Place 1 - 2 blankets down the full length of the LSB. This will provide significantly improved comfort, reduce pressure sore development, limit vibration to the patient during both road and helicopter transport, and prevents heat loss through lying on the LSB.

Place adequate padding under the lumber spine and head to fill the gaps formed by the anatomical curvature of the spine.

In adults, firm padding using a folded towel or similar (NOT PILLOWS) is generally required under the patient’s head to prevent hyperextension of the C-Spine,^{14, 17} while in children under 8 years of age, padding under the torso rather than the head is generally required to prevent hyperflexion of the C-Spine.^19-20 Some adults and children will however require no padding.

For the lumber spine, a hand / wrist airsplint (which is inflated once in position) is the easiest method of padding under the lumber region.

Position Speed-Clip Straps near LSB within easy reach.

To ease and rapidly speed up application of straps, it is best to stand straddled over the patient.

In a suspected spinal injury, one person should also continue holding the head to maintain head alignment until the head blocks (Step 7)   are attached. A Cervical Collar alone has been shown in numerous studies to be ineffective in maintaining adequate C-Spine immobilisation.^21-24

Apply first and second yellows straps across the chest in a crossing application with the adjustable ends at the pelvis. Following application of the straps, there should be just enough slack to allow one hand to be placed between the chest and the strap. The straps should be placed over the clavicle and attached to the pelvic hand hold on the opposite side.

These first two straps will prevent upward sliding of the patient’s body when the LSB is tilted head down, or when the brakes of the vehicle are applied during transport. They will also help prevent lateral movement of the torso if the LSB needs to be tilted sideways.²⁶

Place a yellow strap across the pelvic bone or iliac crest. Ensure that the strap goes over the bone rather than the soft abdomen otherwise abdominal organ damage may occur.

This strap will help prevent lateral movement of the spine.

Using the blue strap, apply a ‘Figure Of Eight’ around the patient’s ankles to prevent downward sliding of the patient on the LSB that may occur if the foot end of the LSB is tilted downwards, or when the Ambulance accelerates. This strap will also help prevent lateral movement of the legs.

Place the red strap across the femur. Extra padding using rolled up towels on each side of the legs may be required for patients with small legs. If the legs are able to move laterally, spinal column movement including the C-Spine can still occur.²⁵

One further strap can be placed loosely over the chest region so as to support the upper arms of the patient from flopping around; to help prevent lateral movement;⁹ and to help prevent the upper arms from moving above shoulder height. Raising the arms above the shoulder level as required for such manoeuvres as the Canadian Log-Roll is in general CONTRA-INDICATED in spinal injuries, as studies have shown this causes sagging of the thoracic and lumber spine.^26-27

Once the patient’s body is secured properly to the LSB, ONLY THEN is the patient’s head secured to the LSB. Ensure the correct amount of firm padding (using a towel, not a pillow) is under the head to maintain the patient’s spine in the neutral in-line position (generally around 2 - 7 cm in an adult). Now place either commercially available Head Blocks or home made Head Rolls (using rolled blankets or towels) on each side of the head. Using 2 - 5 cm tape, tape the Head Blocks and head to the LSB going initially across the C-Collar and then across the forehead. The tape should not be place over the lower jaw as this will clamp the jaw closed therefore interfering with airway management.

The patient can now be log-rolled, tilted, vertically or horizontally lifted, stood up, etc with almost no movement to the body and spinal column until an X-Ray can confirm or exclude the presence of an unstable spinal column.

The curved LSB will also allow for slight tilting of the LSB every 20 minutes to assist with pressure area care (a procedure that cannot be achieved when the patient is laid on a stretcher or flat LSB).