C • DISLOCATIONS OF THE VERTEBRAL COLUMN
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an improvised roll—for instance a rolled-up jacket—should be placed under the suspected
site of injury to restore the normal curvature of the spine and thus relieve pressure from
the spinal cord. It may be emphasized that, by this management, a fracture dislocation
can be reduced already at the place of accident, while the patient is in a flaccid state.
8. Hard objects, such as coins, keys, pipes, tins, lighters, and match-boxes must be
removed from the pockets of the injured in order to avoid development of pressure sores
during transport. While awaiting the arrival of medical aid and ambulance, the patient
should be covered to keep warm. However, hot-water bottles must never be used
on any
part of the body.
9. Pads ofsoft material should be placed between the knees and in particular the ankles.
Knees and ankles should be loosely bound together and a soft support should be placed
underneath the calves to prevent pressure sores developing on the heels.
TRANSPORT BY AMBULANCE OR AIR
(a)
Preparation of the stretcher
The traumatic paraplegic should be transported on a rigid stretcher to prevent sagging
of the spine into flexion, or, if this is not available, on a board. If the site of the fracture
is known, a support should be placed on the stretcher in accordance with the level of
the injury so that a moderate hyperextension is accomplished once the patient is placed
on the stretcher. If the site of the fracture is obscure, the normal curvatures of the spine
should be maintained by placing supports under the small of the back and the nape of the
neck. Ambulances should be provided with packs of sorbo-rubber of various sizes and
width to be placed underneath the suspected fracture. For the nape of the neck, such
support must naturally be small and narrow.
(b)
Lifting the injured on to the stretcher
If the injured is already lying on a blanket with a support underneath the fracture, the
lifting can be done by the first aiders from either side holding onto the blanket. However,
the safest lifting is done directly from the supine position by four or five first aiders
maintaining hyperextension by holding the support underneath the fracture in position.
The person holding the head should be in command and the injured should be lifted
at the order 'up' or 'lift' simultaneously in one piece. The team should carry out the lifting
preferably from the side opposite to the stretcher, with the exception of the man who is
holding the head. Lifting the injured with the aid of webbing bands, as suggested in the
manual of the St John's Ambulance Brigade, is, as a rule, undesirable, as it involves
turning the injured and unnecessary manipulation and movements which could easily
result in further damage to the spinal cord.
(c)
Immediate medical first aid
Morphine should not be given indiscriminately to these patients, as its administration,
in particular in patients with cervical cord lesions and others with suspicion of lung
