The foundational principle of first aid is nonmaleficence, or “do no further harm,” which mandates that unnecessary movement must be avoided. After ensuring the immediate environment is safe for the rescuer, the first priority is to stabilize the patient in the position found. Moving a victim without specialized training and equipment greatly increases the risk of turning a manageable injury into a catastrophic, life-altering one. The default action is to wait for trained medical professionals to arrive and take over the scene.
The Risk of Neurological Damage
Movement poses the greatest threat to a victim who may have an unstable spinal injury, which is often not obvious immediately after an accident. The spinal cord is a delicate central nervous system pathway housed within the protective column of stacked vertebrae. If an accident fractures or dislocates one or more of these bony segments, the spine becomes structurally unstable.
Any rotation, flexion, or extension of the head, neck, or torso can cause the unstable vertebrae to shift. This movement can result in a fragment of bone or a misaligned disc compressing or shearing the spinal cord tissue. An injury that was initially a fracture without nerve damage can instantly become a permanent spinal cord injury, leading to paralysis below the level of the damage. For example, a fracture in the cervical or thoracic spine that has not yet damaged the cord can be converted into a complete injury by a simple turn of the neck.
Worsening Internal and Musculoskeletal Injuries
Beyond the neurological risks, moving a victim can significantly worsen existing internal and musculoskeletal trauma. If a victim has suffered a bone fracture, the broken ends of the bone may be jagged and sharp. Moving the limb or the body can cause these sharp fragments to move, potentially severing nearby major blood vessels, nerves, or soft tissues.
A fractured rib, for instance, can be pushed inward by movement, puncturing a lung and causing a life-threatening collapsed lung, or pneumothorax. Similarly, movement can disrupt the body’s natural response to internal bleeding. The body attempts to slow hemorrhage by forming clots around damaged vessels, but jostling the patient can dislodge these nascent clots, accelerating blood loss. Rapid blood loss can quickly lead to hypovolemic shock, a condition where the body does not have enough blood volume to pump.
When Immediate Movement is Necessary
The rule against moving a victim is overridden only by the presence of an immediate, life-threatening danger to the patient or the rescuer. This exception means the risk of death from the environment is greater than the risk of further injury from movement. Examples of an immediate life threat include a vehicle on fire, an imminent explosion, a collapsing structure, or being in the path of uncontrolled traffic.
Movement may also be necessary if the victim must be moved to provide time-sensitive, life-saving care, such as repositioning them onto a firm surface to perform cardiopulmonary resuscitation (CPR). The decision to move must be based on objective, immediate hazards, not on the convenience of the rescuer or the comfort of the injured person. If the scene can be made safe without moving the victim, such as diverting traffic or extinguishing a small fire, the victim should remain in place.
Safe Techniques for Emergency Victim Movement
If an immediate life threat demands moving the victim, the process must be executed with controlled techniques to minimize secondary injury. The goal of any emergency move is to keep the head, neck, and torso aligned as a single unit, maintaining in-line stabilization.
The clothes drag involves grasping the victim’s clothing near the neck and shoulders, supporting the head with the forearms, and dragging the person straight along the long axis of the body. The blanket drag uses a blanket or similar item placed next to the victim, gathered, and used to pull the person to safety. For any drag technique, the movement should be quick, controlled, and directly away from the hazard, prioritizing a straight path to a secure location. These techniques should only be employed as a last resort when facing an unavoidable hazard, never for routine transport or assessment.