Spinal injury occurs with approximately 2% of trauma (injury) patients. Although this figure appears relatively low, suspecting and correctly treating the injury is essential, because poor treatment of a patient with a spinal injury could result in them becoming crippled for life or even death.

The spinal cord is an extension of the brain stem, and travels down the back of the spinal vertebrae. Vital nerves, controlling breathing and movement of limbs travel down the spinal cord. The weakest part of the spinal column is the neck, and indeed a neck injury can be the most severe type of spinal injury, because the nerves controlling breathing may become severed.

Suspect spinal injury if the casualty has:

• Sustained a blow to the head, neck or back (especially resulting in unconsciousness).
• Fallen from a height (e.g. fall from a horse).
• Dived into shallow water.
• Been in an accident involving speed (e.g. car accident or knocked down).
• Been involved in a ‘cave in’ accident (e.g. crushing, or collapsed rugby scrum).
• Multiple injuries.
• Pain or tenderness in the neck or back after an accident (pain killers or other severe injuries may mask the pain).
• OR: if you are in any doubt.

Possible signs and symptoms of spinal injury

Remember, if only some of these signs and symptoms are present, nerves may already be damaged. You should treat a patient who you suspect has a spinal injury which may stop these signs and symptoms from developing.

• Pain or tenderness in the neck or back.
• Signs of a fracture in the neck or back.
• Loss of control of limbs at or below the site of injury.
• Loss of feeling in the limbs.
• Sensations in the limbs, such as pins and needles or burning.
• Breathing difficulties.
• Incontinence.

Treatment of spinal injury

If the patient is conscious

• Reassure the patient. Tell them not to move.
• Keep the patient in the position you find them.
• Do not allow them to move, unless they are in severe danger.
• Hold their head still with your hands. Keep the head and neck in line with the upper body.
• Dial 999 for an ambulance.
• Keep the patient still and warm until it arrives.

If the patient is unconscious and breathing normally

• Do not move the patient unless they are in severe danger.
• If the patient is breathing normally this means the airway must be clear, so there is no need to tip the head back.
• The ‘jaw thrust’ technique can be used to keep the airway open without moving the head.
• Constantly monitor breathing.
• Dial 999 for an ambulance.
• Hold the head still with your hands. Keep the head and neck in line with the upper body.
• If you have to leave the casualty, if they begin to vomit, or if you are concerned about their airway in any way, place the casualty in the recovery position. Keep the head, neck and upper body in line as you turn the patient. Doing this effectively takes more than one rescuer, so get local help if you can.
• Keep the casualty warm and still.
• Constantly monitor Airway and Breathing until help arrives.

If the patient is not breathing normally

• If the patient is not breathing normally, the airway will need to be opened.
• Head tilt may be used, but the tilt should be the minimum that is required to allow unobstructed rescue breaths.
• Only if you are trained and confident, you can try the ‘jaw thrust’ technique to open the airway, but if you find the patient is still not breathing normally, you should then open the airway using the head tilt method before carrying out resuscitation.
• Re-check breathing once the airway has been opened.
• If the casualty is still not breathing normally, dial 999 for an ambulance, then carry out resuscitation.
• Obtain the help of others to support the head as you resuscitate.
• Remember – successful resuscitation that results in paralysis from a neck injury is a tragedy, but failing to maintain an adequate airway will result in death.