Prevent and prepare

• Promote and practise safe behaviours, such as wearing a seatbelt and using a headrest when travelling by car or wearing back protection when travelling by motorcycle or horse.
• Players should not play sports if they experience spinal pain.
• Junior sports coaches should consider when the introduction of tackling is appropriate and should endeavour to teach the correct technique (Harmon et al., 2019).
• Remove trip hazards from places of work and home, particularly where elderly people or people with a disability live, to reduce the chance of trips and falls.
• Always ensure ladders are stabilised before climbing them.
• Supervise children who are climbing on frames or furniture.
• Never dive into shallow water, or water with an obstructed view or high flow (e.g. rivers) and take particular care when diving in the dark.

Early recognition

You may suspect a spinal injury if the injured person has:

• fallen from a height greater than standing
• been involved in a road traffic collision
• bumped their head while diving head-first into shallow water
• been involved in a traumatic event (e.g., explosion, mechanical incident).

Older adults (over the age of 65) and people with an underlying bone condition may be more susceptible to spinal injuries following minor traumas such as a slip, trip or fall. 

The person may also have:

• a tingling sensation in their arms or legs or other parts of the body
• pain or tenderness in their neck or back
• obvious deformity to their head, neck or spine
• other painful injuries, especially at the head or neck
• sensory deficit (e.g., numbness) or muscle weakness (e.g., paralysis) in the torso or upper extremities. This may be accompanied by loss of urine or stool.

However, some people with a spinal injury may not experience any symptoms.

Be alert as babies and young children may be unable to recognise they have a spinal injury. Likewise, someone with an altered mental status (under the influence of alcohol or drugs) may be less likely to be able to recognise they have a spinal injury.

Pelvic fracture

First aid providers need specific training to recognise a pelvic fracture. Pelvic fracture may be associated with spinal injury.

A person with a pelvic fracture may:

• Experience pain at the hip, pelvis, groin or even the knee. This gets worse when moving.
• Not be able to support their legs. Sometimes, the foot (on the side of the fracture) is in an abnormal position.
• Experience sensory disturbances and tingling sensations in their legs.
• No longer be able to pass urine. Sometimes, there is spontaneous loss of urine. In some cases, there is blood in the urine.
• Show signs of Shock.

First aid steps

Spinal injury

1. If the person is responsive and alert, reassure them and ask them to stay as still as possible. If necessary, (e.g., they are a child, are drunk, or do not follow to your instructions) gently support their head to help them to prevent movement of their neck and spine.
2. Access emergency medical services (EMS).
3. Ensure minimal handling or movement of the person at all times. Monitor their breathing and level of response for any changes.

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NOTE

• Do not move the person if you suspect a spinal injury.
• If the person has to be moved, (e.g., there is imminent danger) this is best done with at least two first aid providers, where one can keep the person’s head in line with their spine.

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SPECIAL CASE

An unresponsive and breathing person with suspected spinal injury

If the person is Unresponsive and breathing normally:

• Leave the person as you have found them (e.g. on their back or side).
• Maintain an open airway using the head tilt/chin lift or jaw thrust manoeuvre. The jaw thrust manoeuvre may cause less spinal motion.
• Gently support their head in this position to prevent any movement.
• Access EMS and follow their instructions.
• Monitor their breathing and level of response for any changes.

Pelvic fracture

1. Help the person to lie down on their back and to keep still with their legs straight.
2. Place padding between their legs and then immobilise their legs by binding them together at their knees and feet.
3. Access EMS.
4. Monitor the person’s breathing, circulation and level of response, particularly looking for any signs of Shock.

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CAUTION

If you suspect a pelvic fracture, do not ‘rock’ or rotate the pelvis as this can restart or worsen bleeding.

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Access help

Injuries to the spine are difficult to confirm and difficult to manage in out-of-hospital settings. Help should be sought as soon as possible if an injury to the spine is suspected.

Recovery

Signs and symptoms of spinal injuries should have been resolved before returning to activities with associated risks (e.g., some work activities, driving or operating machinery, contact sports).

Context considerations

• Knowing the mechanism of the injury is crucial to identifying a potential spinal injury. Help learners practise identifying if incidents in relevant contexts may have involved an abnormal force to the body resulting in a violent bending or twisting of the spine.
•  Equipment for stabilisation and transport may be context specific. Consider the options for these with learners and use what is locally available (Pysny et al., 2017; Schimelpfenig et al., 2017).
• Rolling and lifting techniques should only be applied if absolutely necessary and when appropriate resources are available. More than one first aid provider is needed to apply these techniques safely so they should be discouraged when providers are acting alone (Schimelpfenig et al., 2017).

Learner considerations

• It is common for learners to be highly concerned about a spine injury in the event of a high-impact incident. Education providers should emphasise the importance of providing life-saving care by maintaining the person’s airway and breathing and giving CPR when necessary.
• Consider how different learners may change the meaning of certain signs and symptoms – tingling, tenderness, deformed, etc. Discuss terminology with learners to help them to understand different signs and symptoms and be able to judge the seriousness of the injury using these terms.
• A pelvic fracture is very difficult to recognise so first aid providers should not be expected to recognise one. Consider whether learners need to learn this topic.

Facilitation tips

• This topic should be covered across each domain of the Chain of survival behaviours, with emphasis added depending on the learner. For example, sports coaches might focus on prevention, whereas parents of young children might focus on recognition. All learners will need to practise stabilisation techniques as part of the first aid action.
• Discuss the mechanism of the injury which will help learners understand when to suspect a spinal injury. Consider different scenarios (children playing on climbing frames, trampolining, road traffic collisions etc) and discuss the types of force that could lead to a spinal injury.
• Emphasise that the use of cervical collars is not advised for first aid providers. Manual stabilisation of the person with a suspected spinal injury is the most important action in order to limit unnecessary movement which might cause further damage.
• Practise or demonstrate manual stabilisation techniques with learners, with the injured person in different positions (i.e., lying on their back, sitting etc).
• Explain how manual stabilisation aims to mirror a person’s general anatomical standing position.
•  Discuss the importance of conservative handling and minimising movement. Use the ‘prevention of further injury’ and ‘promotion of recovery’ first aid principle. 

Facilitation tools

• Create contextually relevant scenarios to reinforce learning (e.g., sport-focused role play examples for schools and sports club contexts, road traffic accidents using chairs and tables to represent cars for road users) (Kureckova, 2017). Videos of these scenarios can also be very effective.
•  Practise asking questions and basic history taking to help with the identification of a spinal injury.
•  Depending on the type of education, it may be appropriate to touch on basic sensory monitoring skills (i.e. fingers and feet), or basic assessment tools such as “AVPU”. See General approach.

Learning connections

•  Make connections between spinal injuries and Head injuries.
•  Consider the change in airway management for a person with spinal injury who is Unresponsive and breathing normally.