# Immobilization: Head Strap, Chin strap, or Head & Chin straps



## Freddy_NYC (Jun 14, 2009)

What is the best way to immobilize the pt's head using a Sta-Blok Head Immobilizer (aka shark fins)? 
There are two straps provided: velcro head strap and a sticky tape strap for the chin. Iv'e seen people use the sticky strap to go over both the velcro head strap. But Ive also seen people use the chin strap only for the chin as the directions say.


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## MSDeltaFlt (Jun 14, 2009)

Put the head strap over the head. Put the sticky tape strap under the chin.  That's the best way to do it.  It doesn't immobilize, it only restricts.  But it will get the job done.

The best and only way to *immobilize* is the use of a halo; which requires the application of sedatives and opioites for conscious sedation, and torque wrenches. It's archaic and painful, but it works.


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## 46Young (Jun 15, 2009)

The latest and greatest term nowadays is spinal motion restriction. I would think, should your pt suffer neurological damage in your care, the attorney will look into your method of restriction. If you deviate from the manufacturer's guildlines, you risk liability. You can potentially be accused of causing/exacerbating the pt's injury by not following the directions. Are you allowed to use towel rolls for head blocks? Freddy, where do you work in NY?


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## Freddy_NYC (Jun 15, 2009)

Dear 46young, 

I'm bran spankn new so any advice is welcome thanks for repy'n to my post.  We don't use towel rolls for head blocks and in NYC most EMS uses the laerdal HeadBed™ II Head Immobilization Device. Are towel rolls better?


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## lightsandsirens5 (Jun 16, 2009)

Freddy_NYC said:


> Dear 46young,
> 
> I'm bran spankn new so any advice is welcome thanks for repy'n to my post.  We don't use towel rolls for head blocks and in NYC most EMS uses the laerdal HeadBed™ II Head Immobilization Device. Are towel rolls better?



Ha! Anything is better than the Head Bed 2s. I like towel rolls because they kindof conform to the pts head, but then again I dont like them because they sometimes seem too "squishy" (for lack of a better word). We use re-usable vynal covered foam blocks and 2 inch tape. (One strip low across the forhead and one strip under the chin.) From what I have seen and used out there, I like that best so far. It just seems to me that all the disposable stuff is practically worthless when it comes to trying to immob. a pts head.


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## 8jimi8 (Jun 16, 2009)

I just tell the patient, "this device is a REMINDER NOT TO MOVE YOUR HEAD.  WE SUSPECT THAT YOU HAVE A SPINAL INJURY AND MOVING COULD CAUSE PERMANENT, IRREVERSIBLE DAMAGE." and document placement and explanation.  Do you have patients flopping around when they are supposed to be immobilized?  Maybe ask the driver to slow down on the turns?!


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## SoCal (Jun 16, 2009)

We use the same head beds and I use the Velcro strap for the top, and I use like 2 inch cloth tape over the chin and back underneath the board.


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## Volunteer_EMT_Ph (Jun 16, 2009)

Do any of you guys tried using duct tape?  Is it ok to use such tape for head immobilization?


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## firecoins (Jun 16, 2009)

Volunteer_EMT_Ph said:


> Do any of you guys tried using duct tape?  Is it ok to use such tape for head immobilization?



I know someone who does.  I don't advocate it.


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## vquintessence (Jun 16, 2009)

Volunteer_EMT_Ph said:


> Do any of you guys tried using duct tape?  Is it ok to use such tape for head immobilization?



*Perhaps* for the chin, and only if they have short hair and no beard.  Otherwise, no.  All with Firecoins on this one.  Duct tape leaves a helluva residue behind, not to mention the pain of removing, even on a young healthy individual with good skin condition!

Sort of related:  Used duct tape on my car once to cover the trim and windows while I prepped it for a good coat of flat black.  The tape left behind a nasty residue, had to use a razor blade on the glass and some of the trim got wrecked.


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## Freddy_NYC (Jun 16, 2009)

Thank you guys for your replys 

I guess what I'm trying to ask is I've seen people immobilized (spinal motion restrictioned) with:

Head strap only 
Head and chin strap

Is there any reason for not using a chinstrap?


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## Ridryder911 (Jun 16, 2009)

Freddy_NYC said:


> Thank you guys for your replys
> 
> Is there any reason for not using a chinstrap?



Ever seen a head injury patient with projectile vomiting? 

R/r 911


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## Freddy_NYC (Jun 16, 2009)

Oh dear, vomiting on a backboard, not fun. 
So to be clear you're saying head and chin strap. However if there is a possibility of Vomit/Nausea no chinstrap? 

Thanks
Freddy


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## SoCal (Jun 16, 2009)

In EMS, you will find a lot of variables that affect what you do as a Medic/ EMT so there is no real cookie cutter answer to your question. You will find out a lot of what we do in EMS is that way.


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## AnthonyM83 (Jun 16, 2009)

In THEORY, shouldn't the tape not affect the opening of the mouth if it's properly placed on the hard plastic of collar?

LA County "recommends" that a chin strap not be used except over rough terrain or when moving a KED'ed patient onto backboard and such, so I haven't often used it... So would like to hear thoughts from others on its actual (rather than theoretical) risks / benefits.


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## Volunteer_EMT_Ph (Jun 17, 2009)

I agree.  Duct tape indeed leaves a lot of residue that's hard to remove, and it's also painful, though I haven't used it on a pt's head.

One question about the straps: which is better, one that secures to the head block or one that secures to the spineboard?


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## Scout (Jun 17, 2009)

Correct Why would you be puttign tape in contact with the skin?


Bottom tape is on collar top but has a 4x4 between the head and tape or tape gets doubled. I'd freak if i saw tape on skin like that. There I no need.

Rid i dont follow with the vomiting?


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## lightsandsirens5 (Jun 17, 2009)

Scout said:


> Correct Why would you be puttign tape in contact with the skin?
> 
> Bottom tape is on collar top but has a 4x4 between the head and tape or tape gets doubled. I'd freak if i saw tape on skin like that. There I no need.



Don't come up my way! Protocols say 2 inch tape right on the forehead just above (if not on<_<) the eyebrows. (Plus the tape under the chin.) The only time we are even allowed to think about doubling the tape over is when the pt is elderly and/or has very fragile skin that the regular cloth tape would lift right off. (We may be starting to carry paper tape for this. Put down a layer of paper tape first, then 2 inch tape over that.)  Frankly, I don't see what the big deal is with people doing everything possible to keep tape off skin. What would be more importaint to you, your eyebrows, or the ability to walk? (Not that taping the head eliminates the risks. But if I had a busted neck, I'd want to be as immobilized as you can get. In the field, that means full spinal precautions. It seems to me that when the tape is not in contact with the skin, the pt is able to move their head alot more.)


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## Freddy_NYC (Jun 17, 2009)

So on laerdal's website they have a picture of someone on a backboard 
no chin strap. 
http://www.laerdal.com/doc/7160084/Sta-Blok-Head-Immobilizer.html

The website says a "Blue Security strap" (sticky tape) is included to provide extra stability. Do you suppose the blue strap is for extra head strap stability since the head is only secured by velcro. 

To secure the chin. I will secure using tape from the ambulance. Sounds good?


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## 46Young (Jun 17, 2009)

Freddy_NYC said:


> Dear 46young,
> 
> I'm bran spankn new so any advice is welcome thanks for repy'n to my post.  We don't use towel rolls for head blocks and in NYC most EMS uses the laerdal HeadBed™ II Head Immobilization Device. Are towel rolls better?



I used the head bed in NY, and I think they suck. They fail to secure the head if the pt is moved up/down stairs with a more vertical position. I make towel rolls by placing the first the long way, and folding each side about 1/3 of the way in, leaving about a 1-1 1/2" space of single thickness running down the entire length. I take a second towel, place it the same way, but staggered about 8 inches or so below the first one. I fold this so the ends meet in the middle, to acheive double thickness the whole way. I then roll the second towel up, then continue by picking up the first towel and rolling it over and with the second one. This results in a cylindrical roll, firm enough for cervical restriction applications. A sheet can be used for the second towel, for more stability. Make sure to tape it. We also use the trauma weave for the body. This has proven effective in securing the pt, and not allowing them to slide up or down. If you use regular straps, I recommend using cravats to make stirrups for the feet, looped through the bottom of the board, to prevent the pt from slipping. If you don't do this, and you need to raise the board to navigate stairs or a tight elevator, the C-collar will choke the pt(bad). I also advocate using 2 inch tape along the chin of the collar, and the pt's forehead, to add stability to the restriction, and to lessen the pt sliding. I like to run the forehead tape back down toward the shoulders on either side, and run the ends of the chin tape up to the top of the board, in a crisscross pattern. This goes for te head bed, as well.


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## 46Young (Jun 17, 2009)

Scout said:


> Correct Why would you be puttign tape in contact with the skin?
> 
> 
> Bottom tape is on collar top but has a 4x4 between the head and tape or tape gets doubled. I'd freak if i saw tape on skin like that. There I no need.
> ...



Rid was being sarcastic. Freddy did say he was brand spanking new, and asked a legitimate question.


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## 8jimi8 (Jun 17, 2009)

Rid wasn't being sarcastic... people with head injuries sometimes vomit forcefully.


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## Freddy_NYC (Jun 17, 2009)

46Young: thank you for explaining towel rolls. I now have a better understanding of this technique. 

8jimi8 & Rid: So you're saying some EMT's hold off on the chin strap if there's vomiting?


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## 8jimi8 (Jun 18, 2009)

don't you think vomit would get all over the strap, or keep the patient from effectively opening their mouth to expel said vomit?


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## Scout (Jun 18, 2009)

No the strap, at least here, goes on the collor not their mouth. The Collar therefor would be the only thing preventing? an open mouth. Not that i have ever seen a problem with thes. We just roll to the side, i cant see an impact of a chin strap on this.


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## Ridryder911 (Jun 18, 2009)

If you sucesssfully place a chin strap on the patients chin to prevent "slippage" or movement. Then NO they will not be able to open their mouth sucessfully to vomit. Sorry, I have seen this & increase risks or a sure chance of aspiration. 

The "chin strap" method was abolished several years ago when the majority of the cervical collars were the whiplash collars made of soft foam and EMS was taught to use Kerlix /king when immobilizing on a short spine board. Remember also the short spine board, the restraining for head was placed in a modified circular pattern. 

When the KED device entered the area, big debate was if the chin strap was really needed or even really made a difference? Then with the surplus of cervical collars becoming rigid or hard the "chin" strap is more commonly placed over the cervical collar and not really on the chin itself and personally believe it should not be called a chin strap (since it is not on the chin). 

There are a few that still that make a figure 8 type and thus pulling on the chin & forehead. And again, those have a high increase of aspiration, and please do not tell me that it is simple just to turn them over on the side ( I will tell you that you are inexperienced) . Patients vomit rapidly, when the patient inhales there is a high chance of aspiration if any vomitus is in their mouth. Even good suctioning with movement cannot ensure total prevention. 

Personally, I do not like any device restraining the mouth area. I have yet seen any device manufactured that really provides true immobilization as it is supposed to be done and most are crap, and only give an illusion of immobilizaition, and yes I have played the majority of them . 

R/r 911


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## Scout (Jun 18, 2009)

Just so i have it clear. 

I refer to a stiff neck collar,We typically use a hard foam block with the supplied foam straps. The lower of the two straps does not come in contact with the skin. It is either on the bridge of the chin of the collar, or just below it, but on the plastic of the collar.

Do some places put the chin strap above the collar on the skin.
and when i said just turn it was not to imply simplicity. and i misuse the term immobilization, it is used for simplicity and historic reasons rather than an inference to an actual act.


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## MRE (Jun 18, 2009)

Scout said:


> Do some places put the chin strap above the collar on the skin.



I'm sure some people do it, but they should not.  The chin strap should not put any downward pressure on the chin as this will tend to close the airway (think reverse jaw thrust).  Lifeguards do backboarding without applying C Collars and they are taught to do only the forehead strap and leave the chin strap off.


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## WolfmanHarris (Jun 22, 2009)

lightsandsirens5 said:


> Don't come up my way! Protocols say 2 inch tape right on the forehead just above (if not on<_<) the eyebrows. (Plus the tape under the chin.) The only time we are even allowed to think about doubling the tape over is when the pt is elderly and/or has very fragile skin that the regular cloth tape would lift right off. (We may be starting to carry paper tape for this. Put down a layer of paper tape first, then 2 inch tape over that.)  Frankly, I don't see what the big deal is with people doing everything possible to keep tape off skin. What would be more importaint to you, your eyebrows, or the ability to walk? (Not that taping the head eliminates the risks. But if I had a busted neck, I'd want to be as immobilized as you can get. In the field, that means full spinal precautions. It seems to me that when the tape is not in contact with the skin, the pt is able to move their head alot more.)



Your protocols are that specific? Ours says, "perform c-spine immobilization" the rest is left to us to do as taught and as appropriate to the patient's condition.

Generally I do have tape in contact with the patient's skin (Cloth 2" bandage tape) but I can definitely see the problems with it. Namely, how many of our SMR's end up as cosmetic? Without the ability to clear c-spine in the field, quite a lot. So if your patient walks out of the ED after two, three hours with nothing wrong with them, was the discomfort you added with the tape in their hair still worth it? Maybe, maybe not.

Now consider the amount of research that supports SMR? Very little, and none of it of the best quality. We continue to do it as common sense medicine and because ethically how do you test for this? How many case studies are on the book showing poor SMR leading to neurological deficit or any other increased morbidity?

Restrict motion? Definitely. Ensure a patent airway that can be cleared easily? Definitely. Worry about which taping method is the be all and end all of SMR? Not so sure.


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## Cbyoung71 (Apr 16, 2014)

How many of you work at a service that doesn't have to c-spine every MVA patient ?


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## chaz90 (Apr 16, 2014)

Cbyoung71 said:


> How many of you work at a service that doesn't have to c-spine every MVA patient ?



Lots of threads around this forum on the subject if you look around a bit 

No where I've ever seen has automatically required SMR of every patient from an MVA. I know there are services from the Dark Ages still out there, but something that asinine would be a deal breaker for me.


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## Medic Tim (Apr 16, 2014)

Cbyoung71 said:


> How many of you work at a service that doesn't have to c-spine every MVA patient ?



The service I work for uses the canadian c spine rules.  When I worked in maine we used a modified nexus. 

In our next protocol update we may no longer use boards for transport (fingers crossed). The state of nh and services throughtout the usa have already adopted this.


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