HEAD AND NECK INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 112

Figure 8-3. Cervical collar made with a SAM Splint®
If an individual with suspected spine injury has to be moved, this must be
done—preferably after the neck has been splinted—with spine protective precautions. The
thoracic and lumbar spine must be protected by the so-called logroll maneuver, meaning
the body must not be torqued during the rolling procedure for assessing the back or for
placing the person in a lateral position to avoid aspiration while vomiting. At the same
time, the cervical spine must be protected by manual in-line traction that keeps the neck in
a neutral position by avoiding rotation, flexion, or extension. Different techniques for the
adequate transport of a spine-injured person have been described ( Chapter 7: Rescue and
Evacuation ) . However, perfect logrolling and transportation techniques are cumbersome
and usually require at least four helpers ( Fig. 8-4 ) .
During evacuation, a person with a confirmed or suspected vertebral fracture must be
secured so that his body does not roll or twist as it is moved over rough terrain. A rigid
support, such as a metal basket or a broad wooden board, is essential. A rolled-up jacket
or a similar cushion should be placed under the small of the back to support the spine in
that area. With injuries of the neck, a cervical collar must be installed or improvised with a
SAM Splint®, orpadding must be placed onboth sides ofthe head and neck to prevent the
head from rolling from side to side ( Fig. 8-5 ) .
An individual with spinal cord damage and paralysis requires special attention during
evacuation, particularly when evacuation takes more than several hours. The immobilized
person must be protected from heat loss (hypothermia), which may occur very fast in the
outdoor environment. Care must also be given to the areas that support the body's weight,
suchasheels,buttocks,shoulders,andelbows.Pressureontheseareaspreventsbloodfrom
circulating through the tissues. Normally such deprivation of the blood supply results in
pain, and the person shifts position. Individuals with spinal cord injuries may not be able
to feel pain and may not be able to shift position. After a few hours of being deprived of
blood, the tissues in these areas die, eventually resulting in ulcers known as bed sores or
pressure sores. To avoid this complication, the pressure points, particularly the heels and
buttocks, must be carefully padded. Furthermore, this padding must be rearranged every
couple of hours, day and night. As mentioned, severe vertebral fractures that damage the