“I’ve fallen, and I can’t get up” was a catchphrase of the late 1980s from a U.S. television commercial for a medical alert button. It was used in a number of funny knock-offs.
But to hear a guest say this, laying at the base of the stairs while out at sea, it’s not so funny.
Anytime someone falls, always ask yourself if there could be internal damage, an injury you can’t see. Anytime you suspect spinal injury, do not move the affected person unless it is immediately necessary.
Permanent paralysis and other serious injuries may happen if you move an injured person improperly.
Always assume a person has a spinal injury if:
The fall victim sustained a head injury and you notice a change in their level of consciousness
The fall victim complains of severe pain in the neck or back
The fall has exerted substantial force on the back or head
The fall victim complains of weakness, numbness or paralysis
The fall victim lacks control of his or her limbs, bladder or bowels
The fall victim’s neck or back is twisted or positioned oddly
On dry land, when emergency medical services (EMS) are available, it is always best to call for help and wait for professionals to move the injured person. But at sea, not moving the person may not be an option.
Often EMS will hold the victim’s head stable until a cervical collar and backboard can be applied. A cervical collar is also referred to as a neck brace or c-collar and is often found in the better quality medical kits you find onboard yachts.
Any time a guest or crew member sustains a traumatic head or neck injury, assume they may have a cervical fracture. These type of injuries make them a high risk for spinal cord injury. Movement can make this type of injury worse, leading to paralysis or death.
At sea, these injuries may occur in anyone suspected of having whiplash because of a boating or personal watercraft accident.
In order to prevent further injury, such patients should have a collar placed by medically trained crew until X-rays can be taken to determine if a cervical spine fracture exists. Here are the proper steps when applying a cervical collar:
1. Realign the cervical spine through a manual stabilization, if possible. From behind, this requires the rescuer to place their hands over the patient’s ears and, using their forearms and elbows along the spine, use the hands to release pressure.
2. While holding the patient’s head steady, have a second rescuer remove clothing and jewelry that might interfere with applying the collar, making certain not move the injured person. Cut away what you need to using trauma shears if available.
3. From the patient’s front, rescuer 2 should open the collar and slide the collar up the patient’s chest to the chin.
4. While rescuer 1 continues to hold the patient’s head secure, slide the back of the collar over the left shoulder into place. The collar should be secure enough to keep the head from moving but not so tight as to cause pain or restrict breathing or circulation.
Please note that the cervical collar only stabilizes the top seven vertebrae, C1 through C7. To better protect the patient, additional immobilization devices such as a Kendrick Extrication Device (KED) or backboard should be used to stabilize the entire spinal column.
There are several companies that make cervical collars, which generally come in adult and pediatric sizes. Today would be a great day to check out your yacht’s medical first aid kit to see which sizes you have and how many of each. On the water, think boat accident, which typically means multiple injured people, so one collar may not be sufficient.
As with any medical emergency, training is key. All crew should have the opportunity to hold a pretend patient’s spine or stabilize the head. All crew should train how to apply the c-collar and fit it properly.
Keith Murray, a former firefighter EMT, owns The CPR School, a first-aid training company. He provides onboard training for yacht captains and crew and sells and services AEDs. Contact him at 877-6-AED-CPR, 877-623-3277 or www.TheCPRSchool.com. Comments on this column are welcome at firstname.lastname@example.org.