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How we treat casualties with spinal injuries

By 7th October 2016Medical

Spinal injuries can be caused through significant forces involved in traumatic incidents.  Although a rare injury our medics treat a couple of dozen competitors with suspected cervical spinal injuries every year.  The cervical spine involves the top seven vertebrae from the base of the skull to the similar level of the shoulders.

Vertebrae = the bony sections making up the spinal column.

Any vertebrae fracture is potentially serious.  The fracture could cause spinal cord swelling or even full transection and such injuries can lead to life threatening or life changing conditions.  Nerves that control the function of muscles stem from the spinal cord.  An injury that affects the spinal cord in the lower spine could cause temporary or permanent paralysis of the lower limbs, whereas an injury to the cervical spine could affect breathing and cause immediate death.

Spinal cord = nervous tissue which is an extension of the brain that runs the length on the spinal column.


At the time of injury the spinal cord may not be immediately affected and the patient may not show any neurological changes.  However, such an injury could be exacerbated through excess movement.  That’s why patients with relevant history and examination findings are treated with caution and a signifiant underlying injury must be suspected by the medics.

Our medics use the NEXUS c-spine rules to confirm whether the patient should be treated for cervical spinal injuries or not.  This clinical examination tool comprises five criteria.  Immobilisation of the casualty is not indicated if they meet all five criteria:

  • No neurological deficit e.g. pins and needles/loss of feeling
  • No midline tenderness e.g vertebrae tenderness
  • No altered level of consciousness e.g. patient is fully awake with no history of reduced level of consciousness.
  • Not intoxicated
  • No distracting injuries e.g significant painful fractures.

img_3526If we decide through using the NEXUS rules that the patient may have a spinal injury we will fully immobilise them.  To be done correctly, immobilisation can take several minutes and involves several medics or helpful marshals and event staff.  We will apply a hard collar around the neck of the patient, before placing a split, scoop stretcher under them and securing them to it.  This immobilisation process helps keep the spine in a neutral alignment and reduces the risk of worsening what could be a relatively stable fracture of the vertebrae and thus reducing likelihood of spinal cord damage.  This process could take longer if the patient is wearing a helmet or body armour as this will have to be removed first.

Thankfully the majority of the time our efforts have been proved purely precautionary and subsequent imaging (MRI/X-rays) performed in hospital have returned negative findings.  In fact sometimes we’ve seen patients back at events the same day to say thank you.  We’d of course rather this than making any potential injury significantly worse.

If a patient is complaining of back or neck pain or has been injured by falling or crashing at speed then those first on scene (often event marshals) should instruct the patient to remain still and call for medical assistance.  The marshal could hold the head still to prevent the patient from moving it.   It’s a great idea to offer your marshal team first aid training.  We can assist with this.



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