Wilderness Medicine | Focused Spine Assessment

Okay so at this point I think we should
do a focused spine assessment. Should we look at the field guide so that we make
sure we follow all the steps? That sounds great. Page 19: Five steps. So the first thing Charlie,
I want to make sure that I ask you some questions. I may have already asked you some of these questions and then I’m going to do some physical exam tests
and, again, I’ve already done these so I realize I’m repeating them so bear with
me if you will. Okay. What’s your full name? Charles Romeo Manganiello. Roughly what time of day is it? About one o’clock. Where are you? At the Sinks Canyon Center in Lander, Wyoming. And one more time what happened to you? I was climbing the tree and there was some snow up there
and I slipped and fell. Okay, so he is oriented to person, place,
time, and event. Have you had any alcohol today? No. Any drugs? No. Prescriptions? Pain medications?
Anything that might cloud your thinking? Not at all. Okay great. So he’s sober. And we didn’t find any injuries on head
to toe. Is there anything that’s starting to hurt you at this point? No. So he doesn’t appear to be distracted by pain. And he’s calm and engaging in conversation so he’s a reliable patient. Okay next thing Charlie. I want to check your hands and your feet again. Let’s start with your hands. Can you wiggle all your fingers for me? Great. Which finger am I touching? The left pinky. Okay how about over here? The right pinky. Okay, great. Go ahead and give me a squeeze. Hands feel warm to me with a strong radial pulse. That hand feels warm. Also a strong radial pulse. Are your hands warm to you? Yes. Do you have any funny sensations?
Hot and cold flashes, numbness, tingling? Anything that’s not normal for you? No. Lets do the same on your feet. Can you go ahead and just bend your knees
for me so I can see your feet. Okay, go ahead and push down on the gas. Pull up. Okay, wiggle all your toes. Which toe am I pinching? The left pinky toe. Now? The right big toe. Okay. Your feet feel nice and warm to me. Do they feel warm to you? Yes. Okay, same question. Hot and cold
sensations, numbness tingling? Anything out of the ordinary? No. Okay, so I’ve got good circulation, sensation, and
motion in all four extremities. You agree? I agree. Okay, you can tuck your legs back into the bag. I’m gonna take this bag out from under
your legs so we can roll you on your side one more time. Just like we did before we are going to roll you up on your side and I’m going to walk my fingers down your
spine and I want you to tell me if I cause you any discomfort. On my three. One. Two. Three. Starting right back up here. Any pain Charlie? No. Okay, I’m going to reach under these clothes again. Okay. Still your spine? Yup. Any pain? No. Okay, we’ll go back down on your count Travis. One. Two. Three. So Travis and Charlie, what we found on our
assessment is that Charlie is awake and oriented to person, place, time, and event. He’s sober and he’s not distracted so
he’s a reliable patient. Charlie, what I found on my assessment is
that you had good circulation, sensation, and motion in both hands and both feet and when we pressed on your spine from
top to bottom you had no complaints of pain when I did that. So those are all the steps of the focus
spine assessment. At this point it is my recommendation that
Travis can let go of your head and we’ll release spinal stabilization. Travis, are you okay with that? I’m okay with that. Charlie, does that feel okay to you, that we let go of spine stabilization? Yes. Okay Travis, so go ahead and let go of his head. Charlie we can get you into a position that’s more comfortable for you.


  1. This was a truly enlightening and informative video. I am currently two weeks away from receiving my NJ EMT license and certification. (I plan on attending NOLS's WMI this upcoming Spring.) This video was a great encapsulation of a critical part of the initial patient assessment process.

    Thank you

  2. I dont know what protocol is for wilderness EMT's but for me as an OEC technician we can't release stabilization of the neck after we have applied it

  3. Great video. I'm taking the WMI class in Bishop and it's very helpful. Also as a recent grad of USC film school – I'm impressed by the production quality, especially the sound (and cc). Thanks! John

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