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The 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 loss of movement (paralysis) below the site of the 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 (for example, if you need to get someone out of a burning car).

If you are not sure if 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, chest, or back (for example, a car accident)
• Diving accident
• Electric shock
• Extreme twisting of the middle of the body
• Landing on the head during a sports injury
• Fall from a great height

• Head held in unusual position
• Numbness or tingling that spreads down an arm or leg
• Weakness
• Difficulty walking
• Paralysis (loss of movement) of arms or legs
• No bladder or bowel control
• Shock (pale, clammy skin; bluish lips and fingernails; acting dazed or semiconscious)
• Lack of alertness (unconsciousness)
• 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.
3. Do not allow the person to get up and walk unassisted.

IF THE PERSON IS UNRESPONSIVE

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 located at the person's 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 still. Unless there is urgent danger, keep the person in the position where found.

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

Neck injury

Hockberger RS, Kaji AH, Newton EJ. Spinal injuries. In: Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St Philadelphia, Pa: Mosby Elsevier; 2006:chap 40.

Hoyt DB, Coimbra R, Acosta J. Management of acute trauma. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 20.

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

Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.