Spinal Motion Restriction (SMR) in Transportation Endorsement

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When a serious injury happens in the workplace, protecting the spine should be a top priority—especially if transporting an injured worker is required. Spinal Motion Restriction (SMR) is a vital skill for first aid attendants with a Transportation Endorsement, ensuring that patients with suspected spinal injuries are properly stabilized before and during transport.

A WorkSafeBC-approved Transportation Endorsement course teaches first aid attendants how to apply SMR safely, minimizing movement and preventing further spinal damage. In this guide, we’ll break down when and how to apply Spinal Motion Restriction, the equipment needed, and the step-by-step process for stabilizing and transporting injured workers safely.


What is Spinal Motion Restriction (SMR)?

Spinal Motion Restriction (SMR) is a technique used to limit movement of the spine in patients who have suffered trauma and are at risk of a spinal cord injury. The goal is to prevent further damage, which could lead to paralysis or other long-term neurological issues.

For first aid attendants with a Transportation Endorsement, knowing how to apply SMR is essential when packaging and transporting injured workers to medical care.


When Should Spinal Motion Restriction Be Applied?

A Transportation Endorsement first aid attendant should apply Spinal Motion Restriction if a patient has experienced trauma and shows any of the following signs:

🔹 High-Risk Mechanism of Injury – Falls from height, motor vehicle accidents, direct blows to the head or spine, or significant force injuries.
🔹 Neck or Back Pain – The patient reports discomfort in their spine or surrounding areas.
🔹 Neurological Symptoms – Numbness, tingling, or weakness in arms or legs.
🔹 Altered Level of Consciousness – Confusion, disorientation, or unresponsiveness.
🔹 Visible Spinal Deformity – A clear misalignment of the spine.

If any of these conditions are present, Spinal Motion Restriction must be applied immediately before transporting the injured worker.


Key Principles of Spinal Motion Restriction

To properly apply SMR, first aid attendants must follow these critical principles:

Manual Stabilization – Before any movement, use both hands to hold the patient’s head and neck in a neutral position.
Neutral Alignment – Keep the head and spine straight—avoid bending the neck forward or backward.
Minimize Movement – Reduce unnecessary movement of the patient’s head, neck, or back.
Use Proper EquipmentRigid hard collars, scoop stretchers, and long spine boards help maintain spinal alignment.
Teamwork & Communication – Applying SMR often requires multiple people—clear communication is essential.
Ongoing Reassessment – Even after securing the patient, continue monitoring their condition and adjust as needed.


Step-by-Step Guide to Applying Spinal Motion Restriction

Step 1: Initial Assessment & Manual Stabilization

🚨 Assess the Scene: Ensure safety before approaching the patient.
👀 Evaluate the Mechanism of Injury: Look for high-risk factors for spinal trauma.
🗣️ Communicate with the Patient: Tell them not to move and explain the process.
Manually Stabilize the Head & Neck: Place both hands on either side of the head, using your elbows or thighs for support.
🤝 Hand Off Stabilization (if needed): If assistance is available, instruct a trained helper to hold the head in place while you prepare equipment.


Step 2: Primary Survey & Critical Interventions

Once the head and neck are stabilized, conduct a Primary Survey to identify life-threatening conditions:

✔️ Airway (A): If the patient is unconscious, use the head-tilt chin-lift to open the airway.
✔️ Breathing (B): Check for normal breathing—look, listen, and feel for 5–10 seconds.
✔️ Circulation (C): Assess shock symptoms and control severe bleeding.
✔️ Critical Interventions: Apply tourniquets, CPR, or major wound care before moving to the next step.


Step 3: Applying a Rigid Hard Collar

🩺 Ensure Neutral Head Positioning – Adjust the patient’s head only if safe.
📏 Measure for the Correct Collar Size – Use the distance between the chin and trapezius muscle to select the proper fit.
📦 Apply the Collar – Slide the back of the collar behind the neck, then secure the front under the chin.


Step 4: Positioning the Patient for Transport

🔹 If the Patient is Face Down (Prone to Supine Spinal Roll)

✔️ One rescuer holds the head and neck.
✔️ Other rescuers position themselves at the patient’s side.
✔️ The patient is rolled as a unit, avoiding twisting.
✔️ Once face-up (supine), ensure neutral spinal alignment.

🔹 If the Patient is Sitting (Sitting to Supine Positioning)

✔️ Slowly lower the patient onto their back while maintaining spinal precautions.
✔️ A second rescuer helps support their weight.


Step 5: Packaging for Safe Transport

Using a Scoop Stretcher

1️⃣ Separate the stretcher into two halves.
2️⃣ Slide each half under the patient.
3️⃣ Reconnect the stretcher and secure with straps.

Using a Long Spine Board

1️⃣ Log roll the patient onto their side.
2️⃣ Check the back for injuries.
3️⃣ Roll them onto the board and secure with straps.
4️⃣ Use padding for comfort.


Step 6: Transfer & Ongoing Care

🚑 Use Safe Lifting Techniques – Carefully move the patient into an Emergency Transport Vehicle (ETV).
👀 Monitor & Reassess ABCs – Check airway, breathing, and circulation every 5 minutes.
📞 Communicate with the Next Level of Care – Provide paramedics or hospital staff with a full report.


Key Takeaways for Transportation Endorsement First Aid Attendants

✔️ Spinal Motion Restriction is a life-saving skill for workplace first aid attendants.
✔️ SMR is required when spinal injury is suspected due to trauma.
✔️ Manual stabilization and proper equipment (hard collar, scoop stretcher, spine board) are essential.
✔️ Clear communication and teamwork make SMR safer and more effective.
✔️ Ongoing assessment ensures the patient remains stable during transport.

By mastering Spinal Motion Restriction, first aid attendants with a Transportation Endorsement can confidently transport injured workers while minimizing spinal injury risks.


Get WorkSafeBC-Certified in Spinal Motion Restriction & Transportation Endorsement!

At Fundamental First Aid in Vancouver, we offer WorkSafeBC Transportation Endorsement courses, including Spinal Motion Restriction training.

🚑 Hands-on practice with real-world scenarios!
🚑 On-site group training for workplaces!
🚑 Essential certification for high-risk job sites!

👉 Book your Transportation Endorsement course today and gain the skills needed to safely transport injured workers!

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