Safe Transport of a Patient with Suspected Spinal Injury

Improper movement can convert a stable spinal injury into permanent paralysis. Follow the log-roll principle: move the body as a single unit, maintaining inline neutral alignment.

Step-by-Step (Prehospital / First Responder)

1. Scene Safety & Assessment: Mechanism (fall, MVC, dive)? LOC? Neuro deficit? Call EMS if any red flag.
2. Manual Inline Stabilization (MILS): One rescuer holds head/neck in neutral (ears aligned with shoulders) continuously until fully immobilized on backboard.
3. Assess ABCs: Airway (jaw thrust if needed), Breathing, Circulation. Control major hemorrhage.
4. Apply Cervical Collar: Proper size (measure chin to trapezius). Does not replace MILS.
5. Log Roll onto Backboard:
   • Team of 3–4: Leader at head (MILS), 2 at chest/hips, 1 at legs.
   • On command: "Roll toward me" – move as unit, no twisting.
   • Slide board under, or scoop stretcher.
6. Secure to Board:
   • Straps: chest, pelvis, legs (crossed).
   • Head immobilization: blocks + tape/strap across forehead/chin.
   • Check: no movement of head relative to torso.
7. Transport: Board on stretcher → ambulance. Secure stretcher in vehicle.
8. En Route: Monitor vitals, neuro checks q5–15 min. IV access, warm fluids. Notify receiving trauma center.
9. Hospital Handoff: Mechanism, exam findings, interventions, imaging done.

Critical Pearls

• Never move a potential spinal injury patient alone.
• Never remove helmet unless airway compromised (then: 2-person helmet removal with MILS).
• Backboards cause pain/pressure ulcers—transfer to firm mattress ASAP in ED.
• Pediatrics: larger head → torso elevation (padding under shoulders) for neutral alignment.

When in doubt, immobilize. The cost of over-triage is discomfort; the cost of under-triage is paralysis.