First responders and bystanders often struggle with the decision of whether to move an injured person to apply a device like a sling or a tourniquet. Making the correct choice involves a careful, rapid assessment of the victim’s immediate threats to life against the potential for permanent damage from movement. Established protocols prioritize survival while minimizing harm.
Scene Safety and the Principle of Minimal Movement
Confirm the scene is safe for both the victim and the rescuer. Never move an injured person unless they are in immediate, life-threatening danger, such as an active fire, a collapsing structure, or an ongoing traffic threat. If the scene is safe, the default protocol is to assume a spinal injury in any case of significant trauma, even if the victim does not complain of neck or back pain.
Moving a person with an unstable spinal injury can cause permanent paralysis by damaging the spinal cord. Therefore, all care should be delivered to the victim in the position they were found. If movement is absolutely required—for example, to access a life-threatening wound or to roll an unconscious victim to ensure an open airway—techniques like the log roll must be used to keep the head, neck, and spine aligned as one unit. The movement should be minimal and slow, ideally performed with multiple people to maintain spinal motion restriction. Call emergency medical services (EMS) immediately, as they are equipped to safely handle and transport victims with suspected spinal trauma.
Applying a Sling Prioritizing Immobilization Over Repositioning
A sling is used to support and immobilize an upper limb injury, such as a suspected fracture, sprain, or dislocation. While painful, these injuries are not an immediate threat to life. Since the injury is not life-threatening, moving the victim to achieve a better angle for sling application is strongly contraindicated.
The priority is to immobilize the limb in the position of comfort or the position it was found, rather than attempting to reposition it for a textbook sling fit. Any unnecessary movement of a fractured or dislocated limb could exacerbate the injury or converting a closed fracture into an open one. The rescuer should gently slide the sling material underneath the limb and secure it without forcing the arm into a specific angle, ensuring that the entire arm, including the fingers, is supported.
Applying a Tourniquet When Intervention Trumps Movement Concerns
A tourniquet is reserved for severe, life-threatening hemorrhage from an extremity that cannot be controlled by direct pressure alone. Time is the most critical factor. The guiding principle here is “life over limb,” meaning that saving the victim’s life by controlling catastrophic bleeding takes precedence over the risk of potential secondary injury from movement.
If a severe bleed requires a tourniquet, it must be applied rapidly, tightly, and high on the limb, two to three inches above the wound and between the wound and the heart. If the victim’s position prevents access to the bleed site, or if the victim is exposed to an immediate threat, minor movement to apply the tourniquet or drag them to safety is acceptable. Any possible effort should still be made to maintain the head and neck in a neutral, stable position if a spinal injury is suspected. The application of the tourniquet cannot be delayed.