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Spinal injuries

Spinal injuries may involve bones or soft tissue, including nerves, muscles, ligaments and tendons. Spinal cord injuries may result from trauma, infection, tumours, or a disruption to blood supply. If the spinal cord has not been severed or damaged in the initial impact, it is possible to protect it from further injury with proper management.

Unless an accident has been witnessed, or a neck/back injury is highly improbable, always treat casualties with head and/or neck injuries as potential spinal injuries. It is better to over-treat than under-treat.

Causes of spinal injury include:
  • Motor vehicle crashes
  • Diving accidents
  • Assaults
  • Industrial accidents (falls or something falling from a height)
  • Head injuries
  • Landing heavily on your feet or buttocks from a height
  • Falling over (elderly people)

Most spinal injuries occur in the neck (e.g. whiplash, diving in shallow water) or lower back (e.g. vehicle accidents).

Signs and symptoms of spinal injuries
  • Pain and tenderness at the site of injury, aggravated by any movement
  • Evidence of a wound
  • Swelling or bruising over the injured area
  • Loss of feeling or sensation
  • Altered level of consciousness
  • Loss of control of bladder and bowels
  • Weakness of the extremities
  • Alteration in vital signs, eg respiratory distress, slowing pulse

Management of spinal injuries

Conscious casualties
  • Do not move the casualty unless it is absolutely necessary
  • Seek urgent medical aid — call Triple Zero (000) for an ambulance
  • Fully immobilise the casualty before moving.  A careful and accurate assessment is essential; however, life-threatening injuries must take priority
  • Never rush the treatment — take your time and handle the casualty slowly and carefully
  • Remove all objects from the casualty’s pockets — this will prevent pressure sores developing (make sure you keep notes of anything you take out of a person’s pocket and keep the things you remove in a safe place. It is also a good Idea to have a witness to this)
  • Prevent any twisting or bending of the spine
  • Rest and reassure the casualty
  • Keep the casualty warm
  • Monitor and record vital signs
  • Treat for shock

Unconscious casualties
  • DRSABCD
  • place the casualty in the lateral position with head support to maintain alignment of the neck
  • monitor and record vital signs
  • seek urgent medical aid — call Triple Zero (000) for an ambulance
  • keep the casualty warm

If you must move a casualty with a suspected spinal injury, follow these guidelines:
  • Immobilise the lower limbs by applying a triangular bandage — figure-of-eight around the feet
  • You may also have to secure the hands together
  • When preparing to move the casualty, have at least eight people to perform the lift, where possible
  • It is the person at the head of the casualty who is in control of the lift, as they must ensure that alignment of the spine is maintained

Removing helmets
  • It may be necessary to remove helmets from casualties in order to gain backward head tilt to check/clear the airway or to treat injuries

Full face helmets should be removed only if absolutely necessary, ie if you are unable to maintain the casualty’s airway or if resuscitation is required.

Removing helmets requires two people, one to support the head and neck of the casualty and one to perform the removal:
  • support the head and neck
  • undo the chin strap (it can be carefully cut if necessary)



Different helmets


Cycling, climbing, skateboarding etc type of helmet:
gently lift the helmet up from the head

Open face motorcycle helmet:
stretch the sides of the helmet away from the face
lift the helmet up and back

Full face motorcycle helmet:
  • Stretch the sides of the helmet away from the face
  • Tilt the helmet back until the chin piece has cleared the nose
  • Then tilt the helmet forward, following the curve of the back of the head
  • Lift the helmet up and away from the head


"The spine can be broken even if there is no evidence of paralysis. When in doubt, always treat the casualty for a cervical spinal injury"


"Removing motorcycle helmets should only be done if the first aider is concerned for the casualtyís airway or if the casualty requires CPR"