After the patient has been fully immobilized on a backboard or other rigid device, it may be necessary to secure their hands to prevent the patient's arms from falling open during movement. Hands and/or arms may be secured in a variety of ways that change depending on the situation and the patient's level of consciousness. For instance, a patient who is conscious may be able to keep their arms across their chest with no external securing needed where an unconscious patient's arms may need to be secured both to the board and to each other to prevent movement.
Who?[edit | edit source]
Patients who need their hands or arms secured to the board are those who are at risk of either disrupting movement procedures by reaching/grabbing or those who are unable to control their limbs.
Conscious Patients[edit | edit source]
Minimize the need for securing a conscious patient's arms by describing the procedure and any movements to be made; remember your patient has just lost their ability to spontaneously look around or move on their own (if they were immobilized correctly). Sudden or unexpected movements can lead to an involuntary stabilization reflex where the patient reaches out and grabs the first thing their hand contacts. This can be dangerous for both the patient and the rescuers.
Semiconscious/Unconscious Patients[edit | edit source]
Patients who are semiconscious may not be able to fully understand or follow directions and patients who are fully unconscious will follow gravity when it comes to where their arms and legs go. For these patients it is imperative that arm/leg control is implemented and reassessed before, during, and after movement, as these patients may be unable to verbalize pain to let you know about a finger caught underneath the backboard. Additionally, it is incredibly dangerous to both the patient and rescuer to attempt movement without properly secured limbs as these limbs may fall off the board at inopportune times and get caught on doorframes, between railings, or on furniture.
When?[edit | edit source]
Regardless of whether or not the patient is conscious, semi-conscious, or unconscious the hands are always secured at the end of immobilization. For conscious patients it leaves them some semblance of free movement for as long as possible, and for semiconscious or unconscious patients it allows for easier access and movement during immobilization for the rescuers. The only exception to this is if the patient is actively fighting the rescuers or exhibits behavioral agitation that does not respond to de-escalation measures. This is a scene hazard that needs to be taken care of before treatment/intervention may be performed. In this case, the patient's limbs may be secured in a way that permits further treatment or immobilization without further injury to the patient.
Why?[edit | edit source]
Securing a patient's hands during movement reduces the chance for injury to the patient from collision with rescuers or objects as well as reducing rescuer risk by making the patient more stable and less likely to "tip".
How?[edit | edit source]
The prehospital environment is constantly changing, and you will often find patient's whose symptoms or conditions are abnormal and may present differently than you may expect. Improvisation is a key skill that can help an EMT work their way around the unique problems that can pop up during routine operations. Along this line of thought, there is no definitive recommendation for how to secure a patient's hands, outside the use of a commercial device. There are two major conditions that must be fulfilled while securing the patient's hands; firstly the patient must have no negative impact to their CSM, and secondly the patient's hands should be able to be unsecured quickly if needed.