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Spinal Immobilization Procedures by Lifeguard Personnel By Gerald M. Dworkin January 9, 1997
In order to properly recognize and manage suspected spinal injuries
caused from head-first entries into the water, Lifeguard, Water Rescue,
Public Safety, and other Rescue personnel must be trained to evaluate
the mechanism of injury as well as the signs and symptoms associated
with spinal trauma. The rescuer must assume that a spinal injury exists
if the forces causing or resulting from the trauma are sufficient to
damage the spine. The Principles of Spinal Motion Restriction should include:
These principles have been advocated for the past 20 years within EMT,
Paramedic, First Responder, and even First Aid and Lifeguard Training
courses. Yet, with the release of the 1995 American Red Cross Lifeguard
Training Programs, the Red Cross has abandoned these principles and
is now advocating that spinal immobilization in the water be accomplished
by as few as two lifeguards using a rigid board with a commercial head
immobilizer, a sub-standard strapping system, and without the use of
a cervical extrication collar. It is our belief at Lifesaving Resources that the procedures advocated
by the American Red Cross do not meet the Standard of Care dictated
by the EMS community, and that these procedures are dangerous which
can increase the severity of the injury. It is our belief that the procedures
advocated by the Red Cross should be the exception, not the standard.
Therefore, we encourage the Red Cross to reconsider their position and
to modify their procedures to include the following: (A) Proper rescue procedures require the use of at least 3 rescue personnel
to effectively maintain in-line stabilization of the head and neck,
to immobilize the patient to a rigid backboard, and to remove the victim
from the water. In situations where appropriately trained personnel
are not available, we encourage the Red Cross to advocate that the patient
should be supported in the water until appropriate EMS personnel can
be obtained unless contraindicated. (B) Adequate in-line stabilization and support requires a rigid backboard,
a cervical immobilization device (i.e. commercial head immobilizer),
and an appropriately sized cervical extrication collar. The use of a
Cervical Immobilization Device (C.I.D.) should be used in conjunction
with an appropriately sized cervical extrication collar. The C.I.D.
does not replace the need for the cervical collar, nor does the use
of the cervical collar replace the need for the C.I.D. (C) Appropriate immobilization requires the use of an effective strapping
system which would prohibit movement laterally (side-to-side), anteriorly
(up from the board), or head-to-foot (towards the head or towards the
foot of the board). The strapping system advocated by the Red Cross
which uses 3 straps placed laterally across the patient does not accomplish
these goals. We recommend two straps placed diagonally across the patient's
chest with one anchor point being directly over each shoulder and the
other anchor point being just below each armpit. In addition, at least
3 straps should be placed laterally across the patient at the torso,
hips, and lower extremities. A 1988 study identifies secondary cord injuries as a significant source
of major neurological deficit. Improper handling and transportation
techniques by pre-hospital personnel may be responsible for up to 10%
of these secondary injuries. We believe that the procedures advocated
by the Red Cross will be responsible for causing an increase in secondary
injuries during the rescue phase by improperly trained lifeguards. The rationale used by the Red Cross to explain the change in their procedures to exclude the instruction in the use of cervical collars is as follows:
It is our belief at Lifesaving Resources that this rationale should
warrant an increase in the education and training of lifeguard personnel
through formal lifeguard training programs and in-service lifeguard
training. It should not be an excuse to eliminate the instruction and
use of cervical extrication collars. The advances in pre-hospital equipment, education and training have
reduced the number of spinal cord injured patients and the severity
of injury. Only through the availability of appropriate spinal immobilization
equipment and the effective training of lifeguard and other rescue personnel
can we expect to reduce the number and severity of spinal cord injured
patients in the water. Lifesaving Resources Inc. - www.lifesaving.com - 603/563-8330 |
The
American Red Cross Lifeguard Training curriculum is currently advocating
a sub-standard procedure for the immobilization of suspected spinal
injured patients in shallow or deep water. This issue is being presented
to solicit the opinions of other Lifeguard and EMS personnel, instructors,
and administrators. 