4 Head and Spinal Injuries

Recognizing a possible injury

Head, neck, and spinal injuries can damage the brain, bones, or spinal cord. A serious injury may be present even when there is no obvious wound or when only some warning signs appear, so treat the possibility cautiously.

Warning signs and injury risk

Suspect a possible injury after a Significant mechanism of injury, including a vehicle crash, a fall from height, a headfirst impact, or a hard blow during sport. A significant event or a change in responsiveness is reason to take the possibility seriously.

Warning signs include:

• Head, neck, or back pain, tenderness, or an unusual position or deformity.

• Confusion, unusual behavior, repeated questions, reduced alertness, or loss of consciousness.

• Weakness, numbness, tingling, loss of movement, or difficulty with balance.

• Seizure, nausea or vomiting, or impaired vision.

• Blood or clear fluid from the ears or nose, or bruising around the eyes or behind the ears.

• Changes in breathing.

Get help and keep the person still

First check that the scene is safe, using protective equipment if available. Call 911 for a significant injury, suspected neck or spinal injury, Altered responsiveness, or other serious warning signs. Ask someone else to call if possible.

Tell the person to stay still and leave them in the position found unless movement is needed for immediate safety, CPR, or to manage an airway problem. Do not ask them to sit, stand, or test their movement.

Limit movement while providing care

Limit head and neck movement. If you can do so without forcing the person's position, steady the head and neck with your hands. Do not try to straighten a painful or oddly positioned neck or back. Leave a helmet in place unless it must be removed to provide CPR or manage the airway.

Stay with the person, reassure them, and protect them from becoming too cold or hot. Continue care within your training while waiting for emergency responders.

Monitor breathing and responsiveness

Keep checking whether the person responds and whether they are breathing normally. Notice and report any change to emergency responders, including becoming more confused or drowsy, becoming unresponsive, or breathing abnormally. Do not leave the person alone if you can avoid it.

If the person becomes unresponsive and is not breathing normally, call 911 if that has not been done. Begin CPR and use an AED if available, following your training and the dispatcher’s instructions. A suspected spinal injury does not take priority over an immediate threat to breathing. Move the person only as much as needed to provide lifesaving care; get help to maintain head, neck, and back alignment where possible.

When a position change is necessary

If vomiting, blood, or another Airway problem makes a position change necessary, get assistance and move the person as carefully as possible while keeping the head, neck, and back aligned. Do not attempt a solo roll if help is available.