Packaging Conscious Patients Without Spinal Motion Restriction

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Not every injured or ill worker requires Spinal Motion Restriction (SMR). In many first aid scenarios, the patient is conscious, stable, and doesn’t show signs of spinal injury—but still requires safe and comfortable transport to medical care.

For first aid attendants with a Transportation Endorsement, knowing how to properly package a conscious patient without SMR is just as important as managing spinal injuries. This ensures the patient remains stable, comfortable, and well-monitored throughout transport.

In this guide, we’ll break down:
When SMR is NOT required
Best practices for positioning and packaging conscious patients
Key steps for monitoring and responding to condition changes during transport


When is Spinal Motion Restriction (SMR) Not Required?

Spinal Motion Restriction is primarily used for trauma patients with suspected spinal injuries. However, if a patient meets the following criteria, SMR is likely unnecessary:

🔹 No Significant Mechanism of Injury – The patient did not experience a fall, vehicle accident, or direct impact to the head or spine.
🔹 No Neck or Back Pain – The patient has no complaints of pain in the neck, back, or spine.
🔹 No Neurological Deficits – The patient is not experiencing numbness, tingling, or weakness in their arms or legs.
🔹 Normal Level of Consciousness – The patient is fully alert, oriented, and responsive.
🔹 No Spinal Deformity – There are no visible abnormalities in spinal alignment.

If the above signs are absent, the focus shifts to ensuring patient comfort and stability during transport rather than restricting spinal motion.


Key Principles for Packaging Conscious Patients Without SMR

When transporting a conscious patient without spinal precautions, first aid attendants should prioritize:

Position of Comfort – The patient should be positioned in a way that reduces discomfort (semi-sitting or lying down).
Ease of Monitoring – Ensure quick access to check airway, breathing, and circulation (ABCs) during transport.
Padding & Support – Use adequate padding to prevent pressure sores and provide comfort.
Safe Transport – Secure the patient without restricting movement unnecessarily.
Flexibility – Be prepared to adjust positioning or transport method if the patient’s condition changes.


How to Package a Conscious Patient Without SMR

Step 1: Initial Assessment 🩺

✔️ Perform a scene assessment to ensure the area is safe.
✔️ Introduce yourself and assess consciousness – Ask the patient about symptoms and relevant medical history.
✔️ Determine if an ambulance or emergency response is required.


Step 2: Primary Survey (ABC’s & Critical Interventions) 🚨

✔️ Airway – Ensure the airway is clear.
✔️ Breathing – Check for normal breathing patterns.
✔️ Circulation – Look for signs of shock (cool, pale, clammy skin).
✔️ Rapid Body Survey – Identify major bleeding or hidden injuries.

🚑 If needed, activate emergency response and prepare for transport.


Step 3: Position the Patient for Transport

Depending on their injury or medical condition, the patient should be positioned for maximum comfort and stability:

🔹 Medical Emergencies (e.g., Chest Pain)

✔️ Position the patient in a semi-sitting position to ease breathing.
✔️ If appropriate, provide two 80mg chewable ASA tablets (if not allergic).
✔️ Monitor ABCs every five minutes.

🔹 Non-Trauma Patients (e.g., Seizures, Diabetic Collapse)

✔️ If the patient has recovered from a seizure and does not have a suspected spinal injury, they can be positioned for comfort.
✔️ Use a basket stretcher with padding to ensure support.


Step 4: Secure the Patient for Safe Transport

✔️ Prepare the Stretcher: Line a basket stretcher with padding for comfort and head support.
✔️ Assist the Patient into Position: Carefully guide the patient into their chosen position of comfort.
✔️ Use a Scoop Stretcher if Needed: If the patient is unable to move independently, use a scoop stretcher to transfer them into the basket stretcher before removing it.
✔️ Secure the Patient: Apply stretcher straps to prevent unnecessary movement, while allowing for breathing comfort and ongoing monitoring.


What to Do if the Patient’s Condition Changes During Transport

Even if a patient initially appears stable, their condition can change unexpectedly. Be prepared to respond.

🛑 If the Patient Loses Consciousness
✔️ Stop the vehicle immediately.
✔️ Reassess ABCs – Check airway, breathing, and circulation.
✔️ If the patient is not breathing, begin CPR.

🚑 If Cardiac Arrest Occurs
✔️ Call for emergency medical assistance immediately.
✔️ Start CPR (30:2) and use an AED if available.
✔️ Communicate the updated condition and exact location to emergency services.


Ongoing Care During Transport

Once the patient is inside the Emergency Transport Vehicle (ETV):

✔️ Reassess ABCs immediately and every five minutes.
✔️ Secure Equipment – Ensure all first aid supplies are easily accessible.
✔️ Communicate with the Driver – Confirm the destination and update them on the patient’s status.
✔️ Prepare to Handoff to Medical Care – Be ready to provide a detailed report to paramedics or hospital staff.


Key Takeaways for Transportation Endorsement First Aid Attendants

✔️ Not every patient requires Spinal Motion Restriction (SMR).
✔️ Position of comfort is crucial for conscious, non-SMR patients.
✔️ Always secure the patient safely but allow for easy monitoring.
✔️ Reassess ABCs every five minutes during transport.
✔️ Be prepared to respond if the patient’s condition changes.

By following these best practices, Transportation Endorsement first aid attendants can confidently transport conscious patients safely and comfortably, ensuring the best possible outcome.


Get WorkSafeBC-Certified in Transportation Endorsement!

At Fundamental First Aid in Vancouver, we offer WorkSafeBC-approved Transportation Endorsement courses, teaching:

🚑 Proper patient transport techniques
🚑 Spinal Motion Restriction (SMR) and non-SMR packaging
🚑 Emergency response during transport

👉 Train with us today—book your Vancouver T.E. course and gain the skills needed for safe patient transport!

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