# Tips for holding c spine?



## Stingray91 (Aug 11, 2011)

Quick question from a newbie here :unsure:..

Do you guys have any tips for how to position your body while holding c spine?
We're basically doing practicals until the State which is next month and a lot of students are having a hard time with getting a good position with their body on the floor while holding c spine. 
For example, Trauma pt. is supine; the person at the head (holding c spine) is kneeling the whole time. This would be a "good" position so a decent log roll can be done, but this causes discomfort for a lot of the students' knees. One more example would be sitting down with the legs crossed (indian style) which is more comfortable than kneeling, but not such a good position to be in to do a log roll.


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## Shishkabob (Aug 11, 2011)

Do what's most comfortable for you, so long as you can still do what's required.


Standing, kneeling, laying down, bending over, sitting backwards.


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## HotelCo (Aug 11, 2011)

Linuss said:


> Do what's most comfortable for you, so long as you can still do what's required.
> 
> 
> Standing, kneeling, laying down, bending over, sitting backwards.



This. 

I find that sitting back on my feet while kneeling is comfortable enough. 


Sent from my iPhone using Tapatalk


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## Imacho (Aug 11, 2011)

Stingray91 said:


> Quick question from a newbie here :unsure:..
> 
> Do you guys have any tips for how to position your body while holding c spine?


Use both hands.


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## tickle me doe face (Aug 11, 2011)

Imacho said:


> Use both hands.



couldn't you kind of hold their head between your knee caps, while kneeling?

that way your hands are free if needed.


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## mikie (Aug 11, 2011)

If if wasn't a state test, i'd say use your knees/thighs if you're going to be down for a while, plus you can maintain the airway (to some degree)

edit: just don't get too close, for sexual assault purposes..


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## dixie_flatline (Aug 11, 2011)

tickle me doe face said:


> couldn't you kind of hold their head between your knee caps, while kneeling?
> 
> that way your hands are free if needed.



In Maryland that is an instant fail.

Also, no one should be sitting Indian-style (on their but with legs crossed/under them) while holding C-spine, or pretty much any time while on a call.  You have no leverage to do anything useful, and you can't move quickly if the situation requires it.  Similar to people keeping stethoscopes around their neck (she would grab it and drag you around), if my instructor saw a student sitting like that she would push you down and point out why it was a bad idea.

There is a heck of a lot of kneeling involved in this job, especially during class. They need to toughen up a little bit, and if anything, the primary provider needs to get better at their rapid trauma assessment to minimize scene time.


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## tickle me doe face (Aug 11, 2011)

dixie_flatline said:


> In Maryland that is an instant fail.
> 
> Also, no one should be sitting Indian-style (on their but with legs crossed/under them) while holding C-spine, or pretty much any time while on a call.  You have no leverage to do anything useful, and you can't move quickly if the situation requires it.  Similar to people keeping stethoscopes around their neck (she would grab it and drag you around), if my instructor saw a student sitting like that she would push you down and point out why it was a bad idea.
> 
> There is a heck of a lot of kneeling involved in this job, especially during class. They need to toughen up a little bit, and if anything, the primary provider needs to get better at their rapid trauma assessment to minimize scene time.



why?

the same way that you could hold a jaw thrust type maneuver with you knees while bagging if need be?


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## DarkStarr (Aug 11, 2011)

Always have one knee off the ground, ya know, in case you need to bolt!


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## CheifBud (Aug 11, 2011)

tickle me doe face said:


> couldn't you kind of hold their head between your knee caps, while kneeling?
> 
> that way your hands are free if needed.



I would have been tossed out so hard my classmates would have a real trauma scenario to work with.

I like the leaning back on my feet squatting which I believe someone said.  And I sometimes place my arms between my knees for even more stabilization.  It's about the same comfort wise as kneeling but I have a little bit more free movement of my body (knees aren't stuck to the ground) if someone needs to get around me.  Great strength training for your calf muscles too!


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## mikie (Aug 12, 2011)

dixie_flatline said:


> In Maryland that is an instant fail.


 
Though like i said in my previous post, I wouldn't advocate it for the state test, but how would it be considered a Significant Action (not "instant fail" in MD), provided the student maintains inline stabilization without compromising c-spine...no where on the testing sheet does it say the hands must be used to take c-spine


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## MediMike (Aug 12, 2011)

If that is considered an instant fail then I guess I've been a loser the past 10 years.  How do you expect to manage the airway and maintain C-Spine? Or do you just get one or the other?  Hmm...decisions decisions...


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## Tigger (Aug 12, 2011)

tickle me doe face said:


> why?
> 
> the same way that you could hold a jaw thrust type maneuver with you knees while bagging if need be?



Err how do you plan on log rolling someone with your knees? Also I'm sure the conscious patient will love having you place their head between your legs :blink:.


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## dixie_flatline (Aug 12, 2011)

tickle me doe face said:


> why?
> 
> the same way that you could hold a jaw thrust type maneuver with you knees while bagging if need be?



I highly doubt you could hold a jaw thrust with your knees.  You can manage a head-tilt, but no way you can do a jaw thrust without your hands.


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## dixie_flatline (Aug 12, 2011)

MediMike said:


> If that is considered an instant fail then I guess I've been a loser the past 10 years.  How do you expect to manage the airway and maintain C-Spine? Or do you just get one or the other?  Hmm...decisions decisions...



Real world?  Obviously you do what you need to do.  We all know that c-spine precautions aren't needed probably 98% of the time they're used, but it's pretty difficult to make that call in the field (and _highly_ inadvisable).  

The OP is a student preparing for his state exam, so I don't want to give him any advice that could fail him.  I don't have a background as a MIEMSS/MFRI evaluator, but my class was told by ours that removing a hand or using your knees was considered an SA because you stopped maintaining c-spine precautions.  You have a problem with the way EMT testing is done - and I'm sure we all have several valid complaints - take it up with those who can help.  Don't give potentially bad advice to a student.


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## tickle me doe face (Aug 12, 2011)

Tigger said:


> Err how do you plan on log rolling someone with your knees? Also I'm sure the conscious patient will love having you place their head between your legs :blink:.



geez im not saying you have to straddle them.:blink:

and you could easily place your hands between or over your knees and transfer c-spine to yourself, same as if you were transfering c spine to another EMT

Adapt, improvise and overcome!


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## tickle me doe face (Aug 12, 2011)

double post


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## tickle me doe face (Aug 12, 2011)

MediMike said:


> How do you expect to manage the airway and maintain C-Spine? Or do you just get one or the other?  Hmm...decisions decisions...



flip a coin?


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## adamjh3 (Aug 12, 2011)

Airway takes priority. What's the point of maintaining c-spine if your patient isn't breathing?


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## MSDeltaFlt (Aug 12, 2011)

Look at the state's check off list.  It should have a list of critical criteria.  Study those critical criteria.  DON'T DO THOSE!  Otherwise, do whatever's comfortable. 

Not rocket science.


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## Tigger (Aug 12, 2011)

tickle me doe face said:


> geez im not saying you have to straddle them.:blink:
> 
> and you could easily place your hands between or over your knees and transfer c-spine to yourself, same as if you were transfering c spine to another EMT
> 
> Adapt, improvise and overcome!



I fail to see how that is not is straddling them, but I digress. I guess I just don't see the point of using your knees, the person controlling c-spine has one job, to control c-spine, pending some sort of airway issue or whatnot.


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## dixie_flatline (Aug 12, 2011)

Tigger said:


> I fail to see how that is not is straddling them, but I digress. I guess I just don't see the point of using your knees, the person controlling c-spine has one job, to control c-spine, pending some sort of airway issue or whatnot.



And as far as the *test* is concerned, at least in Maryland, airway is another person's job (for us it was a "ghosty firefighter").  You verbalize that you are having another provider bag at X breaths/min and then it's considered done unless the evaluator says otherwise. The secondary partner at the head simply maintains c-spine _no matter what_.


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## StickySideDown (Aug 12, 2011)

NJ TEST situations :

One student holds c-spine that's it. ( I prefer to squat over kneeling )
Another does rapid trauma assessment, and if you have a third they apply a collar after the student passes the PT's neck area to the chest. Then the third does vitals.

When I went through EMT, all students had to be able to perform a efficient and quick assessment. Hence the word rapid, we had to be able to perform the Rapid Trauma Assessment, including the log roll and checking the back in under 1.5 minutes. Easily Accomplished. With three people you can have the Trauma Assessment and vitals done in 2, it isn't hard, practice. 

You can have your PT long boarded, packaged, and ready to go with a set of vitals in 5 minutes with three people.

Real life : Do what needs to be done, assuming it won't do more harm than good. Risk a little to gain a lot, don't risk a lot to gain a little.


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## Stingray91 (Aug 12, 2011)

StickySideDown said:


> NJ TEST situations :
> Real life : Do what needs to be done, assuming it won't do more harm than good. Risk a little to gain a lot, don't risk a lot to gain a little.



I agree with this statement so much.

I'm liking the ideas of sitting back on the feet while kneeling & the one knee off the ground. I'm going to be lead for the rapid trauma assessment and got the timing down to I think 4 minutes on the board, and 8.5 minutes for the reassessment and my partner getting off c spine to do vitals. So I guess around 9 minutes total (minus adding splints or finding a significant MOI life threatening injury or bleed) for a 20 minute limit scenario is pretty good. I just dont want to go too fast so I dont miss anything critical on the state checkoff (I'd like to get my hands on that paper). My partner is going to hold c spine and she says she has bad knees since she was in a car accident. So I'll fwd the tips you guys said here, and keeping at it with the repetition.


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## okeefe (Aug 13, 2011)

kneeling is the best position for holding c spine. Knee pads definitely come in handy in this profession!!


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## Bullets (Aug 13, 2011)

if your going to be down there for a while, lay on your chest


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## Hunter (Aug 14, 2011)

Stingray91 said:


> Quick question from a newbie here :unsure:..
> 
> Do you guys have any tips for how to position your body while holding c spine?
> We're basically doing practicals until the State which is next month and a lot of students are having a hard time with getting a good position with their body on the floor while holding c spine.
> For example, Trauma pt. is supine; the person at the head (holding c spine) is kneeling the whole time. This would be a "good" position so a decent log roll can be done, but this causes discomfort for a lot of the students' knees. One more example would be sitting down with the legs crossed (indian style) which is more comfortable than kneeling, but not such a good position to be in to do a log roll.


 
If you have the room to lay down you can put your hands on the patients shoulders and keep the head aligned with your forearms, it's very stable and it keeps the possibility of drifting to a minimum if you get distracted.


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