NEANN Long Spine Board Manual

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LOG ROLL

PRONE - 4 PERSON

When the patient presents in a semi-prone position (as shown below), a method similar to that for a supine patient is used for the log roll, incorporating the same initial alignment of the patient’s limbs.^1-3

Points To Remember:

1. The patient is rolled away from the direction in which his face initially points.

2. A Cervical Collar cannot be applied as the head will not be re-aligned with this manoeuvre.

3. Remaining in the prone position will limit the patient’s ability to breath due to continual pressure on the rib cage.

4. Arching of the spine will occur with each of the patient’s breaths whilst in the prone position.

5. ALS skills are harder to achieve in the prone position.

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.

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 Officer 1 at the head positions themself at a 45º angle to the patient. Manual In-Line Stabilisation is achieved with Officer 1 placing their distal hand under the patient’s head and their proximal hand on top of the patient’s head. A Cervical Collar cannot be placed into position as with this log roll, the head cannot be re-aligned.
	Officer 2 kneels at the patient’s mid-torso on the side that the patient is to be rolled and extends the patient’s arms down the torso with the patient’s palms facing inwards, then grasps the far side of the patient at the shoulder and just above elbow.
	Officer 3 kneels at the patient’s knees, grasps the hip just distal to the wrist and tightly grasps both trouser cuffs at the ankles. If shorts or a 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, so as to prevent the patient’s pelvis drooping.
	Officer 4 kneels on the opposite side of the patient at 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 The patient is carefully log rolled until at right angles to the ground. Officer 2 at the torso is in charge and sets the pace (since Officer 2 bears most of the weight). Officer 1 at the head watches the torso turn and maintains Manual In-Line Stabilisation of the head, rotating it exactly with the torso. Officer 3 at the legs assists with rotation of the patient’s torso by taking the weight of the pelvis, again watching the torso. The patient’s lower legs roll onto Officer 3’s lower foot to prevent pelvic drooping.



	Step 3 Before rolling the patient down onto the Board, and if appropriate, cut away the clothes covering the patient’s front and examine this area for injuries. A folded blanket running the length of the patient’s body (head to feet) can be placed against the patient to improve comfort after the patient is laid back on the Board. This will also assist in the removal of the Board at a later date.



	Step 4 Now lower the patient and LSB down to the ground together with the LSB assisting to maintain alignment of the patient, again with Officer 2 at the torso setting the pace.



	Step 5 Keeping the patient in the neutral in-line position, gently adjust the patient’s position until centered on the LSB.



	Step 6 Immobilise the patient onto the LSB for transport.⁸



^Bibliography

^{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 1992Log roll Technique 4. 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. 5. 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. 6. 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. 7. Hann www.neann.com Does proper padding reduce pain on Long Spine Boards 8. Victorian Ministerial Task Force on Trauma Review Of Trauma And Emergency Services Report 1999}

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