Spinal injuries at swimming pool

[chris_b]

Hi Everyone,
Looking for a bit of help.

The pool that our club uses want us to show the life guards basics on how to rescue a kayaker during a pool session. Obviously there are basic things like simply pulling the boat upright or popping the deck if a kayaker is trapped or unconscious.

One thing they have asked is how would we deal with a spinal injury? I realise it's very unlikely to happen just wondered if there is a textbook method for this?
Would you simply pull the boat back upright and risk putting torque on the spine or would you pop their deck and pull them clear of the boat again risking strain on the spine.
It would probably depend on the state of the kayaker (upright / unconscious etc). I was assuming worst case scenario upsidedown unconscious kayaker with spinal injury.

Thanks
Chris

[Adrian Cooper]

How would you diagnose (or even suspect) the spinal injury if all you could see was an upturned boat with someone in it?

[W5RAY]

The method that I know of (& I wait to be corrected) is to sink the boat whilst supporting the paddler and then float the paddler out of the boat and straight onto the body board. They can then be strapped into position prior to lifting them and the body board out of the pool!

Ray

[Ieuan Belshaw]

How would you diagnose (or even suspect) the spinal injury if all you could see was an upturned boat with someone in it?

Maybe this will do your back in...

[Tom_Laws]

How would you diagnose (or even suspect) the spinal injury if all you could see was an upturned boat with someone in it?

Give it 5 minutes you won't have to worry about spinal injuries... Your priority is first of all to get them breathing, and your first instinct is going to be to help right the boat. Once they are upright, I like the idea of sinking the boat and floating them onto the back board, with lots of support at all times. Sounds daft but also float the boat to the shallow end... will make everything else much easier!

[chris_b]

How would you diagnose (or even suspect) the spinal injury if all you could see was an upturned boat with someone in it?

Yeh I agree its a bit extreme but just need an answer for them when I am asked about it. We play polo sometimes so I guess there is a risk of being smacked by falling goals or scafolding etc.

Thanks very much for that Ray and Tom, they sound like decent ideas.

[W5RAY]

No probs Chris!

And as Tom say's if they are upside down and even unconscious, being able to breathe is the most important thing, so get them upright first!

Out on the river spinal injuries would normally be related to running drops and landing flat either on rocks or in non aerated water (like landing on concrete that is)!

The most we have ever had to deal with in a pool is a minor cut to the head!

Ray

[garya]

Getting them breathing is the most imortant thing.

For extraction I would go with sinking the boat and floating them out. Think aout how many people you would need and there positions and jobs, would you need to defltae or puncture the air bags in the boat to assist a controlled sinking ? How wold you support or float them to the shallow end ?

Using a KED if the pool have it rather the full spinal board may make it easier to imobalise the person in the seat prior to sinking the boat.

I would recommend Dave Hepworth who runs extreme care if you need to run any specific traing sessions or for professional on this advice.

http://www.extremecare.co.uk/

Gary A

[Jim]

How would you diagnose (or even suspect) the spinal injury if all you could see was an upturned boat with someone in it?

I agree, if they are unconscious and assuming you didn't see what lead up to the situation, there is absolutely no reason to suspect spinal injury - the unconscious person sure as hell won't be telling you their back hurts.

If you really need proper guidelines for this, contact your local ambulance service, they can probably arrange to develop specific training to cover the scenario.

[Tom_Laws]

I would recommend Dave Hepworth who runs extreme care if you need to run any specific traing sessions or for professional on this advice.

I'd rather not see Dave in his Speedos...

As for moving them to the shallow end, how about in their boat?!

[Randy Fandango]

Lordy -- I kind of hope none of you are around if I hurt my back in a boat in a pool! :-)
I would make sure they were breathing (so basically upright) then move them in their boat gently to the pool side, support them in place and them hold them there and wait for the cavalry to arrive.
I personally wouldn't want anyone without proper appropriate training trying their luck at removing me from a boat if I genuinely had a spinal injury and was in no particular danger of hypothermia until those trained at extricating people from dubious positions (paramedics/firefighters) were on hand to take over/give direction.
Giles

[Bards]

Lordy -- I kind of hope none of you are around if I hurt my back in a boat in a pool! :-)
I would make sure they were breathing (so basically upright) then move them in their boat gently to the pool side, support them in place and them hold them there and wait for the cavalry to arrive.
I personally wouldn't want anyone without proper appropriate training trying their luck at removing me from a boat if I genuinely had a spinal injury and was in no particular danger of hypothermia until those trained at extricating people from dubious positions (paramedics/firefighters) were on hand to take over/give direction.
Giles

Word up! Some reasonable thoughts prior to Giles'... BUT indeed the only reason I could see for removal from boat in a swimming pool situation rather than just providing ongoing support whilst awaiting qualified medics (once the casualty is upright) would be if it was necessary to give CPR, in which case it's hard to see how a spinal injury could be identified anyhow, as already mentioned above...
If CPR is called for, then IMO all fears of lawsuits/tricky spinal complications need to be put to one side, as unless oxygen is getting to important areas ASAP, starting with rapid chest compressions, it's likely to be sadly immaterial...

It's a bit worrying if the pool doesn't realise this; are you sure you've been speaking to the right person at the pool? If so, then they seem to be lacking in some vital areas....

Bards

[Randy Fandango]

I thought I'd ask a London firefighter who by total coincidence I've just spent the day teaching kayaking with what she thought might be best in this scenario.
She suggested that if there was genuinely a risk of spinal damage then probably once the fire service had arrived they'd probably use some sort of inflatable platform thingy to go underneath and then stabilise the kayak before gently lifting the boat with paddler in it up onto the side and away from the pool, then gently cut the boat off of the paddler.
She also suggested they might take the roof off of the pool in order to make crane access easier but I think she might have been joking there....
Giles

[TheKrikkitWars]

Lordy -- I kind of hope none of you are around if I hurt my back in a boat in a pool! :-)
I would make sure they were breathing (so basically upright) then move them in their boat gently to the pool side, support them in place and them hold them there and wait for the cavalry to arrive.
I personally wouldn't want anyone without proper appropriate training trying their luck at removing me from a boat if I genuinely had a spinal injury and was in no particular danger of hypothermia until those trained at extricating people from dubious positions (paramedics/firefighters) were on hand to take over/give direction.
Giles

I'm with you there Giles... Spinal Injuries are not the situation to be a have-a-go-hero, not even if you've had training... Leave it to the people who have experience and regular practice* if at all practicable...

*You wouldn't let a long since retired GP give you a lumbar puncture would you?

[twopigs]

.... but just need an answer for them when I am asked about it. We play polo sometimes so I guess there is a risk of being smacked by falling goals or scafolding etc.

Or is it that they think you might suffer a spinal injury if hit by a boat in the lower torso? Maybe their spinal injury is coupled with whimpers of pain rather than being upside down and unconscious?

I'll go with Giles suggestion - take them in boat to shallow end and support until the experts arrive and remove the roof....

[eeonz]

Leave it to the people who have experience and regular practice*

On a REC course recently I asked the trainer how often they have to give CPR. "Oh, not often. Couple of times a week?"... Christ.

[peakfreak]

The BCU Aquatic First Aid teaches the boat sinking method. Whilst any situation does need to be assessed very carefully before carrying out any process, a trauma technician that instructed on my recent FA course did say that in most cases of kayakers injured in water based environments, then the kayakers would be looked upon as the experts so would be called upon to at least assist/advise in a rescue. The thread is on here somewhere.
Also taught, but mainly in the river environment, is a method to splint the spine with splits and then lift the casualty out in thier boat and await rescue services, ensuring the casulaty is kept safe and avoid the situation worsening.
It all depends on how serious the situation is, if it is life threatening, then more imediate action would be required, if not then many hands (and more specialist equipment will make light work.

[GaryM]

As has already been said, get victim to place of safety, and await arrival of specialists. If they know it's a spinal injury, they may well have their own "tame" expert in tow.
If you decide otherwise, then be sure you have good insurance cover, and have read the small print re "Good Samaritan" acts, and find a good barrister.

*You wouldn't let a long since retired GP give you a lumbar puncture would you?

Actually, Yes I would, many of these worked as clinical assistants in anaesthetics/paediatrics and would be very familiar with this procedure, and if they felt otherwise, would have enough sense to leave it to someone else. Now if you had said FY1 doctor first morning in hospital, then I would totally agree.

[john smith]

This is another one of those famous first aid questions that can't really be answered.

If their head is under the water then get it above as gently as possible, how you do it doesn't matter as long as you do it.

Then, if you need to carry out life saving intervention just do it and don't worry.

If you don't, leave them there and wait for more qualified help. That way it ceases to be your problem.

When teaching first aid I spend more time trying to help people relax and realise that actually it really is a very simple process (ie first aid) than I do actually teaching how to do it.

Use your common sense and 99.9999999% of the time it will be spot on.

[otherted]

Chris

We had to do this for our local pool as part of the risk assessment. We went with the boat sinking method for extraction, just don't forget to undo any back rests and suicide straps before trying to pull the "victim" out of a boat.I was the "casualty" when they tested the theory and nearly lost my kneecaps a few times.

[KrisH]

I thought I'd ask a London firefighter who by total coincidence I've just spent the day teaching kayaking with what she thought might be best in this scenario.
She also suggested they might take the roof off of the pool in order to make crane access easier but I think she might have been joking there....
Giles

Given the chance, Firefighters will cut the roof off anything !!!

on a serious note it sounds like a good course of action to me ....

[jamaitch]

Being a lifeguard I agree with the sinking boat idea, obviously head above water first, people with spinal injuries aren't necessarily unconscious though!

Some said further up that if you hadnt seen the incident then there was no reason to treat it as a possible spinal injury, lifeguards are trained for the complete opposite if you didnt see it then you assume it is a spinal until you find out otherwise

Randy Fandango wrote:
I thought I'd ask a London firefighter who by total coincidence I've just spent the day teaching kayaking with what she thought might be best in this scenario.
She also suggested they might take the roof off of the pool in order to make crane access easier but I think she might have been joking there....
Giles

The pool I work at has a slide with suspended tubs which if a very fat person were to have a spinal on, then the firebrigade would be called to chop the slide to bits in order to get the person out

[kippers711]

"stabilise the kayak before gently lifting the boat with paddler in it up onto the side and away from the pool, then gently cut the boat off of the paddler.",
remind me not to take my kayak to pool training anymore :-o

[jmmoxon]

Some said further up that if you hadnt seen the incident then there was no reason to treat it as a possible spinal injury, lifeguards are trained for the complete opposite if you didnt see it then you assume it is a spinal until you find out otherwise

Lifeguards are trained to assume that because unconscious swimmers have probably dived in & hit the bottom, this is unlikely in a kayak, unless they have gone in off a diving board. In fact, I'm not aware of any spinal injury (even waterfall related) where the paddler didn't get themselves out of the kayak - most of them with long, rough trips to hospital afterwards! If you have reason to suspect a back injury then it is probably better to get them out of the kayak whilst upside down (just pulling the deck should achieve this if they are unconscious, if not they will be trying to roll or get out themselves!), if you don't know what happened then it may be better to re-right them quickly if they haven't been under for long, although it is almost impossible to do mouth to mouth with someone in their boat...