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Spinal Injuries in Sports First Aid - Manual Immobilisation Techniques

Perhaps as interesting as what we do teach on the two day Pitch-side Sports First Aid course with AED Training is what we don't teach and why!!!

Manual Immobilisation Techniques for Spinal Injuries

The two day sports first aid course focuses on the use of manual techniques for spinal immobilisation. A manual technique is when the first aider supports the casualty’s head with two hands in order to minimise any movement of the neck or spine. This manual immobilisation technique is simple, memorable and effective in all situations. It is the core skill in all spinal immobilisation and its usefulness must not be underrated, it can be used on casualties in the position they are found in; sitting, lying or standing, whilst awaiting medical assistance. The casualty should not be moved unless there is good reason to do so, so learning a technique which can be applied to any position the casualty is found in is invaluable. It can also be practised in conjunction with a two person or a spinal log roll if it becomes necessary to move the casualty with minimal movement to the spine.


Why have we chosen not to teach the use of spinal boards on our Pitch-side Sports First Aid course?

In the majority of situations dealt with by pitch side first aiders, proficient use of manual immobilisation techniques is entirely suitable and effective.

  • A first aider must first be proficient in manual immobilisation before other techniques and equipment, such as the spinal board, can be introduced.
  • Spinal board training is mostly carried out for specific environments. For example pool lifeguards will learn to use a spinal board and will undergo specific and continual training and rehearsal of their use. Lifeguards have to have this training because it is not possible keep a head neck and spine in line in water without a spinal board and they are responsible for removing casualties from the water.
  • The decision to move a casualty with a suspected spinal injury and place them onto a spinal board is most commonly taken by a qualified medical professional. If you wish to make this decision as a first aider you must have a justified reason why it was not possible to leave the casualty in the position that they were found and immobilise their head and neck using a manual technique.
  • Being strapped to a spinal board is uncomfortable and distressing for conscious casualties. A casualty cannot be removed from the board until they have been cleared by a medical professional, which could be in a few hours time. When in discomfort many casualties continually try to move to reduce the discomfort.
  • Medical professionals have advanced airway management skills and tools such as suction devices and intubation tubes to manage the airway of a casualty who is on their back on a spinal board, should they become unresponsive or start to vomit. A first aider does not have these skills or tools and the first aid treatment for an unresponsive, breathing casualty is to place them on their side in a safe airway position.
  • On a one or two day first aid course which is not revalidated for 3 years it is unreasonable to expect a first aider to be able to acquire and maintain the skills required to use a spinal board safely.
  • Continual updating of these skills is required.

What training and equipment is required to manage a full spinal immobilisation?

Many clubs buy a spinal board but do not realise that they also need collars, blocks and straps as well as staff trained specifically in the use of the equipment.Training should be a minimum of one day and refreshed annually and should include:

  • Understanding which casualties should be immobilised
  • The manual technique in a static position
  • How to measure for the correct collar how to apply the collar how to do the manual technique whilst moving a casualty
  • How to position the casualty correctly on the board
  • How to strap the casualty to the board correctly
  • How to apply blocks and strap the headwhat to do if the casualty vomits
  • What to do if the casualty’s GCS drops

Without advanced airway management equipment the only way for a first aider to manage an airway of an immobilised, vomiting casualty is to tip the whole board on its side - therefore the immobilisation needs to be very good which takes a lot of regular practice. Also, they would have an airway issue if the casualties GCS drops as the recommended first aid positions for an unresponsive, breathing casualty is to roll them into a safe airway position, they cannot be left on their backs.

It is also worth noting that when the emergency services arrive to treat a casualty who is already on a board they will not risk moving them further on to their own equipment so they will take yours. In the short term this means that the club will then not have a spinal board should a second injury occur and in the long term it will be up to you to try to retrieve all your equipment from the hospital. It is uncommon for hospitals to have a system in place to facilitate this.

The conclusion of a recent (2019) Danish study on the spinal stabilisation of adult trauma patients is:

"The evidence for spinal stabilisation of trauma patient is sparse. Based on a systematic review of the existing literature, grading of the strength of the evidence, clinical judgment and a consensus process, our Danish working group formulated the following recommendations for spinal stabilisation of adult trauma patients: a strong recommendation against the efforts of spinal stabilisation in case of patients with isolated penetrating injuries, a weak recommendation against the use of the rigid cervical collar as well as the hard backboard, and a weak recommendation for the use of a vacuum mattress in case of ABCDE-stable patients. Lastly, our working group suggests our algorithm should be adopted based on the clinical findings rather than the mechanisms of injury to guide clinical practice."

[ref: ]

Conscious Casualties

In line with multiple publications on the subject; alert and ABCDE-stable patients will seek to stabilise their spine themselves and in the most comfortable position for them as possible automatically. I.e. a fully conscious patient with a suspected spinal injury should not be strapped to a spinal board!

Why do we put cervical collars on conscious trauma patients?
Benger J, Blackham J
Scand J Trauma Resusc Emerg Med. 2009 Sep 18; 17():44.

Rogers L. No place for the rigid cervical collar in pre-hospital care. Int Paramed Pract [Internet]. 2017;7:12–5. Available from:

There remains a lack of studies and evidence to promote the use of cervical collars in both hospital and pre-hospital environments. Their use by first aiders should not be promoted. There is much reading on this subject in medical journals!!

Safe Airway Positions - Treatment for an unresponsive, breathing casualty

A safe airway position is the treatment for any unresponsive, breathing casualty. The 'recovery position' is the most well-known but is just one of many safe airway positions. On our Outdoor First Aid and Sports First Aid courses we teach the HAINES modified recovery position as standard as it reduced the risk of any further spinal cord damage when moving an unresponsive casualty with a suspected neck injury. Unresponsive casualties cannot be left on their back as this compromises their airway.

Studies have shown that there is less neck movement than when the standard lateral recovery position is used and therefire use of the HAINES modified recovery position carries less risk of spinal cord damage.

We also teach methods for single rescuers to control the head and neck movement during the roll into this position again with the aim of minimising neck movement.


Prehospital personnel who lack advanced airway management training must rely on basic techniques when transporting unconscious trauma patients. The supine position is associated with a loss of airway patency when compared to lateral recumbent positions. Thus, an inherent conflict exists between securing an open airway using the recovery position and maintaining spinal immobilization in the supine position.


Advanced Airway Management Equipment

We do not cover any medical or invasive procedures such as the use of nasopharyngeal airways and handheld suction devices. This is medical training and not first aid. Anything that falls outside the boundarary of commonly accepted first aid practice or the scope of your profession will probably not be covered by your insurers.

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