Spinal Log Roll Guide
Below is a guide to the procedure of log rolling a trauma patient with a potential or actual spinal injury.
The objective of the log roll procedure is to maintain correct anatomical alignment in order to prevent the possibility of further, catastrophic neurologic injury and the prevention of pressure sores.
The log rolling procedure is implemented at various stages of the trauma patient's management including:
- as part of the primary and secondary survey to examine the patient's back
- as part of a bed to bed transfer (such as in radiology)
- to apply cervical collar care or pressure area care
- to facilitate chest physiotherapy etc.
At least four staff members will be required to assist in the log roll procedure as outlined below:
- 1 staff member to hold the patient's head
- 2 staff members to support the chest, abdomen and lower limbs. An additional staff member may be also required when log rolling trauma patients who are obese, tall, or have lower limb injuries.
- 1 staff member to perform the required procedure (ie. assessment of the patient's back)
The steps in the spinal log roll procedure are as follows:
1. Explain the procedure to the patient regardless of conscious state and ask the patient to lie still and to refrain from assisting. . Ensure that the collar is well fitting prior to commencement.
2. If applicable, ensure that devices such as indwelling catheters, intercostal catheters, ventilator tubing etc. are repositioned to prevent overextension and possible dislodgement during repositioning.
3. If the patient is intubated or has a tracheostomy tube, airway suctioning prior to log rolling is suggested, to prevent coughing which may cause possible anatomical malalignment during the log rolling procedure.
4. The bed must be positioned at a suitable height for the head holder and assistants.
5. The patient must be supine and anatomically aligned prior to commencement of log rolling procedure.
6. The patient’s proximal arm must be adducted slightly to avoid rolling onto monitoring devices eg. arterial or peripheral intravenous lines. The patient’s distal arm should be extended in alignment with the thorax and abdomen (Fig 1), or bent over the patient’s chest if appropriate ie. if the arm is uninjured. A pillow should be placed between the patient’s legs.
7. Assistant 1, the assistant supporting the patient’s upper body, places one hand over the patient’s shoulder to support the posterior chest area, and the other hand around the patient’s hips (Fig 1).
8. Assistant 2, the assistant supporting the patient’s abdomen and lower limbs, overlaps with assistant 1 to place one hand under the patient’s back, and the other hand over the patient’s thighs (Fig 1).
Figure 1:
9. On direction from the head holder, the patient is turned in anatomical alignment in one smooth action (Fig 2).
Figure 2: (Note: spinal alignment as indicated by black line)
10. On completion of the planned activity, the head holder will direct the assistants to either return the patient to the supine position or to support the patient in a lateral position with wedge pillows. The patient must be left in correct anatomical alignment at all times.
Reference:
Ackland, HM. The Alfred Spinal Clearance Management Protocol. 2006. The Alfred Hospital, Melbourne, Australia.
Adapted with permission from the author.
Also in this section:
» Candian C-Spine Rule - Decision Instrument» Early Acute Management in Adults with Spinal Cord Injury (USA)
» EAST Spinal Injury Trauma Practice Guideline (USA)
» NEXUS I - Decision Instrument (USA)
» NSW Methylprednisolone Protocol
» The Alfred Spinal Clearance Management Protocol