A spinal injury involves damage to the vertebrae, ligaments, or the spinal cord itself, interfering with message transmission between the brain and the body. The primary goal for any bystander is to prevent a secondary injury, which often occurs from movement of an unstable spine. Unnecessary motion can cause permanent paralysis or serious complications, so a cautious approach is necessary. Immediate action should focus on stabilization and monitoring the victim while awaiting medical professionals.
Scene Safety and Initial Assessment
Before approaching, ensure the environment is safe to prevent becoming a second victim. Look for ongoing dangers such as active traffic, fire hazards, or unstable structures. If the scene remains unsafe, call for help and wait for professional rescuers who can manage the hazard.
Once the scene is secure, approach the victim and immediately activate the emergency medical system by calling 911 or your local emergency number. Check for responsiveness by shouting and gently tapping a shoulder, avoiding any aggressive shaking or movement. If the victim is unresponsive, assess their breathing by looking for chest movement, listening for breath sounds, and feeling for airflow, all without moving their head or neck.
Manual Stabilization of the Head and Neck
If a spinal injury is suspected due to the mechanism of injury, such as a motor vehicle crash or a fall from a height, manual stabilization must begin immediately. This action is the most important intervention a bystander can provide to reduce the risk of further neurological damage. The goal is to keep the head, neck, and spine in the exact position in which they were found.
To achieve manual stabilization, kneel or lie behind the victim’s head to maintain a comfortable and steady position. Place both of your hands on either side of the head, cupping the head over the ears with your fingers spread. This hand placement provides firm, continuous support to prevent any rotational or bending movement of the neck.
You must maintain this manual in-line stabilization continuously until professional emergency responders arrive and take over care. The head must remain aligned with the spine, and you should not attempt to straighten the head or neck unless it is in an acutely awkward position or necessary for life-saving measures, like moving the victim from an active fire. Even if the victim is conscious, instruct them not to nod, turn, or move their head in any way to answer questions.
Maintaining Airway and Monitoring Vitals
While maintaining stabilization, the first priority is ensuring the victim has an open airway and is breathing. If the unresponsive victim is not breathing or is only gasping, you must open the airway without moving the neck, as the standard head-tilt/chin-lift maneuver is contraindicated. The only acceptable method for opening the airway in a suspected spinal injury is the jaw-thrust maneuver.
To perform the jaw-thrust maneuver, place your index and middle fingers beneath the angles of the victim’s lower jaw on both sides. Gently lift the jaw forward and upward, which pulls the tongue away from the back of the throat and opens the airway without requiring neck extension. This technique is designed to minimize movement of the cervical spine.
After establishing an open airway, quickly check for a pulse on the side of the neck closest to you. Look for signs of shock, such as pale, cool, or clammy skin, often accompanied by a rapid and weak pulse. If the victim shows signs of shock, cover them with a blanket or coat to help maintain their body temperature, as hypothermia can worsen the outcome of a traumatic injury.
Preparing for Emergency Responders
As you stabilize the victim and monitor their condition, prepare for a smooth handover to the arriving emergency medical services team. Gather specific details regarding the mechanism of injury, such as the height of a fall or the speed and nature of a motor vehicle collision. This information helps paramedics anticipate the severity and type of spinal trauma.
You should be ready to relay any changes observed in the victim’s condition, including the time they became unresponsive, any difficulty with breathing, or alterations in their level of consciousness. Communicate calmly with the victim, if conscious, to offer reassurance and orientation. Do not give the victim anything to eat or drink, as this could complicate later medical procedures.
Your role at this stage is to be the victim’s advocate and information source, ensuring the medical team receives a complete picture of the event and the victim’s immediate response to the injury. Maintaining manual stabilization and providing accurate information are the most helpful actions you can perform before the professionals assume care.