Transportation of casualties

Spinal and pelvic immobilization

Patients with axial skeletal trauma must be transported strictly on a rigid spine board. If only standard soft canvas stretchers are available, a solid structure made of wide boards or slats must be placed on top of them. Vacuum mattresses and stretchers are considered the ideal modern solution, as they securely immobilize the patient in virtually any required position, ensuring complete stabilization.

The body position during evacuation depends on the level of injury:

• Lower thoracic and lumbar spine: the patient lies supine, with a bolster placed under the lower back to maintain the natural spinal curvature (lordosis). An alternative option is permitted — transportation in the prone position with a large bolster under the chest and head.
• Pelvic bones: the casualty is placed supine, with a bolster placed under the knee joints. A structure made of tied and bent ladder splints can be used to securely maintain this position.

Neck and limb fixation

At the slightest risk of cervical spine injury, immobilization is mandatory. The simplest yet least effective method is a cotton-gauze ring placed under the occiput of a supine patient. The Schanz collar (cotton-gauze bandage), which rests against the external occipital protuberance, mastoid processes, and chest, is much more reliable. Today, the gold standard is standard rigid cervical collars — special adjustable hard collars that are applied very quickly and have completely replaced obsolete plywood splints.

For leg injuries, fixation is often performed using ladder splints. The key rule is that the foot must be set at a strict right angle (90°) relative to the axis of the limb.

Plaster splints with mandatory soft cotton-gauze padding can also be used for immobilization. They perfectly replicate the anatomical contours, which is critically important during long transport. However, plaster requires time to dry and loses strength when wet.

Assessment of limb viability in ischemia

Transport immobilization is absolutely essential even in the absence of fractures, as it helps tissues survive under conditions of insufficient blood supply (ischemia). It is optimal to use pneumatic splints, which act like a tight elastic bandage. The physician assesses the condition of the segment across three stages:

1. Compensated ischemia: tactile and pain sensitivity, as well as active movements, are preserved. There is no threat of massive necrosis, and the limb is viable.
2. Decompensated ischemia: active movements are impossible, and sensitivity is reduced or lost. The limb is conditionally viable, and emergency restoration of blood flow is required to save it.
3. Irreversible ischemia: even passive movements are absent, and rigor mortis of the muscles develops. The segment cannot be saved, and early amputation is indicated. During transportation, it is necessary to leave the tourniquet in place or reapply a hemostatic tourniquet to isolate the dead tissues and prevent the release of toxins into the systemic circulation.

Stages of pre-hospital care

Care prior to hospital admission is divided into several levels depending on the qualifications of the personnel and available equipment:

• First aid: provided at the scene (often as self-help or mutual aid) using improvised means. It is exclusively symptomatic in nature.
• First-line pre-medical care: performed by a paramedic or nurse using medical kits. No diagnosis is made; life-threatening conditions are identified and resolved.
• Emergency medical care: standard emergency medical teams are required to establish a provisional diagnosis. At the same time, bone fragment repositioning, surgical interventions, and X-ray examinations are strictly prohibited.
• Primary specialized care: provided by trauma surgeons in trauma centers, where X-rays can be performed to clarify the diagnosis and determine indications for hospitalization.

Class and exam questions

What else to study on this topic

• Detoxification therapy in the hospital: methods of hemodilution and forced diuresis.
• Use of pneumatic splints and transport modules for external fixation devices.
• Management of ischemic edema and multi-organ pathology in the hospital period.
• Specifics of using vacuum immobilization devices in polytrauma.

Other topics in the section "General Questions of Traumatology and Orthopedics"

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