A suspected spinal injury is a serious medical emergency. Immediate and correct action is essential because inappropriate movement can turn a stable fracture into a catastrophic injury, potentially causing permanent spinal cord damage and paralysis. The primary goal of a first responder is to prevent any movement of the head, neck, and torso, thereby protecting the delicate spinal cord until trained medical personnel arrive.
Identifying Potential Spinal Trauma
A spinal injury should be suspected following any mechanism of injury involving significant force, as these forces are capable of fracturing vertebrae or damaging ligaments. High-risk events include falls from a substantial height, severe blunt force trauma to the head or torso, and diving accidents into shallow water, which result in axial loading on the spine. Severe pain or pressure located in the head, neck, or back is a major indicator, though pain may not always be present.
Physical and neurological indicators include the loss of sensation or abnormal feelings like tingling or burning in the limbs, which suggests nerve involvement. Paralysis or partial weakness, along with the loss of bladder or bowel control, are serious symptoms. Even if symptoms are not immediately obvious, if the mechanism of injury was severe, always assume a spinal injury exists and proceed with caution to protect the person’s spine.
Securing the Scene and Contacting Emergency Services
Before approaching the injured person, ensure the safety of the scene for yourself and others. Look for hazards such as active traffic, fire, downed electrical wires, or unstable structures that could cause further injury. Never enter a hazardous area if it means you will become a victim yourself.
Once the scene is deemed safe, immediately contact emergency services (such as 911 or your local emergency number). Provide the operator with your exact location, the number of people injured, the nature of the accident (e.g., a car crash, a fall), and clearly state that a spinal injury is suspected. Keep the injured person calm and reassure them that help is on the way.
Do not move the injured person unless their life is in immediate danger. Do not attempt to straighten the person, remove any protective gear like helmets, or allow them to sit up. Unnecessary movement risks shifting a fractured vertebra, which can cause irreparable damage to the spinal cord.
Immediate Manual Stabilization
The most important intervention you can provide is manual inline stabilization of the head and neck, often called C-spine control. This technique aims to prevent any rotation, flexion, or extension of the cervical spine. Kneel or lie down directly above the person’s head, positioning your body to maintain a steady, comfortable hold for an extended period.
Place your hands firmly on either side of the person’s head, resting on the bony areas of the jaw and skull. Ensure your grip supports the head without covering the ears, as the person needs to hear your instructions. The head must be held in the exact position it was found. Only if the person is lying flat on their back and the head is significantly turned should you gently move it toward a neutral alignment, stopping immediately if you meet resistance or cause pain.
Your elbows should rest on the ground or on your knees to provide a stable base, minimizing fatigue and accidental movement. The goal is to keep the head, neck, and torso aligned in one straight unit, acting as a human brace. You must maintain this stabilization without letting go until trained Emergency Medical Services (EMS) personnel take over responsibility for spinal restriction.
When Movement is Unavoidable
While the rule is to never move a person with a suspected spinal injury, certain life-threatening conditions override this rule. The principle of “life over limb” dictates that you must address immediate threats to survival, such as a blocked airway or lack of breathing. Movement is justified only if the person is not breathing and requires Cardiopulmonary Resuscitation (CPR), or if the person is actively vomiting and at risk of aspirating the stomach contents.
If CPR is needed, a modified log roll technique is necessary to move the person onto their back. If vomiting occurs, the person must be carefully rolled onto their side to clear the airway. If a second person is available, one rescuer should maintain manual stabilization of the head and neck while the other carefully rolls the body as a single unit, avoiding any twisting of the spine. If you are alone, perform this careful roll yourself, prioritizing spinal alignment while addressing the immediate threat. Once the immediate threat is resolved, return to the manual stabilization position.