Awareness
The first few minutes after a serious accident can be frightening.
You may not know how badly someone is injured or whether helping could make things worse.
When a spinal injury is suspected, the priority is to stay calm, get help, and minimise unnecessary movement. But if the person isn’t breathing, can’t maintain their airway or is in immediate danger, lifesaving action takes priority.
Jason Jaftha, Emergency Care Technician (ECT) at ER24 West Metro, has attended trauma cases involving motor vehicle collisions, falls, and sporting and extreme sports injuries. He shares what bystanders should know while waiting for paramedics.
How can I tell if someone may have a spinal injury?
Always consider the possibility of spinal injury after significant trauma, particularly following a high-energy impact such as a motor vehicle collision, serious fall or sporting injury.
Possible warning signs include:
- Neck or back pain
- Tenderness along the spine
- Numbness or tingling
- Weakness or loss of sensation
- Difficulty moving the arms or legs
- Difficulty walking or maintaining balance.
However, spinal injury is not always immediately obvious.
“Someone may be conscious, talking, walking and initially say they feel completely fine,” says Jaftha.
He recalls attending a serious motor vehicle collision in which an elderly man’s double-cab bakkie had been struck by a bus and rolled. When paramedics arrived, the man was standing next to the vehicle and insisted that he was fine.
Because of how the injury happened, the team took spinal precautions and transported him for further assessment. Once the initial adrenaline and activity surrounding the incident had settled, he began experiencing pain.
Being able to stand or walk after an accident does not automatically rule out a serious injury.
What should I do in the first five minutes?
1. Make sure the scene is safe
Before approaching, check for hazards such as moving traffic, fire, or an unstable environment. Don’t put yourself in danger while trying to help someone else.
Once it’s safe, get emergency assistance and reassure the injured person that help is on the way.
2. Keep them calm and still
If the person is in a safe position, encourage them not to move unnecessarily.
If there is a reasonable suspicion of a neck or spinal injury, a bystander can gently support the person’s head by placing their hands on either side of the head, around ear level. This helps discourage unnecessary movement while waiting for paramedics.
Do not force the head or neck into a different position or attempt to straighten it.
Jaftha also stresses how important it is to explain what you’re doing before touching the person. For example: “I’m going to gently hold your head still while we wait for the ambulance. Please try not to move your neck. Help is on the way.”
Clear communication can help the injured person remain calm and avoid unnecessary movement.
What should I avoid doing?
If you suspect a spinal injury, don't move the person unless there’s a good reason to do so.
Never:
- Pull them to their feet
- Sit them up unnecessarily
- Try to straighten their neck
- Force their head into a particular position
- Assume they’re uninjured because they say they feel fine.
The goal is not to try to correct the spine yourself. It is to keep the person as still as possible until trained medical help arrives.
When is it necessary to move someone?
There are circumstances where moving a person with a suspected spinal injury is necessary, for example:
- They’re in immediate danger, such as exposure to fire or moving traffic
- Their airway cannot be maintained
- They have a life-threatening airway obstruction
- They’re not breathing normally and require CPR
- Another immediate threat puts their life at risk.
The distinction is important: avoid movement, but do not allow a suspected spinal injury to prevent lifesaving action.
“A suspected spinal injury should never prevent a bystander from taking appropriate action to save someone's life,” says Jaftha.
What if they’re unconscious or not breathing?
If someone is unconscious but breathing normally, and their airway can be maintained in their current position, try to keep them still and monitor them while waiting for emergency assistance.
If they vomit, develop an airway obstruction or can no longer maintain their airway, protecting the airway becomes your priority. Follow the emergency call operator’s instructions and move the person if necessary.
If someone is not breathing normally, begin appropriate CPR, following the call operator's guidance.
The same principle applies to a life-threatening airway obstruction.
“You cannot protect a spine at the expense of losing a life,” says Jaftha.
What information should I give emergency services?
When calling for help, explain as clearly as possible what happened, how the injury occurred, and whether:
- There was a fall, collision or significant impact
- The person lost consciousness
- They have neck or back pain
- They have numbness, tingling or weakness
- They can move their arms and legs
- They’ve already been moved
- There are hazards at the scene.
The mechanism of injury – in other words, the specific way the trauma occurred – and your observations can help emergency personnel assess the situation before they arrive.
The myth: “Never move someone with a spinal injury”
One common misconception is that someone with a suspected spinal injury must never be moved.
It is true that you should avoid unnecessary movement, but lifesaving action takes priority when someone can’t breathe, can’t maintain their airway, or is in immediate danger.
The five-minute takeaway
After a serious accident, remember:
- Make the scene safe
- Get help
- Keep the person calm
- Minimise movement
- Monitor their breathing
- If their airway or breathing is compromised, act to save their life.
Jaftha assures that you don’t need to perform complicated medical procedures while waiting for paramedics. “Sometimes the most valuable things you can do are to remain calm, reassure the injured person, prevent unnecessary movement, and provide accurate information to emergency services.”