Spinal Immobilization (Supine Patient)
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Candidate:
EMT student ID's are usually in this format: 123456FT-01. For refresher or skills only, place "CE" in this field.
Examiner:
Military Time Only (example: 1523)

Skills Section

Action

Points Possible

Points Awarded

Takes or verbalizes appropriate PPE precautions

1

Directs assistant to place/maintain head in the neutral, in-line position

1

Directs assistant to maintain manual stabilization of the head

1

Reassesses motor, sensory and circulatory function in each extremity

1

Applies appropriately sized extrication collar

1

Positions the immobilization device appropriately

1

Directs movement of the patient onto the device without compromising the integrity of the spine

1

Applies padding to void between the torso and the device as necessary

1

Immobilizes the patient’s torso to the device

1

Evaluates and pads behind the patient’s head as necessary

1

Immobilizes the patient’s head to the device

1

Secures the patient’s legs to the device

1

Secures the patient’s arms to the device

1

Reassesses motor, sensory and circulatory function in each extremity

1

Military Time Only (example: 1523)

Critical Criteria Section

Critical Criteria

Administrative Section

Clear Signature