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Chapter 11Caring for head, neck and spinal injuries

Causes of HNS injuries

Head neck and spine can result in lifelong disability or even death

Rarely happen during supervised diving into deep water.

Most often occur: at shallow end, in a corner or where the bottom

slopes from shallow to deep water. Also, from striking a floating object while diving in. Lakes depths change wit the tide or current or

someone plunges head-first into shallow water or breaking wave

Continue:

Aquatic environments that are caused by high-impact/high-risk activities Entering head-first into shallow water Falling from greater than standing height Entering the water from height Striking a submerged or floating object Receiving a blow to the head Colliding with another swimmer Striking the water with high impact (falling while water

skiing)

Signs and Symptoms of HNS injury

You should suspect a possible HNS only if the activity was high-impact or high-risk and signs or symptoms of injury are present: Unusual bumps, bruises or depression on head, neck

or back Heavy external bleeding from head, neck or back Bruising of the head (around eyes and behind ears) Blood or other fluids in the ears or nose Seizures Changes in level of consciousness Impaired breathing or vision

Continue: Signs and Symptoms

Nausea or vomiting Partial or complete loss of movement of any body

area Loss of balance Victim hold his/her head, neck or back Severe pain or pressure in the head, neck or back Back pain, weakness, tingling or loss of sensation in

the hands, fingers, feet or toes Persistent headache

Caring for HNS injuries

Your job is to minimize movement of the head, neck, and spine

You must use SPECIFIC rescue techniques

If victim is breathing: Immobilize victim using a backboard

If victim is not breathing: Immediately remove the victim from the water using a

two-person removal from the water and provide resuscitation care

Higher priority is given to AIRWAY management, giving VENTILATIONS or performing CPR than to spinal immobilization.

What care to provide?

Depends on: Victim’s condition (whether he/she is

conscious and breathing) Location of the victim (shallow or deep water,

at the surface or of the water, submerged or not in the water)

The availability of additional help, such as other LGs bystanders, fire fighters police or EMS personnel

Facility’s specific procedures Air and Water temperature

Caring for HNS injuries in WATER

Follow these general rescue procedures:1. Activate the facility’s EAP.

2. Safety enter the water. Minimize water movement by using a slide-in-entry

3. Perform a rescue providing in-line stabilization appropriate for the victim’s location and whether the victim is face –up or face-down.

4. Move the victim to safety. Deep water move to shallow

Manual In-Line Stabilization

Head splint technique: Used for performing manual inline stabilization for

victims in the water Face-up or Face-down Shallow or deep water Near or below the surface Objective to get the victim into a face-up position

while minimizing movement of the HNS.

Contine

5. Check for consciousness If the victim is breathing, proceed with the spinal backboarding procedure If the victim is not breathing, immediately remove the victim from the

water using two-person-removal for the water, and provide resuscitative care

Do NOT delay removal from water by strapping the victim onto the board or using the head immobilizer device

6. Backboard the victim using the spinal backboarding procedure

7. Remove the victim from the water.

8. Re-assess the victim’s condition and provide appropriate care. Additionally:

Minimize shock by keeping the victim from getting chilled or overheated If the victim vomits, tilt the backboard on one side to help clear the vomit

from victim's mouth

Vary the technique in the following ways based on victim’s position in the

water. Face-up APPROACH from behind victim’s head

Face-down APPROACH from the victim’s side

Shallow water- NO rescue tube needed

Victim at the surface in deep water, you may need the rescue tube to support yourself

Submerged, Do NOT use the rescue tube when you are submerging and brining the victim to the surface. Once at the surface another LG will place the tube under armpits to helps support.

Avoid lifting or twisting the victim when performing the skill

Do NOT move the victim any more than necessary

Minimize water movement by moving het victim away from crowded areas and toward the calmest water possible

Keep victim’s mouth and nose out of the water

Immediately check victim for consciousness and breathing once victim is face up

Spinal Backboarding Procedure

Helps to immobilize the victim during the process of removing him/her from the water.

Minimum of 2 LGs needed

Submerge the board, position it under the victim, and carefully raise it up to the victim’s body

Secure the victim to backboard w straps and head immobilizer device.

Rescue tubes can be placed under the board

Communication between LGs is critical during this procedure.

Communication to the victim is also critical Tell victim not to nod or shake head but instead say yes or no if need to

respond to a question!

Team Spinal Backboarding

Other LGs may be necessary to ensure your safety as well that of the victim. Other LGs can help by: Submerging and positioning the backboard under victim Supporting the rescuer at the head of the backboard in deep water Supporting the backboard while the straps and head immobilizer

are secured Securing the straps or head immobilizer device Communication with and reassuring the victim Guiding the backboards it is being removed from the water Removing the backboard from the water Providing care after the victim has been removed from the water

Immobilization equipment for HNS injuries

Backboards Minimum of 3 straps to secure victim to board

Head immobilizer that can be attached to the top of board

Vary in shape, size, buoyancy, number, or style of body straps and style of head immobilizer device.

Head-chin Support

Alternate method

Must be done in at least 3 feet of water

Do not use rescue tube for support when performing rescue

Removal

Once placed on backboard remove from water

Assess victim’s condition and provide the appropriate care

Place a towel or blanket on the victim to keep him/her warm

Removal from extremely shallow water

Use the technique, for backboarding, “speed slide”

Carefully lift up the backboard and victim using proper lifting techniques to prevent injuring yourself.

Remove the backboard and victim from the water by slowly walking out. Keep the board as level as possible during the removal

Gently lower the backboard and the victim to the ground once out of the water using proper lifting techniques to prevent injuring yourself

Moving water

Move to calmer water, if possible

If no barriers, have rescuers form a “wall with their bodies to block the waves

Rivers, Streams, and winding river attractions

Ask other LGs or patrons for help keeping objects and people from floating into rescuer

Do NOT let current press sideways on the victim or force the victim into a wall. This will twist the victim’s body.

Keep the victim’s head pointed upstream into the current

Catch Pools

More force than winding river: difficult to hold a victim still Immediately signal to other LGs Someone should stop the flow of water by pushing

the emergency stop button. Once in-line stabilization is achieved and the victim

is turned face-up move victim to calmest water in catch pool

Usually center of catch pool (if one slide) Move between slides (if two slides)

Caring for HNS injuries on Land

Goal: Minimize movement of HNS Activate EAP Follow general procedures:

Size up the scene Perform a primary assessment Summon EMS personnel Perform a secondary assessment Provide the appropriate care

Use appropriate PPEAPPROACH VICTIM FROM THE FRONT

Caring for a Non-Standing victim

REMAIN in the position in which he or she was found until EMS personnel assume control

Support the head in the position you found it.

Do NOT attempt to align the head and neck

Gently position the victim’s head in line with the body ONLY if you cannot maintain and open airway.

Caring for a Standing Victim

Secure the victim to the backboard while he/she remains standing. Slowly lower him/her to the ground

If EMS can arrive within a few minutes you may maintain manual stabilization with the victim standing.

Final thoughts. . .

HNS injuries are rare at aquatic facilities

If you suspect a HNS injury summon EMS immediately

Minimize movement by using in-line stabilization