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Once the airway is protected, oxygen is administered and the casualty has been
positioned, an intravenous infusion should be examined briefly before transportation. A
scoop strecher can be asembled underneath a casualty who is lying free and used for transfer
to a spinal board or ambulance strecher. Casualties fifted with spinal immobilisers must be
supported in and not lifted by the splint. In the absence of life threatening injury, casualties at
risk of spinal trauma should be transported carefully to hospital and hard objects should be
removed from any anaesthetic parts of the body. If there is impending regurgitation or
vomiting, the casualty who is strapped to a spinal board can be safely tilted head down or
turned into a lateral position by one person using the board. This is safer than a hurriedly
attempted and unco-ordinated turn of a an unsplinted casualty into the lateral position.
If spinal cord injury is present, peripheral vasodilation exposes the casualty to greater
heat loss. It is important that body temperature is maintaned as close to normal as possible
during transit.
Spinal examination
Examination of the whole length of the spine must be perfoemed in all unconscious
patients with multiple trauma. In the supine position, the cervical and lumbar lordoses may be
palpated by sliding a hand under the patient. Unless there is an urgent need to inspect the
back, it is ussually examined near the end of the secondary survey. A co-ordinated log roll,
maintaning spinal alignment, is performed by a team of four led by the person who is holding
the patients head. Another doctor then examines the back for specific signs of injury,
including bruising or deformity of the spine, vertebral tenderness, malalignment of spinous
processes or an increased interspinous gap. The whole length of the spine must be palpated
and a rectal examination is ussually undertaken at this time to assass anal tone and sensation.