Prehospital chart for c-spine clearance

1. C-spine clearance is required in all trauma patients where mechanism of injury suggests injury to the spine, such as MVCs, falls, or head trauma. Manual immobilization of the patient must be maintained until the provider is able to clear c-spine. If the patient fails any of the above criteria then the patient must be c-collared and immobilized. Reliable Patient, Reliable Assessment: To pass this test, the patient must be alert and oriented to person, place and time, GCS 15. The patient must be old enough to understand the questioning. The patient cannot be too drunk or otherwise mentally altered so as to affect understanding. And the patient must be free of distracting injuries, i.e. so distracted by the broken femur that they do not notice the small pain in their neck. No C-spine pain on palpation: The medic will walk their fingers down along the entire spine looking for step-offs, crepitus, or pain from the patient. Be sure to start at the very base of the occiput as that is where C1 and C2 start the spine. No Deficits to Pulse, Motor or Sensation: Assess bilateral grips and push-pulls. Ask the patient about paresthesias, such as numbness or tingling. Having the patient also spread their fingers, in a ‘Spock’ movement, against resistance, assesses to the level of C6. Manual inline immobilization of the c-spine is a gently guided positioning of the patient’s spine into a straight alignment, where the head is at a slight ‘sniffing’ position. C-Spine Clearance Requires: Reliable Patient, Reliable Assessment No Point Tenderness to Cervical Spine No Deficits to Pulse, Motor or Sensation