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TRANSFER and IMMOBILIZATION TECHNIQUES

Spinal Immobilization vs. Spinal Motion Restriction Spinal immobilization and spinal motion restriction both relate to preventing movement of the spine.  Spinal immobilization involves the use of cervical immobilization devices such as cervical collars and spine boards to minimize movement of the spine.  Conversely, spinal motion restriction refers to maintaining anatomical alignment of the spine and minimizing movement without the use of such cervical immobilization devices.

Though a long standing practice, the benefit of spinal immobilization in most trauma patients is unproven.  Recent literature indicates that spinal immobilization may actually harm some patients, resulting in agitation, pain, increased radiography, pressure sores, tissue ischemia, aspiration and respiratory compromise. Studies have also suggested that there is no significant difference in movement within the spinal column when comparing patients immobilized to a backboard versus those who were placed on a gurney. Thus, the criteria for the application of spinal precautions though unproven but generally accepted and prudent, should continue to be updated to follow validated, evidence-based indications.1  However, most experts participating in Sports Medicine Concepts’ In 2Min or Less!® sports emergency care curriculum prefer traditional spine immobilization using a cervical collar and spine board when transporting a potentially neurologically injured athlete.  Most experts express that the complications found to be associated with use of spinal immobilization using a spine board result from prolonged immobilization, and that spinal immobilization of patients presenting with mid-line cervical pain, neurological signs and symptoms, or apprehension secondary to an axial load mechanism of injury is warranted in management the neurologically unstable athlete.  Evidence Category C.

Therefore, spinal immobilization will be considered for patients that have sustained blunt trauma through a high-energy or axial load injury mechanism and present with any of the following:
  • Altered level of consciousness
  • Drug or alcohol intoxication
  • Inability to communicate
  • Spinal column pain and/or tenderness
  • Neurologic complaints (e.g., numbness or motor weakness)
  • Anatomic deformity of the spine
  • Distracting injury (injuries so severely painful that neck examination is unreliable, [e.g., severe thoracic trauma, long bone fractures, crush injuries, large burns])
For these athlete, a cervical collar will be applied and the athlete immobilized to a spine board.

Spinal motion restriction will be considered when athletes meet NEXUS exclusionary criteria.2

Transferring to a Spine Board Transferring an athlete to a spine board may be required in order to immobilize an athlete to protect against secondary injury or to facilitate transport to an appropriate medical facility.  The medical team recognizes that there are various accepted techniques employed to transfer an injured athlete to rigid support.  When transfer to rigid support is indicated, The will decide which transfer technique is most appropriate based on the team’s expert opinion of how best to utilize existing emergency response equipment and personnel to meet the team’s Primary Objectives™ established for each unique injury management scenario.

In all transfer techniques the task is completed under the direction of the A-Man.  The A-Man’s primary responsibilities include:

  • Maintain manual head stabilization until full immobilization to the long spine board (LSB) is achieved;
  • Directs the log roll maneuver;
  • Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso;
  • Positions the patient in cervical neutral position and directs B- and C-Man to pack-n-fill as required to maintain proper neutral position.

Upon completion of any transfer technique, the medical team will likely need to utilize a V-Slide technique to properly position the athlete on the LSB.

A variation of the flat-log techniques described blow would involve log rolling the patient to 45º while the LSB is slid in against the ground with the back of the LSB resting on the thighs of B- and C-Man.  Once in position, A-Man directs the medical team to lower the athlete onto the LSB, then lower the LSB to the ground.

The various techniques that the medical team may elect to employ to transfer an injured athlete to rigid support are outlined below:

From Supine

5-Person Log Roll-Push

A-Man

  • Maintain manual head stabilization until full immobilization to the long spine board (LSB) is achieved;
  • Directs the log roll maneuver;
  • Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso;
  • Positions the patient in cervical neutral position and directs B- and C-Man to pack-n-fill as required to maintain proper neutral position.

Step 1

  • B- and C-Man clear the area of any extraneous objects or medical equipment;
  • If the protective athletic equipment remains in place, B- and C-Man utilize pack-n-fill towels to maintain cervical neutral alignment;
  • If the protective athletic equipment has been removed, B- will apply a c-collar on the patient and provide pack-n-fill padding as required to support cervical neutral position;
  • B-Man kneels at the patient’s mid-torso, straightens the patient’s arms with the patient’s palms facing in next to the torso. Palm-out may result in elbow joint damage during the roll;
  • B-Man then grasps the far side of the patient at the shoulder and just above the elbow;
  • C-Man kneels next to B-Man and grasps the patient just above the elbow, crossing over the B-Mans arm;
  • C-Man’s lower hand grasps the patient at the mid-thigh;
  • C-Man places their lower foot up against the patient’s legs, just below the knees for the patient’s lower legs to roll onto during the log roll, to prevent the patient’s pelvis drooping;
  • D-Man kneels next to C-Man and grasps the patient’s mid-thigh with their upper hand by crossing over the C-Man’s arms;
  • D-Man grasps the patient with their lower hand at the ankles;
  • E-Man kneels on the opposite side of the patient at the patient’s pelvic level;
  • E-Man’s upper hand is placed on the patient’s upper arm and the lower hand is placed on the patient’s upper leg.

Step 2

  • Under the direction of the A-Man, the patient is carefully log rolled until at a right angle to the ground;
  • A-Man watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso:
  • C-Man at the patient’s legs assists with rotation of the patient’s torso and takes the weight of the patient’s pelvis, again watching the torso. The patient’s lower legs roll onto B-Man’s lower foot to prevent pelvic drooping.
  • D-Man facilitates the efforts of the B- and C-Man by carefully pushing the patient into proper position.

Step 3:  If appropriate, a folded blanket running the length of the patient’s posterior body (head to feet) can be placed against the patient to improve comfort after the patient is laid back on the LSB.  This will also assist in the later removal of the patient off the LSB.

Step 4:  E-Man slides the LSB in against the ground with the edge of the LSB towards the patient’s back. Align the patient’s shoulders level with the shoulder markings on the LSB.

Step 5:  Lower the patient onto the LSB, again with A-Man setting the pace.

Step 6:  Keeping the patient in the neutral in-line position, use a v-slide to gently adjust the patient’s position sideways so that the patient is centered on the LSB.

Step 7:  Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal column and for comfort; Immobilize the patient onto the LSB for transport.

4-Person Log Roll-Push

A-Man

  • Prepare to log roll the patient in the direction opposite the patient’s face by assuming a start position with the A-Man’s inside knee positioned at the patient’s lower shoulder;
  • Place hands on head/helmet with the palms together and thumbs down, and the arm corresponding to the direction of the log roll on top such that the A-Man’s arms are twisted at initiation of the log roll and untwist during the maneuver;
  • Maintain manual head stabilization until full immobilization to the long spine board (LSB) is achieved;
  • Directs the log roll maneuver;
  • Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso;
  • Positions the patient in cervical neutral position and directs B- and C-Man to pack-n-fill as required to maintain proper neutral position.

Step 1

  • B- and C-Man clear the area of any extraneous objects or medical equipment;
  • If the protective athletic equipment remains in place, B- and C-Man utilize pack-n-fill towels to maintain cervical neutral alignment;
  • If the protective athletic equipment has been removed, B- will apply a c-collar on the patient and provide pack-n-fill padding as required to support cervical neutral position;
  • B-Man kneels at the patient’s mid-torso, straightens the patient’s arms with the patient’s palms facing in next to the torso. Palm-out may result in elbow joint damage during the roll;
  • B-Man then grasps the far side of the patient at the shoulder and just above the elbow;
  • C-Man kneels next to B-Man and grasps the patient’s pelvic bone;
  • C-Man’s lower hand grasps at the ankles.
  • C-Man places their lower foot up against the patient’s legs, just below the knees for the patient’s lower legs to roll onto during the log roll, to prevent the patient’s pelvis drooping;

Step 2

  • Under the direction of the A-Man, the patient is carefully log rolled until at a right angle to the ground;
  • A-Man watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso:
  • C-Man at the patient’s legs assists with rotation of the patient’s torso and takes the weight of the patient’s pelvis, again watching the torso. The patient’s lower legs roll onto B-Man’s lower foot to prevent pelvic drooping.

Step 3:  If appropriate, a folded blanket running the length of the patient’s posterior body (head to feet) can be placed against the patient to improve comfort after the patient is laid back on the LSB.  This will also assist in the later removal of the patient off the LSB.

Step 4:  D-Man slides the LSB in against the ground with the edge of the LSB towards the patient’s back. Align the patient’s shoulders level with the shoulder markings on the LSB.

Step 5:  Lower the patient onto the LSB, again with A-Man setting the pace.

Step 6:  Keeping the patient in the neutral in-line position, use a v-slide to gently adjust the patient’s position sideways so that the patient is centered on the LSB.

Step 7:  Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal column and for comfort; Immobilize the patient onto the LSB for transport.

2-Person Log Roll

A-Man

  • Inform and reassure the conscious and alert patient about the use of the scoop stretcher and what they can expect to experience during the process;
  • Maintain manual head stabilization until full immobilization is achieved;
  • Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso.

B-Man

  • Clear the area of any extraneous objects or medical equipment;
  • If the protective athletic equipment remains in place, utilize pack-n-fill towels to maintain cervical neutral alignment;
  • If the protective athletic equipment has been removed, a c-collar will be placed on the patient and padding will be placed under head of patient as needed;
  • Kneels at the patient’s mid-torso on the side to which the patient is to be log rolled. The patient’s legs are tied together and the knees bent up to a 90º angle;
  • The patient’s arms are extended beside their torso with their palms facing inwards;
  • Grasps the far side of the patient at the shoulder;
  • Grasp lower arm grasps the patient’s hip just distal of the wrist and runs their arm along the patients upper legs which will help assist with the log roll;
  • Position patient’s lower foot so that on log rolling the patient, the patients knees will rest of B-Man’s foot to reduce the patient’s pelvis drooping;
  • Carefully log roll patient until they are at right angles to the ground;
  • As the B-Man at the patient’s torso will bear most of the patient’s weight during the log roll the B-Man is in charge and sets the pace;
  • A folded blanket running the length of the patient’s posterior body (head to feet) can be placed against the patient to improve comfort after the patient is laid back on the spine board.  This will also assist in removing the patient from the spine board;
  • Slide the spine board in against the patient’s back and elevate the side of the spine board furthest from the patient at a 45º angle towards the patient’s back. Align the patient’s shoulders level with the shoulder markings on the spine board;
  • Lower the patient and elevated side of the spine board down onto the ground together, with the spine board assisting to maintain alignment of the patient, again with B-Man at the patient’s torso setting the pace. The spine board, therefore, acts a body splint for lowering the patient;
  • Straighten out the patient’s knees;
  • Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the patient’s spinal column and to improve comfort;
  • Immobilize the patient on the spine board.

6-Person Straddle Lift-Slide

Key Points

  • When lifting, each responder should rest their elbows on their legs to remove the strain from their backs;
  • If applying the LSB, the patient needs to be lifted only 5-6″ off the ground;
  • If using a Scoop or a thick LSB, the patient will need to be lifted slightly higher for the patient to clear the frame;
  • In this procedure, the responder’s limb closest to the patient’s head will be referred to as the responder’s upper limb, and the responder’s limb closest to the patient’s feet will be referred to as the responder’s lower limb.

Step 1: Place the LSB at the patient’s feet and in-line with the patient’s body so that the LSB can be slid under from the patient’s feet.  A-Man positions at the patient’s head and squats down on their knees.  A-Man positions at the patient’s head and squats down on their knees. Manual in-line stabilization of the patient’s head is performed by A-Man with elbows resting on their legs for stability.  A cervical collar is applied in the absence of protective athletic equipment. The manual in-line stabilization is maintained until full spine immobilization is achieved.  B- and C-Man straddle the patient’s torso. B- and C-Man pull the patient’s clothes at the shoulders firmly to the sides with their lower hands to allow their upper hand to easily slide under patients shoulders. DO NOT lift patient’s shoulder upward during this procedure. B- and C-Man’s upper elbow should rest on their upper thigh to avoid strain on the responder’s back during the lift.  B- and C-Man’s lower hand should be placed under the patient’s lumbar spine.  D- and E-Man straddle the patient on either side of the patient’s mid thigh. C- and D-Man pull the patient’s clothes at the patient’s bottom firmly sideways with lower hand to allow their upper hand to slide easily under patient’s bottom. DO NOT lift patients bottom upward. D- and E-Man’s upper elbow should rest on their upper thigh to avoid strain on their back during the lift.  F-Man is positioned above the patient’s head to slide the LSB into place.  Before inserting the LSB, F-Man insert a forearm airsplint on top of the LSB where the patient’s lumbar spine will be positioned.

Step 2:  With A-Man at the patient’s head in-charge, A-E-Man lift the patient only enough for F-Man to slide the LSB under the patient.

Step 3:  F-Man then slides the LSB underneath the patient.   The patient is then immobilized to the Board for transport.

4-Person Straddle-Lift- Slide

Key Points

  • When lifting keep the arms and back straight, and use your quadriceps to do the lift;
  • When applying the LSB, the patient needs to be lifted only 5″ off the ground;
  • If using a Scoop Stretcher or a thick LSB, the patient will need to be lifted slightly higher for the patient to clear the frame.

Step 1:  Place the LSB above the patient’s head and in-line with the patient’s body.   Alternatively, the LSB can be slid under from the patient’s foot end if access above the patient’s head is not possible. A-Man positions at the patient’s head and squats down on their knees with one leg on either side of the LSB so that the LSB can be slid through A-Man’s legs.  Manual in-line stabilization of the patient’s head is performed by A-Man with elbows resting on their legs for stability.   A Cervical Collar is also applied in the absence of protective athletic equipment. The Manual in-line stabilization is maintained until full spine immobilization is achieved.  B-Man 2 is positioned above the patient’s head to slide the LSB into place. Before inserting the LSB, E-Man should place a forearm airsplint on the LSB where the patient’s lumbar spine will be positioned.

Step 2:  C-Man straddles over the patient’s torso and faces side-on to the patient. C-Man then squats down and places their hands underneath the patient’s armpits. C-Man’s arms should rest on their inner legs with their back and arms kept straight. D-Man (at the same time as C-Man) straddles over the patient’s upper legs and faces the same way as C-Man. D-Man then squats down and places their hands underneath the patient’s bottom. D-Man’s arms should rest on their inner legs with their back and arms kept straight.

Step 3:  WithA-Man in charge, A-Man at the head lifts by slightly flexing both their elbows. C-Man at the patient’s chest and D-Man at the patient’s pelvis keep their arms and backs straight and lift the patient approximately 5″ of the ground by flexing their quadriceps only. B-Man then slides the LSB underneath the patient.

2-Person Straddle-Lift-Slide

Key Points

  • When lifting keep the arms and back straight, and use your quadriceps to do the lift;
  • When applying the LSB, the patient needs to be lifted only 5″ off the ground;
  • Padding using blankets is recommended for LSB comfort;

Step 1: A-Man places the LSB above the patient’s head in-line with the patients body and then positions beside the LSB.

Step 2: B-Man straddles the patient’s torso facing A-Man, squatting down and is positioned at the patient’s torso and places a pillow under the patient’s head (if non trauma) or towel (if trauma).  B-Man supports the patient’s head as A-Man slides the LSB under the patient’s head.

Step 3: B-Man now repositions their hands underneath the patient’s armpits. B-Man’s arms should rest on their inner legs, with their back and arms kept straight. B-Man lifts the patient’s torso by slightly flexing their quadriceps, but only enough to slide the LSB underneath the patient’s torso.  A-Man stops sliding the LSB when it touches the patient’s bottom. The curve of the LSB will allow the LSB to slide correctly aligned under the patient.

Step 4: B-Man now moves down to the patient’s pelvis and straddles the patient, squatting down and placing their hands underneath the patient’s bottom.  B-Man’s back and arms are kept straight. B-Man then lifts the patient’s pelvis by slightly flexing quadriceps. A-Man then slides the LSB underneath the patients bottom and legs until the patient’s shoulders are correctly aligned with the shoulder markings on the LSB. The patient is then secured to the LSB for safety during transport.

6-Person Lift-Slide

After careful evaluation of various transfer techniques the  medical team has adopted the following 6-person lift-slide technique as its preferred method of transferring an injured patient to a long spine board (LSB).  However, the medical team may elect to employ any of the other accepted transfer techniques, if deemed by the medical team to be more appropriate to the given situation.

Key Points

  • When lifting, each responder should rest their elbows on their legs to remove the strain from their backs;
  • If applying the LSB, the patient needs to be lifted only 5-6″ off the ground;
  • If using a Scoop or a thick LSB, the patient will need to be lifted slightly higher for the patient to clear the frame;
  • In this procedure, the responder’s limb closest to the patient’s head will be referred to as the responder’s upper limb, and the responder’s limb closest to the patient’s feet will be referred to as the responders lower limb.

Step 1:  Place the LSB at the patient’s feet and in-line with the patient’s body so that the LSB can be slid under from the patient’s feet.  A-Man positions at the patient’s head and squats down on their knees. Manual in-line stabilization of the patient’s head is performed by A-Man with elbows resting on their legs for stability.  A cervical collar is applied in the absence of protective athletic equipment.  Manual in-line stabilization is maintained until full spine immobilization is achieved.  B- and C-Man kneel on either side of the patient’s torso. B- and C-Man pull the patient’s clothes at the shoulders firmly to the sides with their lower hands to allow their upper hand to easily slide under patients shoulders. DO NOT lift patient’s shoulder upward during this procedure. B- and C-Man’s upper elbow should rest on their upper thigh to avoid strain on the responder’s back during the lift.  B- and C-Man’s lower hand should be placed under the patient’s lumbar spine.  D- and E-Man kneel on either side of the patient’s mid thigh.  C- and D-Man pull the patient’s clothes at the patient’s bottom firmly sideways with lower hand to allow their upper hand to slide easily under patient’s bottom. DO NOT lift patients bottom upward. D- and E-Man’s upper elbow should rest on their upper thigh to avoid strain on their back during the lift.  F-Man is positioned above the patient’s head to slide the LSB into place.  Before inserting the LSB, F-Man insert a forearm airsplint on top of the LSB where the patient’s lumbar spine will be positioned.

Step 2:  With A-Man at the patient’s head in-charge, A-E-Man lift the patient by slightly flexing their arms upwards, lifting the patient only enough for F-Man to slide the LSB under the patient.

Step 3:  F-Man then slides the LSB underneath the patient.   The patient is then immobilized to the Board for transport.

Scoop Stretcher

 Scoop Stretcher Football Review Scoop Stretcher Ice Hockey and Slide Board Review
A-Man
  • Inform and reassure the conscious and alert patient about the use of the scoop stretcher and what they can expect to experience during the process.
  • Maintain manual head stabilization until full immobilization is achieved.

B- and C-Man

  • Clear the area of any extraneous objects or medical equipment;
  • If the protective athletic equipment remains in place, utilize pack-n-fill towels to maintain cervical neutral alignment;
  • If the protective athletic equipment has been removed, a c-collar will be placed on the patient and padding will be placed under head of patient as needed.

Adjust length of Scoop Stretcher

  • Place scoop stretcher beside patient in closed position with shoulders at level of the pin;
  • Loosen leg extension locks and lengthen until heels of feet are level with bottom of foot plate;
  • Re-tighten locks with finger pressure only;
  • Splitting the scoop stretcher in half at both ends;
  • Place one half on each side of the patient;
  • Join head end of scoop stretcher together approximately 3ft from patient’s head with leg section partially spread apart;

Slide scoop stretcher into place

  • Move to head end of patient and kneel down above scoop;
  • Grasp each side of scoop stretcher and slide into place until patient’s head is 2.5″ from locking pin;
  • Reposition until straddling over patient with feet at pelvic level;
  • Grasp patient’s clothes at the shoulders and pull clothes out laterally, while avoiding lifting patient;
  • Kneel at patient’s feet;
  • Grasp foot end of scoop stretcher with hands on top of Scoop on either side of locking mechanism;
  • Slowly bring sides together until plates on each side of patient touch patient’s buttocks;
  • Reposition by maintaining straddle over patient and placing feet at extension poles of scoop stretcher;
  • Squat down and grasp patient’s clothes at buttocks level and pull out laterally, but do not lift patient;
  • Help close the foot end by placing lateral inward pressure on the extension poles with feet;
  • Continue to close scoop stretcher together and lock foot end into place;
  • Hold locking pin up whilst closing;
  • Place a forearm airsplint under patient’s lumber back and inflate until comfortable.

Immobilize or secure patient to scoop stretcher as required by patient’s condition

  • Check to ensure locking pins are secure;
  • Check to see that the patient is reasonably comfortable and that immobilization technique has not resulted in any increased signs and symptoms;
  • Check all distal pulses, myotomes, and dermatomes.  Loosen any immobilization straps accordingly.
  • Check for proper neutral alignment;
  • Check to ensure proper occipital and lumber padding.

From Prone

In athletics, expert opinion suggests that it is generally agreed upon that an athlete should be repositioned from prone to supine before being transferred to rigid support.  This is so because most experts feel that most athlete’s will not ultimately require immobilization on rigid support, or that completion of critical care tasks would be unecessarily delayed by the transfer process.  However, there may be instances where the medical team elects to transfer a prone athlete directly to rigid support.  When transfer from prone to rigid support is required the medical team will employ one of the following accepted techniques:

5-Person 180º- Log Roll

A-Man

  • Inform and reassure the conscious and alert patient about the use of the scoop stretcher and what they can expect to experience during the process;
  • Prepare to log roll the patient in the direction opposite the patient’s face by assuming a start position with the A-Man’s inside knee positioned at the patient’s lower shoulder;
  • Place hands on head/helmet with the palms together and thumbs down, and the arm corresponding to the direction of the log roll on top such that the A-Man’s arms are twisted at initiation of the log roll and untwist during the maneuver;
  • Maintain manual head stabilization until full immobilization to the long spine board (LSB) is achieved;
  • Directs the log roll maneuver;
  • Watches the torso turn and maintains neutral in-line support of the head, rotating it exactly with the torso;
  • Positions the patient in cervical neutral position and directs B- and C-Man to pack-n-fill as required to maintain proper neutral position.

Key Points:

  • The patient is log rolled away from the direction in which the patient’s face initially points;
  • A Cervical Collar is not applied until the patient is in the supine position on the LSB;
  • Remaining in the prone position will limit the patient’s ability to breath due to pressure on the rib cage and prevent proper cervical neutral alignment;
  • Arching of the spine will occur with each of the patient’s breath whilst in the prone position;
  • In this procedure, the responder’s limb closest to the patient’s head will be referred to as the responder’s upper limb, and the responder’s limb closest to the patient’s feet will be referred to as the responder’s lower limb.

Step 1:  A-Man positioned at the patient’s head, positions their arms in anticipation of the full rotation that will occur as described above.  A-Man positions at a 45º angle to the patient, with arms placed so that the elbow to the side the patient will be rolled onto is in line with the patient’s inner shoulder to roll.  B-Man kneels at the patient’s mid-torso, on the other side to which the patient is to be rolled, and extends the patient’s arms down the patients torso. B-Man places their upper hand under the patient’s shoulder and the lower hand under the patient’s abdominal region level with lower ribs. C-Man kneels on the same side as B-Man at the patient’s thigh, slides their upper hand under the patient’s pelvic region, and lower hand under patient’s upper leg.  C-Man also places a rolled up towel against the patient’s leg just below the knees for the lower legs to roll onto during the log roll to prevent pelvic drooping.  D- and E-Man kneel on the side to which the patient is to be rolled. D-Man kneels at the patient’s mid torso grasping the patient’s opposite side shoulders and opposite lower chest. E-Man kneels at the patient’s thigh grasping the patient’s opposite pelvis and opposite mid femur.  A LSB is rested on the knees of D- and E-Man so that the side of the LSB furthest from the patient is elevated at an angle of 45º.  The LSB’s shoulder marking is aligned with the patient’s shoulders.

Step 2:  The patient is carefully log rolled until the patient’s back is placed on the LSB. A-Man at the patient’s head is in charge and sets the pace.  A-Man watches the patient’s torso turn and maintains the current position of the head, rotating it exactly with the patient’s torso. Only after the patient is completely log rolled onto the their back is the patient’s head then slowly re-aligned to the neutral in-line position unless contra-indicated. B- and D Man both assist with rotation of the patient’s torso. C- and E Man both assist with rotation of the patient’s pelvis, ensuring the patient’s pelvis rotates in-line with the patient’s torso.

Step 3:  While rotating the patient, D- and E-Man steadily shuffle backwards until the LSB and patient are flat on the ground. Keeping the patient in the neutral in-line position, use the v-slide technique to gently adjust the patient’s position sideways until centered on the LSB.

Step 4:  A-Man now re-aligns the patients head into the neutral in-line position unless contra-indicated.

Step 5:  Apply appropriate pack-n-fill padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal column.   In the absence of protective athletic equipment, A cervical collar is now applied, and the patient immobilized to the LSB for transport.

References:
  1. National Registry of Emergency Medical Technicians.  National Registry of EMT’s Resource Document on Spinal Motion Restriction/Immobilization.  Accessed 9/2/19.
  2. Hoffman J, Mower W, Wolfson A, Todd K, Zucker M. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. The New England Journal of Medicine. July 13, 2000;343(2):94-99.