- To assist officers in clinically clearing the spine
- C-Spine assessment is performed using clinical judgement and findings from examinations, the NEXUS Clinical Decision Rule can be used to aid this decision.
- Prior to clearance a thorough primary/secondary and Neurological survey must be completed.
- Asses high risk factors that limit the ability to clear C spine, utilise a SPEED assessment when high risk factors are present
- Patients with no neurological deficit may self-extricate short distances (a few steps)
- Careful clinical judgment should be used, if self-extrication is likely to aggravate the injury then alternative methods of extrication should be used.
- Ensure a Lanyard is placed and education is given on self-splinting prior to self-extrication.
- Once on the stretcher apply head blocks and treat although a spinal injury is present.
High risk factors include:
- Age: Older than 65 years
- Known pre-existing spinal conditions (e.g. ankylosing spondylitis, rheumatoid arthritis, spinal surgery, spinal stenosis etc.)
- Dangerous mechanism(s) of injury, including but not limited to:
- Fall: ≥ 1 meter OR 5 stairs
- High axial loading to the head (e.g. diving, rugby scrum, surfing etc.)
- Motor Vehicle Collision at high speed (≥ 60km/hr)
- Motor Vehicle Rollover
- Ejection from a vehicle
- Accidents involving motorised recreational vehicles (e.g. quad-bikes, ATV's, motorbikes, etc.)
- Bicycle collision
- Pedestrian/s struck by vehicle
- Abnormal neurological status
- Obvious or subtle numbness, tingling or strength deficit in peripheries which was not present prior to the incident/injury
- Abnormal neurological status which occurred prior to Ambulance arrival must be taken into account in conjunction with a SPEED assessment and consideration of a Dangerous mechanism of injury. Document score and findings
The NEXUS criteria stipulates that cervical spine injury cannot be excluded if any of the following criteria are present:
- Posterior midline cervical spine tenderness:
- Tenderness is considered present in the following circumstances:
- Pain on palpation of the posterior midline cervical spine from nuchal ridge to the prominence of the first thoracic vertebra OR
- Pain on direct palpation of any cervical spinous process
- Tenderness is considered present in the following circumstances:
- Altered Mental Status (including any of the following):
- Glascow Coma Scale ≤ 14 OR
- Disorientation to time, place, person or events (TPPE) OR
- Inability to remember three simple objects at five minutes OR
- Delayed or inappropriate response to external stimuli
- Focal neurological deficit:
- Determined to be ANY abnormality, be it sensory or motor on examination, either reported by the patient or elicited by the examiner
CAUTION: Do not look for alternative explanations for neurological deficit; if present, assume spinal cord injury
- Determined to be ANY abnormality, be it sensory or motor on examination, either reported by the patient or elicited by the examiner
- Evidence of intoxication (including but not limited to):
- Recent history reported by the patient or an observer of ingestion/consumption of an intoxicating substance (including but not limited to alcohol) OR
- Physical exam results indicative of intoxication such as:
- Odour of alcohol
- Slurred speech
- Ataxia
- Dysmetria or other cerebellar findings
- Behaviour consistent with intoxication
- Tests of bodily secretions which are positive for drugs (including but not limited to alcohol) that affect mental alertness
- Painful distracting injuries
- Painful distracting injuries can be considered as any condition thought by the clinician to be producing pain sufficient to distract the patient from a second (neck) injury. This may include (but is not limited to):
- Any suspected long-bone fracture
- Large lacerations
- Degloving; Crush injury
- Significant Burns
- Any other injury causing functional impairment
- Following the NEXUS assessment a SPEED assessment should be conducted to rule out spinal cord injury
- Discontinue if patient non-compliant or not tolerant of hard collar and opt for manual in-line stabilisation or head-blocks only.
| Settings | |
|---|---|
| Extended Care: | |
| Colour assist: | |
Document Control
Clinical Resources Website
St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.
Other users – Terms of Use
The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.
St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.
St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website.
No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au
Where links are provided to resources on external websites, St John WA:
- Gives no assurances about the quality, accuracy or relevance of material on any linked site;
- Accepts no legal responsibility regarding the accuracy and reliability of external material; and
- Does not endorse any material, associated organisation, product or service on other sites.
Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.
To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).
Cookies
Please read this cookie policy carefully before using Clinical Resources from St John WA.
The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.
Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.
If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.