C-Spine Precautions – It is a big fear, even if only in the very back of our minds, for adventurers, to have a big fall or injury that makes it necessary to take what the medical profession calls C-Spine precautions. For those that do not know exactly what that is, let me give you a better understanding of this important topic.
The “C” in C-Spine precautions stands for cervical. The cervical spine (C-Spine) contains the first 7 bones (vertebrae) in the spine. The bones of the spine protect what is called the spinal cord. The spinal cord, simplified, is a bunch of nerves that the brain uses to tell the body to do things. Among other things, if the spinal cord is injured, a person can become paralyzed, and worse, stop breathing. It doesn’t take a rocket scientist to realize the severity of these types of injuries. While today’s post is to teach you how you might be able to take C-Spine precautions, you can read my post on “when” to use this technique here.
So, unless you are on a huge expedition, with an entire crew, including medical professionals, you probably do not have a real c-spine precautions collar in your backpack. You are in the back country, and your best adventure buddy has taken a really nasty fall. You make the decision that it is necessary to find a way to help your buddy protect his/her spinal cord and take c-spine precautions. As with so many medical situations in the wilderness, creativity may come into play. While these types of injuries may be the scariest, I was completely stoked when I learned this technique in my NOLS Wilderness Medicine For Medical Professionals course. Take a deep breath and know that you can totally do this!
BONE: IF AVAILABLE, ONE PERSON NEEDS TO HELP HOLD THE INJURED PERSON’S HEAD STILL AND IN ALIGNMENT WITH THE SPINE, WHILE ANOTHER PERSON IS PREPARING THE COLLAR. It is easiest to do this by kneeling at the persons head and placing a knee on each side of the head, using hands and knees to gently help injured person keep head still. This person can also be CALMLY talking to the injured person, if they are alert, keeping them informed of what is happening.
You need to find a long-sleeved clothing article. A sweatshirt, like the one I used for this demonstration, works best. If you only have a couple long sleeve summer shirts, use them together to increase bulk or thickness.
BONE: EVEN IN THE SUMMER, BRING A LONG SLEEVE ARTICLE OF CLOTHING ON ADVENTURES. These items can protect your skin from the sun, branches, and bugs, even if you don’t need to use them for c-spine precautions.
From here I am going to use pictures to demonstrate how to place your improvised collar.
Lay your shirt out flat, with the front facing up. This will ensure that all the snaps, buttons, etc. will all be on the inside, and away from delicate skin. Smooth out as many wrinkles as you can. Also, take care to keep any debris off of the shirt; rocks, leaves, dirt, etc.
If you are using a shirt with a hood, tuck it in here at the beginning. Again, try to decrease any bunching up. Continue trying to keep garment as free of wrinkles as you can, throughout the rolling up.
BONE: WHILE IT MAY NOT SEEM LIKE A BIG DEAL, IF A PERSON HAS TO WEAR THIS FOR AN EXTENDED PERIOD OF TIME, WAITING FOR A HIGHER LEVEL OF CARE, EVERY LITTLE BUMP AND POKE WILL START TO RUB/IRRITATE. While the most important part in this is to keep the spinal cord safe, we also want to take effort to ease as much discomfort as we can. The more comfortable the injured person is, the easier it will be to get them to leave the c-spine precautions on.
Now you need to begin rolling up the shirt from the bottom.
At this point, check one more time to see if there is any debris on the shirt, and that you have smoothed out bumps and wrinkles the best you can. Also, remove items like necklaces, etc. that will otherwise end up in between the collar and the skin.
While continuing to keep injured person’s head as still as possible, place shirt across the neck.
Encouraging the injured person to NOT lift, or try to move their own head, slide one sleeve under the neck, to the other side. If the injured person is wearing a shirt with a collar, try to place the shirt collar you are putting on them underneath the collar of the shirt the injured person is wearing.
Now slide the other sleeve under the neck, to the opposite side. At this point you should begin to snug up the shirt around the neck by pulling on each sleeve, at the same time, in opposite directions. If injured person is alert, ask how it is feeling, using encouraging and calm interaction. While, of course, we do not want to take away their ability to breathe, we do want the collar to be snug.
Now tie the shirt sleeves snuggly in the front. Your c-spine precautions collar is now in place. While waiting for a higher level of care, continue to keep an alert injured person informed of what is going on. Attend to any other needs they may have. Continue to remind them to keep their head still. You will also need to periodically check the c-spine precautions collar, to be sure it is still snug.
BONE: IF INJURED PERSON BECOMES NAUSEATED, ROLL THEIR ENTIRE BODY ONTO THEIR SIDE, KEEPING THEIR HEAD ALIGNED, UNTIL NAUSEA AND/OR VOMITING GOES AWAY!
Find a friend and practice placing on each other. I was shocked at how snug and yet comfortable this version of a c-spine precautions collar really is!
While, of course, I really love the extra attention of shares and comments, I really REALLY would love for you all to share this post with your friends and family so they too will know how to apply this collar!!
*For those of you that do not know, I am an RN. I have practiced in an ICU/Emergency Room setting for the majority of my 12 years of being a nurse. I have also completed my Wilderness Medicine For Medical Professionals this past year, 2016, with the National Outdoor Leadership School (NOLS). In an attempt to make wilderness medical situations/emergencies just a little less scary and/or confusing for those who don’t have medical training, I am going to periodically put out “Monday’s Medical Moment” posts. These posts will be for basic information only, and will not be intended to replace the care and treatment of medical professionals, when available.