1. Not to automatically immobilize victims of potential spinal cord injury in the water, but recognize the injury and provide care. 2. There is no single immobilization method that should be applied; three techniques are described that can be used depending on water depth and conditions. 3. For unconscious victims or those not breathing, immobilization is not the priority; immediately begin basic or advanced life support instead.

1. SPINAL CORD INJURY IMMOBILIZATION IN THE AQUATIC ENVIRONMENT September 2007 Leonardo A. Manino EPSA President - Argentina ILS Full Member Chief Lifeguard Rosario. Argentina EMT-P SBV-PHTLS Instructor

3. SCI Affects the sensitivity and loss of movement below the level of the injury COMMON CAUSES: MOTOR VEHICLE CRASHES FALLS PENETRATING INJURIES SPORTS INJURIES 60% are diving related

4. SCI in water Toledo,Castilla La Mancha ,Spain:rivers/lakes have a high impact ( 5 %) Hospital Nacional de Paraplejicos Washington State US: lakes have a medium impact (0.5%) R. S Watson MD, Peter Cummings MD y cols. Periodicity of SCI depends on the characteristics of the environment: Rio de Janeiro: beaches have a very low incidence (0,009%) Szpilman, MD, Brewster, Lg.

5. IN WATER SCI SITUATIONS HIGH IMPACT TRAUMA: Head-first in shallow water and/or from hight structures Water SPORTS accidents Small plane crashes Fights in the water Victims in trouble for unknown reason

6. Gentility of Dr. Szpilman

9. SCI Mechanisms of injury VERTICAL COMPRESSION Projet Wipeout. Hoag Memorial Hospital Presbyterian N ewport B each , Ca . EUA. HYPERFLEXION

10. HYPEREXTENSION Projet Wipeout. Hoag Memorial Hospital Presbyterian Newport Beach, Ca . EUA SCI Mechanisms of injury ROTATIONAL INJURY

13. www.socorrismo.com

14. SCI : SINGS AND SYMPTOMS Pain on the head, neck or back . Loss of movement and sensitivity below the level of injury. Numbness, Pins and needles in legs or arms Lacerations and contusions in head or face. NOTE: the lack of neurologic deficit or the absence of sings and symptoms does not rule out a bony fracture or an unstable spine .

16. 1-VICE GRIP 2-EXTENDED ARMS GRIP 3-BODY HUG SCI Immobilization techniques

17. VICE GRIP A- WATER ABOVE THE LG HIP D- POOLS AND OPEN WATER B- VICTIM IN PRONE POSITION C- SUMERGED VICTIMS

18. VICE GRIP 2.- CERVICAL COLLAR 3.- SPINAL BOARD 1.- MANUAL IN LINE INMOBILIZATION 4.- IN WATER FULL INMOBILIZATION

19. EXTENDED ARMS GRIP A- WATER BELOW THE LG`S HIP. D-POOL, OPEN WATER B- PRONE POSITION VICTIMS C. DEEP WATER

20. EXTENDED ARMS GRIP 1.- MANUAL IN LINE INMOBILIZATION 2.- CERVICAL COLLAR 3.- SPINAL BOARD 4.- IN WATER FULL INMOBILIZATION

21. BODY HUG A- IN OPEN WATER WITH SURF CONDITIONS WATER ABOVE LG HIP B- VICTIMS IN PRONE POSITION C. IN POOLS

22. BODY HUG Full Inmobilization out of water

23. 2.-There is no single method to be applied. The three techniques shall be handle. SUMMARY 1.- Not to authomatically immobilize the victim in the water but recognize the potential SCI. 3.- Unconscious victims or not breathing , the immobilization is not a priority but giving immediately place to BLS/ALS .

24. Bibliography PRE HOSPITAL TRAUMA LIFE SUPPORT MANUAL 5th edition. National Association of EMTs (US) The Committee on Trauma of the American College of Surgeons. 2003 SPINAL INJURIES: IMMOBILIZATION AND EXTRACTION. Peter Wernicki, M.D., Peter Fenner, M.D., David Szpilman, M.D. Hand Book of drowning. 2003. AQUATIC CERVICAL SPINE INJURY(CSI) – How often do we have to worry ? Szpilman , MD, Brewster, Lg, Cruz Filho, MD – Cervical Spine Injuries among Submersion Victims , The Journal of TRAUMA R. S Watson MD y cols. Hospital Nacional de Parapléjicos from Toledo Health Service of Castilla-La Mancha – Spain www.diariomedico.com Projet Wipeout. Hoag Memorial Hospital Presbyterian N ewport B each , Ca . EUA. IN-WATER CERVICAL SPINE INJURY ALGORITHM . Szpilman - Manino . 2004

25. SPINAL CORD INJURY IMMOBILIZATION IN THE AQUATIC ENVIRONMENT by Leonardo A. Manino

26. NO Yes NO Yes IN-WATER CERVICAL SPINE INJURY ALGORITHM SUSPICIOUS OF CERVICAL SPINE INJURY? Start rescue without cervical spine immobilization. See In-water Basic Life Support algorithm . Evaluation by the Emergency Medical System - Advanced Life Support Ambulance – Transport to the Hospital VICTIM IS CONSCIOUS? NO Yes Place victim’s face out of water and check: The victim is breathing ? In Line Manual Immobilization At first without equipment Open airways and start 5 to 10 mouth-to-mouth ventilation s in place and rescue to a dry place while ventilate, without cervical immobilization Rescue the victim out of the water. Place the victim parallel to the waterline. Start Basic Life Support and Reassure cervical immobilization. Full cervical immobilization Use a back board when available to pull the victim out of water. SHALLOW WATER? (lifeguard can stand up) “VICE GRIP” technique NO Yes Above Lifeguard’s hip? “BODY HUG” technique “EXTENDED ARMS GRIP” technique Wait for further help (vessel) Use a rescue flotation device (tube) when available Yes NO Manino-Szpilman 2004