What spinal immobilisation techniques are taught on a Sports First Aid course?
The two day sports first aid course focuses on the use of manual techniques for spinal immobilisation. A manual technique is when the first aider supports the casualty’s head with two hands in order to minimise any movement of the neck or spine. This manual immobilisation technique is simple, memorable and effective in all situations. It is the core skill in all spinal immobilisation and its usefulness must not be underrated, it can be used on casualties in the position they are found in; sitting, lying or standing, whilst awaiting medical assistance. The casualty should not be moved unless there is good reason to do so, so learning a technique which can be applied to any position the casualty is found in is invaluable. It can also be practised in conjunction with a two person or a spinal log roll if it becomes necessary to move the casualty with minimal movement to the spine.
Why do we choose not to teach the use of spinal boards on our Pitch Side Sports First Aid course?
In the majority of situations dealt with by pitch side first aiders, proficient use of manual immobilisation techniques is entirely suitable and effective.
- A first aider must first be proficient in manual immobilisation before other techniques and equipment, such as the spinal board, can be introduced.
- Spinal board training is mostly carried out for specific environments. For example pool lifeguards will learn to use a spinal board and will undergo specific and continual training and rehearsal of their use. Lifeguards have to have this training because it is not possible keep a head neck and spine in line in water without a spinal board and they are responsible for removing casualties from the water.
- The decision to move a casualty with a suspected spinal injury and place them onto a spinal board is most commonly taken by a qualified medical professional. If you wish to make this decision as a first aider you must have a justified reason why it was not possible to leave the casualty in the position that they were found and immobilise their head and neck using a manual technique.
- Being strapped to a spinal board is uncomfortable and distressing for conscious casualties. A casualty cannot be removed from the board until they have been cleared by a medical professional, which could be in a few hours time. When in discomfort many casualties continually try to move to reduce the discomfort.
- Medical professionals have advanced airway management skills and tools such as suction devices and intubation tubes to manage the airway of a casualty who is on their back on a spinal board, should they become unresponsive or start to vomit. A first aider does not have these skills or tools and the first aid treatment for an unresponsive, breathing casualty is to place them on their side in a safe airway position.
- On a one or two day first aid course which is not revalidated for 3 years it is unreasonable to expect a first aider to be able to acquire and maintain the skills required to use a spinal board safely.
- Continual updating of these skills is required.
What training and equipment is required to manage a full spinal immobilisation?
Many clubs buy a spinal board but do not realise that they also need collars, blocks and straps as well as staff trained specifically in the use of the equipment.Training should be a minimum of one day and refreshed annually and should include:
- Understanding which casualties should be immobilised
- The manual technique in a static position
- How to measure for the correct collarhow to apply the collar how to do the manual technique whilst moving a casualty
- How to position the casualty correctly on the board
- How to strap the casualty to the board correctly
- How to apply blocks and strap the headwhat to do if the casualty vomits
- What to do if the casualty’s GCS drops
Without advanced airway management equipment the only way for a first aider to manage an airway of an immobilised, vomiting casualty is to tip the whole board on its side - therefore the immobilisation needs to be very good which would take a bit of practice. Also, they would have an airway issue if the casualties GCS drops as the recommended first aid positions for an unresponsive, breathing casualty is to roll them into a safe airway position, they cannot be left on their backs.
It is also worth noting that when the emergency services arrive to treat a casualty who is already on a board they will not risk moving them further on to their own equipment so they will take yours. In the short term this means that the club will then not have a spinal board should a second injury occur and in the long term it will be up to you to try to retrieve all your equipment from the hospital. It is uncommon for hospitals to have a system in place to facilitate this.