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How Should an Unconscious Person with a Suspected Neck Injury be Positioned?

Published online by Cambridge University Press:  28 June 2012

Barry D. Gunn
Affiliation:
Department of Anatomy and Cell Biology, The University of Melbourne, Melbourne, Australia
Norman Eizenberg*
Affiliation:
Department of Anatomy and Cell Biology, The University of Melbourne, Melbourne, Australia
Morry Silberstein
Affiliation:
Department of Radiology, The University of Melbourne, Melbourne, Australia
Joan M. McMeeken
Affiliation:
Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
Elizabeth A. Tully
Affiliation:
Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
Barry C. Stillman
Affiliation:
Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
Douglas J. Brown
Affiliation:
Medical Director, Spinal Injuries Unit, Austin Hospital, Melbourne, Australia Geoffrey A. Gutteridge, FANZCA
Geoffrey A. Gutteridge
Affiliation:
Director of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
*
Department of Anatomy and Cell Biology, The University of Melbourne, Parkville 3052, Victoria, Australia

Abstract

Introduction:

Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the “lateral recovery position,” coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.

Hypothesis:

It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the “HAINES modified recovery position.” HAINES is an acronym for High Arm IN Endangered Spine.

Methods:

Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.

Results:

For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).

Conclusion:

An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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References

1. Nimmo, WS, Smith, G (eds): Anaesthesia Volume I. Blackwell Scientific; 1989, Chicago, Ill. p 436.Google Scholar
2. Pressley, M, MacDonald, L (eds): Australian First Aid. Melbourne: Ruskin Press, 1984, pp 4882.Google Scholar
3. MacDonald, L, Verhoeven, A (eds): Australian First Aid, Volume 1, 2nd ed. Melbourne: Canberra Press, 1989, pp 3134.Google Scholar
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5. Van Norstrand, R: Industrial First Aid: A Reference and Training Manual, 2nd ed, 1992, pp 147151.Google Scholar
6. Martin, JT (ed): Positioning in Anaesthesia and Surgery, 2nd ed. Saunders, Philadelphia, Pa. 1987, pp 175176.Google Scholar
7. Sunderland, S: Nerve Injuries and Their Repair: A Critical Appraisal. Melbourne: Churchill Livingstone, 1991, p 134.Google Scholar
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