First Aid in Suspected Cervical Spine Injury

When to Suspect Cervical Spine Injury

• Significant neck or spine pain after trauma
• Diminished level of consciousness or unconsciousness after trauma
• Neurologic deficits (weakness, numbness, tingling in limbs)
• High-energy mechanism: motor vehicle collision, fall from height, axial loading (diving, "spear tackling" in football), direct blow to head/neck
• Any unconscious trauma patient - assume unstable cervical spine until proven otherwise

Step-by-Step First Aid Principles

1. Scene Safety & Call for Help

• Ensure the scene is safe before approaching
• Call emergency services (EMS) immediately
• Do not attempt to move the patient unless there is immediate life-threatening danger (fire, drowning, airway obstruction)

2. Initial Assessment - ABCs First

• Airway, Breathing, Circulation (ABCs) take priority over spinal precautions
• Assess level of consciousness
• If the patient is unconscious, assume an unstable cervical spine injury

3. Manual Inline Spinal Motion Restriction (SMR) - Key Modern Concept

• Position yourself at the top of the patient's head
• Place your hands on the patient's shoulders, thumbs extending anteriorly over the clavicles, fingers behind the neck
• The head is immobilised between your forearms - this is the preferred manual inline restriction technique
• Alternatively, hold the head between both hands on either side of the skull
• Keep the head in a neutral position (not flexed or extended), pointing in the same direction as the rest of the body
• In a conscious patient, this should be the most comfortable position - do not force the head into a neutral position if doing so causes pain
• Maintain this position until EMS arrives

4. Airway Management

• If the patient is breathing normally, maintain manual SMR and do not move them
• If the patient is NOT breathing or airway is obstructed: use the jaw thrust maneuver (NOT head-tilt/chin-lift) to open the airway - this opens the airway while keeping the cervical spine stable
• If jaw thrust fails to open the airway and the patient is in cardiac arrest, a head-tilt/chin-lift is acceptable - airway takes absolute priority
• If the patient vomits and risks aspiration, log-roll them with the team while maintaining spinal alignment

5. Cervical Collars - Revised Guidance

• Soft cervical collars only indicate a possibility of spinal injury - they provide minimal motion restriction. Use only as a marker, not a primary protective device (ANZCOR 2025)
• Semi-rigid (hard) collars may be used when manual SMR is impossible, for extrication/transport, but only for the shortest time necessary by trained providers
• Head blocks that restrict only the head more than the body can actually increase cervical spine motion when the body moves and should NOT be used by first aiders
• Do NOT rely on any device to replace manual inline restriction in an unconscious patient

6. Do NOT Move the Patient Unless Necessary

• Do not attempt to move, straighten, or position the patient unless there is immediate danger or airway compromise
• If transport is needed before EMS, use a 6-person lift or log-roll technique onto a spine board, with one designated person controlling the head and neck throughout

7. Helmet Considerations (Sports Injuries)

• In football/hockey players wearing shoulder pads: leave the helmet on - removing it causes the head to hyperextend (shoulder pads elevate the torso, helmet maintains neutral alignment)
• The face mask should be removed as early as possible to allow airway access, but the helmet and chin strap should remain in place
• If shoulder pads AND helmet must both be removed, they must be removed simultaneously by a coordinated team

8. Transport

• Transport should be to a trauma center with diagnostic (CT/MRI) and surgical spinal capabilities
• Do not place the patient back on a long spine board longer than necessary - prolonged use causes pressure injuries and respiratory compromise
• Continue monitoring neurologic status: limb movement, sensation, respiratory pattern

What NOT to Do

Red Flags Requiring Immediate EMS Response

• Bilateral limb weakness or paralysis
• Sensory loss below neck level
• Inability to control bladder or bowel
• Priapism (male patients) - a sign of spinal shock
• Diaphragmatic breathing with absent chest wall movement
• Rapidly deteriorating consciousness after neck trauma

Key Conceptual Shift: "Motion Restriction" Not "Immobilization"