The primary symptoms of a fractured spine are pain, shock, and paralysis. Pain is likely to be acute at the point of fracture. It may radiate to other parts of the body. Shock is usually severe, but (as in all injuries) the symptoms may be delayed for some time. Paralysis occurs if the spinal cord is seriously damaged. If the victim cannot move the legs, feet, or toes, the fracture is probably in the back; if the fingers will not move, the neck is probably broken. Remember that a spinal fracture does not always injure the spinal cord, so the victim is not always paralyzed. Any person who has an acute pain in the back or the neck following an injury should be treated as though there is a fractured spine, even if there are no other symptoms.

Emergency treatment for all spinal fractures, whether of the neck or of the back, has two primary purposes: (1) to minimize shock, and (2) to prevent further injury to the spinal cord. Keep the victim comfortably warm. Do not attempt to keep the victim in the position ordinarily used for the treatment of shock, because it might cause further damage to the spinal cord. Just keep the victim lying flat and do NOT attempt to lower the head.

To avoid further damage to the spinal cord, DO NOT MOVE THE VICTIM UNLESS IT IS ABSOLUTELY ESSENTIAL! If the victim's life is threatened in the present location or transportation is necessary to receive medical attention, then, of course, you must move the victim. However, if movement is necessary, be sure that you do it in a way that will cause the least possible damage. DO NOT BEND OR TWIST THE VICTIM'S BODY, DO NOT MOVE THE HEAD FORWARD, BACKWARD, OR SIDEWAYS, AND DO NOT UNDER ANY CIRCUMSTANCES ALLOW THE VICTIM TO SIT UP.

If it is necessary to transport a person who has suffered a fracture of the spine, follow these general rules:

If the spine is broken at the neck, the victim must be transported lying on the back, face up. Place pillows or sandbags beside the head so that it cannot turn to either side. DO NOT put pillows or padding under the neck or head.

If you suspect that the spine is fractured but do not know the location of the break, treat the victim as though the neck is broken (i.e., keep the victim supine). If both the neck and the back are broken, keep the victim supine.

No matter where the spine is broken, use a firm support in transporting the victim. Use a rigid stretcher, or a door, shutter, wide board, etc. Pad the support carefully, and put blankets both under and over the victim. Use cravat bandages or strips of cloth to secure the victim firmly to the support.

When placing the victim on a spineboard, one of two acceptable methods may be used. However,

DO NOT ATTEMPT TO LIFT THE VICTIM UNLESS YOUHAVEADEQUATE ASSISTANCE. Remember: Any bending or twisting of the body is almost sure to cause serious damage to the spinal cord. Figure 4-42 shows the straddle-slide method. One person lifts and supports the head while two other persons each lift at the shoulders and hips, respectively. A fourth person slides the spineboard under the patient. Figure 4-43 shows the proper procedure in performing the log-roll method. The victim is rolled as a single unit towards the rescuers, the spineboard is positioned, and the victim is rolled back onto the spineboard and secured in place. If there are at least four (preferably six) people present to help lift the victim, they can accomplish the job without too much movement of the victim's body. NEVER attempt to lift the victim, however, with fewer than four people.

Evacuate the victim very carefully.
Pelvic Fracture
Fractures in the pelvic region often result from falls, heavy blows, and accidents that involve

crushing. The great danger in a pelvic fracture is that the organs enclosed and protected by the pelvis may be seriously damaged when the bony structure is fractured. In particular, there is danger that the bladder will be ruptured. There is also danger of severe internal bleeding; the large blood vessels in the pelvic region may be torn or cut by fragments of the broken bone.

The primary symptoms of a fractured pelvis are severe pain, shock, and loss of ability to use the lower part of the body. The victim is unable to sit or stand. If the victim is conscious, there may be a sensation of "coming apart." If the bladder is injured, the victim's urine may be bloody.

Do not move the victim unless ABSOLUTELY necessary. The victim should be treated for shock and

Figure 4-43.-Log-roll method of moving spinal cord injury victim onto a backboard.

Figure 4-42.-Straddle-slide method of moving spinal cord injury victim onto a backboard.

kept warm but should not be moved into the position ordinarily used for the treatment of shock.

If you must transport the victim to another place, do it with the utmost care. Use a rigid stretcher, a padded door, or a wide board. Keep the victim supine. In some cases, the victim will be more comfortable if the legs are straight, while in other cases the victim will be more comfortable with the knees bent and the legs drawn up. When you have placed the victim in the most comfortable position, immobilization should be accomplished. Fractures of the hip are best treated with traction splints. Adequate immobilization can also be obtained by placing pillows or folded blankets between the legs as shown in figure 4-44 and using cravats, roller bandages, or straps to hold the legs together, or through the use of MAST garments. Fasten the victim securely to the stretcher or improvised support, and evacuate very carefully.