Pediatric Trauma Life Support Course – Chapter 12 – Spinal Motion Restriction and Extrication Skills

I’m taking the upcoming the Pediatric Trauma Life Support Course at IU Health’s Emergency Response Training Institute. And these are excerpts

The Course uses the textbook, Pediatric Trauma Life Support For Prehospital Care Providers, 3rd Edition, 2009. There is a free 2017 online update PDF.

This post is on notes from the Chapter 12 of textbook along with additional resources.

Here are excerpts (my study notes) from the chapter:


While relatively uncommon, a spinal injury in the pediatric patient can be a life altering event. Appropriate assessment and proper management techniques can greatly improve the chances for a successful outcome for the victim of such an injury.   .   .   .   Therefore, you should have a low threshold for motion restriction of  pediatric patients.

Initial spinal motion restriction and the ITLS Primary Survey, including the Initial Assessment and Rapid Trauma Survey, literally go “hand in hand.”

Spinal Motion Restriction

Following are situations that require spinal motion restriction:

  1. Mechanism of injury–motor vehicle collision, falls, sports
  2. Significant injury above the nipple line
  3. Head injury
  4. Altered mental status
  5. Distracting injuries
  6. Poor history
  7. Unknown mechanism of injury

Cervical Collar Application

Spinal motion restriction of a child begins with manual stabilization. After completing the ITLS Primary Survey, apply an appropriately sized cervical collar (Fig. 12.1). Maintain the neck in a neutral position before and during application.

Log-roll the child onto an appropriate spinal motion restriction device. Remember to examine the child’s back and allow for a space under the shoulders by placing the child supine. You need may need to place a folded sheet, towel, or padding on the board to make up the difference created by the head. The smaller the child, the more padding is needed. If you cannot accomplish log-rolling, pull the child onto a backboard using a long axis–type drag. Avoid lifting the child if possible. It is extremely difficult to lift a child without manipulating the spine. The main goal is to place the child on a spinal motion restriction device with minimal spine movement.

Secure the child to the spinal motion restriction device. It is necessary to use straps or other restraining devices to limit the child’s movement. Because this can be a very frightening procedure, especially for younger children, involve the parent or guardian as much as possible to comfort the child. It is okay for children to be scared. Do not discourage the child or tell him to “be quiet.” Comfort the child and explain what you are doing. Secure the child’s body first, then his head.

Secure the head to the spinal motion restriction device using a cervical immobilization device or towel rolls and tape. Secure the head to prevent lateral movement of the cervical spine (Fig. 12.2).

Selecting Appropriate Equipment

Cervical Collar

Ensure that the cervical collar fits the child properly. A collar that does not fit properly can actually worsen a cervical spine injury. An appropriately fitted cervical collar will position the child in the “neutral” position, which will decrease any pressure on the spinal cord (Fig. 12.4)

Backboards/Pediatric Boards and Straps

After selecting an appropriately sized cervical collar, secure the child on a rigid device.   .   .   .   Secure the child in a neutral position. When working with a small child, place  a “filler” such as a blanket or foam pad under the child’s shoulder area to allign the neck properly (Fig. 12.6). The child should “fit” the board or device so that the child will not move when the device is tilted. Secure the child to the board with straps or other securing devices to prevent movement. Usually, a minimum of three straps is needed to accomplish this task. Secure the chest (above the nipple line), pelvis, and lower extremities  (above the knees) to prevent movement (Fig. 12.7).

Head Motion Restriction Devices

After the cervical collar is in place and you have secured the child’s torso to the board, secure the head. You may accomplish this with commercially available devices, cardboard, plastic, or foam (Fig 12.8). If these are not available, you may use a rolled blanket or other lightweight bolsters to secure the head. The head motion restriction device must prevent lateral and anterior movement of the cervical spine.

Child Passenger Restraint Devices

Assess a child found in a car seat while still in the seat. The results of your assessment will determine whether the child should be extricated from the car seat before further examination or intervention.

Extrication for a Normal Assessment–No Abnormalities Found

Insert text – dictate.

Extrication for an Abnormal Assessment–Injury Suspected

Insert text – dictate.

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