A spinal injury involves damage to the vertebrae, ligaments, or the spinal cord, which transmits messages between the brain and the rest of the body. Such an injury carries a high risk of permanent functional loss below the site of trauma. The primary goal of immediate first aid is to prevent a secondary injury, which is further damage caused by movement of the unstable spine. The most important action is immediately calling emergency medical services (EMS) to ensure trained professionals and appropriate equipment arrive swiftly. The following steps are designed to minimize movement and sustain the victim until professional help takes over.
Scene Safety and Initial Assessment
Before rushing to the victim, assess the environment for personal safety. Hazards like moving traffic, unstable structures, fire, or downed power lines could create a second victim if not managed first. Only proceed if the scene is safe, or if the victim can be moved a short distance out of immediate, life-threatening danger, such as an active fire.
Once the scene is safe, approach the victim and speak clearly to check for responsiveness. If the victim is conscious, instruct them explicitly not to move their head, neck, or back. This verbal instruction helps the victim maintain their current position, which aids self-stabilization. If they are unresponsive, assume a spinal injury has occurred, especially following a high-impact incident like a fall or a motor vehicle crash.
Maintaining Manual Stabilization of the Head and Neck
Following the initial assessment, begin manual in-line stabilization (MILS) to prevent movement of the head and neck relative to the body. This technique maintains the head in a neutral position, keeping it aligned directly with the trunk and avoiding flexion, extension, or rotation. Position yourself at the victim’s head for optimal control.
Place your hands on both sides of the victim’s head, with palms resting over the ears and fingers spread to support the back of the head (occiput). Apply gentle but firm pressure to maintain alignment, being careful not to apply any pulling force or axial traction. This manual support acts as a temporary cervical collar, preventing the unstable spine from causing further trauma.
This continuous manual support must be maintained without interruption. Do not release the hold until EMS personnel have taken over stabilization with specialized equipment. If the victim is found with their head in a twisted position, gently move it toward neutral. Stop immediately if you meet resistance, the victim reports increased pain, or their neurological condition worsens.
Monitoring Vital Functions and Managing Shock
Once manual stabilization is established, monitor the victim’s immediate health status, specifically their airway, breathing, and circulation (ABCs). This assessment must be done without releasing stabilization or causing any head or neck movement. Check the airway and breathing using the look, listen, and feel method, observing the chest for movement and listening for breath sounds.
If the victim is unconscious and not breathing, open the airway using the jaw thrust maneuver. This involves lifting the jaw forward without tilting the head back, avoiding hyperextension that could cause further spinal cord damage. If no pulse is detected, start cardiopulmonary resuscitation (CPR) while continuing to support the head and neck during chest compressions.
Watch for signs of shock, a life-threatening condition where the body is not getting enough blood flow. Signs include pale, cool, and clammy skin, resulting from the body shunting blood away from the skin to internal organs. Maintain the victim’s body temperature by covering them with a blanket or jacket to prevent heat loss, all while maintaining manual stabilization. Communication with a conscious victim should be calm and reassuring.
Critical Actions to Strictly Avoid
The most harmful action an untrained person can take is moving or repositioning a victim with a suspected spinal injury. Movement, even slight adjustments, can turn an unstable vertebral fracture into a complete spinal cord severance, leading to permanent paralysis. Unless the victim is in immediate, life-threatening danger, they must remain in the exact position they were found.
Do not attempt to remove protective gear, such as a helmet or shoulder pads, unless necessary to access the airway for resuscitation. Removing a helmet improperly can cause significant neck movement, and only trained personnel should perform this task. Never offer the victim anything to eat or drink, as this could complicate later medical procedures. Finally, resist the urge to straighten or manipulate visibly deformed limbs or joints, as this movement can transmit force to the spine.