Spinal injuries are one of the most complex and difficult situations to handle in first aid at the scene, and if not handled properly, can lead to serious consequences. In which environments are spinal injuries likely to occur in accidents? A fall from a place twice your height, such as a mountain slide, falling down stairs, etc.; a high-speed impact, such as a car accident; a bump or heavy object hitting your head, neck, and other parts of your spine. If any of these 3 spinal injury mechanisms exist, it is possible that a spinal injury has occurred to the injured person, and even though it cannot be determined at the scene, in the traditional EMS setting, we must team the injured person for spinal alignment, stabilization and immobilization in all cases where a spinal injury mechanism exists.

How do we properly initiate EMS at the scene when we are not sure of a spinal injury?

Step 1: Check the patient for vital signs You should approach the injured person from the front and check the patient's vital signs:

Is the patient conscious?

Is there a pulse?

If the patient is conscious, tell the injured person not to make excessive movements, such as sudden standing, twisting the body, neck, etc. Additional movements should be avoided to aggravate the spinal injury.

Is the airway open?

Is the breathing normal?

Is it a life-threatening hemorrhage?

Step 2: Quickly determine the injury

To perform a spinal assessment, the Society of Field Medicine has specific field guidelines for spinal assessment. To perform a spinal evaluation, the casualty needs to meet all of the following requirements:

The patient is awake and conscious, cooperative, alert and free of distracting injuries.

There is no spinal pain, numbness or tingling.

Physical examination is performed, including:

A: No spinal pressure pain.

B: Normal motor/perceptual function of the extremities:

1. abduction of fingers or extension of fingers/wrist against external forces;

2. flexion of the foot/big toe toward the sole/back of the foot;

3. the ability to distinguish sharp/painful from dull pain/light touch in the extremities. What if the injured person is confused or for other reasons, and I and the field personnel are still unable to accurately determine if the patient has a spinal injury? It is always recommended that such cases be treated as if there is a mechanism for spinal injury! In other words, when a serious spinal injury cannot be ruled out, the protection of the injured patient should include having appropriate spinal protection.

Step 3: If the patient is identified/suspected of having a spinal injury

If in an urban setting, do not lift the patient lightly, call emergency services quickly and wait for a medical professional to attend to the patient;

If the casualty is to be left to seek help, it is best to place the casualty on his or her side to better protect the airway, especially if the casualty has a low level of consciousness

If it is in a wilderness environment, or any environment is unsafe and requires emergency evacuation, you must be doubly careful when carrying, improper handling can cause secondary injury to the spine and irreversible consequences.