Req 15 — Spinal Injury Management

A spinal injury in the water is one of the most dangerous situations you can encounter — not because of the water, but because of what happens next. Moving a person with a spinal injury incorrectly can cause permanent paralysis or death. Your job as a rescuer is to stabilize the victim’s head and spine, keep them breathing, and wait for professional medical help.

15a — Causes, Signs, and Symptoms

Common Causes of Spinal Injury in Aquatic Settings:

• Diving into shallow water — the most common cause. A person dives headfirst and strikes the bottom, a sandbar, or a submerged object.
• Diving off elevated surfaces — diving boards, rocks, docks, or cliffs into water of unknown depth.
• Falls — slipping on a wet pool deck, falling off a boat, or falling from a waterside cliff.
• Being struck — hit by a boat, surfboard, watercraft, or another swimmer.
• Being tumbled by waves — large surf can slam a person headfirst into the sand.

Signs and Symptoms to Watch For:

15b — Supporting a Faceup Subject

This technique is called in-line stabilization. You keep the victim’s head, neck, and spine in a straight line while supporting them at the surface in standing-depth water.

Step by step:

1. Approach the victim carefully — do not create waves or disturbance that could move them.
2. Position yourself at the victim’s head. Stand behind them (at the top of their head).
3. Place your hands on either side of the victim’s head — one hand on each side, fingers supporting the back of the skull, palms against the ears.
4. Gently squeeze your forearms against the victim’s upper arms/shoulders. This traps the head between your forearms and creates a “splint” effect.
5. Keep the head, neck, and body in a straight line. Do not tilt, bend, or rotate.
6. Lower yourself so that the victim’s head and body float at the surface. The water provides buoyancy — you provide stability.
7. Hold this position and wait for help. Do not move the victim unless they are in immediate danger (e.g., the water is rising).

15c — Turning a Facedown Subject Faceup

A facedown victim with a potential spinal injury cannot breathe. You must turn them faceup — but you must do it without bending or twisting their spine. This technique is called a log roll or vice grip turn.

Step by step:

1. Approach the victim at their side, near their head.
2. Place one arm along the victim’s spine — your forearm along their back, your hand supporting the base of their skull.
3. Place your other arm along the victim’s chest — your forearm across their breastbone, your hand supporting their chin.
4. Clamp your arms together, trapping the victim’s head between your forearms. This is the “vice grip.”
5. Slowly roll the victim toward you, rotating their entire body as a single unit. Do not let the head move independently of the body.
6. Continue the rotation until the victim is faceup.
7. Transition to the faceup support position — both hands supporting the head, forearms bracing the shoulders.
8. Ensure the victim’s face is clear of the water and check for breathing.

Critical Rules for Spinal Management