Wilderness Medical Society snowmass 2005 Page 189
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entire body angled upward approximately 30% (reverse trendelenberg position) to
decrease the chance of aspiration and to decrease ICP.
While all persons with a mechanism of injury that includes head involvement are
strapped to a backboard in an urban setting, this is not necessary if the patient assessment
does not indicate that evacuation is required. When evacuation is initiated, reassessment
of the requirement for neck or spine immobilization should be made periodically. If the
spine can be cleared, the rigid immobilization should be terminated, even through the
evacuation process is continued.
IV. CONTROVERSIES
A. Does any loss of consciousness following a blow to the head warrant evacuation of the
patient? If the patient has been unconscious for only a brief period of time and/or with no
obvious evidence of brain injury (see above), the patient may be left in the wilderness and
carefully monitored for 24 hours.
B. What is meant by "a brief period of time" in relation to unconsciousness? Seldom, if
ever, is a period of unconsciousness accurately timed. The patient and/or witnesses are
often unsure unconsciousness occurred. If a rescuer has been unable to get a response
from a patient after aggressive stimulation, it may be assumed the patient has been
unconscious for more than a brief period of time. Many authorities feel that a loss of
consciousness for less than 30 seconds qualifies as a brief period of time, but consensus
has not been reached on this topic.
