What would you do if an unconscious casualty has a suspected spinal injury?

Assessing an injured person

The 3 priorities when dealing with a casualty are commonly referred to as ABC, which stands for:

• Airway
• Breathing
• Circulation

Airway

If the person appears unresponsive, ask them loudly if they're OK and if they can open their eyes.

If they respond, you can leave them in the position they're in until help arrives.

While you wait, keep checking their breathing, pulse and level of response:

• Are they alert?
• Do they respond to your voice?
• Is there no response to any stimulus (are they unconscious)?

If there's no response, leave the person in the position they're in and open their airway.

If this is not possible in the position they're in, gently lay them on their back and then try to open their airway.

To open the airway, place 1 hand on the person's forehead and gently tilt their head back, lifting the tip of the chin using 2 fingers. This moves the tongue away from the back of the throat.

Don't push on the floor of the mouth, as this will push the tongue upwards and obstruct the airway.

If you think the person may have a spinal injury, place your hands on either side of their head and use your fingertips to gently lift the angle of the jaw forward and upwards, without moving the head, to open the airway.

Take care not to move the person's neck. But opening the airway takes priority over a neck injury. This is known as the jaw thrust technique.

Breathing

To check if a person is still breathing:

• look to see if their chest is rising and falling
• listen over their mouth and nose for breathing sounds
• feel their breath against your cheek for 10 seconds

If they're breathing normally, place them in the recovery position so their airway remains clear of obstructions, and continue to monitor normal breathing.

Gasping or irregular breathing is not normal breathing.

If the person isn't breathing or is not breathing normally, call 999 for an ambulance and then begin CPR.

Circulation

If the person isn't breathing normally, you must start chest compressions immediately.

Agonal breathing is common in the first few minutes after a sudden cardiac arrest (when the heart stops beating).

Agonal breathing is sudden, irregular gasps of breath. This shouldn't be mistaken for normal breathing and CPR should be given straight away.

If the person isn't breathing, call 999 for an ambulance and then begin CPR.

First aid courses

The advice given on this page only covers common first aid situations and is not a replacement for taking a first aid training course.

Spinal injury is damage to any part of the spinal cord. Injury to the spine interferes with the transmission of messages to and from the brain which may result in paralysis in the legs or arms. If the injury is very high up the spine, breathing can also be affected.

What to do

Unconscious casualty

1. Follow DRSABCD St John Action Plan.
2. Reassure the casualty.
3. If the casualty is breathing but remains unconscious, place them into the recovery whilst holding the head and spine in a neutral position to prevent twisting or bending during movement.
4. Support head and neck in the neutral position place hands on either side of the casualty’s head to prevent twisting or bending the spine.
5. Maintain a clear and open airway.
6. Urgent medical aid. Call Triple Zero (000) for an ambulance.

Conscious casualty

1. Follow DRSABCD St John Action Plan
2. Rest and reassure.
3. Loosen tight clothing.
4. Support and hold head and neck in a neutral position, place hands on either side of the casualty’s head to prevent twisting or bending the spine.
5. Urgent medical aid. Call Triple Zero (000) for an ambulance.

Caused by

• Traffic-related accidents.
• Workplace related accidents.
• Sporting accidents.
• Falls or hit by a falling object.
• Significant blows to the head.

Signs and symptoms

• Pain at or below site of injury.
  
• Tenderness or deformity.
• Absent or altered sensation below site of injury e.g. tingling.
• Loss of/or impaired movement below site of injury.
• Nausea.
• Headache or dizziness.
• Breathing difficulties.
• Altered conscious state.

What steps should be taken when a casualty suffering from a spine injury is unconscious?

When should you attempt to move a conscious person with a suspected spinal injury?

Under which circumstances should you suspect a spinal injury?

When should someone with a spinal injury be placed in the recovery position?