First Responder EMS Curriculum for Training Centers in Eurasia

3. Try to pad the extremity to prevent pressure and discomfort to the patient.4. Do not intentionally replace protruding bones.5. Whenever in doubt, manually stabilize the injured extremity.5. Injuries to the SpineInjuries to the spine can result in some of the most physically disabling injuries a FirstResponder may encounter. These injuries may result in a patient losing effectiverespiratory effort and in paralysis. One must always suspect a spinal cord injury whenevertrauma occurs. Several mechanisms of injury, however, should create a higher index ofsuspicion when evaluating a trauma patient.Suspicious mechanisms of injury include motor vehicle accidents; pedestrian versusvehicle accidents; falls; blunt trauma; motorcycle accidents; penetrating injuries to thehead, neck, or back; hangings; and diving accidents. Consider any unresponsive traumapatient to have a spinal cord injury, until proven otherwise.a. Signs and SymptomsSpinal cord injury can result in many different signs and symptoms. These signs andsymptoms depend primarily on the level of spinal cord injury. Perform full spineimmobilization of any trauma patient suspected of a spinal column injury or exhibitingany of the following signs or symptoms to prevent worsening of the spinal cord injury.Signs and symptoms of spinal cord injury include:1. Tenderness of the cervical, thoracic, lumbar, or sacral spine.2. Pain associated with moving. Do not ask these patients to move to try to find a painresponse. Do not move the patient to test for a pain response.3. Pain independent on movement or palpation along the spine or lower legs. This painmay be intermittent.4. Soft tissue injuries associated with the trauma. Suspicious injuries include the headand neck (cervical spine), the shoulders, back, or abdomen (thoracic, lumbar), andthe lower extremities (lumbar, sacral).5. Numbness, weakness, or tingling in the extremities.6. Loss of sensation or paralysis below the suspected level of injury.7. Loss of sensation or paralysis in the upper or lower extremities.8. Respiratory impairment (high cervical spine).9. Loss of bladder and/or bowel control.10. Ability of the patient to walk, move extremities or feel sensation, or lack of pain inthe spinal column does not rule out the possibility of spinal column or cord damage.b. Assessing the Potential Spine-Injured PatientIn a responsive patient, assess the mechanism of injury by asking questions. Questionsto ask include:1. What happened?2. Where does it hurt?3. Does your neck or back hurt?4. Can you move your hands and feet?5. Can you feel me touching your fingers and toes?In the unresponsive patient, maintain the patient’s airway and breathing. Stabilize thepatient’s head and neck manually in the position found, and obtain information from176 First Responder EMS Curriculum/AIHA, July 2002