Treating Cervical Spinal Neck Injuries when Disaster Strikes

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What I am about to teach goes against International Standards for First Aid for lay rescuers. Ask me if I care. I don’t. Why? Because the international standards only get updated every 5 years so they are WAY behind in the use of Tourniquets. But also what they advocate for spinal injuries when it comes to Airway Management is not only wrong it is dangerous and causes unneeded harm to the patient. The reason behind this is because they don’t think you can handle a simple procedure. I do… with a few caveats.

WARNING: Spinal Injuries are dangerous. If you do not feel comfortable even with training performing any of these tasks then it is best not to make the attempt. Never attempt any of these procedures without training and guidance from a professional rescuer. Do at your own risk.

So to avoid getting myself or sued let me preface this by saying this is for entertainment purposes only. Consult a physician prior to attempting any medical interventions. If you suspect anyone of a neck injury call 911 or activate EMS immediately. Good Samaritan laws will not protect you if you do something that violates established standards.


  • C-Spine: NECK
  • MOI: Mechanism of Injury or how you got hurt
  • GSW: Gun Shot Wound
  • BA: Blunt Assault or Bain attacks
  • SW: Stab Wounds
  • Fully Immobilized: C-Collar properly placed and strapped down to a long spine board.

What you need for Neck Injury Treatment

  • A safe scene or cover: Never attempt any rescue if it is unsafe to do so! This includes under combat conditions. Suppress enemy fire before helping others. Direct the wounded to suppress enemy fire.
  • A long spine board: Don’t go out and buy one. You can easily make a spine board at home.
  • C-Collar (Neck Brace) or SAM Splint: C-Collar Preferably because the C-Collar can accommodate an Endotracheal Tube (ET tube) Click here for sizing instructions.
  • Straps or belts.
  • Sandbags, pillows, boots or other padding.
  • Tape (duct, gorilla, or medical)
  • A good Orthopedic Surgeon.

How to Treat Neck Injuries when Disaster Strikes

Suspect someone has a C-Spine injury if they have a significant MOI. I am talking they fell off a roof, they got into a car accident with airbag deployment, a blast injury, BA, SW to the head or neck, GSW,

How to immobilize: If the victim is in a car immobilize the c-spine with your hands but make sure not to cover the ears. Do not allow for flexing, extending, or rotating of the head or neck. If on the ground place the victims head between your knees and place your knee cap at their shoulder. This will allow your hands to be free.


Place a C-Collar or Sam Splint on the patient.

When a long spine board does come continue to hold the patient’s head and neck in line with the rest of the spine. When you roll the patient onto the spine board then you are going to roll the patient on the count of the person holding the neck. So that person needs to make sure everyone on the team understands what the commands are and how to execute. Place the victim on the spine board by placing it as you roll the patient.

Apply at least 3 straps to the patient. Place a sandbag, boots, pillows, or padding on either side of the patients head on the long spine board. fold the tape in half over enough area to cover the chin and forehead so that the tape doesn’t adhere to the forehead or chin. Criss-cross the tape. The patient should ideally not be able to move their head or neck.

Special Considerations
Airway management

This is where The Dave Black has beef with the international standards for first aid. In dealing with airway blockages the preferred method is utilize the jaw thrust for professional rescuers. For the general public it is the head tilt chin lift and rolling the patient into the recovery position. So instead of teaching the very simple procedure of the Jaw Thrust  which would negate the need for the recovery position. They simply tell you to do the head tilt chin lift. This causes flexing in neck which could result in Cervical Spinal Cord Injury (CSCI) which could result in paralysis including an inability to breathe on their own.

So now because they didn’t want to teach you the Jaw Thrust you could potentially have to hook them up to a respirator for the rest of their lives. Brilliant. I am not about to let anyone make that mistake here. Yes Airways do trump spinal injuries. That being said you do not want to cause further harm to your patient. So if you are on your own and you come upon someone who isn’t breathing with a suspected spinal injury than perform the Jaw Thrust. If you are unsuccessful and you have no way of reaching higher levels of care. Then after exhausting all possibilities is it okay to perform the head tilt chin lift.

Jaw Thrust

The Jaw thrust is a simple yet effective maneuver to clear the tongue from blocking the airway. Your tongue is indirectly attached to your jaw or mandible. So if you push on the back of the jaw below your ear and you press it forward so you have a really bad under-bite you will have a clear airway. It is that simple.

Safety Pin

God damn it I love safety pins. So your hands are full. You have too many patients… not enough time. You got a patient with suspected C-Spine injury with a c-collar on, immobilized on a long spine board, and is unconscious. If you don’t hold the airway they will die. If you do someone else will die. Safety Pin their tongue to their lip. OUCH! Well it is better than dying. The worst thing that can happen is infection.


Before you can move a person with a C-spine injury from a car you need to immobilize them. There are Oregon Spine Splints or a half spine board that works for this purpose. This often requires special training and equipment. So only remove someone from a vehicle if it is on fire or otherwise presenting a life threat to the patient.

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About David Black

Trained and Certified: National Registry EMT, Wilderness EMT, US Army 68W, Tactical Combat Causality Care (TCCC), Basic Life Support for Healthcare Workers, Advanced Cardiac Life Support, Pediatric Advanced Life Support, US Coast Guard Medical Person In-Charge, Pre-Hospital Trauma Life Support. International Trauma Life Support. HAM Radio Technician. Trained and Certified to Instruct: Combat Life Saver Instructor and Community Emergency Response Team Trainer. CPR, AED, First Aid.

7 thoughts on “Treating Cervical Spinal Neck Injuries when Disaster Strikes

  1. Every RC should incorporate TCCC into their BCT because you are way more likely to use your IFAK than your Rifle. If someone needs help in that regard feel free to contact me. I have friends across the country who can help.

  2. The OD green ACE ambu-perfit adult sized C-collar which is available on the following websites: North American Rescue, Remote Medical International, and They are not very expensive about the price of the USCrow survival manual so while you shop you can pick up both. I recommend one for every platoon size element and have SAM splints in each CLS bag. I have used C-Collars way more often than I have used an AED. Keep it attached to your long spine board or outside of your Aid Bag so you do not lose it. Also if you come upon a car accident or whatever. Do not use it unless it is SHTF. Just hold the person still until EMS arrives. No sense in wasting your supplies because the EMS will not have the OD green one I can promise you that.

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