The log roll is a coordinated maneuver used in emergency and clinical settings to safely move an injured person while maintaining a straight, neutral alignment of the spine. This technique restricts independent movement of the head, neck, and torso, which is paramount when a spinal injury is suspected. The primary goal is to prevent secondary injury to the spinal cord resulting from movement of an unstable vertebral segment.
Recognizing When Log Rolling is Necessary
The decision to perform a log roll is driven by the need for spinal protection, often indicated by the mechanism of injury or the patient’s condition. Log rolling should be used for any trauma patient with a high suspicion of an unstable spinal injury, especially if the patient is unconscious or unable to provide a reliable assessment of pain or sensation.
The technique is frequently performed to facilitate assessment of the patient’s posterior surface, such as examining the back or placing the patient onto a rigid transfer device like a backboard. Even if the cervical spine (neck) is cleared, a log roll is required to protect the thoracic (mid-back) and lumbar (lower back) sections.
The procedure is also used for essential care, such as pressure relief or changing linens, without compromising spinal alignment. While standard for spinal immobilization, caution is needed in cases of severe pelvic trauma, as the rotational force could cause further harm. The overriding principle is to treat any potential spinal injury as confirmed until medical imaging proves otherwise.
Necessary Personnel and Role Assignment
The log roll is a coordinated team effort that requires a minimum of four trained individuals to be performed safely and effectively. Each member has a distinct role to ensure the body moves as a single, rigid unit, much like a log.
The most important role is the Leader, positioned at the patient’s head, who maintains continuous Manual Inline Stabilization (MIS) of the head and neck. This individual controls the cervical spine and serves as the verbal initiator for all movement, giving the final command to begin and end the roll.
The remaining personnel, typically two or three individuals, are positioned on the side toward which the roll will occur. These Helpers manage the torso and extremities, placing their hands across the patient’s body to control the shoulder, chest, hips, and legs.
The hands of the Helpers overlap on the patient’s far side, providing a single, strong column of support that prevents differential movement between body segments. A fourth person, if available, may be tasked with managing equipment, such as sliding the backboard beneath the patient or performing the quick assessment of the back.
Executing the Log Roll: A Step-by-Step Guide
Proper execution begins with preparation: informing the patient, applying a semi-rigid cervical collar if possible, and ensuring proper anatomical alignment. The team positions themselves on the side toward the roll, with the Leader ensuring all members are ready and understand the direction of movement.
The patient’s arms should be positioned across their chest, often by having them “give themselves a hug,” to keep them out of the way. A pillow or rolled towel should be placed between the patient’s knees to help maintain lower extremity alignment throughout the rotation.
The Helpers position their hands, typically overlapping to create continuous support. The Leader, maintaining firm control of the head, gives a clear, verbal command—such as “on three, one, two, three, roll”—to synchronize the team’s movement.
On the command, the team simultaneously rolls the patient toward them, rotating the body as a single unit (30 to 90 degrees). This movement prevents twisting or bending of the spinal column. While the patient is on their side, the team performs a rapid assessment of the back or quickly places the rigid backboard.
Once the backboard is in place and angled against the patient’s body, the Leader gives a second command to roll the patient back to the supine position onto the board. This step must be equally synchronized and controlled, ensuring the patient is centered on the board before removing hands.
Post-Roll Stabilization and Transfer
After the log roll, when the patient is supine on the backboard, the focus shifts to comprehensive immobilization for safe transfer. The first step involves securing the torso and lower body to the backboard using straps across the chest, hips, and legs.
The most important stabilization step is the final securing of the head, which must remain in a neutral, in-line position. Specialized head immobilization devices, such as foam blocks or firm rolls, are placed on either side of the head, and straps or tape secure the forehead and chin to the backboard.
This multi-point fixation prevents any lateral flexion, rotation, or hyperextension of the head and neck during transport. After full immobilization, the team must continuously monitor the patient’s circulation and neurological status, checking for signs of distress or numbness, as the pressure from the rigid board and straps can compromise circulation or breathing.