Log-roll procedure for potential spine injuries. Team work (four responders)

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:  

While painting the house, your neighbor fell from the scaffolding from a height of 3 meters. You heard a call for help and arrived at the scene. The person lies on his back without moving. The scene of the incident is safe. 
There are no signs of bleeding or open wounds. The person is conscious and complains of back pain, headache, dizziness and nausea.

Turn the person on his side.

Equipment for the practical skill:

• simulator (simulated patient);
• blanket (towels, pillows, pads, etc.)

The procedure for performing a practical skill

• Check the scene.
• Call to bystanders for help.
• Check the casualty consciousness.
• If the casualty is in consciousness:
  • reassure the casualty and advise him not to move;
  • call 103 for emergency help, or ask a helper to do this;
  • kneel or lie behind the casualty’s head;
  • rest your elbows on the ground or on your knees to keep your arms steady;
  • grasp the sides of the casualty’s headЖ
    • spread your fingers so that you do not cover his ears, so he can hear you;
    • steady and support his head in this neutral position, in which the head, neck, and spine are aligned.
• Call 3 bystanders for help. Explain to these assistants that we need to turn the victim on his side to avoid asphyxia if vomiting starts.
• Ask one assistant place the casualty’s arms crossed over chest.

• Position assistants and explain their roles:
  • You support the person head.
  • All assistants position themselves on one side of the victim.
  • First assistant:
    • body position is at mid-chest level;
    • one hand is on the upper third of the shoulder;
    • second hand is on the hip joint.
  • Second assistant:
    • body position is mid-thigh level;
    • one hand is at the level of the pelvic region;
    • second hand is on the knee joint.
  • Third assistant supports the person legs together by holding the ankles.

• If everyone is in proper position, you (the person securing the head) direct your helpers to roll the casualty in the agreed upon direction, keeping the casualty’s head, trunk, and legs in a straight line at all times; the upper leg should be supported in a slightly raised position to keep the spine straight.

• Use blankets, pillows, and twists of clothing to ensure that the casualty remains stable on his side without changing the position of the spine. Continue to hold him in this position until the ambulance arrives.
• If vomiting occurs, monitor the evacuation of vomit from the oral cavity and the patency of the airways.
• Monitor vital signs – level of response, breathing, and pulse – while waiting for help.