Advanced Spinal Assessment
Advanced Spinal Assessment
EMT/ADVANCED EMT/PARAMEDIC STANDING ORDERS
PURPOSE:-
This protocol provides guidance regarding the assessment and care of patients who have a possible spinal injury, utilizing spinal motion restriction. Spinal motion restriction is defined as application of a cervical collar and maintenance of the spine in neutral alignment. Determination that immobilization devices should be used should be made by the highest level EMS provider. All steps of spinal assessment algorithm below must be documented in the PCR.
All patients that have a mechanism of injury that could cause a spinal injury, including high risk or questionable injury mechanisms, should have a spinal assessment.
Spinal Assessment: Spinal motion restriction is required when ANY of the following conditions apply : See Spinal Motion Restriction Protocol (49 Skills).
- Unreliable patient:
- Child who cannot participate in assessment.
- Anxious and/or uncooperative.
- Communication barriers (e.g., deafness, hard of hearing, language, understanding).
- Altered mental status (not alert and oriented x 3).
- Evidence of alcohol or drug intoxication.
- Distracted by circumstances or injuries to self or others (ie, any other injury capable of /producing significant pain in this patient).
- Any abnormal neurological function in extremities (check all 4 extremities):
- Numbness or tingling (paresthesia).
- Motor strength not full and symmetrical.
- Sensation nt intact and symmetrical.
- Midline tenderness on palpation:
- Explain to the patient the actions that you are going to take. Ask the patient to immediately report any pain, and to answer questions with a “yes” or “no” rather than shaking the head.
- With the patient’s spine supported to limit movement, begin palpation at the base of the skull at the midline of the spine.
- Palpate the vertebrae individually from the base of the skull to the bottom of the sacrum.
- On palpation of each vertebral body, look for evidence of pain and ask the patient if they are experiencing pain. If evidence of pain along the spinal column is encountered, utilize spinal motion restriction.
- Pain with movement of neck (cervical flexion, extension and rotation).
- If the capable patient is found to be pain-free, ask the patient to turn their head first to one side (so that the chin is pointing toward the shoulder on the same side as the head is rotating) then, if pain-free, to the other. If there is evidence of pain, utilize spinal motion restriction.
- With the head rotated back to its normal position, ask the patient to flex and extend their neck. If there is evidence of pain, utilize spinal motion restriction.
Do not assist patient in attempts to rotate neck.
High Risk Mechanism Include:-
- Motor vehicle crash >60 mph, rollover, ejection. Simple low-speed, rear-end MVC can usually be excluded. (Simple low-speed collision does not include: Being pushed into oncoming traffic, being hit by a bus or large truck, rollover, or being hit by a high-speed vehicle.)
- Falls > 3 feet/5 stairs. Patients > 65 years or with a high-risk history such as osteoporosis should be given extra consideration, including falls from standing.
- Axial load to head/neck (e.g., diving accident, heavy object falling onto head, contact sports).
- Significant injury or mechanism of injury above the clavicle.
- Injuries involving motorized recreational vehicles.
- Bicycle or pedestrian struck/collision.
