EMS professionals should only log roll a patient after gaining an adequate number of personnel to do so safely, and this is largely based on the size, weight, and strength of the EMS professionals and the patient.

Log rolls are often performed on patients who have suspected neck and/or back injuries.

► Because of the potential neck and back injuries, at least three EMS professionals are recommended during the log roll maneuver.

The patient should ideally lie flat on his or her back (supine position), but not all circumstances will present this way.

EMS professionals should always be prepared to improvise while still maintaining the highest levels of patient care and supporting spinal integrity. Remember, rule one in EMS is “do no harm.”

During the log roll,

1. EMS professional one kneels at the patient’s head and initiates and maintains head and C-spine control to prevent movement.
2. EMS professional two applies a cervical collar while EMS professional one continues to hold in-line stabilization.
3. EMS professional two positions at the patient’s torso (chest and hips), and EMS professional three positions at the patient’s legs on the same side as EMS professional two. They choose the patient’s least-injured side whenever possible.
4. If the patient has a unilateral injury, EMS professionals two and three position on the opposite side of the injury. If injuries are on both sides, they choose the safer side for the roll.
5. EMS professional two places one hand on the far shoulder and one on the far hip. EMS professional three places one hand on the far flank/low back and one on the far knee. Their arms form an “X” for firm control during the roll.
6. EMS professionals two and three use proper body mechanics, keep backs straight, and signal readiness to EMS professional one.
7. EMS professional one explains the procedure to the patient if conscious and then commands the roll using a loud count: “One, two, three.”
8. On “three,” EMS professionals two and three roll the patient as one unit toward themselves in a smooth, controlled motion, while EMS professional one maintains head and C-spine control in line with the torso to prevent movement.
9. Once on the side, EMS professional two assesses the spine for step-offs, deformities, or tenderness.
10. The team slides a long spine board, sheet, or other transfer device firmly against the patient’s back.
11. EMS professional one gives the command, “One, two, three.” On three, EMS professionals two and three roll the patient back onto the device in the supine position, while EMS professional one maintains head and C-spine control.
12. The team positions the patient supine on the device, secures spinal immobilization, and prepares for further treatment and transport.

The patient has now been successfully and safely log-rolled and can be repositioned, further treated, or secured for movement.

NOTE: The above steps 1-12 are not to be memorized as individual steps. (No one will ask you what numbered step in the log roll involves the spine board, for example. No one will ask, "Which step is Step #6?") The steps are numbered only to demonstrate the sequence. Any number of numbering schemes could have been used.