1. Spinal injuries during sea rescue require proper spinal immobilization but this is often forgotten due to the aquatic environment. 2. During a national disaster drill, rescuers experienced difficulties with spinal immobilization at sea due to rough conditions and lack of training. 3. Proper training on spinal immobilization techniques for aquatic rescues is needed to ensure rescuers can safely immobilize victims with potential spinal injuries despite challenges of waves, wind, and long distances to retrieve victims.

1. Spinal Care during Sea Rescue:
HUKM experience
Ismail MS, Azhar AA, A.Khaldun, Shalimar A,
Muszaphar SS.
Dept of Emergency Medicine
HUKM

2. Introduction
• Spinal injury NOT common but very
devastating.
• The higher the injury level the worse will be
the outcome
• Most victims are in their prime time
• Significant loss of work-force to family and
community and the nation

3. Spine injuries
• Incidence : 40 per million (US)
: 15 per million (UK)
• In Malaysia: Incidence 19.8 per 1000 MVA
victims had spinal injuries
• 57.89% involve the cervical spine
• SCI was only 5.3%
• Mean age : 29.7 years old
• Age peak: 20-24 male 25-29 female
• Majority : Male

4. • Spinal care is very important
• Should receive utmost attention
During primary survey & resuscitation
Spinal immobilization > spinal clearance
Regardless of the situation

5. Important reminders
• Early diagnosis is essential, prompt Mx
planning for spinal & spinal cord injuries-
reduce the morbidity & mortality
• Early stages- life-saving procedures takes
priority.
• Movement of non-immobilized pts with
unrecognized, unstable vertebral injuries
put the spinal cord at high risk.
TOTAL SPINAL IMMOBILIZATION
• medical & legal consequences.

6. Spinal immobilization
On the land

7. • Awareness: well created
• Well understood
• Much emphasis has been put
• Indications- clear
• Rescuers are quite well trained with the
technique

8. Spinal column
Cervical
Thoracic
Lumbar
Sacrum
Coccyx

9. In the sea
• Most of time it is forgotten
• Indication not clear
• Technique not well described or understood
• Not many rescuer know how to execute the
procedure
• Not much attention are put into it.

10. Our experience
• Put to test during the national level mock
disaster drill in Kuala Terengganu
• Difficulty was noted and address to
• Feedback
• Improvement proposed

11. The TEAM

12. The equipment

13. Semi rigid Cervical Collar

17. Full set-up for
spinal care during
Sea/ aquatic rescue

18. The transport

20. The training and technique

21. Training for the aquatic rescue

22. Vice grip vs
In-line immobilization

24. • Assess airway and breathing
• Cervical collar if indicated
3. Any injury above clavicle
4. Neck pain
5. Neurological sign
6. Unconsciousness
7. History of diving

25. Putting the cervical collar
• Use adjustable collar
• Applied the collar while another rescuer is
supporting the head-neck with in line
immobilization
• *Need to loosen / open the buoyancy vest

27. Putting the patient on the aqua
spinal board

30. The sea rescue
• Sea condition was quite rough
• Wind was 35 knots
• Waves was between 1.5- 2.0 m

34. In the sea
• Condition slight different
• Waves- much stronger
• Wind quite strong
• Helicopter downdraft was quite powerful
• Getting to the victim is more further away
• Technique remained the same

35. Conclusion
• Spinal care in aquatic injuries should
receive equal emphasis just like their
counterpart on land injuries
• Spinal care technique should be taught to all
rescuer whether it is on land or water.
• Spinal care (immobilization) technique can
and should be applied to all indicated
patients.

36. Thank you for your kind
attention
Terima kasih