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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