FOOTHILL COLLEGE
Seated Spinal Immobilization
Candidate Name: _________________________________________ Date: ______________________
Examiner Name and Signature: _________________________________________________________
Time Started: __________ Time Ended: __________ Points: _____/11 PASS/FAIL (Circle One)
| Points Possible | Points Awarded | |
| Directs assistant to place/maintain head in the neutral, in-line position | 1 | |
| Directs assistant to maintain manual immobilization of the head | 1 | |
| Assesses motor, sensory, and circulatory functions in each extremity | 1 | |
| Applies appropriately sized extrication collar | 1 | |
| Positions the immobilization device behind the patient | 1 | |
| Properly secures the device to the patient’s torso | 1 | |
| Evaluates torso fixation and adjusts as necessary | 1 | |
| Evaluates and pads behind the patient’s head as necessary | 1 | |
| Secures the patient’s head to the device | 1 | |
| Moves or verbalizes proper movement of the patient to long backboard | 1 | |
| Reassesses motor, sensory, and circulatory function in each extremity | 1 |
Total Points Awarded_______________
Critical Criteria
____ Did not immediately direct or take manual immobilization of the head
____ Did not properly apply appropriately sized cervical collar before ordering the release of manual immobilization
____ Released or order release of manual immobilization before it was maintained mechanically
____ Manipulated or moved patient excessively causing potential spinal compromise
____ Head immobilized to device before torso sufficiently secured to device
____ Device moves excessively on the patient’s torso
____ Head immobilization allows for excessive movement
____ Torso fixation inhibits chest rise, resulting in respiratory compromise
____ Upon completion of immobilization, head is not in a neutral, in line position
____ Did not reassess motor, sensory, and circulatory functions in each extremity after immobilization to backboard
Notes: ____________________________________________________________________________________________
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