Safety Issues

Introduction

Safety is a very important consideration for people living with a spinal cord injury. Because of the possibility of altered feelings and movement in various body parts, personal safety must be a prime concern to prevent re-injury. While it is important to promote a person's independence, it is critical to ensure that the environment is safe. This lesson will review tips for improving safety measures in the home, during activities and in relation to health issues affected by spinal cord injury.

Health Related Safety

Prevent Pneumonia!

• keep moving, get out of bed, do breathing exercises
• drink plenty of fluids - 8 glasses of water a day and avoid alcohol
• increase turn times in bed to every 2 hours while congested
• have someone "assist cough" and/or "clap and vibrate" your chest as needed
• cough often
• call the doctor if you are coughing up yellow, green or red mucous, if you have a temperature of 101 or higher that will not go away with Tylenol or Motrin, or if you are staying congested even after trying everything you know to do
• do not smoke; try to quit if you haven't already
• avoid people with colds or flu
• eat a balanced diet
• dress for the weather
• get the flu or pneumonia vaccine if your doctor approves
• the number 1 way to prevent pneumonia is to KEEP MOVING! Stay active!

Be Aware of the Signs and Symptoms of Autonomic Dysreflexia

• keep your autonomic dysreflexia card with you at all times
• tell your caregivers/friends about autonomic dysreflexia so they know how to help you if you become unable to help yourself
• pay attention to your body...headache, sweating and red blotches above the injury, chill bumps above the injury, high blood pressure (remember that your blood pressure may only need to rise 30-40 points to acquire dysreflexia) or irregular heartbeat
• make attempts to prevent dysreflexia from happening, but if it does, perform the proper steps (see the autonomic dysreflexia lesson), if that doesn't work, call 911 for help

Be Aware of the Signs and Symptoms of a Urinary Tract Infection

• notify the doctor when you have a fever greater than 100 degrees, blood in the urine, new leaking in between ICs, feeling like you have to urinate all of the time or burning upon urination

Check Your Skin at least Twice a Day

• look for red areas, blisters and burns
• stay off the red area as soon as you notice it; this means you would need to stay in bed (until the redness goes away) if this is an area that you sit on; notify your health care provider for instructions
• see the "Caring for the Skin" module for information on proper skin care
• be careful of water temperature to avoid burns
• be cautious of wheelchair parts becoming hot in the sun because of potential burns to your skin
• be careful of transfers that might cause friction wounds
• be careful of new shoes...watch for blisters and gradually break in new shoes 

Notice how the hips are rubbing against the wheels.

Home Safety

Monitor water temperature

• keep water heater set at 120 degrees to avoid burns
• check skin for burns/blisters after shower/baths
• test water temperature before entering into tub of shower
• cover hot water pipes with insulation to avoid feet coming in contact with a heat source

Check water temperature first!

Use Caution When Cooking

• use care in the kitchen to avoid burns
• be careful around the oven door or when reaching over a hot stove
• be careful to avoid hot grease or water splatters
• never carry hot liquids between your legs as they may spill
• do not put hot plates or pots on you lap; use a cup holder or a rolling cart to transport hot items

Maintain Telephone Accessibility

• keep a phone available to you...one that is accessible to your needs
• keep emergency phone numbers and numbers of friends, family or healthcare providers near the phone or programmed into the phone

Never Smoke in Bed

• never hold an ashtray on your lap as the heat may burn through to your legs

Keep Body at least 6 Feet Away from Portable Heaters and Fireplaces

Wheelchair Safety

Inspect Tires

• make sure there is adequate tread on the tires so it will not slip when the locks are applied
• make sure there is enough air in the tires so you do not slip when the brakes are applied

Use Wheel Locks Properly

• never use the wheel locks to slow the chair down while moving; this may cause the chair to stop suddenly and may literally throw you out of the chair or flip the chair over
• always lock the wheel chair with both locks each time you are about to do a transfer
• if the chair is not locking well, check the tires for adequate air and presence of treads

Check Caster Wheels

• make sure caster wheels are facing straight ahead to prevent the chair from sliding sideways when transferring

Check Hand Rims

• make sure hand rims are not jagged or rough so as not to cut your skin; file the rough areas if they become sharp

Inspect Cushion

• look for holes, tears or places where there is no support; call your healthcare provider if you notice problems with your cushion...remember, it is important to have an adequate cushion to prevent skin sores

Arm and Foot Rests

• protect hands, arms and feet from "too hot" surfaces on arm and foot rests especially when the chair is out in the sun

Anti-tip Bars (Wheelie Bars)

• should be down unless you are a proficient and skilled wheelchair user 
• if anti-tip bars are removed to do weight shifts or to go up a curb make sure to put them back on immediately; it is important to make caregivers and family / friends aware of this

Safe Transfers

 Be Careful of Your Skin

• do not let your skin drag over the surface upon which you are transferring
• be careful not to allow friction or shearing on your skin

Wear Clothes

• always wear some type of clothing over the buttocks area when doing sliding board transfers to avoid shearing or friction wounds to the skin
• if transferring into the shower or to the commode, you may use a pillow case under your bottom since you will not be clothed
• having clothing on is generally a good idea with any type of transfer in order to protect the skin

 Lift Body

• make efforts to lift the body (do not drag or slide) over wheels or wheelchair parts when transferring to and from the chair (in order to protect the skin)

Wear Shoes

• always protect the feet with shoes unless you have a sore on one or both of your feet
• consider surf shoes while swimming or scuba diving as well
• consider surf shoes/water booties during showering to protect feet during transfers
• always check your feet after wearing shoes for blisters to red areas

Safe Positioning

#1 Goal is to Prevent Skin Sores

• use correct padding and bridging techniques as you learned in rehabilitation (see skin care lesson for more information)
• use correct positioning techniques (proper alignment of body) in the chair and in bed as you learned in rehabilitation (see skin care lesson for more information)
• follow your turn schedule all of the time
• do your weight shifts correctly each and every time; do weight shift as instructed so it is effective but also so you do not fall out of your chair
• wear clothes that are loose enough in the positions you like to be in; (sometimes clothes are loose enough while lying down but when sitting, they are too tight}

Take Care of Your Wheelchair Cushion

• clean weekly in between if it becomes soiled
• inspect the cushion weekly to make sure it is providing proper support and is protecting your skin...make sure there are no air leaks or flat areas;
• do no slouch; sit up straight in the chair

Sports and Leisure Safety

While sports and leisure activities are very important in your life, please remember to consider safety issues while having fun.

• Protect body from bumps, bruises, cuts and scrapes while "playing"
• Wear proper clothing (consider outdoor temperature) including socks and shoes as appropriate for land sports
• Wear proper swimwear including surf shoes while in the pool, ocean or diving
• Wear sunscreen when it is sunny even if it is cool outside (you can get sunburn snow skiing!)
• Check your medicines to see if they will cause a sensitivity to the sun. Many medicines make it more likely to get a sunburn while in the sun
• Avoid staying wet too long (sitting on wet towels or wheelchair cushions, wearing wet clothes) as excess moisture can also cause skin problems
• Protect yourself from over exposure to heat and cold (see the Special Concerns Lessons for more information)
• Protect yourself from insect bites as they can become infected and cause skin problems
• Sit far enough away from campfires and space heaters to avoid burns (about 6 feet is generally pretty safe)
• Avoid leaning on elbows while doing activities on tables or desks (studying, playing board games)