Log-Rolling and Discontinuing Spinal Precautions on Immobilized Patients

Medical Directive ID: 
EMG-2012-004
Lead Contact Person: 
Janice Qubty, Manager, Adult Emergency Services, Victoria Hospital
Sue Kriening, Manager, Adult Emergency Services, University Hospital
Alison Armstrong, Clinical Educator, Emergency Services, Victoria Hospital
Physician/Nurse Lead: 
Dr. Gary Joubert, Chief, Department of Emergency Medicine
Dr. Trevor Gilkinson, VH Site Chief, Emergency Medicine
Dr. Karl Theakston, UH Site Chief, Emergency Medicine
Program: 
Emergency Medicine - Emergency Department
Approval By: 
Medical Advisory Committee
Original Effective Date: 
Wednesday, May 8, 2013
Revised Date: 
Wednesday, May 8, 2013
To Be Reviewed Date: 
Friday, May 8, 2015
This Medical Directive Applies to the following sites: 
LHSC-UH
LHSC-VH
This Medical Directive Applies to the following patient population: 
Out-Patients
Adults
Order: 
  1. Victoria Hospital (VH) and University Hospital (UH) qualified Registered Nurses (RN) in the Emergency Department (ED) may log-roll appropriate immobilized patients off the transport immobilization board using accepted log-rolling technique and documenting a pre/post log roll assessment including neurological vital signs.
    • Patients for whom diagnostic imaging is anticipated will remain on a slider board.
      • At UH, patient will remain in Cervical Collar and await physician assessment. 
      • At VH, qualified RNs will proceed to the next order of this directive. 
  2. VH Qualified Registered Nurses (RN) in the VH Adult Emergency Department may remove the cervical collar on emergency patients in accordance with the conditions identified in the Canadian Cervical-Spine Rule (CCR) and specified in the CCR Medical Directive (EMG-2011-004).
    • Implementers will evaluate the patient for inclusion and exclusion criteria to determine eligibility for appropriateness of applying the CCR (Canadian Cervical-Spine Rule) using the London Health Sciences Centre (LHSC) checklist Emergency Department Checklist Cervical Spine (C-Spine) - (NS6698) for assessment and documentation. This assessment will include the evaluation of neck tenderness and range of motion, when appropriate- and may require removal of tape and neck restraints as well as temporary loosening of the C-Spine collar – for assessment (NS6698)
    • If the patient is determined to no longer require C-Spine immobilization according to the CCR, then the RN will remove the C-Spine collar and any other neck restraints as per the directive.
  3. VH Qualified Registered Nurses (RN) in the VH Adult Emergency Department may discontinue spinal precautions on appropriate emergency patients who have C-Spine Precautions discontinued in accordance with the conditions identified in the CCR Medical Directive (EMG-2011-004).
  • The nurse will evaluate the patient for inclusion and exclusion criteria to determine eligibility for discontinuing spinal precautions using the CCR Tool.
    • If any abdominal, pelvic or thoracic/lumbar spine pain, patient will remain lying flat. Use slider board if radiological imaging anticipated. If no abdominal/pelvic pain or thoracic/lumbar spine pain, the patient will be assisted to a seated and then standing position; if tolerated, patient will be ambulated to an appropriate assessment area.
Click the link to view the entire medical directive in detail: 

Signatures

SurnameKnown ByDate Signed
AguannoAlainaJul 4 2013 04:11:41:567PM
ArbeauRyanJul 2 2013 10:27:21:683AM
ArntfieldRobertMay 20 2013 08:46:33:893AM
BhimaniMunsifJun 19 2013 06:46:53:857PM
BrineMegganJul 4 2013 08:56:34:630PM
ChurchKaralynJun 18 2013 11:25:42:607PM
CoomeGrantJun 24 2013 09:59:43:640AM
CunninghamChristyJun 17 2013 02:06:07:760PM
DagnoneRobert VicoMay 22 2013 02:28:47:413PM
DavisMatthewMay 22 2013 11:27:44:677AM
DonovanKeithJul 23 2013 08:23:33:323PM
DreyerJonMay 23 2013 12:28:41:437PM
DukelowAdamJun 10 2013 03:01:08:397PM
EdmondsMarciaJun 2 2013 05:54:39:450PM
El-HalabiWaseemMar 6 2016 06:28:16:317PM
ElsadiSalmanAug 18 2013 08:00:07:713PM
FotheringhamMaryApr 6 2015 02:16:47:170PM
FoxcroftLauraMay 22 2013 08:20:30:903PM
FussJeffreyMay 22 2013 11:06:55:950AM
GiffinDawnMay 19 2013 03:17:49:563PM
HamesHeatherMay 24 2013 04:12:20:000PM
HaneyElizabethJun 10 2013 09:59:21:760AM
HassaniBehzadAug 25 2013 01:54:06:770AM
JonesAndrewJun 10 2013 01:02:45:647PM
LewellMichaelMay 27 2013 03:02:42:440PM
LoubaniTarekMay 19 2013 07:09:52:967AM
MacDonaldChristieMay 19 2013 11:59:12:937AM
MalSameerAug 13 2014 12:58:19:380PM
MaxwellH BrentJun 19 2013 08:29:24:907AM
McCauleyWilliamJun 5 2013 01:38:58:180PM
McConnellAllisonMar 13 2019 08:04:40:587PM
McNeilCearaJul 10 2013 07:47:03:317PM
MeiwaldAllisonMay 19 2013 04:58:54:577PM
MillardWandaJun 14 2013 10:43:38:250AM
MosdossyGregoryJun 2 2013 05:28:57:247PM
MurphyDavidMay 30 2013 11:04:19:010AM
MyslikFrankAug 22 2016 11:48:02:970AM
NgVictorMay 20 2013 05:12:53:200PM
OuelletteDavidJun 19 2013 05:13:15:597PM
PeddleMichaelJul 4 2013 03:08:09:620PM
PillonSylviaJul 16 2013 04:44:45:157PM
PriceLauraMay 28 2013 08:03:20:170AM
PringleDerrickJul 30 2013 08:40:14:563PM
ReddyRameshAug 5 2013 02:00:27:873AM
ReganKellyMay 25 2013 04:39:26:543PM
RichardsonChristineAug 14 2013 09:40:56:830PM
RoebothamRoyMay 28 2013 09:54:28:757AM
SedranRobertMay 29 2013 03:03:28:020PM
ShahAmitJun 29 2013 10:26:50:177PM
ShepherdLisaJun 1 2013 07:39:33:877AM
SkoretzTerryJun 19 2013 05:59:54:470AM
TanakaPeterMay 21 2013 09:26:56:500AM
TheakstonKarlJun 21 2013 12:28:22:980PM
ThompsonDrewJun 2 2013 03:59:23:690PM
ValdisLaurenAug 28 2017 01:50:56:040PM
YanJustinJul 18 2014 08:42:59:513AM