Was securing a skating rink for my service the other day. During my mostly boring time in the rink I started simulating scenarios and M.O in my mind, when a question popped in my now frozen mind: child falls on ice, back first. Kinematics hard, child lying on ice. What should I do until a unit comes (I was alone with an AED and a back pack basic AB equipment): Child should be covered and isolated from the ice on the one hand, on the other hand moving him without collar-backboard could jeopardize spinal stability. Provided it takes the unit about 10 min to arrive, child complaining severe back pain, what is the best M.O. for this case?
Hypothermia VS spine immobalization...
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Bieber
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If you had another pair of hands available, you could have someone take C-spine, place a blanket on the ice, and slide the patient up and onto the blanket until someone with a board arrived.
Doesn't take a lot of coaching to get bystanders to help you put someone on a board. Also, if someone is ice skating they could be reasonably expected to be wearing warm clothes, meaning hypothermia probably won't set in inside 10 minutes. 30 minutes, I'd be worried. Finally, I'm a little dubious on the chances of a child injuring their spine in what is essentially a ground level fall.
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I agree with the other replies. If you have the bystanders, it is easy to just simply tell them what to do. If you are the only other person around, I would stick with preventing hypothermia. Hypothermia can lead to circulation problems and eventually shock. Circulation is a priority over spinal immobilization, its the C in ABCs. Hypothermia can also lead to hypoglycemia which will decrease organ function.
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If you aren't comfortable moving the patient, an "emergency" or space banket is pretty effective and doesn't take up much room in a kit.
After running this scenario in my head, i agree with everything said above (and knowing someone who is currently recovering from over a year of paraylsis from a hockey accident), first suggest that the rink should invest in a backboard w/ head immobilizer. A rink i used to play at has one. It is no different then having one a any swimming pool.
mycrofft
Still crazy but elsewhere
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Space blanket will conduct heat by contact, not so good on ice.
Better than nothing.
On the other hand, if you can get the pt on the mylar, you can slide him as a unit to the side.
Better than nothing.
On the other hand, if you can get the pt on the mylar, you can slide him as a unit to the side.
reaper
Working Bum
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Treat the child as needed. Cover with blanket and hold manual c-spine. Hypothermia is not going to set in, in 10 minutes, laying on an ice rink.
82nd medic
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You don't need an actual c collar to get c spine control. Newspaper, roles up paper, pair of shoes, hell 2 rolls of TP and some tape can make an effective c collar.
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While true, treading water while boarding someone, even just boarding someone in the water is a beast all on its own, if your ever at a pool thats quiet ask the guards to let you, at my summer job I let people do it all the time if we aren't busy.
But I agree, with an EMT on staff, proper spinal immobilization equipment should be present.
82nd medic
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Aren't places like that required by law to have certain medical gear? The ice rink near where I grew up had a spine board but it might have just been a decision by the business not a requirement
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I know unsupervised pools are not required to, not sure about hockey rinks.
You'd be surprised how parents let their kids skate on the rink. I've seen them without helmets going very fast. This is something that I've been thinking about, too. Thanks for discussing this.
Also, an hockey injury is usually never just a ground fall.