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This topic covers the identification and management of head, neck and spinal injuries.
The practical aspects of this topic will be covered in the practical component of this course.
Introduction to Head, Neck and Spinal Injuries
Injuries to the head may be complicated because of injury to the brain. No head injury should be disregarded, as even a mild injury may lead to complications.
When a casualty has a serious head injury, the neck or spine may also be injured.
Similarly, spinal injuries are always serious and must be treated with great care. Spinal injuries may lead to paraplegia or quadraplegia, and should be handled with the utmost care.
Every year, more than 400 people in Australia may sustain a spinal injury which could lead to them spending the rest of their lives in a wheelchair.
About 50% of these injuries result from road traffic accidents, with the remainder occurring in the sporting, occupational and domestic environments.
In many cases, these injuries could have been prevented.
Common Causes of Head Neck and Spinal Injuries
Car accidents
Motorcycle accidents
Gunshot and knife wounds
Sporting accidents
Diving accidents
Landing heavily on the buttocks
Landing heavily on the feet
Falls
Blows to the head
Blows to the back
Head, neck and spinal injuries cannot always be prevented.
However, taking simple safety precautions can greatly lessen your chances of suffering a serious injury.
The following is a list of examples of places where with care and attention, possible spinal injuries could be avoided.
You should always wear a seatbelt in the car. This is a legal requirement, for your own safety.
If you are restrained in an accident, there is less chance of suffering serious injury.
Legally, you must wear a protective helmet when riding a motorcycle. You must also wear a helmet to ride a bicycle. If you are in an accident, the helmet could prevent serious injury, and could even save your life.
Safety rules in sports should always be followed. In addition, it is wise to wear protective headgear when playing cricket or rugby football or when horse riding.
You should always check the water depth before diving into a swimming pool, river or lake.
10-12 per cent of spinal injuries in Australia result from diving accidents.
You should wear protective head gear if you are on a construction site, in case of falling objects which might hit you on the head.
Signs and Symptoms - Head Injuries
One of the most obvious signs of head injury is a history of the injury (e.g. seeing the casualty hit their head).
Similarly, a casualty with a visible wound to the scalp or the face may also be suffering internal head injuries.
Blood may appear from the ears or nose.
Other signs and symptoms include:
· Headache
· Loss of memory
· Altered or abnormal responses to commands and touch
Wounds to the scalp or to face.
Management of Head Injuries
Place casualty in a comfortable position with head and shoulders slightly raised.
Support casualty’s head and neck during movement; avoid twisting movement as they could have spinal injury.
If blood or fluid comes from ear, cover with a dressing and lie casualty on injured side to allow fluid to drain.
Control bleeding but do NOT apply direct pressure to the skull.
Signs and Symptoms of Spinal Injuries
As for head injuries, the history is an important indicator of a spinal injury. Causes of spinal injuries include:
· Falls from a height
· Direct blow to the spine
· Penetrating injury such as a gunshot or knife wound
· Diving or surfing accident
· High speed accidents
· Being thrown from a vehicle
· Pedestrian being hit by a vehicle
· Being hit from above by falling objects
· Skateboard or cycle accidents
Any casualty who is unconscious as a result of a head injury must be presumed to have a spinal injury.
If a casualty is conscious, signs and symptoms of spinal injury may include:
· Pain at or below the site of the injury
· Tenderness over the injury site
· Absent or altered sensation (e.g. tingling in hands or feet)
Loss of movement or impaired movement below the site of the injury
Management of Spinal Injuries
Unconscious casualty with suspected spinal injury:
1. Follow DRABCD
2. Place unconscious casualty in recovery position supporting neck and spine at all times
3. Maintain a clear and open airway
4. Hold head and spine steady with supports, to prevent twisting or bending movement
5. Call 000 for ambulance
Take extreme care at all times to maintain alignment of neck and spine.
Conscious casualty with suspected spinal injury:
1. Calm the casualty
2. Loosen tight clothing
3. Do not move casualty unless in danger
4. Support head and neck
5. Call 000 for ambulance
Take extreme care at all times to maintain alignment of neck and spine.
If you are managing a casualty who is wearing a motorcycle helmet, you should only remove the helmet if it is absolutely necessary. For example, if it is obstructing the breathing, or if the casualty is vomiting.
If removal is necessary, you should ask the casualty to remove it if possible.
If you must do it, removal should be performed by two people. You must take great care not to move the head and neck.
1. Unfasten the chin strap.
2. One person must support the casualty's head and neck while the other lifts the helmet.
3. Pull sides of helmet apart to take pressure away from casualty’s head.
4. Gently lift helmet back and up off head.
Head, Neck and Spinal Injuries – Summary
Head, neck and spinal injuries should never be treated lightly.
If a casualty with a head injury has been unconscious, even for a moment, they should seek medical aid.
If you suspect a spinal injury, always have somebody support the casualty's head.
A suspected neck injury should be managed as if it was a spinal injury.
For further information on head, neck and spinal injuries, see Australian First Aid Chapter 8.
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