Emphasize mechanism of injury crating high index of suspicion for C-spine injury, and high morbidity/mortality associated with C-spine injury

MOI (Mechanism of Injury).  This is a medical term for "how did it happen?".  Some of this is common sense, if the victim's helmet is cracked wide open you should take C-Spine precautions.  The same can be said for a victim that is unconscious (other than drowning), has spinal deformities, or complains about severe head or neck pains.  A head blow with vomiting or unequal pupils is most likely a concussion.  Ask the victim to squeeze both hands, if one is substantially weaker than the other you have the potential for spinal injury.

I hope you never encounter this sort of injury as we are typically unable to properly care for the victim.  In general, we are left with some tough choices.  Triage is the first order of business, can they breath?  If not, carefully rotate the head and body so it is face up paying special attention to maintaining spine and head alignment.  Assign one person to the head only!  This person is the commander and all others take instructions from him.  Move the victim as little as possible to get them to safety.  EMTs use backboards for a very good reason, it is very difficult to safely move persons with C-Spine injuries.  Begin your examination and complete a SOAP form if you have one in your first aid kit.  Make a copy and send a pair of runners to get professional assistance whenever possible.  Do your best to immobilize the patient and make comfortable.

Damage to the top of the spine (C1 & C2) can often lead to death.  The rest of the spinal column, especially the upper part can lead to paralysis: C-Spine Morbidity.  This is why we take our time in these rescues and leave extensive movement to the professionals.

Discuss and demonstrate rotation of an in-water face-down victim to a face up motion using techniques that minimizes spinal motion and ultimately allow an open airway

For a C-Spine injury, it is imperative that the head is immobilized.  A back board (can be a challenge to improvise one) is needed to ensure the head and back stay put while extricating.  Keep the helmet on if possible.  The helmet is easier to hold that the head and lifts the head a bit.  It also makes it easier to secure the head so it doesn't move sideways.  Once the victim is in a safe location, either on shore or perhaps on a mid-stream flat rock - wait for professional help if possible.  They have the special training and certainly the right equipment like a real back board or litter.  Always seek help if possible for these types of injuries - why take chances.  The following EMT video, especially the second half is a great demonstration on the technique and all of the precautions you need to take: C-Spine Immobilization.

One way to flip an unconscious swimmer safely face up are using both his arms to cradle the head and carefully rotate.  The other way is the manually immobilize the head and slowly duck under them.  Administer CPR as soon as possible if necessary, don't wait to get them on shore.  Remember your a team, have someone heading off to get professional help quickly.  Here is a great article with diagrams on handling C-Spine injuries in aquatic environments: Handling C-Spine Injuries.

Here is a video from a Safety & rescue class practicing a C-Spine Rescue: C-Spine Rescue Practice Video.

Maintain in-line c-spine control to the extent possible and bring victim face up

For a C-Spine injury, it is imperative that the head is immobilized. A back board (can be a challenge to improvise one) is needed to ensure the head and back stay put while extricating. Keep the helmet on if possible. The helmet is easier to hold that the head and lifts the head a bit. It also makes it easier to secure the head so it doesn't move sideways. Once the victim is in a safe location, either on shore or perhaps on a mid-stream flat rock - wait for professional help if possible. They have the special training and certainly the right equipment like a real back board or litter. Always seek help if possible for these types of injuries - why take chances. The following EMT video, especially the second half is a great demonstration on the technique and all of the precautions you need to take: C-Spine Immobilization.

One way to flip an unconscious swimmer safely face up are using both his arms to cradle the head and carefully rotate. The other way is the manually immobilize the head and slowly duck under them. Administer CPR as soon as possible if necessary, don't wait to get them on shore. Remember your a team, have someone heading off to get professional help quickly. Here is a great article with diagrams on handling C-Spine injuries in aquatic environments: Handling C-Spine Injuries.

Here is a video from a Safety & rescue class practicing a C-Spine Rescue: C-Spine Rescue Practice Video

Recommended only for unconscious victims where no other option exists

A contact rescue is certainly an option if the victim is unconscious and your boat isn't available fast enough, perhaps you are at lunch when the accident took place. An unconscious swimmer needs extra care to ensure they remain face up and breathing. Unconscious swimmers are certainly at risk for C-Spine injuries which require special handling. Check their helmet and back to look for evidence of severe injuries. If awake, do their extremities work right, any tingling in the extremities? Ask if they took a hard head shot. Go on any intermediate trip these days and you will find that half the boaters have helmets that don't fit right. Many helmets also have very thin padding as well. For these paddlers, a hard head shot is going to cause a concussion (due to roll back) or transfer a great deal of energy to their neck. Be extra careful with head and neck injuries.

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