In all instances where a victim is discovered floating face down within the break zone, they should be considered to have suffered a spinal injury.
Extracting a victim with a suspected spinal injury from shallow water is a two-part process:
Part 1
Extended-arm roll over
Perform an extended-arm roll to turn the victim to a face-up position. The extended-arm roll over technique maintains the victim’s airway while immobilising their head in the neutral position by pinning the victim’s head between their arms. The technique is particularly useful in calm, shallow waters.
First responder (head position/team leader)
- Call/signal for ‘assistance required’.
- Approach the victim from their head and position your body so that it can protect the victim from oncoming waves.
- Grasp the victim’s upper arms.
- Manoeuvre the victim’s arms so they are placed on either side of the victim’s head in alignment with their body. This will stabilise their head in a neutral position.
- Reach under the victim with one arm to grasp the victim’s corresponding arm (e.g., right arm holding right arm) at the level of the ears, holding their arms firmly alongside their head.
- Roll the victim gently onto their back so that they face towards you during the roll.
- Maintain this grip and move forwards (corkscrew), at the same time rolling the victim towards you until they are in a face-up position.
- Determine if the victim is conscious or unconscious:
- unconscious—call out for assistance, such as more lifesavers and a spinal board.
- conscious—reassure the victim by explaining how you are going to extract them from the water.
Second responder (hip position)
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- Support the victim’s hips with both hands.
- Slowly raise the hips in line with the surface of the water.
- Signal for ‘assistance required’ to attract more lifesavers to assist with the spinal board carry.
Note: Alternatively, you can stabilise the victim’s head in water and maintain their airway by using the vice grip roll-over technique when you are in sufficiently deep water to be able to fully submerge underneath the victim.
Vice grip roll over
Follow the below steps to perform a vice grip roll over:
- Adopt vice grip:
- Clasp the back of the victim’s head with one hand and position the forearm so that it is lying against the victim’s spine – take care not to push the head forward
- Grip the victim’s jaw with the other hand and position the forearm down the victim’s chest
- Squeeze the forearms together to create a vice that supports the neck and head.
- Move under the victim and roll the victim into a face up position while maintaining the vice grip and taking care not to raise the victim out of the water; this may cause movement of the spine.
- Move forward to create a corkscrew effect to keep the roll smooth as the victim is turned and you end up on the opposite side of the victim.
- Stabilise the victim on their back and monitor.
Care must be taken to ensure that pressure is not applied to the soft tissue part of the neck and that the victim’s head is not pushed backwards out of the neutral position.
Part 2—Spinal board carry
After stabilising the victim’s head, and while reassuring the victim if conscious, a spinal board (or rescue board if no spinal board is available) can be moved into place under the victim to support their spine and transport them back to shore. SLSA recommends that a minimum of five lifesavers perform this procedure when possible. The lifesaver taking the role of first responder will not grasp the board at any point during the procedure as they continue to stabilise the victim’s head.
Responder with spinal board
- Align the spinal board along the victim’s side opposite the lifesaver who is supporting the victim’s hips (in the hip position).
- Submerge the spinal board under the victim by placing it vertically on its edge before pushing it down strongly into the water.
- Guide the spinal board so that it floats into position under the victim. Other responders except the first responder can assist you with this as they arrive and take their team position.
- Inform the lifesaver supporting the victim’s hips that they can release their hold when the spinal board is in place, so the victim is in contact with the spinal board.
- Without losing contact of the spinal board and while the team leader maintains control of the victim’s head, the extraction team will need to position themselves around the spinal board for best weight distribution, facing the direction they intend to walk as follows:
- victim left shoulder
- victim right shoulder
- victim left knee
- victim right knee.
- Grasp the spinal board beside you using the closest handle.
- Lift the victim simultaneously to a position above water level when instructed by the head position (team leader).
- Walk as a team and at the same slow pace towards the shore while following any further instructions from the head position. The head position always walks forward to avoid tripping and does not turn their body to maintain stabilisation of the victim’s head.
- Continue to walk up the beach beyond the high tide line once at shore.
- Slowly lower the victim while simultaneously dropping to a one-knee position when instructed by the head position.
- Slowly lower the victim while simultaneously dropping to a kneeling position when instructed by the head position.
- Slowly lower the victim simultaneously to the ground when instructed by the head position.
- Lower the victim’s arms so that they are in a more comfortable position and less likely to move. The head position continues to maintain stabilisation of the victim’s head.
- Manage the victim’s airway and provide spinal care.
Responding to waves
The first responder in the head position should always have their back to the surf to protect the victim from oncoming waves. They will instruct at least one responder to alert of oncoming waves and provide warnings and advice on movement. When responding to waves:
- stop and stabilise the victim then brace yourself before a wave or white water hits the rescue team
- where possible, all responders should simultaneously lift the spinal board, so the victim’s head remains out of water
- ensure the victim is secure after any wave before continuing to walk as a team towards the shore when instructed by the head position/team leader.
Note:
- Avoid tripping by not crossing your legs as you carry a victim on a spinal board.
- All responders should keep their backs straight and practise safe manual handling when lifting and lowering a victim using a spinal board (see Manual handling).
- The first responder (head position/team leader) continues to maintain stabilisation of the victim’s head while the victim is lowered to the ground and other responders manage the victim’s airway.
- The first responder may need to be relieved of their head position after the victim is lowered to the ground. This should be done with minimal movement of the victim’s head and neck.
- Team positions may change throughout the process.
