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THE LOG ROLL
EMS professionals should only perform the task of log rolling a patient after gaining an adequate number of personnel to safely do so, and this is largely based on size, weight, and strength of the EMS professionals and the size and weight of the patient.
Log rolls are often performed on patients who have suspected neck and/or back injuries.
► Because of the potential neck and back injuries, at least three EMS professionals are recommended during the log roll maneuver.
The patient should ideally be lying flat on his or her back (supine position), but not all circumstances will present this way.
EMS professionals should always be prepared to improvise while still maintaining the highest levels of patient care and supporting spinal integrity. Remember, rule one in EMS is “do no harm.”
During the log roll,
- the first EMS professional will be positioned on their knees with one knee on either side of the patient's head. The patient may or may not have a cervical collar in place (depending on suspected neck injury and whether or not EMS has already made contact with the patient and performed C-spine immobilization).
- EMS professional number one is responsible for maintaining the integrity of the patient's C-spine during the log roll and will be focused on this important step, but EMS professional number one also gives the command to the other two EMS professionals to roll the patient once the entire team is in position.
- EMS professional number one should place one hand on either side of the patient's head and gently but firmly hold it in place, maintaining manual in-line spinal immobilization. If the patient does not yet have a cervical collar in place and the patient has a suspected neck injury, it is at this time that
- EMS professional number two should apply the cervical collar and assess the patient for other injury using the rapid trauma examination.
- After application of the cervical collar and rapid trauma examination assessment (if it is necessary), EMS professional number two will position himself/herself on their knees at one side of the patient's torso.
- EMS professional number three will position himself/herself on their knees at the legs of the patient, on the same side of the patient as EMS professional number one.
If the patient also has a leg, hip, arm, shoulder, or torso injury found during the rapid trauma exam assessment that affects one side of their body and not the other (known as a unilateral injury), the EMS professionals should position themselves on the opposite side of said injury or injuries. (If the patient has injuries on opposite sides of the body, assessment findings and pathophysiology as well as provider judgment will be used to determine which injury is worse or more painful, and EMS professionals number two and three will position themselves on the opposite side of said injury.)
- The side of the patient that is closest to EMS professionals two and three will be the side of the patient that the patient is log rolled upon, and so to prevent further injury or severe pain, EMS professionals should not log roll the patient onto an injury, or at least not the worst of the injuries present.
Once EMS professionals numbers two and three are in position, and if for example, EMS professionals number two and three have decided to position themselves on the patient's left side, EMS professional number two places his/her right hand across the patient on the patient's opposite-side shoulder, palm down. The left hand of EMS provider two will be placed on the patient's opposite-side buttocks, palm down.
- EMS professional number three places his/her right hand on the same side of the patient that EMS professional number two has, on the patient's lower back/flank, creating an “X” made by the crossing of the two EMS professionals arms, at the patient's midsection and allowing for greater control during the log roll.
- EMS professional number three places his/her left hand on the same side of the patient as all the other hands, at the patient's knee, palm down.
Both EMS professional two and EMS professional three should maintain proper body mechanics, keeping their back straight and head up.
- EMS professionals number two and number three should communicate to EMS professional number one that they are in position and ready to log roll, that is, once they are in fact in the correct position and ready.
- EMS provider one should explain to a conscious and alert patient what the maneuver will consist of when possible.
- When everyone is in position (EMS professional number one maintaining manual in-line stabilization of the patient's cervical spine, and EMS professionals numbers two and three at the patient's least-injured side and positioned with the correct hand-placement), EMS professional number one will give the order to roll the patient on his/her count of three. EMS professional number one will always count aloud “one, two, three.”
On “three,” EMS professionals two and three will roll the patient as a team toward themselves, while EMS professional number one maintains in-line cervical integrity by turning the patient's head to the same side that the patient is rolling toward and thereby preventing the patient's head from moving upon any axis.
The team will roll until the patient is as close to on their least-injured side as possible.
This roll will be smooth and controlled, and creates two positions to be aware of: the low side of the patient is now the side that is touching the ground or the side that the patient is rolled upon (the least-injured side); the high side of the patient is now the side of the patient that is off the ground and that EMS professionals two and three have their hands placed on.
- Once the patient is on his or her side, EMS professional number two should perform a spinal assessment with the hand closest to the patient's head, to identify any other spinal injury, if necessary.
- After this assessment, a long spine board, rolled sheet, bariatric movement device, or other patient movement device can be placed behind the patient, correct-side up and as close to the patient's low side as possible.
Once the device is in place, EMS professional number one will communicate to EMS professional number two and EMS professional number three that the team will roll the patient back into the flat-on-back position (supine), on the count of three.
- EMS professional number one will count aloud “one, two, three.” On “three,” EMS professionals two and three will roll the patient as a team, away from themselves, while EMS professional number one maintains in-line cervical integrity by turning the patient's head to the same side that the patient is rolling toward, and preventing the patient's head from moving upon any axis.
The team will roll the patient, smoothly and in a controlled manner until the patient is flat on the device that the team placed prior to the return roll. EMS professional number one will continue holding manual in-line stabilization of the patient's cervical spine.
The patient has now been successfully and safely log rolled, and can be repositioned, further treated, or secured for movement.
NOTE: The above steps 1-15 or not to be memorized as their individual steps. (No one will ask you what numbered step in the log roll involves the spine board, for example. No one will ask, "Which step is Step #6?") The steps are numbered only to demonstrate the sequence. Any number of numbering schemes could have been used.