An injury to the spine is a serious and potentially grave injury. At best it may represent a rupture of ligaments or a crack in the vertebrae, but at worst it may mean injury or severance of the spinal nerve cord. The possibility of an injury progressing due to instability of the vertebrae means that all spinal injuries need to be treated the same and with the utmost care and urgency until a firm diagnosis is made by a qualified medical practitioner or casualty team.

If the casualty is not correctly handled, the spinal cord may be permanently damaged, with paralysis or death resulting.

Spinal injury generally occurs as a result of a direct force, a fall or hyperflexion or extension such as in a whiplash injury.

A fracture of the vertebrae will not be known until an X-ray is taken, but a dislodged vertebrae may be palpable. If the patient is conscious the pain must be taken into account but pain is generally a better sign than no pain.


If the patient is conscious then remind and insist that he/she does not move.

Assess by asking questions, which should include: ‘Where does it hurt?’, ‘Can you feel your fingers and toes?’, ‘Can you move your fingers and toes?’. The point of asking these questions is simply to reassure and to have an idea of the gravity of the situation. Whatever the answers, the individual must not move until medical expertise has arrived. Brief the medic on his/her arrival.

Cover the individual with a blanket or whatever it takes to keep him/her warm.

If medical aid is not forthcoming or unavailable, only then should transportation of the individual be considered.

Enlist as much help as possible and keep the individual’s shoulders and pelvis firmly held in the position that the casualty was found. Place pads of soft material between the thighs, knees and ankles.

Make do with whatever material is available.

The casualty is best transported in the face-upwards position but only if that was the position in which he/she was found. Do not turn the neck to accommodate this.

An unconscious casualty must be supported with blankets, pillows or any material to avoid movement.

A stretcher must be a stiff board. Consider a door if nothing else is available.

Once the casualty is on the board and supported, strap down around the forehead, shoulders, pelvis and knees and then place in the smoothest vehicle available.

Avoid giving anything by mouth.

At all times throughout this procedure ensure that the airways, breathing and circulation (ABC) are intact. Commence cardiopulmonary resuscitation (CPR) at any stage, attempting to keep the patient in the correct position.