application of the VACMAT

Step 1.

First Officer undertakes a full assessment of the patient before application of the VacMat. This includes:

· Check safety, scene, and situation.

· A Second Officer brings c-spine into neutral in-line position (unless contra-indicated) and performs manual head stabilisation.

· Perform Primary Survey:

   i. Response

   ii. Airway

   iii. Breathing

   iv. Circulation (Pulse & Major Bleeds)

· Perform Basic Care:

   i.    Rest,

   ii    Reassure

   iii. Oxygen

   iv. Position

   v.   Pulse Oximeter

   vi. ECG Monitor

· Perform A Vital Signs Survey:

   i.    Conscious Status Assessment

   ii.   Perfusion Status Assessment

   iii. Respiratory Status Assessment

· Perform A Secondary Survey:

   i.     Motor/Sensory x 4

   ii.    Head

   iii.   Spine

   iv.   Chest

   v.    Abdomen

   vi.   Pelvis

   vii. Legs

   viii. Arms

● Check AMPLE:

i. Allergies

ii Medications

iii. Past medical history

iv. Last oral intake

v. Events leading up to injury

● Apply Other Spinal Equipment

    i.     Cervical Collar

    ii.    Cervical Extrication Device (if indicated)

    iii.   Long Spine Board or Scoop Stretcher



Step 2 Place the patient onto the VacMat using the Long Spine Board or Scoop Stretcher and remove. Ensure the patients shoulders are 2 - 3 cm above the sew down point of the black shoulder straps.



Step 3 Place adequate padding under the head and lumber spine to fill the gaps formed by the anatomical curvature of the spine. The VacMat does not always fill these gaps, especially under the head. 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.^19-20Some adults and children will however require no padding. If no spinal injury is suspected, a pillow can be substituted for the towel to improve patient comfort. For the lumber spine, occasionally padding may be required to fill the lumber region. A hand / wrist airsplint (which is inflated once in position) is the easiest method to achieve this. NOTE In a suspected spinal injury, one person should also continue holding the head to maintain head alignment until the head is immobilised to the VacMat (Step 10). A Cervical Collar alone has been shown in numerous studies to be ineffective in maintaining adequate C-Spine immobilisation.^21-24



Step 4 Apply both black shoulder straps across the chest in a crossing application. Following application of the straps, there should be just enough slack to allow one hand to be placed between the chest and the strap. Over tightening will compromise respiratory effort^15-16. These first two straps will prevent upward sliding of the patient’s body when the VacMat 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 VacMat needs to be tilted sideways (vomiting patient).²⁶



Step 5 Apply the green chest strap 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 to cause sagging of the thoracic and lumber spine.^26-27



Step 6 Place the yellow pelvic 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.



Step 7 Place the red femur strap across the upper legs. If the legs are able to move laterally, spinal column movement including the C-Spine can still occur.²⁵



Step 8 Using the black foot strap, apply a ‘Figure Of Eight’ around the patient’s ankles to prevent downward sliding of the patient on the VacMat that may occur if the foot end of the VacMat is tilted downwards, or when the Ambulance accelerates. This strap will also help prevent lateral movement of the legs.



Step 9 Once the patient’s body is secured properly to the VacMat, ONLY THEN is the patient’s head secured to the VacMat. Ensure the correct amount of firm padding (using a towel) is under the head to maintain the patient’s spine in the neutral in-line position (generally around 2 - 7 cm in most adults).



Step 10 Apply 25mm Collar Strap by attaching side hook velcro tabs to head flaps with sliders level with front of head flaps. Tighten strap by ensuring foam pad is centred on c-collar (away from chin support), placing thumbs on centre of strap, and pulling both ends with equal pressure. Place only enough pressure to prevent movement, but not to deform collar or place pressure on the jaw line. Velcro into place. Under no circumstances is pressure to be placed on the patients jaw line as this may clamp the mouth shut, compromising the patients airway. If no C-Collar can be applied, tighten strap by ensuring pad centered on maxilla just under nostrils, placing thumbs on center of strap, and pulling both ends with equal pressure. Velcro into place.


Apply 50mm Forehead Head Strap by attaching side hook velcro tabs to head flaps with sliders level with front of head flaps, ensuring forehead head strap bottom aligns with bottom of patients eyebrows. Tighten strap ensuring foam pad centered on forehead, placing thumbs on center of forehead, and pulling both ends with equal pressure. Velcro into place.



Step 11 Apply 50mm Forehead Head Strap by attaching side hook velcro tabs to head flaps with sliders level with front of head flaps, ensuring forehead head strap bottom aligns with bottom of patients eyebrows. Tighten strap ensuring foam pad centered on forehead, placing thumbs on center of forehead, and pulling both ends with equal pressure. Velcro into place.



Step 12 Readjust straps following evacuation of the air out of the VacMat as the straps will loosen off.



Step 13 The patient is now fully immobilised to the VacMat and ready for moving. Secure the VacMat to the stretcher ready for Ambulance transport.