musculoskeletal system p.5 Figure 2 Spinal cord and spin p.6 Figure 3 Spinal nerves p.6 Figure 4 Spinal cord injuries p.6 Figure 5 Hyperextension p.7 Figure 6 Hyperflexion p.7 Figure 7 Compression p.7 Figure 8 Distraction p.8 Figure 9 Rotation p.8 Figure 10 Level of injury p.9 Figure 11 Conscious victim lowering themselves to ground p.10 Figure 12 Infant with support p.11 Figure 13 Hold the victim s head p.11 Figure 14 Vice grip p.12 Figure 15 Trapezius grip p.12 Figure 16 Reassure the victim p.12 Figure 17 Position board behind victim p.13 Figure 18 Taking hold of spinal board p.13 Figure 19 Lowering victim on spinal board p.13 Figure 20 Four-person log roll p.15 Figure 21 Three-person log roll p.15 Figure 22 Clearing the airway p.15 Figure 23 Strapping p.16 Figure 24 Adopt vice grip p.17 Figure 25 Move under victim p.17 Figure 26 End result p.17 Figure 27 Extended arms p.18 Figure 28 Raise the victim s hips p.18 Figure 29 Position the spinal board p.18 Figure 30 Removing victim from the water p.18 Spinal Management Certificate Learner Guide v2.1 May 2017 Page 20 of 20