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LOG ROLL

SUPINE - 4 PERSON

 

 

The following method of log roll which uses the arms by the side to splint the body,  has been shown through x-ray studies to be the safest log rolling method currently available.1  Techniques which elevate the arms above the head or place the arms across the chest   result in thoracic / lumbar spine sagging,1-3 and should therefore be avoided whenever possible.

 In this procedure, the Officer’s limb closest to the patient’s head will be referred to as the Officer’s upper limb, and the Officer’s limb closest to the patient’s feet will be referred to as the Officer’s lower limb.

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Training Requirements:

  • 4 x Staff

  • 1 x Patient

  • 1 x Cervical Collar

  • 1 x Long Spine Board

  • 1 x Blanket

  • 1 x Towel

  • 1 x Hand / Wrist Airsplint
 
 
 

Step 1

While Manual In-Line Stabilisation is maintained by Officer 1 at the patient’s head, Officer 2 applies a Cervical Collar, and places the LSB alongside the Officer 1. The Manual In-Line Stabilisation is maintained until full spine immobilisation is achieved as a Cervical Collar will at best provide only 50% immobilisation.5-10 

Officer 2 kneels at the patient’s mid-torso, straightens the patient’s arms with the patient’s palms facing in next to the torso.  Palm-out may result in elbow joint damage during the roll. Officer 2 then grasps the far side of the patient at the   shoulder and just above the elbow. 

Officer 2 at the torso is in charge and sets the pace for the log roll since they lift most of the weight. 

Officer 3 kneels next to Officer 2 and grasps the patient’s pelvic bone.  Officer 3’s lower hand grasps both trouser cuffs at the ankles.  If shorts or skirt are  being worn, tie a figure-of-eight around the ankles with a triangular bandage and grasp the triangular bandage.  Officer 3 also places their lower foot up against the patient’s legs, just below the knees for the patient’s lower legs to roll onto during the log roll, to prevent the patient’s pelvis drooping. 

 

Officer 4 kneels on the opposite side of the patient at the patient’s pelvic level. Officer 4’s upper hand is placed on the patient’s upper arm and Officer 4’s lower hand is placed on the patient’s upper leg.

 
 
 
 

Step 2

With Officer 2 at the chest in charge, the patient is carefully log rolled until right angles to the ground.

Officer 1 at the head watches the patient’s torso turn and maintains manual support of the head, rotating it exactly with the torso.

Officer 3 at the patient’s legs assists with rotation of the  patient’s torso and takes the weight of the patient’s pelvis, again watching the torso.  The patient’s lower legs roll onto Officer 2’s lower foot to prevent pelvic drooping.

 
 
 
 

Step 3

Before rolling the patient down onto the LSB, and if appropriate, cut away the clothing covering the patient’s back and examine this area for injuries.

A folded blanket running the length of the patient’s posterior body (head to feet) can be placed against the patient to improve comfort after the patient is laid back on the LSB.15-18      This will also assist in the later removal of the patient off the LSB.

 
 
 
 

Step 4

Officer 4 slides the LSB in against the patient’s back and elevates the side of the LSB furthest from the patient at a 45º angle towards the patient’s back.  Align the patient’s shoulders level with the shoulder markings on the LSB. 
 
 
 

Step 5

Lower the patient and elevated side of the LSB down onto the ground together, with the LSB assisting to maintain alignment of the patient, again with Officer 2 at the patient’s torso setting the pace.  The LSB therefore acts a body splint for lowering the patient.
 
 

Step 6

Keeping the patient in the neutral in-line position, gently   adjust the patient’s position sideways so that the patient is centred on the LSB.

 

 
 
 

Step 7

Apply appropriate padding under the patient’s head and lumbar spine to maintain proper alignment of the spinal   column11 and for comfort.12  Immobilise the patient onto the LSB for transport .19

 

 

 
 
 
 

Bibliography

 1. Suter
Prehospital And Disaster Medicine  Vol 7  No 2  April -June  1992
Thoraco-Lumbar Spinal Instability During Variation Of The Log roll Manoeuvre
 

2. McGuire
Journal Of Trauma  May  1987
Spinal Instability And The Log rolling Manoeuvre
 

3. Seaman
Emergency   May 1992
Log roll Technique
 

4. Chandler
Annals Of Emergency Medicine  October  1992
Emergency Cervical Spine Immobilisation
 

5. Cline
Journal Of Emergency Medicine  1990
Comparison Of Rigid Immobilisation Collars
 

7.         Cline
Journal Of Trauma  25:649-653  1985
A Comparison Of Methods Of Cervical Spine Immobilisation Used  In Patient Extrication And Transport

9. Graziano
Annals Of Emergency Medicine  October  1987
Radiological Comparison Of Prehospital Cervical Immobilisation Methods

 10.         Heurta
Annals Of Emergency Medicine  October  1987
Cervical Spine Immobilisation in Paediatric Patients: Evaluation Of Current Techniques
 

11.         Manix
Eighth Annual Conference And Scientific Assembly Of The National Association Of EMS Physicians
A Comparison Of Prehospital Cervical Immobilisation Devices
 

12.        Podolsky
Journal Of Trauma  No 6  1983
Efficacy Of Cervical Spine Immobilisation Methods
 

13.       Shriger
Annals Of Emergency Medicine   Vol  20:878-881  August  1991
Spinal Immobilisation On A Flat Board:  Does It Result In Neutral Position Of The Cervical Spine?
 

14. Goldberg
Annals Of Emergency Medicine
Effects Of  Spinal Immobilisation On Healthy Volunteers

 

15.          Walton R, DeSalvo JF, Ernst AA, Shahane A.
  Acad Emerg Med 1995 Aug;2(8):725-
  Padded vs unpadded spine board for cervical spine immobilization.
 

16.          Hauswald M, Hsu M, Stockoff C.
  Prehosp Emerg Care 2000 Jul-Sep;4(3):250-2
  Maximizing comfort and minimizing ischemia: a comparison of four methods of spinal immobilization.
 

17.         Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR.
  Ann Emerg Med 1995 Jul;26(1):31-6
  Pain and tissue-interface pressures during spine-board immobilization.

 18. Hann
  www.neann.com
  Does proper padding reduce pain on Long Spine Boards

 19.        Victorian Ministerial Task Force on Trauma
  Review Of Trauma And Emergency Services     Report 1999

 

 

 
 
 
 

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