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The EMT student should understand how to manage trauma-related issues of the head and spine. The student will learn how to recognize life threats associated with these injuries as well as the need for immediate spinal stabilization and, potentially, airway and breathing support.  We will discuss the anatomy and physiology of the nervous system and the pathophysiology, assessment, and management of traumatic brain and spinal cord injuries. We will also discuss traumatic brain injury (TBI), including initial mechanism of injury, and primary (direct) versus secondary (indirect) injury. Transport considerations are discussed with a focus on potential deterioration. Last we will discuss helmet removal.

Knowledge Domains: The EMT student should know the anatomy and physiology of the nervous system, including its divisions into the central nervous system (CNS) and peripheral nervous system (PNS), and the structures and functions of each. You should know the functions of both the somatic and autonomic nervous systems. You must know the major bones of the skull and spinal column and their related structures; include their functions as they relate to the nervous system. You need to explain the different types of head injuries, their potential mechanism of injury (MOI), and general signs and symptoms of a head injury that the EMT should consider when performing a patient assessment. You should know what traumatic brain injury (TBI) is.

The EMT should know the difference between a primary (direct) injury and a secondary (indirect) injury; include examples of possible MOIs that may cause each one. You should know the different types of brain injuries and their corresponding signs and symptoms, including increased intracranial pressure (ICP), concussion, contusion, and injuries caused by medical conditions. You should be able to describe the different types of injuries that may damage the cervical, thoracic, or lumbar spine; include examples of possible MOIs that may cause each one.

The EMT must explain the steps in the patient assessment process for a person who has a suspected head or spine injury, including specific variations that may be required as related to the type of injury as well as list the mechanisms of injury that cause a high index of suspicion for the possibility of a head or spinal injury. The EMT must know the medical care of a patient with a head injury; include the three general principles designed to protect and maintain the critical functions of the CNS and ways to determine if the patient has a traumatic brain injury. You should also know the medical care of a patient with a spinal injury; include the implications of not properly caring for patients with injuries of this nature, the steps for performing manual in-line stabilization, implications for sizing and using a cervical spine immobilization device, and key symptoms that contraindicate in-line stabilization.

The EMT should be able to explain the process of preparing patients who have suspected head or spinal injuries for transport; include the use and functions of a long backboard, short backboard, and other short spinal extrication devices to immobilize the patient’s cervical and thoracic spine. Last the EMT should know the different circumstances in which a helmet should be left on or taken off a patient with a possible head or spinal injury and the steps to follow to remove a helmet, including the alternate method for removing a football helmet.