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. 1
- 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.