REPOSITION AND CHECK PADDING

Non-medical and Medical Responders

Identify casualties who cannot reposition themselves or have difficulty doing so. Reposition the casualty and check padding at least every 2 hours.6 If laying on a harder surface, they may need to be repositioned as frequently as every 1 hour to prevent skin breakdown. To prevent ischemic tissue injury and the formation of pressure sores, frequent movement of the casualty is necessary. Relieving pressure from superficial capillaries allows the skin to recover from the temporary ischemia.7 Some of the most vulnerable areas to pressure include the back of the head, elbows, heels, and sacrum. Casualties who can reposition themselves should be encouraged to do so every 2 hours. If possible, ensure the casualty’s head of bed is elevated to about 30 degrees. This is especially important for unconscious patients, as it helps to reduce the risk of pneumonia.

Unconscious Casualties

- Minimum: Use extra clothing, blankets, and other soft items to pad bony prominences and create a wedge under the casualty, rolling them to one side every 1-2 hours. Use extra blankets to safely raise the casualty’s head 30 degrees.
- Best: Use pillows and wedges to achieve pressure relief and turn the casualty every 1-2 hours. Use a wedge to raise their head 30 degrees.

** Maintain spinal/log roll precautions during reposition if there is concern for spinal injuries, but the patient should still be repositioned carefully despite spinal injury concerns

Guide for changing linen and repositioning

- First, ensure there is enough slack on any lines (IV, foley, etc.) or wires/cords prior to rolling.
- Carefully remove pillows, blankets, or soft items being used for positioning.
- With two personnel, if possible, roll the casualty onto one side (if concerned about spine injury, carefully log roll while maintaining spine stabilization).
- Roll the old linen inward to the middle of the bed (long ways). Place new linen down and tuck under the old linen roll.
- Gently roll casualty in the opposite direction. Pull out the old linen and pull through the new linen.
- Place pillows, blankets, or soft items under casualty for positioning.
- Ensure the casualty’s ankles, knees, and elbows are not resting on top of each other and arms are not resting on the abdomen, by placing padding between them.
- Ensure the casualty’s head and neck are in line with the spine.
- Use additional padding items to relieve pressure from boney prominences. For example, pillows or other soft items can be placed underneath the casualty’s calves to prevent pressure on heels.
- Ensure creases and bumps in clothing, sheets, and blankets are smoothed out under the casualty.
- If any areas of non-blanchable erythema are noted, outline area with marker and prevent placing casualty on the affected area until it recovers or add additional padding if that is not possible.
- Burned and injured extremities should be slightly elevated and slightly flexed to optimize venous return and maintain adequate peripheral pulses.