Immobilisation

PRINCIPLES OF IMMOBILISATION

• Prioritise life-threatening problems before immobilisation.
• Use MILS when cervical spine injury is suspected.
• Choose the device by suspected injury, player condition, environment and extraction plan.
• Minimise unnecessary movement during assessment, transfer and extrication.
• Explain the procedure to the player; coordinate all movement with one clear leader.
• Assess distal circulation, sensation and movement before and after limb immobilisation.
• Reassess ABC and neurological status after immobilisation and after every transfer.

ASSESS → STABILISE → IMMOBILISE → SECURE → REASSESS

CERVICAL COLLAR

Restricts excessive cervical movement when the spine cannot be clinically cleared — midline tenderness, neurological deficit, altered mental status, intoxication or distracting injury.

1. Maintain MILS throughout.
2. Assess the neck and select the correct size.
3. Prepare the collar before application.
4. Position the posterior section; support the chin in the chin piece.
5. Secure firmly without excessive tightening.
6. Check the collar does not compromise airway or breathing.
7. Continue spinal motion restriction; reassess neurological status.

MILS → ASSESS → SIZE → APPLY → SECURE → REASSESS

FIFA sizing

Neutral head: line from the chin back to the sternomastoid; measure fingerbreadths down to trapezius. Between two sizes → start SMALLER (too big extends the neck).

FIFA contraindication

Airway obstruction — keep MILS instead until the airway is dealt with.

FIFA reminder

A collar alone does not immobilise: keep MILS until blocks, tape and a device are on. Recheck the player after fitting. Follow local guidance — some countries no longer use collars.

HEAD IMMOBILISER

Lateral head support during spinal motion restriction and transport, used with an appropriate transfer device.

1. Maintain manual head stabilisation until fully secured.
2. Neutral position unless movement causes pain, resistance or neurological symptoms.
3. Place the lateral blocks evenly.
4. Secure forehead and chin straps per device design.
5. Keep access to the airway and ears.
6. Reassess airway and neurological status.

MANUAL CONTROL → BLOCKS → STRAPS → AIRWAY CHECK → REASSESS

SPINAL BOARD & SPIDER STRAP

Rigid surface for controlled extrication or transfer; spider straps secure the torso, pelvis and lower limbs.

1. The team leader coordinates; maintain spinal alignment.
2. Position the player centrally.
3. Secure torso and pelvis before the head, then the legs.
4. Straps snug enough to control movement without impairing breathing or circulation.
5. Secure the head last while manual stabilisation is maintained.
6. Reassess ABC and neurological status.

BODY FIRST → LEGS → HEAD LAST → REASSESS

A scoop moves a trauma player only about 15°, compared with a 90° log roll. For cardiac arrest a rigid long board may give better compressions. A basket makes carrying a scoop or board safer.

1. FIFA extrication order (suspected neck injury): size and fit the collar — check the mouth can still open.
2. Move the player onto the scoop or spine board — Orange leads.
3. Apply straps — the first, centre strap lined up with the sternum.
4. Apply head blocks and fix them to the board, then tape.
5. Only now can MILS be released.
6. Slide the basket under the scoop and extricate with 6 people if possible.

LOG ROLL (FIFA SKILL ZONE)

Head

MILS. Controls the move: explains the signal and says how far (90° log roll vs 15–20° tilt for a scoop).

Chest

One hand on the player's far shoulder, one on the hip.

Pelvis

One hand on the waist, the other under the knee.

Legs

One hand under the lower leg, the other under the ankle.

Fifth person

Places the board / device.

Use for suspected spinal injury, reduced GCS with possible head / neck injury, extrication, or a vomiting player needing spinal precautions.

SCOOP STRETCHER

Lifting and transfer with reduced rolling — useful to move an injured player from the pitch to another transport device.

1. Set up below the feet (FIFA): basket in line with the player, 2–3 basket lengths from the feet; scoop out of the basket, extended and split, laid between the feet and the basket.
2. Adjust length to the player.
3. Separate the two halves.
4. Position each half alongside with minimal movement.
5. Connect head and foot ends securely.
6. Check all locks before lifting.
7. Enough rescuers; lift on the team leader's command.
8. Reassess after transfer.

SIZE → SPLIT → POSITION → LOCK → CHECK → LIFT

BASKET STRETCHER

Protected carrying platform for difficult terrain or longer manual carries — stairs, slopes or poor pitch access.

1. Set up below the feet (FIFA): basket in line with the player, 2–3 basket lengths from the feet, scoop or board laid out between them.
2. Transfer the player into the basket with an appropriate technique / device.
3. Position centrally.
4. Secure torso, pelvis and legs.
5. Check straps and handles before movement.
6. Adequate personnel and coordinated commands.
7. Monitor the player continuously.

TRANSFER → CENTRE → SECURE → CHECK → CARRY → MONITOR

LIMB SPLINTS

1. Expose and inspect the injured limb where appropriate.
2. Control significant bleeding before splinting.
3. Check distal circulation, sensation and movement (CSM).
4. Immobilise the joints above and below the suspected fracture when practical.
5. Pad voids and bony prominences.
6. Secure without excessive pressure.
7. Recheck CSM.

CSM BEFORE → SPLINT → SECURE → CSM AFTER

EXTREMITY FRACTURE (FIFA PROTOCOL)

Any extremity fracture is a distracting injury — always do the full primary survey (A–E) and clear or protect the cervical spine first.

1. Stabilise the limb: one hand above and one below the fracture.
2. Inspect: swelling, deformity, bruising, wound. Feel: tenderness, crepitus, pulses and sensation. Active, then passive movement.
3. Analgesia — FIFA suggests inhaled methoxyflurane where available.
4. Wounds: clean thoroughly, cover with saline-soaked swabs and dress.
5. Apply the splint, then recheck circulation and neurology.
6. Open fracture (a wound over or near the break): refer to hospital; early antibiotics are advisable.
7. Extricate — or, if there is no neck injury and the player can help, assist them into the basket stretcher.

ARM SLING

1. Support the injured arm while applying.
2. Forearm comfortably across the chest.
3. Sling under the forearm, secured around the neck.
4. Keep the hand visible for circulation checks.
5. Reassess CSM.

SUPPORT → SLING → SECURE → CSM CHECK

T-SHIRT ARM SLING (IMPROVISED)

1. Use when no conventional sling is available or rapid pitchside support is needed.
2. Support the arm against the torso.
3. Use the lower part of the player's shirt to support the forearm.
4. Secure without restricting breathing or circulation.
5. Avoid manipulating a suspected fracture or dislocation.
6. Reassess CSM.

SUPPORT → FOLD / SECURE → COMFORT → CSM CHECK

PITCHSIDE SCENARIOS

COMMON MISTAKES TO AVOID

• Applying equipment before an appropriate primary assessment.
• Releasing MILS too early.
• Incorrect collar sizing.
• Uncoordinated lifting without a clear leader.
• Straps too loose or too tight.
• Moving a suspected fracture to get a 'normal' position.
• Not checking CSM before and after splinting.
• Not reassessing ABC and neurology after immobilisation or transfer.

Device-specific manufacturer instructions and your local clinical protocol take precedence where applicable.