1. Chapter Injuries to the Head and Spine Twenty-Four

3. Anatomy Review: Nervous System

4. Spinal Column

5. Anatomy Review: Skull and Facial Bones

6. Bone Dura mater Arachnoid Pia mater Subarachnoid space Subdural space Intracerebral Dura mater Arachnoid Skull Pia mater Contents of the Skull Epidural space (potential)

7. I NJURIES TO THE HEAD

9. Direct Occurs when the brain is lacerated, punctured, or bruised by the broken bones of the skull, by bone fragments, or by foreign objects. Brain Injury Indirect Can be the result of closed injuries to the skull and certain types of open skull injuries.

18. Tell new EMT-Bs that an epidural hematoma is often associated with severe blows to the temporal regions of the head. If they recognize an epidural hematoma in its early stages and promptly transport the patient to a trauma center, it can make the difference between life and death. Tell them to be aggressive if they suspect an epidural hematoma may be developing. P RECEPTOR P EARL

19. I NJURIES TO THE SPINE

21. Mechanisms of Spinal Injury

22. Whiplash

23. Tell new EMT-Bs that as a rule of thumb, they should assume any fall three times the patient’s height or with enough force to cause open PSDEs to the ankles will also be accompanied by a spine injury. P RECEPTOR P EARL

33. Assess sensation in all extremities.

34. Assess motor function.

35. Assess strength: feet and hands

41. S PINAL IMMOBILIZATION

42. Stabilize and measure.

43. Choose correct collar size.

44. Prepare collar.

45. Slide collar under chin.

46. Secure collar; maintain in-line position.

48. Select immobilization device.

49. Manually stabilize patient’s head in neutral, in-line position. Assess distal pulse, motor function, and sensation (PMS).

50. Apply the appropriately sized extrication collar. Position device behind patient.

51. Secure device to patient’s torso. Evaluate and pad behind patient’s head as necessary. Secure patient’s head to device.

52. Evaluate and adjust straps. As needed, secure patient’s wrists and legs.

54. Maintain stabilization; apply collar.

55. Prepare and position device.

56. Move patient onto board. Apply padding to voids.

57. Secure body, then head.

58. Reassess PMS.

59. Standing Takedown: Maintain stabilization and apply collar.

60. Standing Takedown: Position board and EMT-Bs.

61. Standing Takedown: Grasp board after reaching under patient’s shoulders.

62. Standing Takedown: Carefully lower patient; then secure board.

64. Manually stabilize; apply collar.

65. After putting end of board next to patient, position hands on legs/pelvis and chest/arms.

66. Rotate patient and reposition hands.

67. Lower patient to board.

68. Move patient into position on board.

69. Secure patient and transport.

70. H ELMET REMOVAL

76. Tell new EMT-Bs that many EMS providers put the controversy of helmet removal vs. nonremoval into the following perspective: If your child’s neck was injured in a football accident, would you want the trainer and the EMT-B to remove the helmet at the scene or would you prefer that this be left to the emergency department staff, who probably will not have the assistance of the trainer or the benefit of frequent practice in the helmet removal technique? P RECEPTOR P EARL

77. Stabilize head and helmet. Fingers should be on patient’s mandible. Second EMT-B loosens strap. 1 2

78. Transfer stabilization to second EMT-B. Carefully remove helmet. 3 4

79. Prevent head from falling once helmet removed. Begin routine stabilization and immobilization. 5 6

81. 1. Describe the mechanisms of head and spinal injury. 2. When should rapid extrication be used? 3. Describe the steps in helmet removal. 4. When is it appropriate to remove a child from a car seat as opposed to immobilizing the child in the seat? R EVIEW QUESTIONS