How to Provide First Aid for a Suspected Cervical Spine Injury

A group of Emergency Medical Technicians work on a patient in a field rescue.

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If someone has neck pain after a significant injury, you should always suspect a cervical (C) spine injury. Whether they truly have one or not, holding the C-spine is imperative in these cases, as the cervical vertebrae (spine bones of the neck) could be shifted or damaged if the neck is twisted, compressed, or hyperextended.

A fracture or displacement of the C-spine—whether the result of the initial injury or a lack of immobilization after it occurred—can press on or cut the spinal cord. This can result in temporary or permanent paralysis or even death.

There are many ways in which the neck could be injured in such a way as to cause a C-spine injury. Some common causes include:

  • Vehicle or bicycle accidents
  • Sports injuries
  • Falls
  • Assaults

Follow the first aid protocol for how to hold the C-spine properly if you find yourself coming to the aid of anyone who has hurt their neck, and proceed with caution until the injury is properly evaluated by medical personnel.

What to Do for a Suspected C-Spine Injury

First aid involves taking precautions to avoid further injury as much as treating issues that need attention. The benefits of immobilizing a potentially compromised C-spine are so significant that there should be no question about taking these important steps, whether they end up proving necessary or not.

1. Ensure that the environment is safe for both rescuer and patient before providing any first aid. Always practice universal precautions and use personal protective equipment, if possible, whenever you may come in contact with blood or body fluids.

2. Call 911 for an ambulance. Make sure you know your location, particularly if you are calling 911 on a cell phone.

3. Check to see if the patient is breathing:

  • If the patient is not breathing or breathing abnormally (gasping), begin CPR. Perform chest compressions, or hands-only CPR, until help arrives. While it’s important to minimize movement of the spine, lifesaving first aid such as CPR should take priority. If someone is available to help, that person can place one hand on either side of the patient’s head to keep it in a neutral position while you perform CPR. If you’re trained in rescue breathing, use the jaw-thrust maneuver rather than the head-tilt chin-lift maneuver to keep the neck in a neutral position. 
  • If the patient is unconscious but breathing, place both hands on either side of their head to keep it steady until medical help arrives. In most cases, the patient should not be moved if you suspect a cervical spine injury. However, if the patient's airway needs to be kept clear from vomit or fluids, you can place the victim in the recovery position. Carefully roll the person onto their side while supporting the head, neck, and spine in a straight position. (If possible, have multiple people help with this.) Next, place padding, such as a pillow, under the patient's head to keep the neck straight.
  • If the patient is awake, place both hands on either side of the patient's head to steady it. Hold the patient's head gently but firmly to keep it from moving. Only release the head to help with the patient's airway, breathing, or circulation, or if the scene becomes unsafe. If you need to attend to their injuries or someone else’s, you can ask them to stare at something on the ceiling or in the sky to keep their head still.

4. Continue to immobilize the patient's head in any of the above situations until medical help arrives.

Patients should also be encouraged to keep their bodies as still as possible, as any movement can put the C-spine at risk.

Important Tips

Don't wrestle with a patient to keep their head straight. You could do more damage by forcing a patient not to move than just allowing it to happen.

Always call 911 for suspected cervical spine injuries. Once the patient arrives at the hospital, they must undergo diagnostic tests, such as an MRI, CT scan, or x-ray, to determine the extent of the damage.

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  1. Berg RA, Hemphill R, Abella BS, et al. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S685-705. Doi:10.1161/CIRCULATIONAHA.110.970939

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