Upon arriving at the scene of a motor vehicle crash, you find a single patient still seated in his car. There are no scene hazards. As you approach the vehicle, you note that the patient is semiconscious and has a large laceration to his forehead. You should: A) apply a cervical collar and quickly remove the patient with a clothes drag. B) apply a vest-style extrication device before attempting to move the patient. C) slide a long backboard under his buttocks and lay him sideways on the board. D) direct your partner to apply manual in-line support of the patient’s head
The Correct Answer and Explanation is:
The correct answer is D) direct your partner to apply manual in-line support of the patient’s head.
When dealing with a motor vehicle crash victim who is semiconscious and has sustained an injury (in this case, a large forehead laceration), spinal protection should be the primary concern, especially considering the possibility of a spinal injury. Here’s why option D is the best choice:
- Spinal Immobilization: The priority in this scenario is to prevent further harm to the patient’s spine, especially if there’s a concern for a neck or back injury. Manual in-line support (MILS) is a technique where one person holds the head and neck in a neutral position to prevent movement of the cervical spine while another person prepares for extrication. This minimizes the risk of causing spinal cord damage during movement.
- Semiconscious Patient: A semiconscious patient may have impaired ability to respond or protect themselves. Therefore, any movement should be done cautiously and with the utmost consideration for potential spinal injury.
- Approach Before Extrication: The application of manual in-line support should be the first step before attempting any extrication techniques. While other techniques, such as using a vest-style extrication device, are useful once the patient’s spine is secured, this step should come after confirming spinal immobilization.
Why the other options are not ideal:
- Option A (clothes drag): A clothes drag should only be used in situations where the patient is in immediate danger, such as in a fire or if there is a threat of further harm. This method does not provide spinal immobilization, which is crucial in this case.
- Option B (vest-style extrication device): While a vest-style extrication device is important for moving a patient, it should not be the first step. Manual in-line support must be applied before any extrication to ensure that the spine is protected.
- Option C (sliding a long backboard): Sliding a backboard under the patient without manual in-line support can risk spinal movement and cause further injury. Always stabilize the head and neck first before moving the patient.
In summary, manual in-line support (D) is the safest initial step in ensuring spinal protection for a semiconscious patient in a motor vehicle crash. After that, proper immobilization and extrication procedures can follow.
