Breakdown: History of Recovery Vehicles in the British Army by Brian S. Baxter

By Brian S. Baxter

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In this position the airway is patent, but will become obstructed if the ambulance officer or emergency physician insists on the patient lying flat. When the patient is sitting it is important to consider how you will maintain cervical spine integrity—but maintaining the airway is more important than insisting on rigid cervical spinal immobilization in the supine position (see Rule 16). Airway obstruction with facial injuries may also be a result of heavy bleeding, or from the swelling associated with a fractured jaw.

If there is mid-line tenderness, flexion and extension films are used to assess for ligamentous injury. The level of motor deficit is taken as the lowest muscle with power of 3/5 (American Spinal Injury Association Scale, where grade 3 power is a full range of movement against gravity). The level of sensory deficit is taken as the lowest dermatome bilaterally to have normal sensation. When CT is available, it is appropriate to image the lower cervical spine if not seen on plain X-ray. When CT of the brain is undertaken following blunt trauma, it is recommended to extend the imaging to include C1–3.

There may have been a two-way exchange of violence and the patient may be carrying a weapon. Hypoxia causes confusion and aggression. Do not give the hypoxic patient the opportunity of confusing you with an aggressor. Do a rapid frisk for weapons and make them safe. If you do not know how to make a firearm safe, place it on the floor out of the way and have it guarded until the police arrive. It is standard practice within a field hospital to ensure the removal of all weapons and pyrotechnics before the patient enters the hospital complex.

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