Spinal Care during Sea Rescue: HUKM experience

Ismail MS, Azhar AA, A.Khaldun, Shalimar A, Muszaphar SS.

Dept of Emergency Medicine

HUKM

Introduction

• Spinal injury NOT common but very devastating.

• The higher the injury level the worse will be the outcome

• Most victims are in their prime time

• Significant loss of work-force to family and community and the nation

Spine injuries

• Incidence : 40 per million (US) : 15 per million (UK)• In Malaysia: Incidence 19.8 per 1000 MVA

victims had spinal injuries• 57.89% involve the cervical spine• SCI was only 5.3% • Mean age : 29.7 years old• Age peak: 20-24 male 25-29 female• Majority : Male

• Spinal care is very important • Should receive utmost attention

During primary survey & resuscitation Spinal immobilization > spinal clearanceRegardless of the situation

Important reminders• Early diagnosis is essential, prompt Mx

planning for spinal & spinal cord injuries- reduce the morbidity & mortality

• Early stages- life-saving procedures takes priority.

• Movement of non-immobilized pts with unrecognized, unstable vertebral injuries put the spinal cord at high risk.

TOTAL SPINAL IMMOBILIZATION• medical & legal consequences.

Spinal immobilization

On the land

• Awareness: well created

• Well understood

• Much emphasis has been put

• Indications- clear

• Rescuers are quite well trained with the technique

Spinal columnCervical

Thoracic

Lumbar

Sacrum

Coccyx

In the sea

• Most of time it is forgotten

• Indication not clear

• Technique not well described or understood

• Not many rescuer know how to execute the procedure

• Not much attention are put into it.

Our experience

• Put to test during the national level mock disaster drill in Kuala Terengganu

• Difficulty was noted and address to

• Feedback

• Improvement proposed

The TEAM

The equipment

Semi rigid Cervical Collar

Full set-up for spinal care duringSea/ aquatic rescue

The transport

The training and technique

Training for the aquatic rescue

Vice grip vs In-line immobilization

• Assess airway and breathing

• Cervical collar if indicated

1. Any injury above clavicle

2. Neck pain

3. Neurological sign

4. Unconsciousness

5. History of diving

Putting the cervical collar

• Use adjustable collar

• Applied the collar while another rescuer is supporting the head-neck with in line immobilization

• *Need to loosen / open the buoyancy vest

Putting the patient on the aqua spinal board

The sea rescue

• Sea condition was quite rough

• Wind was 35 knots

• Waves was between 1.5- 2.0 m

In the sea

• Condition slight different

• Waves- much stronger

• Wind quite strong

• Helicopter downdraft was quite powerful

• Getting to the victim is more further away

• Technique remained the same

Conclusion

• Spinal care in aquatic injuries should receive equal emphasis just like their counterpart on land injuries

• Spinal care technique should be taught to all rescuer whether it is on land or water.

• Spinal care (immobilization) technique can and should be applied to all indicated patients.

Thank you for your kind attentionTerima kasih