What is the recommended treatment for someone with a back or neck injury?

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.

There are several, validated clinical decision rules. The Canadian C-spine rule and NEXUS are the two most clinically utilised in Australia. These two clinical decision tools help you to decide who needs radiology to rule out a significant cervical spine injury.

Have a working understanding of both rules. Whichever rule you chose to apply, complete all the components of that rule.

If a patient passes either rule they can be cleared clinically without injury. Specifically, the NEXUS rule allows you to clear patients with a serious mechanism of injury if they are symptoms free, where as The Canadian rules do not. However, the Canadian rules allow you to clear a patient with neck pain if they have low risk features, where as the NEXUS rule does not.

Canadian Cervical Spine Rule (Canadian C-spine Rule)

8900 patients. 100% sensitive, 42.5% specific.

NEXUS (National Emergency X-Radiography Utilization Study)

>34,000 patients. It only included a very small number of infants, so be careful about applying rules to the paediatric populations.
Found to be 99% sensitive for detecting ANY injury, 99.6% specific for detecting ‘significant’ injury. However, in patients >65 years, sensitivity dropped to only 89% for clinically significant injury.
12.9% specific.

In recent years there has been increasing discussion around the use of spinal immobilisation both pre and in hospital, in particular the use of the rigid cervical collar and the evidence behind it (1-6).

There is no scientific evidence that any type of cervical collar used in prehospital transport or initial trauma management is effective in stabilising an acutely injured cervical spine or preventing further neurological deterioration in those with spinal cord injury (7). However, there is evidence that rigid collars can lead to significant complications and morbidity when used to secure the c-spine.

These complications include (11-13):

Pressure areas of the scalp and neck
Increased pain adversely affecting compliance with immobilisation strategies designed to protect patients from further harm
Impaired jugular venous return and rises in intracranial pressure both in head-injured and healthy people
Impaired respiratory effort and forced expiratory volume, particularly in older patients with chest injury or comorbid respiratory conditions, predisposing these patients to aspiration
Increased complexity of airway management
Increased extrication time and delay to definitive treatment

Evidence indicates that we are unable to completely immobilise the C spine in any collar and there is no data to support that any additional movement of an injured C spine causes more damage (13, 14).

After consultation with specialist clinicians across NSW and consideration of the available evidence, The Institute of Trauma and Injury Management (ITIM) and ECI have concluded that the risks of immobilisation with rigid collars outweigh the chance of benefit.

ITIM and ECI are advocating for the adoption of foam cervical collars in the initial management of injured adults and children requiring cervical spine precautions being transported by NSW Ambulance and presenting to NSW Health facilities.

For more information, please read our Position Statement on maintaining cervical spine precautions. This statement also covers application of foam collars in a variety of clinical scenarios.

Autonomic dysreflexia is a medical emergency that can occur in people with spinal cord injury at or above the sixth thoracic (T6) level. It is a sudden and severe rise in blood pressure resulting from overactivity of an isolated sympathetic nervous system below the lesion, triggered by a nociceptive stimulus that can result in intracranial haemorrhage, fits, arrhythmias, hypertensive encephalopathy and even death. This potentially life-threatening condition requires immediate and decisive action. Below are some useful links to assist in the management of this condition in the emergency department:

Autonomic Dysreflexia Medical Emergency Card

Autonomic Dysreflexia Algorithm

Treatment of Autonomic Dysreflexia for Adults and Adolescents with Spinal Cord Injuries (updated 2014)

Video Presentation on Autonomic Dysreflexia by Dr James Middleton

Autonomic Dysreflexia in adults with spinal cord injuries - HETI module - only accessible to NSW Health employees

Safety Notice 14/10 - Autonomic Dysreflexia (revised) 2010

Management of the Neurogenic Bladder for Adults with Spinal Cord Injuries

Management of the Neurogenic Bowel for Adults with Spinal Cord Injuries