Spine Immobilisation and Log-Rolling

Need 4 people:
- 1 for manual inline immobilisation of the head and neck
- 1 for the torso
- 1 for the pelvis and legs
- 1 to direct and move the spine board.
Assumes any extremity suspected of being fractured is already immobilised.

Immobilisation with log roll
- generally pre-hospital.

1. Place long spine board next to pt's side.  Straps positioned for fastening across thorax, just above iliac crests, thighs and just above the ankles.  Straps or tape must be used to secure the head and neck on the long board.

2. Apply gentle manual immobilisation to the head and apply a semirigid collar.

3. Straighten arms and place palm-in next to torso.

4. Straighten legs carefully into neutral alignment with spine.  Tie ankles together with roller-type dressing or cravat.

5. 1 person maintains head and neck alignment while another reaches across and grasps the patient at the shoulder and wrist.  A third reaches across and grasps the pt's hip just distal to the wrist with 1 hand, and with the other hand firmly grasping the roller bandage or cravat securing the ankles together.

6. At the direction of the head person, the pt is cautiously logrolled toward the 2 assistants on the pt's side, but only to the minimal degree that allows the spinal board to be positioned.  Neutral alignment must be maintained.

7. Spine board is placed eneat the pt, and the pt is logrolled as a unit onto the board.  Remember it is used only for transporting and should not be left on for any long period of time.  Pressure sores develop at ~2 hrs and longer.

8. Padding may be required under the pt's head to avoid hyperextension of the neck and for comfort.

9. Padding, rolled blankets or similar devices are placed on either side of the pt's head and enck. and the pt's head is secured firmly to the board.  Tape is also placed over the cervical collar.

Paediatric Pt:
If a paediatric spinal board isn't available, pack blanket rolls along the entire sides to prevent lateral movement.
Pad under the shoulders to elevate the torso: a child's head is relatively large and will flex the c-spine otherwise; this padding should extend from lumbar spine to top of shoulders and laterally to board edges.

Removal from a spine board:

Perform as early as possible on transferral to hospital.
- best when pt being rolled to examine the back.
Safe povement requires continous maintenance of anatomic alignment with manual inline immobilisation of the head and neck.
Can use:

1. Modified logroll
- as above

2. Scoop stretcher
- allows rapid safe transfer.

After transfer the pt must be securely immobilised again until spine injury excluded.