Chapter 11
Caring for head, neck and spinal injuries
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Causes of HNS injuries
S Head neck and spine can result in lifelong disability or even
death
S Rarely happen during supervised diving into deep water.
S Most often occur:
at shallow end, in a corner or where the bottom slopes from
shallow to deep water.
S Also, from striking a floating object while diving in.
S Lakes depths change wit the tide or current or someone
plunges head-first into shallow water or breaking wave
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Continue:
S Aquatic environments that are caused by high-impact/high-
risk activities
S Entering head-first into shallow water
S Falling from greater than standing height
S Entering the water from height
S Striking a submerged or floating object
S Receiving a blow to the head
S Colliding with another swimmer
S Striking the water with high impact (falling while water skiing)
Signs and Symptoms of HNS injury
S You should suspect a possible HNS only if the activity was
high-impact or high-risk and signs or symptoms of injury
are present:
S Unusual bumps, bruises or depression on head, neck or back
S Heavy external bleeding from head, neck or back
S Bruising of the head (around eyes and behind ears)
S Blood or other fluids in the ears or nose
S Seizures
S Changes in level of consciousness
S Impaired breathing or vision
Continue:
Signs and Symptoms
S Nausea or vomiting
S Partial or complete loss of movement of any body area
S Loss of balance
S Victim hold his/her head, neck or back
S Severe pain or pressure in the head, neck or back
S Back pain, weakness, tingling or loss of sensation in the hands,
fingers, feet or toes
S Persistent headache
Caring for HNS injuries
S Your job is to minimize movement of the head, neck, and
spine
S You must use SPECIFIC rescue techniques
S If victim is breathing:
S Immobilize victim using a backboard
S If victim is not breathing:
S 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?
S Depends on:
S Victim’s condition (whether he/she is conscious and
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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
S 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
S Head splint technique:
S Used for performing manual inline stabilization for victims in
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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
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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:
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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.
S Face-up APPROACH from behind victim’s head
S Face-down APPROACH from the victim’s side
S Shallow water- NO rescue tube needed
S Victim at the surface in deep water, you may need the rescue tube to
support yourself
S 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.
S Avoid lifting or twisting the victim when performing the skill
S Do NOT move the victim any more than necessary
S Minimize water movement by moving het victim away from
crowded areas and toward the calmest water possible
S Keep victim’s mouth and nose out of the water
S Immediately check victim for consciousness and breathing once
victim is face up
Spinal Backboarding Procedure
S Helps to immobilize the victim during the process of removing him/her
from the water.
S Minimum of 2 LGs needed
S Submerge the board, position it under the victim, and carefully raise it up
to the victim’s body
S Secure the victim to backboard w straps and head immobilizer device.
S Rescue tubes can be placed under the board
S Communication between LGs is critical during this procedure.
S Communication to the victim is also critical
S Tell victim not to nod or shake head but instead say yes or no if need to respond
to a question!
Team Spinal Backboarding
S Other LGs may be necessary to ensure your safety as well that of
the victim. Other LGs can help by:
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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
S Backboards
S Minimum of 3 straps to secure victim to board
S Head immobilizer that can be attached to the top of board
S Vary in shape, size, buoyancy, number, or style of body straps
and style of head immobilizer device.
Head-chin Support
S Alternate method
S Must be done in at least 3 feet of water
S Do not use rescue tube for support when performing rescue
Removal
S Once placed on backboard remove from water
S Assess victim’s condition and provide the appropriate care
S Place a towel or blanket on the victim to keep him/her warm
Removal from extremely
shallow water
S Use the technique, for backboarding, “speed slide”
S Carefully lift up the backboard and victim using proper lifting
techniques to prevent injuring yourself.
S Remove the backboard and victim from the water by slowly
walking out. Keep the board as level as possible during the
removal
S 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
S Move to calmer water, if possible
S If no barriers, have rescuers form a “wall with their bodies
to block the waves
Rivers, Streams, and winding
river attractions
S Ask other LGs or patrons for help keeping objects and
people from floating into rescuer
S Do NOT let current press sideways on the victim or force
the victim into a wall. This will twist the victim’s body.
S Keep the victim’s head pointed upstream into the current
Catch Pools
S More force than winding river: difficult to hold a victim still
S Immediately signal to other LGs
S Someone should stop the flow of water by pushing the
emergency stop button.
S Once in-line stabilization is achieved and the victim is turned
face-up move victim to calmest water in catch pool
S Usually center of catch pool (if one slide)
S Move between slides (if two slides)
Caring for HNS injuries on Land
S Goal:
S Minimize movement of HNS
S Activate EAP
S Follow general procedures:
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Size up the scene
Perform a primary assessment
Summon EMS personnel
Perform a secondary assessment
Provide the appropriate care
Use appropriate PPE
Caring for a Non-Standing victim
S REMAIN in the position in which he or she was found until
EMS personnel assume control
S Support the head in the position you found it.
S Do NOT attempt to align the head and neck
S Gently position the victim’s head in line with the body
if you cannot maintain and open airway.
Caring for a Standing Victim
S Secure the victim to the backboard while he/she remains
standing. Slowly lower him/her to the ground
S If EMS can arrive within a few minutes you may maintain
manual stabilization with the victim standing.
Final thoughts. . .
S HNS injuries are rare at aquatic facilities
S If you suspect a HNS injury summon EMS immediately
S Minimize movement by using in-line stabilization