A spine injury can end in permanent paralysis, and the spinal cord does not repair itself the way skin and bone do. Fear of adding to that damage can stop people from touching an injured person at all. Protecting a damaged spinal cord needs no equipment, only your hands, your voice, and a clear idea of when moving someone is the right call.
What Counts as a Spine Injury
A spine injury covers damage to the bones of your back, the spinal cord they protect, or both. Your spine is a column of 33 vertebrae running from the base of your skull to your tailbone. Each vertebra has a hole through the middle of it, and those holes line up to form the spinal canal, a bony tunnel that surrounds the spinal cord along its whole length.
A broken vertebra does not always mean an injury to the spinal cord. Bone can fracture or dislocate while the cord inside stays intact. Your brain and spinal cord make up the central nervous system, and the cord is a bundle of nerve fibres carrying signals in both directions.
Spinal nerves leave the cord through nerve roots between the vertebrae to pass every message between that system and the rest of your body. Damage to the spinal cord stops those messages below the injured point, and the neurological loss that follows takes in muscle movement, sensory feeling in the skin, and autonomic body functions such as bladder control and bowel control. Spinal cord injury belongs with the neurological disorders, the conditions in which the nervous system itself is damaged.
The severity and location of the damage set what is lost, and the level of injury names the part of the spinal cord that was damaged. Damage to the cervical spinal cord can affect all four limbs and the muscles used for breathing. This is called tetraplegia. Damage lower in the spinal column affects the legs and lower back, and this is called paraplegia. An incomplete injury may leave some muscle movement or feeling below the level of injury, while a complete injury leaves none.
Damage does not stop at the moment of impact. Bleeding and swelling around the spinal cord can cause further loss over the following hours. This is called secondary injury, and first aid on the scene is aimed at limiting it.
How Spine Injuries Happen in Australia
Falls and motor vehicle accidents are the leading causes of spinal injury in Australia. Falls account for 56% of spinal injury hospitalisations and transport crashes for 31%, out of more than 26,000 admissions in a single year.
Falls climb with age. Slips at standing height onto hard floors can cause a spine injury in an older person whose bones have thinned, and a low fall can damage the cord in a neck already narrowed by arthritis.
Motor vehicle crashes injure riders as well as drivers, and riders on the road face the highest risk of spinal cord damage. Motorcyclists, cyclists, and quad bike riders made up close to one in three cases of traumatic spinal cord injury recorded by the Australian Spinal Cord Injury Register in 2017 to 2018.
Sports-related injuries and water incidents account for a smaller share of spinal trauma. Diving into shallow water, being dumped by a wave in the surf, rugby tackles, and falls from horses can all cause spinal cord damage through force to the head and neck. Workplace incidents and heavy blows to the head make up most of the rest.
Signs and Symptoms of a Suspected Spinal Cord Injury
Suspect a spine injury from the way the incident happened, before you look for a single symptom. Any fall from a height or motor vehicle crash is treated as a spinal injury, and any injury above the shoulders as a suspected cervical spine injury, until proven otherwise at hospital.
Ask the injured person what they feel, and do not ask them to move anything to find out. Symptoms they can report include:
- pain in their neck or back
- tingling or numbness in their arms, legs, or anywhere below the injured level
- weakness, or no muscle movement at all
- loss of feeling in their skin
- nausea, headache, or dizziness
Watch their head, their breathing, and their skin while you talk to them. Signs you can see include:
- their head or neck held at an odd angle
- signs of a head injury, such as bleeding from the scalp
- limp or stiff muscles
- difficulty breathing
- confusion, drowsiness, or unconsciousness
- cold, clammy skin
- loss of bladder or bowel control
- an erection in males, called priapism
The signs and symptoms depend on the location of the injury and the extent of injury. An incomplete injury can leave someone standing, walking, and talking with nerve or spinal cord damage already done. An unconscious person reports nothing. What happened to them is your only guide.
First Aid for a Suspected Spinal Injury
Airway and breathing outrank spinal care in every case.
- Make the scene safe. Check for traffic, fire, fuel, water, and unstable ground before you approach, and keep onlookers back.
- Call 000. Ask for an ambulance, say you suspect a spine injury, and give your location and what happened.
- Check their response and breathing. If they are unresponsive and not breathing normally, start CPR and continue until paramedics take over.
- Tell them to stay still. Do not hold down or restrain a person who is agitated or uncooperative.
- Support their head and neck with your hands. Kneel behind their head. Place your hands on their shoulders with your thumbs forward across their collarbones and your fingers behind their neck, then hold their head between your forearms. If you cannot get behind them, cup their head between both hands, one on each side of their skull. Keep their head pointing the same way as their body, neither tipped forward nor tilted back.
- Keep them warm. Cover them with a blanket or jacket, and give them nothing to eat or drink.
Cervical spine immobilisation with a rigid cervical collar is not part of Australian first aid. ANZCOR advises first aid providers against semi-rigid cervical collars. Fitting a cervical collar moves the neck, presses on the skin, raises pressure inside the skull, and can block the airway if the person vomits. Rigid collars are reserved for trained crews moving someone when manual support is impossible. Your hands support the cervical spine better than any collar available to you.
Danger to their life is the only reason to move an injured person before the ambulance arrives: fire, oncoming traffic, rising water, or the need for a firm flat surface to do CPR. If you must move them, support their head and neck in line with their body, and move the whole person as one piece.
The Role of the First Aider Before Paramedics Arrive
Once you have taken hold of someone’s head, keep holding it until a paramedic takes over. Passing the head to a second pair of hands adds movement.
The rest of your job is information. Note the time of the incident, what the person hit or landed on, how far they fell, and whether they lost consciousness at any point. Ask them what hurts, what they can feel, and what they can move. Report changes as they happen. Someone who could wiggle their toes when you arrived and cannot now has a worsening spine injury. Emergency care is planned around that detail.
Control what other people do. Stop anyone from sitting the person up, propping their head on a bag, pulling them out of a car, or carrying them somewhere more comfortable. Stay beside them, keep talking to them, and tell them what you are doing before you do it.
High-Risk Settings: Water, Roads, and Sport
The setting of a spine injury changes what you can safely do about it.
In water, breathing comes first. Someone who has dived into a sandbar or been dumped by a wave is often face down and cannot lift their head clear. Turn them face up while keeping their head, neck, and back in line. Two techniques exist for this, the extended arm roll-over in shallow water and the vice grip roll-over where the water is deep enough to submerge yourself beneath them, and both are taught to trained rescuers. Once they are face up and breathing, support them in the water and wait for help rather than dragging them onto the sand.
On the road, a conscious person who is breathing is safer left in their seat until paramedics arrive with the equipment to lift them out. Move them only if the vehicle is on fire, leaking fuel, filling with water, or in the path of traffic. Infants and children stay in their car seat where it is safe to leave them there, and the whole seat can be lifted from the car with the child still strapped in.
On the field, stop play and send someone to call 000. If the player is breathing, leave them where they landed and support their head. If they are not breathing, roll them onto their back as one piece and start CPR. A player who gets up on their own can still have a serious neck injury, and neck pain, tingling, or weakness after a collision needs an ambulance rather than a seat on the bench.
The Recovery Position
An unconscious person who is breathing is turned onto their side into the recovery position, and a suspected spine injury does not change that. A blocked airway or inhaled vomit can kill within minutes, while careful handling keeps the risk to their spine low through the turn.
Turn them as one piece. With helpers, one person holds the head and directs the turn while the others move the shoulders, hips, and legs together on a count. Alone, use your forearms to hold their head in line with their shoulders as you roll them towards you. Keep their head, neck, and back in a straight line throughout, and do not twist their body at any point.
To open their airway, use a jaw thrust or a chin lift. Both move the cervical spine less than a head tilt does. If neither opens their airway, tilt their head back. Once they are on their side, support their head, watch their breathing, and be ready to start CPR.
Get Trained in Spinal Injury First Aid
First aid for a spine injury is a matter of holding still what would otherwise move, and doing it with nothing but your two hands. Nothing in a first aid kit improves on that.
Positioning your hands on the head and shoulders of an injured person is awkward the first time you do it, and the first time should not be at a crash site. Nationally recognised first aid training gives you a qualified trainer who corrects your grip, your airway checks, and your compressions while you learn, along with a statement of attainment that Australian employers accept.
You cannot pick the moment someone lands badly in front of you, but you can enrol in first aid training before that day comes and know exactly what to do with your hands when it does.
FAQs
Do Children Need to Be Positioned Differently?
Yes. Children under eight have heads that are large compared with their bodies, and lying flat on a hard surface pushes their neck into a forward bend. Padding of about 2.5 cm under their shoulders holds the neck in a neutral line.
Can the Spinal Cord Be Damaged Without a Broken Bone?
Yes. The spinal cord may be bruised, stretched, or squeezed inside an intact spinal column, most often in children and in older adults whose spinal canal has narrowed with age. X-rays and CT scans of the bones can look normal in these cases, and magnetic resonance imaging is used to show damage to the cord itself.
Do Paramedics Still Use Spinal Boards?
Yes, but only to move someone, and only for the length of the move. Long back boards cause pain in the neck, shoulder blades, and lower back, and people who are paralysed or unconscious face a higher risk of pressure injuries from them. Ambulance crews lift the person off the board once the move ends to relieve pressure on the skin.
