4-10. Spinal Column Fractures

Table of Contents

It is often impossible to be sure a casualty has a fractured spinal column. Be suspicious of any back injury, especially if the casualty has fallen or if his back has been sharply struck or bent. If a casualty has received such an injury and does not have feeling in his legs or cannot move them, you can be reasonably sure that he has a severe back injury, which should be managed as a fracture. Remember, that the possibility of a neck fracture or injury to the back should always be suspected, and it is often impossible to be sure if a casualty has a fractured spinal column. If the spine is fractured, bending it can cause the sharp bone fragments to bruise or cut the spinal cord and result in permanent paralysis or death (Figure 4-28A). The spinal column must maintain normal spinal position at the lower back (lumbar region) to help remove pressure from the spinal cord.

• a. If the casualty is not to be transported until medical personnel arrive —
• • • Caution him not to move. Ask him if he is in pain or if he is unable to move any part of his body.
  • • Leave him in the position in which he is found. DO NOT move any part of his body, unless he is in imminent danger.
  • • If the casualty is lying face up, slip a blanket or other supporting material under the arch of his lower back to help support the spine in a normal position (Figure 4-28B). Take care not to place so much bulky padding as to cause potential damage by causing undo pressure on the spine. If he is lying face down, DO NOT put anything under any part of his body.

Figure 4-28. Spinal column must maintain a normal spine position.

• b. If the casualty must be transported to a safe location before medical personnel arrive and if the casualty is in a —
• • • Face-up position, transport him by litter or use a firm substitute, such as a wide board or a door longer than his height. Loosely tie the casualty’s wrists together over his waistline, using a cravat or a strip of cloth. Tie his feet together to prevent the accidental dropping or shifting of his legs. Lay a folded blanket across the litter where the arch of his back is to be placed. Using a four-man team (Figure 4-29), place the casualty on the litter without bending his spinal column or his neck.

Figure 4-29. Placing face-up casualty with fractured back onto litter.

• • • • The number two man positions himself at the casualty’s head. His responsibility is to provide manual in-line (neutral) stabilization of the head and neck. The number three, and four men position themselves on one side of the casualty; all kneel on one knee along the side of the casualty. The number one man positions himself to the opposite side of the casualty (or can be on the same side of number three and four). The numbers two, three, and four men gently place their hands under the casualty. The number one man on the opposite side places his hands under the injured part to assist.
    • • When all four men are in position to lift, the number two man commands, “PREPARE TO LIFT” and then, “LIFT.” All men, in unison, gently lift the casualty about 8 inches. Once the casualty is lifted, the number one man recovers and slides the litter under the casualty, ensuring that the blanket is in proper position. The number one man then returns to his original lift position (Figure 4-29).
    • • When the number two man commands, “LOWER CASUALTY,” all men, in unison, gently lower the casualty onto the litter.
  • • Facedown position, he must be transported in this same position. The four-man team lifts him onto a regular or improvised litter, keeping the spinal column in a normal spinal position. If a regular litter is used, first place a folded blanket on the litter at the point where the chest will be placed.