Spinal Injury First Aid: Safe Handling of Unconscious Patients

Suspect spinal injury in ANY unconscious trauma patient. The priority is immobilization—do not move unless absolutely necessary for safety (fire, explosion, drowning).

If You MUST Move (Life-Threatening Danger Only)

1. Log Roll Technique (minimum 3 rescuers):
   • Leader at head: stabilizes head/neck in neutral inline alignment (ears aligned with shoulders).
   • Rescuers at chest, hips, knees: roll as single unit.
   • Place on rigid backboard / flat surface.
2. If Alone: Drag by clothing at shoulders (clothes drag) — keeps head/neck/torso aligned. Or pull by ankles (foot drag) — last resort.

Critical Principles

• Head/neck/spine move as ONE unit. No flexion, extension, rotation, lateral bending.
• Manual inline stabilization (MILS) maintained continuously until full immobilization (collar + blocks + straps + board).
• Do NOT remove helmet (football, motorcycle) unless airway access required — trained personnel only.

After Immobilization

• Call 911 / activate EMS.
• Monitor ABCs (airway, breathing, circulation).
• Keep warm.
• Do not give food/drink.

Red Flags for Spinal Injury

• Mechanism: fall >10 ft, MVC, diving, axial load, high-speed ejection
• Neuro deficits: paralysis, numbness, priapism
• Midline spinal tenderness, step-off
• Altered mental status, intoxication (cannot clear clinically)

When in doubt, immobilize. Let professionals clear the spine in the ER.