Spine Injuries (HB)

(Spinal assessment criteria allow rescuers to determine the need and justification for spine stabilization in the presence of an uncertain or positive mechanism of injury. This evaluation focuses on patient reliability, spinal column stability and neurologic function. Adequate time must be allowed for the evaluation. A clear assessment means that there is no significant spine injury and no need for spine stabilization.)

1. Assess for mechanism of spine injury. If a positive or uncertain mechanism exists, protect the spine by whatever method is feasible and available. This could include (but is not limited to) manual hand stabilizing it in the in-line position.
2. Do a thorough evaluation including a history and physical examination. To rule out a spine injury the patient must meet all of the following criteria:
   • Patient must be reliable. The patient must be cooperative, sober, and alert, and must be free of other distracting injuries significant enough to mask the pain and tenderness of spine injury.
   • Patient must be free of spine pain and tenderness.
   • Patient must have normal motor/sensory function in all four extremities:
     • Finger abduction/adduction or hand/wrist extension (both)
     • Foot planter flexion/extension or great toe dorsiflexion (both)
     • Normal sensation to pain and light touch in all four extremities
     • If reduced function in one particular extremity can be attributed with certainty to a condition unrelated to a potential spine injury (wrist fracture, for example), that deficit alone will not preclude ruling out a spine injury, because the motor/sensory assessment contain redundancy.
3. If a spine injury has not been ruled out, the patient should be stabilized in a safe and comfortable position on a board, litter, or other appropriate carrying devices. Arrange for transport to hospital.

There are situations in wilderness and Wildland fire rescue where the risk of spine stabilization exceeds the presumed benefit. In these circumstances, spinal stabilization may be deferred or modified until risk can be mitigated. In unstable scenes or with unstable patients the remote possibility of exacerbating a spine injury may not justify the additional risk associated with stabilization.