When encountering an injured person, a first aid responder faces a conflict between providing immediate care and the risk of causing further harm. This dilemma centers on the decision of whether to move the victim from their current location. Moving an injured individual, especially one who has experienced significant trauma, is a potentially detrimental action a rescuer can take. The initial impulse to help must be tempered by a careful risk assessment, recognizing that ill-advised movement could have permanent consequences for the victim.
The Default Position: Prioritizing Spinal Safety
The primary rule in emergency first aid is to assume a spinal injury is present following any severe trauma and to avoid moving the person. This caution is based on the high risk of converting a stable injury into a catastrophic spinal cord injury. Unnecessary movement can cause fractured vertebrae to shift or bone fragments to sever the spinal cord, leading to immediate and irreversible paralysis below the point of injury.
The rescuer’s immediate focus must be on keeping the victim still, maintaining the head and neck in the position they were found. Stabilizing the victim in place minimizes movement of the spine, reducing the chance of cord impingement.
The rescuer should immediately contact emergency medical services and then monitor the victim’s responsiveness and breathing. If the person is conscious, they should be instructed to remain absolutely still. Placing rolled towels or blankets on either side of the head and neck can help restrict involuntary movement.
Situations Requiring Immediate Relocation
Moving an injured person is only justified when the immediate environment poses a threat to life that outweighs the danger of movement. The guiding principle in these scenarios is “life over limb,” meaning the risk of death from the environment is greater than the risk of paralysis from moving the victim. These circumstances are rare and must involve an immediate, unavoidable danger to the victim or the rescuer.
One clear example is the presence of fire or the immediate risk of an explosion, such as near a leaking gas line or a burning vehicle. Exposure to toxic environmental hazards like poisonous gas, chemical spills, or high-voltage electrical sources also necessitates immediate relocation. These threats act rapidly and require swift removal from the area.
Another circumstance involves an unstable structure, such as a teetering vehicle or debris from a collapsed building that could shift. Furthermore, rapidly changing natural conditions, like rising floodwaters or a landslide, create an unavoidable hazard. In all these situations, the danger is immediate, and remaining in place is certain to result in death or further severe injury.
Immediate relocation is also required if the victim’s position prevents the rescuer from performing lifesaving procedures, such as providing cardiopulmonary resuscitation (CPR). If the victim is not breathing and is on a soft surface, they must be moved minimally to a hard, flat surface to allow for effective chest compressions. The decision to move must always be based on an immediate and unavoidable threat, not on convenience or comfort.
Minimizing Harm During Emergency Movement
If the scene assessment determines that immediate movement is the only option, the technique must prioritize maintaining the alignment of the head, neck, and torso. The goal is to move the victim as a single unit to prevent any bending or twisting of the spinal column. The rescuer should only move the victim far enough to escape the immediate hazard and no further.
Simple emergency drags are preferred over lifting, as they keep the victim close to the ground and maintain a linear pull. The clothes drag involves gripping the person’s clothing firmly near the shoulders or neck and pulling the victim in a straight line. This method uses the clothing to help stabilize the head and neck area.
The blanket drag is another effective technique, particularly on smooth surfaces, where the victim is rolled onto a blanket or coat, and the material is then pulled. This distributes the victim’s weight more evenly and supports the entire body. For any drag, the rescuer should use their legs, not their back, and avoid twisting their own body.
Before initiating the movement, the rescuer must manually stabilize the victim’s head and neck. This is done by placing both hands on either side of the head, using the forearms to support the neck and shoulders. This manual stabilization must be maintained throughout the entire movement to minimize any rotation or lateral flexion of the spine. Once the victim is in a safe location, the rescuer must immediately reassess their condition and contact emergency services.