Your spinal cord contains the nerves that carry messages between your brain and body. The cord passes through your neck and back. A spinal cord injury is very serious because it can cause paralysis below the site of the injury.

Neck injury

When someone has a spinal injury, additional movement may cause further damage to the nerves in the cord and can sometimes mean the difference between life and death.

If you think someone could possibly have a spinal injury, DO NOT move the injured person even a little bit, unless it is absolutely necessary (like getting someone out of a burning car).

If you are in doubt about whether a person has a spinal injury, assume that he or she DOES have one.

• Bullet or stab wound
• Direct trauma to the face, neck, head, or back (e.g., car accidents)
• Diving accident
• Electric shock
• Extreme twisting of the trunk
• Sports injury (landing on head)
• Major blow to the head or chest, car accident, fall from a great height

• Head held in unusual position
• Numbness or tingling that radiates down an arm or leg
• Weakness
• Difficulty walking
• Paralysis of arms or legs
• No bladder or bowel control
• Shock (pale, clammy skin; bluish lips and fingernails; acting dazed or semi-conscious)
• Unconscious
• Stiff neck, headache, or neck pain

The main goal is to keep the person immobile and safe until medical help arrives.

1. You or someone else should call 911.
2. Hold the person's head and neck in the position in which they were found. DO NOT attempt to reposition the neck. Do not allow the neck to bend or twist.

1. Check the person's breathing and circulation. If necessary, begin rescue breathing and CPR.
2. DO NOT tilt the head back when attempting to open the airway. Instead, place your fingers on the jaw on each side of the head. Lift the jaw forward.

IF YOU NEED TO ROLL THE PERSON

Do not roll the person over unless the person is vomiting or choking on blood, or you need to check for breathing.

1. Two people are needed.
2. One person should be stationed at the head, the other at the person's side.
3. Keep the person's head, neck, and back in line with each other while you roll him or her onto one side.

• DO NOT bend, twist, or lift the person's head or body.
• DO NOT attempt to move the person before medical help arrives unless it is absolutely necessary.
• DO NOT remove a helmet if a spinal injury is suspected.

Call you local emergency number (such as 911) if there has been any injury that affects the neck or spinal cord. Keep the person absolutely immobile. Unless there is urgent danger, keep the person in the position where he or she was found.

• Wear seat belts.
• Avoid drinking alcohol and driving.
• Avoid diving into pools, lakes, rivers and surf, particularly if you cannot determine the depth of the water, or if the water is not clear.
• Avoid motorcycles and all-terrain vehicles.
• Avoid "spearing" (tackling or diving into a person with your head).

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Townsend, Jr., CM, ed. Sabiston Textbook of Surgery. 17th ed. Philadelphia, Pa: Elsevier; 2004:498-502,1952.

DeLee JC, Drez, Jr., D, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders; 2003:798,837.