1.  Chapter 11 Caring for head, neck and spinal injuries

2. Causes of HNS injuries  Head neck and spine can result in lifelong disability or even death  Rarely happen during supervised diving into deep water.  Most often occur:  at shallow end, in a corner or where the bottom slopes from shallow to deep water.  Also, from striking a floating object while diving in.  Lakes  depths change wit the tide or current or someone plunges head-first into shallow water or breaking wave

3. Continue:  Aquatic environments that are caused by high-impact/high- risk activities  Entering head-first into shallow water  Falling from greater than standing height  Entering the water from height  Striking a submerged or floating object  Receiving a blow to the head  Colliding with another swimmer  Striking the water with high impact (falling while water skiing)

4. Signs and Symptoms of HNS injury  You should suspect a possible HNS only if the activity was high-impact or high-risk and signs or symptoms of injury are present:  Unusual bumps, bruises or depression on head, neck or back  Heavy external bleeding from head, neck or back  Bruising of the head (around eyes and behind ears)  Blood or other fluids in the ears or nose  Seizures  Changes in level of consciousness  Impaired breathing or vision

5. Continue: Signs and Symptoms  Nausea or vomiting  Partial or complete loss of movement of any body area  Loss of balance  Victim hold his/her head, neck or back  Severe pain or pressure in the head, neck or back  Back pain, weakness, tingling or loss of sensation in the hands, fingers, feet or toes  Persistent headache

6. Caring for HNS injuries  Your job is to minimize movement of the head, neck, and spine  You must use SPECIFIC rescue techniques  If victim is breathing:  Immobilize victim using a backboard  If victim is not breathing:  Immediately remove the victim from the water using a two- person removal from the water and provide resuscitation care

7. Higher priority is given to AIRWAY management, giving VENTILATIONS or performing CPR than to spinal immobilization.

8. What care to provide?  Depends on:  Victim’s condition (whether he/she is conscious and breathing)  Location of the victim (shallow or deep water, at the surface or of the water, submerged or not in the water)  The availability of additional help, such as other LGs bystanders, fire fighters police or EMS personnel  Facility’s specific procedures  Air and Water temperature

9. Caring for HNS injuries in WATER  Follow these general rescue procedures: 1. Activate the facility’s EAP. 2. Safety enter the water. Minimize water movement by using a slide-in-entry 3. Perform a rescue providing in-line stabilization appropriate for the victim’s location and whether the victim is face –up or face-down. 4. Move the victim to safety. Deep water move to shallow

10. Manual In-Line Stabilization  Head splint technique:  Used for performing manual inline stabilization for victims in the water  Face-up or Face-down  Shallow or deep water  Near or below the surface  Objective to get the victim into a face-up position while minimizing movement of the HNS.

11. Contine 5. Check for consciousness  If the victim is breathing, proceed with the spinal backboarding procedure  If the victim is not breathing, immediately remove the victim from the water using two-person-removal for the water, and provide resuscitative care  Do NOT delay removal from water by strapping the victim onto the board or using the head immobilizer device 6. Backboard the victim using the spinal backboarding procedure 7. Remove the victim from the water. 8. Re-assess the victim’s condition and provide appropriate care. Additionally:  Minimize shock by keeping the victim from getting chilled or overheated  If the victim vomits, tilt the backboard on one side to help clear the vomit from victim's mouth

12. Vary the technique in the following ways based on victim’s position in the water.  Face-up APPROACH from behind victim’s head  Face-down APPROACH from the victim’s side  Shallow water- NO rescue tube needed  Victim at the surface in deep water, you may need the rescue tube to support yourself  Submerged, Do NOT use the rescue tube when you are submerging and brining the victim to the surface. Once at the surface another LG will place the tube under armpits to helps support.

13.  Avoid lifting or twisting the victim when performing the skill  Do NOT move the victim any more than necessary  Minimize water movement by moving het victim away from crowded areas and toward the calmest water possible  Keep victim’s mouth and nose out of the water  Immediately check victim for consciousness and breathing once victim is face up

14. Spinal Backboarding Procedure  Helps to immobilize the victim during the process of removing him/her from the water.  Minimum of 2 LGs needed  Submerge the board, position it under the victim, and carefully raise it up to the victim’s body  Secure the victim to backboard w straps and head immobilizer device.  Rescue tubes can be placed under the board  Communication between LGs is critical during this procedure.  Communication to the victim is also critical  Tell victim not to nod or shake head but instead say yes or no if need to respond to a question!

15. Team Spinal Backboarding  Other LGs may be necessary to ensure your safety as well that of the victim. Other LGs can help by:  Submerging and positioning the backboard under victim  Supporting the rescuer at the head of the backboard in deep water  Supporting the backboard while the straps and head immobilizer are secured  Securing the straps or head immobilizer device  Communication with and reassuring the victim  Guiding the backboards it is being removed from the water  Removing the backboard from the water  Providing care after the victim has been removed from the water

16. Immobilization equipment for HNS injuries  Backboards  Minimum of 3 straps to secure victim to board  Head immobilizer that can be attached to the top of board  Vary in shape, size, buoyancy, number, or style of body straps and style of head immobilizer device.

17. Head-chin Support  Alternate method  Must be done in at least 3 feet of water  Do not use rescue tube for support when performing rescue

18. Removal  Once placed on backboard remove from water  Assess victim’s condition and provide the appropriate care  Place a towel or blanket on the victim to keep him/her warm

19. Removal from extremely shallow water  Use the technique, for backboarding, “speed slide”  Carefully lift up the backboard and victim using proper lifting techniques to prevent injuring yourself.  Remove the backboard and victim from the water by slowly walking out. Keep the board as level as possible during the removal  Gently lower the backboard and the victim to the ground once out of the water using proper lifting techniques to prevent injuring yourself

20. Moving water  Move to calmer water, if possible  If no barriers, have rescuers form a “wall with their bodies to block the waves

21. Rivers, Streams, and winding river attractions  Ask other LGs or patrons for help keeping objects and people from floating into rescuer  Do NOT let current press sideways on the victim or force the victim into a wall. This will twist the victim’s body.  Keep the victim’s head pointed upstream into the current

22. Catch Pools  More force than winding river: difficult to hold a victim still  Immediately signal to other LGs  Someone should stop the flow of water by pushing the emergency stop button.  Once in-line stabilization is achieved and the victim is turned face-up move victim to calmest water in catch pool  Usually center of catch pool (if one slide)  Move between slides (if two slides)

23. Caring for HNS injuries on Land

24. Caring for a Non-Standing victim

25. Caring for a Standing Victim  Secure the victim to the backboard while he/she remains standing. Slowly lower him/her to the ground  If EMS can arrive within a few minutes you may maintain manual stabilization with the victim standing.

26. Final thoughts...  HNS injuries are rare at aquatic facilities  If you suspect a HNS injury summon EMS immediately  Minimize movement by using in-line stabilization