Handling Suspected Spinal Injuries
As a National Mountain Bike Patroller, you may come across a bicyclist or other trail user who has taken a bad fall. After assuring that the scene is safe, you should assess your rescue needs. Do you need extrication equipment to get to and/or stabilize the patient so he doesn't slide down the hill? Will you need more patrollers before you can attempt to move the patient safely? Generally speaking, you should have several trained assistants before you consider moving any patient with a possible spine or head injury. You may have to move a patient without assistance if it is absolutely necessary to check for and treat life-threatening problems to the patient's airway, breathing, or circulation, but keep in mind that you will be risking paralysis in order to save the patient's life.
High speed accidents, bar-hopping, collisions, and falls from significant heights are especially suggestive of spinal injury. Pain along the spine and changes in circulation, sensation, and motion in the arms or legs suggest spinal injury. Any serious head injury also suggests a related neck or spine injury. You must protect the cervical and lower spine from movement when you assess and treat. Injuries to the spinal column place the spinal cord at risk of damage and the patient at risk of paralysis or death. As a general rule, the higher up the spinal cord (toward the head), the more severe the injury.
There are two helpful rules for treating these patients. First, stabilize the head in a neutral position, but never force it or move it if it causes pain. Second, think of the spine as a length of chain, laid out in a straight line. Your goal when working with your patient, is not to move him/her in any way that bends or twists the chain. Think about this. The best way to move a chain and maintain it in a straight line is to pull the chain in line with its long axis. If you try to push a chain, it bends. If you pull a chain to the side, it bends. If you move one segment of a chain, but not the adjacent ones, you bend or twist it. It's the same with the spine. You can move the patient with a minimum of risk by pulling the patient either by the shoulders or legs in line with the axis of the spine, while supporting the head in a position of neutral alignment. Never push the patient, even if along the spinal axis - pushing causes the spine to compress and bend. If you need to roll the patient over, use 3-4 people when possible, rolling the head, feet and everything in between as a single unit at the same rate. Again, imagine rolling every link in the chain simultaneously so each maintains the same orientation. The overall rule is to minimize all movement until the patient can be properly secured with a cervical collar and backboard.