7. IMMOBILIZER 1 (CERVICAL COLLAR, HEAD IMMOBILIZER & SPINAL BOARD) - TRAUMA LIFE SUPPORT MALAYSIA

Notes: 7. IMMOBILIZER 1 (CERVICAL COLLAR, HEAD IMMOBILIZER & SPINAL BOARD) - TRAUMA LIFE SUPPORT MALAYSIA

**Channel:** Malaysian Society for Care of Trauma (MASCOT)

**Video Title:** 7. IMMOBILIZER 1 (CERVICAL COLLAR, HEAD IMMOBILIZER & SPINAL BOARD) - TRAUMA LIFE SUPPORT MALAYSIA

**Description:** This video demonstrates the method for cervical collar, head immobilizer and spinal board application.

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1. Summary

This video from MASCOT demonstrates the correct procedure for applying essential spinal immobilization devices in trauma situations. It covers the step-by-step application of a cervical collar, head immobilizers, and the transfer of a patient onto a spinal board. The primary goal is to maintain neutral spinal alignment and prevent further injury during extrication and transport. Key principles emphasized include the importance of manual in-line stabilization, proper device sizing, and coordinated team efforts.

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2. Key Takeaways

* **Maintain Neutral Spinal Alignment:** The paramount goal is to keep the patient's spine in a straight, neutral position throughout the immobilization process.

* **Manual In-line Stabilization (MIS):** A rescuer must provide continuous MIS from the moment of patient contact until immobilization is complete.

* **Teamwork is Crucial:** Effective spinal immobilization requires coordinated effort from multiple rescuers.

* **Proper Sizing is Essential:** Correctly sized cervical collars and head immobilizers are vital for effective stabilization and patient comfort.

* **Minimizing Movement:** The entire process should aim to minimize any movement of the patient's head, neck, and spine.

* **Sequential Application:** The video demonstrates a logical sequence: MIS, cervical collar, head immobilizers, and then board application.

* **Board as a Movement Device:** The spinal board is primarily used to move the immobilized patient, not as a primary stabilization device on its own.

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3. Detailed Notes

#### **I. Introduction & Purpose of Spinal Immobilization**

* **Objective:** To prevent further injury to the spinal cord in patients with suspected spinal trauma.

* **Mechanism of Injury (MOI) Considerations:** High-risk MOIs often necessitate spinal immobilization (e.g., falls from height, motor vehicle collisions, penetrating trauma to the torso).

* **Key Principle:** Maintain neutral spinal alignment at all times.

#### **II. Manual In-line Stabilization (MIS)**

* **Initiation:** One rescuer applies MIS immediately upon assessing the patient.

* **Technique:**

* Hands are placed on either side of the patient's head/neck, at the occiput and mastoid processes.

* Gentle, firm pressure is applied to prevent any movement.

* Rescuer's body acts as a splint.

* **Duration:** MIS is maintained until all immobilization devices are secured.

#### **III. Cervical Collar Application**

* **Purpose:** To limit cervical spine movement.

* **Sizing:**

* Crucial to select the correct size to prevent hyperextension or hyperflexion.

* Measure from the base of the neck (below the mandible) to the anterior part of the shoulder.

* Fit should be snug but allow for breathing.

* **Application Process:**

* One rescuer maintains MIS.

* The second rescuer applies the collar.

* The collar is slipped behind the neck, with the chin support resting under the chin and the occipital support at the back of the head.

* Fasten the Velcro straps securely, ensuring no pinching of skin.

* Check for any obstruction to breathing.

#### **IV. Head Immobilizer Application**

* **Purpose:** To further restrict lateral (side-to-side) and rotational movement of the head and neck.

* **Types:** Often soft, foam-filled blocks or rigid plastic devices.

* **Application Process:**

* With MIS and cervical collar in place, place the head immobilizers on either side of the patient's head, snugly against the temples/sides of the head.

* Ensure they are evenly positioned.

* Secure with straps or tape, taking care not to obstruct the airway or displace the cervical collar.

* Confirm that the head is neither tilted nor rotated.

#### **V. Spinal Board Application (Log Roll & Board Placement)**

* **Purpose:** To provide a rigid surface for extrication and transport, allowing for continued spinal alignment.

* **Team Coordination:** Requires a coordinated team effort (typically 3-4 rescuers).

* **Log Roll Procedure:**

1. **Rescuer 1 (Head):** Maintains MIS and directs the roll.

2. **Rescuer 2 (Torso):** Places hands on the patient's shoulder and hip on the far side.

3. **Rescuer 3 (Legs):** Places hands on the patient's hip and knee on the far side.

4. **Board Positioner:** Positions the spinal board parallel to the patient.

5. **Command:** Rescuer 1 gives a clear command to roll simultaneously.

6. **Roll:** The patient is rolled onto their side as a unit, maintaining spinal alignment.

7. **Board Placement:** The spinal board is slid underneath the patient.

8. **Roll Back:** The patient is rolled back onto the board.

* **Securing to the Board:**

* **Straps:** Use the provided straps to secure the patient to the board:

* Chest strap (across the sternum/rib cage).

* Pelvic strap (across the pelvis/hips).

* Leg straps (one or two, across the thighs).

* **Head Immobilizers:** Secure the head immobilizers to the board using additional straps or tape, ensuring they are firm.

* **Chin Strap (Optional/Conditional):** A chin strap may be used to prevent jaw drop, but *only if it does not compromise the airway*.

* **Final Check:**

* Confirm neutral spinal alignment.

* Check for any pressure points or discomfort.

* Ensure the airway is clear and breathing is unimpeded.

* The patient is now immobilized on the spinal board and ready for transport.

#### **VI. Key Considerations & Cautions**

* **Airway Management:** Always prioritize airway, breathing, and circulation (ABCs). Immobilization should not compromise airway access.

* **Patient Comfort:** While immobilization is essential, try to make it as comfortable as possible.

* **Reassessment:** Periodically reassess the patient's condition and the security of the immobilization devices.

* **Pediatrics:** Specific considerations apply to pediatric patients (e.g., padding to maintain alignment).

* **Pregnant Patients:** Specialized techniques may be required.

* **Entrapment:** If the patient is entrapped, the method of immobilization may need to be adapted.