What position would you put the victim with a head, neck or back injury

Moving a victim with a head, neck, or spinal cord injury should be left to paramedics or other professionals because permanent damage could result from improper handling.

If a victim must be pulled to safety, move him or her lengthwise and head first, supporting the head and neck. Keep the spine in alignment.

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For burns, the immediate goals are to relieve pain, prevent infection, and treat for shock.

• First- and second-degree burns with closed blisters are best treated with cold water.
  • Immerse the burned area, or cover it with cloths that have been soaked in cold water—don’t use ice water.
  • Avoid using butter or any type of greasy ointment because they can interfere with healing and cause an allergic reaction.
• Second- and third-degree burns with open blisters should be wrapped with a loose, dry dressing.

Treating Carbon Monoxide Poisoning

Improperly working camp stoves and lanterns, as well as wood and charcoal fires, can produce lethal carbon monoxide.

• Symptoms of carbon monoxide poisoning include headache, dizziness, weakness, and difficulty in breathing. The victim’s skin can turn red, and he or she can lose consciousness.
• Get victims into fresh air immediately, and keep them lying quietly. Prompt medical care is essential.

Treating a Chest Wound

A bullet striking the chest can cause a sucking chest wound—a deep, open wound of the chest wall that allows air into the chest cavity.

• All chest injuries are very serious and need immediate medical attention.
• To respond immediately to a chest wound:
  • Use the palm of your hand to cover the wound until a bandage is located.
  • Cover the wound with sterile gauze, a clean cloth, plastic, or foil.
  • Make sure the wound cover forms an airtight seal.
  • Hold the gauze in place with a bandage or tape.
  • If the victim has trouble breathing, remove the bandage, and replace it quickly.
  • Transport the victim to the hospital with the injured side down.

Introduction: Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the "lateral recovery position," coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.

Hypothesis: It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the "HAINES modified recovery position." HAINES is an acronym for High Arm IN Endangered Spine.

Methods: Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.

Results: For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).

Conclusion: An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.

First Aid for Neck/Spine Injury

Anything that puts too much pressure or force on the neck or back can result in a neck and/or spinal injury. Common causes are:

• Accidents - with cars, motorcycles, snowmobiles, toboggans, roller blades, etc.
• Falls - especially from high places
• Diving mishaps - from diving into water that is too shallow
• A hard blow to the neck or back while playing a contact sport such as football
• Violent acts such as a gunshot wound that penetrates the head, neck or trunk

Suspect a neck injury, too, if a head injury has occurred.

Some neck and spinal injuries can be serious because they could result in paralysis. These need emergency medical care. Others, such as whiplash, can be temporary, minor injuries.

A mild whiplash typically causes neck pain and stiffness the following day. Some people, though, have trouble raising their heads off the pillow the next morning. Physical therapy and a collar to support the neck are the most common types of treatment. It often takes three to four months for all symptoms to disappear.

Prevention

• Use padded headrests in your car to prevent whiplash.
• Drive carefully and defensively.
• Wear seatbelts, both lap belts and shoulder harnesses.
• Buckle children into approved car seats appropriate for their age.
• Wear a helmet whenever you ride a bicycle or motorcycle or when you roller skate or roller blade.
• Wear the recommended safety equipment for contact sports.
• Take care when jumping up and down on a trampoline, climbing a ladder or checking a roof.
• Check the depth of the water before diving into it. Do not dive into water that is less that 9 feet deep. Never dive into an above-ground pool.

NOTE: IF YOU SUSPECT A NECK OR BACK INJURY IN YOU OR SOMEONE ELSE,

• YOU MUST KEEP THE NECK AND/OR BACK PERFECTLY STILL UNTIL AN EMERGENCY CREW ARRIVES.

• DO NOT MOVE SOMEONE WITH A SUSPECTED NECK OR SPINE INJURY UNLESS THE PERSON MUST BE MOVED BECAUSE HIS OR HER SAFETY IS IN DANGER.

• ANY MOVEMENT OF THE HEAD, NECK OR BACK COULD RESULT IN PARALYSIS OR DEATH.

Is the injured person not breathing and has no pulse?
	Perform CPR, but without moving the neck or spine and Seek Emergency Care. (See "CPR") But when you do the "Airway and Breathing" part of CPR, do not tilt the head back or move the head or neck. Instead, pull the lower jaw (chin) forward to open the airway.
Is the injured person not breathing, but has a pulse?
	Perform "Rescue Breathing" without moving the neck or spine and Seek Emergency Care. (See "Airway and Breathing".) But do not tilt the head back or move the head or neck. Instead, pull the lower jaw (chin) forward to open the airway. Give first aid before emergency care: Tell the victim to lie still and not move his or her head, neck, back, etc. Immobilize the neck and/or spine. Place rolled towels, articles of clothing, etc. on both sides of the neck and/or body. Tie and wrap in place, but don't interfere with the victim's breathing. If necessary, use both of your hands, one on each side of the victim's head, to keep the head from moving. Note: If you must move someone with a suspected neck or spinal injury follow the above procedures and: Select a stretcher, door or other rigid board. Several people should carefully lift and move the person onto the board, being very careful to align the head and neck in a straight line with the spine. The head should not rotate or bend forward or backward. Make sure one person uses both of his or her hands, one on each side of the victim's head, to keep the head from moving. If you can, immobilize the neck and/or spine by placing rolled towels, articles of clothing, etc. on both sides of the neck and/or body. Tie and wrap in place, but don't interfere with the victim's breathing. Note: If you suspect someone has injured his or her neck in a diving or other water accident: Protect the neck and/or spine from bending or twisting. Place your hands on both sides of the neck and keep in place until help arrives. If the person is still in the water, help the person float until a rigid board can be slipped under the head and body, at least as far down as the buttocks. If no board is available, several people should take the person out of the water, supporting the head and body as one unit, making sure the head does not rotate or bend in any direction.
Does the injured person have any of these signs or symptoms? Paralysis Inability to open and close his or her fingers or move his or her toes. Feelings of numbness in the legs, arms, shoulders or any other part of the body. Appearance that the head, neck or back is in an odd position.
Are any of these present following a recent injury to the neck and/or spine that did not get treated with emergency care at the time of the injury? Severe pain. Numbness, tingling or weakness in the face, arms or legs. Loss of bladder control.
Do you suspect a whiplash injury or has pain from any injury to the neck or back lasted longer than one week?

If you suspect a whiplash injury:

• See your doctor as soon as you can so he or she can assess the extent of injury.
• For the first 24 hours, apply ice packs to the injured area for up to 20 minutes an hour.
  • To make an ice pack, wrap ice in a face towel or cloth.
• After 24 hours, use ice packs or heat to relieve the pain.
  • Taking a hot shower for 20 minutes a few times a day is a good source of heat to the neck.
  • Use a hot water bottle, heating pad (set on low), or heat lamp, directed to the neck for 10 minutes several times a day. (Use caution not to burn the skin.)
• Use a cervical pillow or a small rolled towel positioned behind your neck instead of a regular pillow.
• Wrap a folded towel around the neck to help hold the head in one position during the night.
• If you arm or hand is numb, buy or rent a cervical-traction device. Ask your doctor how to use it.
• Take aspirin, acetaminophen, ibuprofen or naproxen sodium for minor pain. [Note: Do not give aspirin or any medication that has salicylates to anyone 19 years of age or younger unless a doctor tells you to.]
• Get plenty of rest.

© American Institute of Preventive Medicine