Page 63 - 2022 Ranger Medic Handbook

Spinal Cord Injury Management
While cervical spine (C-spine) injuries are relatively common in major trauma, they receive less attention in the combat
environment due to the prevalence of penetrating injury mechanisms. With the high incidence of explosive injury in pres-
ent conflicts, providers must pay attention to the indications for and methods of ruling out cervical or spinal injury. IED
blasts and jump injuries have a high risk for lumbar fractures. Physical exam is essential for C-spine clearance, but most
patients will require some form of imaging.
Spine boards have never been proven to provide any benefit to the patient and often cause harm through prolonged
pressure. Even patients with suspected spinal injuries are best cared for on a rigid litter and not on a spine board. If used, SECTION 2
patients should spend no more than 10 minutes on a spine board as they make transferring/moving patients easier.
Remove the patient as soon as possible from a spine board and place on a padded rigid litter. Do not place a suspected
spine-injured patient on a SKEDCO or other flexible litter.
Likewise, cervical collars are also known to cause harm by interfering with lifesaving interventions and hiding other inju-
ries. Use NEXUS Criteria to aid in C-spine clearance and only place a collar when necessary. Penetrating trauma patients
rarely require cervical collars. If required, perform all lifesaving interventions with an assistant preventing unnecessary
C-spine movement prior to placing a cervical collar.

TCCC Application
Care Under Fire: Manage life-threatening hemorrhage. No specific action. On the battlefield, preservation of the life of
the casualty and Medic is of paramount importance. In these circumstances, evacuation to a more secure area takes
precedence over spine immobilization.
Tactical Field Care: Medics should consider cervical collar placement on all patients who have sustained injuries
through the following mechanisms if the tactical situation allows: major explosive or blast injury; mechanism that pro-
duces a violent impact on the head/neck; mechanism that creates sudden acceleration/deceleration or lateral bending
forces on the neck; fall from height (vs. fall from standing); and ejection or fall from any motorized vehicle. Autopsy data
show patients with penetrating cervical injury in war almost never survive the injury. Therefore, spinal stabilization should
only be performed after all other lifesaving interventions. All providers must be aware that the collar may hide other
injuries, increase the difficulty of airway management, and mask developing pathology such as expanding hematoma.
Patients with isolated penetrating cervical injury who are conscious and have no neurological signs should not have a
cervical collar placed in the prehospital environment. Patients with isolated penetrating brain injury do not require a cer-
vical collar unless the trajectory suggests C-spine involvement. Field expedient cervical immobilization methods include
IV bags, rolled poncho liner, stacked/taped MRE package, rolled up uniform shirt, or snivel gear.
Tactical Evacuation: Evacuate as determined by other significant injury protocols. Evacuate as Urgent patients with
gross neurological deficits. Evacuate as Priority patients without other significant injuries or without neurological deficit.
Consider padding of litter for extended distance evacuations. Ensure hypothermia prevention measures are rendered.
Extended Care
In the event of extended care, there is little that can be done for known spinal injuries. If possible, avoid repeated litter
movements of the casualty. If extended spinal immobilization is expected, then attempt to pad the litter prior to place-
ment of the patient to reduce the risk of development of pressure ulcers. Attempt to pad any areas near bony promi-
nences. Immobilized patients are at risk of aspiration. Be prepared for emergency suction and/or the ability to tip the
immobilized patient if vomiting is imminent. Use prophylactic antiemetics to help reduce risk. High spinal cord injuries
may affect the diaphragm and put the patient at risk for respiratory failure. Be prepared for ventilation procedures. These
patients may also display hypotension (from neurogenic shock) and bradycardia. Fluid challenge within normal guide-
lines. If tachycardia is present, then assume hypovolemic shock and attempt to determine cause.
Patient comfort while immobilized will become a greater concern as time passes. Urination may be controlled by use of
Foley catheterization or tipping the immobilized casualty.

Spinal Injury Assessment
1. Do not administer procedural sedation until after completion of neurovascular check and assessment of GCS.
2. Report & document GCS, paralysis, and any neurological deficit.
3. Concerning MOIs:
a. Any mechanism that produced a violent impact to the head, neck, torso, or pelvis.
b. Incidents producing sudden acceleration, deceleration or lateral bending forces to neck.
4. Distracting injuries are any injury that may potentially impair the patient’s ability to recognize other injuries or neuro-
logical deficit.
2022 RANGER MEDIC HANDBOOK 49