CHAPTER 12
MANAGEMENT OF SPINAL FRACTURES
FIRST AID AND TRANSPORTATION
The initial management of the spinal cord injured must start at the place of accident
(Guttmann, 1968). Proper first aid of a casualty with a suspected vertebral fracture involv
ing the spinal cord not only can reduce the broken vertebra at the place of the accident
and thus remove immediately pressure from the spinal cord, if this is the only cause of the
paraplegia (extremely rare), but can also prevent a primarily partially damaged spinal
cord from becoming a complete lesion. Recently, Geisler, Wynne-Jones & Jousse (1966)
reported 29 patients with traumatic lesions of the spine who developed further paralysis
through faulty handling during first aid.
As the great majority of paraplegics and tetraplegics are conscious after the accident
the following rules should be strictly observed by the first aiders.
1. The injured should be immediately warned not to move at all.
2. All activities of the first-aiders must be carried out slowly and with the greatest
gentleness. Any undue haste or rough handling may instantaneously increase the damage
to the spinal cord.
3. At least three, but better still four or five people, are needed to move such a casualty
from the site of the accident to a more convenient place to await the arrival of medical aid
and ambulance.
4. When lifting the injured, greatest care must be taken not to twist or bend the patient
either backwards or forwards. If an injury to the neck is suspected any twisting of the
neck is particularly dangerous.
5. All movements should be carried out simultaneously by members of the first
aid party so that the patient is turned, lifted or shifted in one piece.
6. Every casualty who is conscious should be placed onto his back—i.e. in supine pos
ition iffound in any other position. This is essential in injuries to any part of the spinal cord
as such a casualty may also have sustained additional injuries to other parts of the body,
in particular the chest, abdomen or long bones. The prone position, which is still advo
cated by some workers, would in these cases be very hazardous, particularly in cervical
lesions where the respiratory muscles of the chest are paralysed. Only those casualties
with suspected injuries to the spine who are unconscious should be placed in lateral
or semi-lateral position, to avoid blockage of the upper respiratory tract by aspiration
of saliva.
7. The most experienced first-aider must take up command and direct all actions. In
injuries of the neck, he should take hold of the casualty's head between his hands and
care must be taken not to twist or bend the head forwards or backwards. Moreover, when
lifting the patient from a car or other vehicle to the ground, the head should be kept in a
straight line within the axis of the body. When placing a paraplegic patient on the ground,
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