HEAD AND NECK INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 111

person with a suspected spine injury is complete immobilization, exact documentation and
timing of the findings, and immediate evacuation, ideally by air transport.
Assessment
Ifaninjuredpersonisunconscious,thepresenceofacervicalfracturemustbeassumed.
Approximately10to15percentofindividualswithheadinjuriessevereenoughtoproduce
unconsciousness have fractures of the cervical vertebrae. If an individual has numbness or
tinglingsensations,orparalysisofanyextremity,aseriousinjurytothespinalcordmustbe
suspected. A spinal cord injury at the level of the neck may result in quadriplegia (paralys-
is of all four extremities), whereas an injury at lower levels of the thoracic or lumbar cord
may result in paraplegia (paralysis of the lower extremities). Bladder and bowel function
may be impaired as well.
When assessing the neurologic impairment in an individual who has sustained a spine
injury, documenting the exact time of assessment is crucial, since neurologic deterioration
may occur over time.
Most individuals with spine injuries do not have neurologic impairment. Pain or ten-
derness along the spine or anywhere in the neck following a fall should arouse concern
about a vertebral fracture. In the wilderness, the personnel taking care of individuals with
suspected spine injuries must be constantly aware that any excessive manipulation during
assessment, particularly manipulation of the neck, may worsen the neurological injury and
the long-term outcome. On the other hand, individuals with traumatic paralysis may even-
tually recover some neurologic functions. Correct handling at the accident scene and early
transport to a trauma center with adequate immobilization are essential.
Treatment
The neck ofan unconscious individual, or a conscious person thought to have a cervical
fracture, must be stabilized as quickly as possible, well before the individual is moved or
transported.Ifacervicalcollarisnotavailable,onecanbeimprovisedwithaSAMSplint®
and can be applied quickly even if the individual is lying in deep snow. One attendant
shouldstabilizetheinjuredperson'sheadandneckwithbothhandswhiletheSAMSplint®
is rolled snugly around the neck like a bandage. The chin must be outside the splint, and
theheadshouldbeinaslightlyextendedposition.Therimofthesplintcanbefoldeddown
itifitformspressurepoints,andtheendcanbesecuredbytapeorbyashortbandage( Fig.
8-3 ) .
No specific treatment other than immobilization is possible in the wilderness for indi-
viduals with spine fractures. Proper immobilization is generally achieved with the injured
person in a neutral supine position without rotating or bending the spinal column, particu-
larly the neck. Unfortunately, ideal immobilization equipment—long spine board and cer-
vical collar—are usually not available at the site of injury.