# Spinal Injury Management Part of the Lifesaving Merit Badge Digital Resource Guide: [Introduction & Overview](https://merit-badge.university/merit-badges/lifesaving/guide/index.md) *Spinal Injury & Resuscitation* > **15.** Demonstrate management of a spinal injury to your counselor: > **15a.** Discuss the causes, signs, and symptoms of a spinal injury. > **15b.** Support a faceup subject in calm water of standing depth. > **15c.** Turn a subject from a facedown to a faceup position in water of standing depth while maintaining support. 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. ### Requirement 15a: Spinal Injury Causes 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. > **Safety First!** > > The number one rule of aquatic spinal injury prevention: **never dive into water where you do not know the depth.** Enter feetfirst until you have confirmed the depth is at least 9 feet for headfirst diving. This single rule prevents the majority of aquatic spinal injuries. **Signs and Symptoms to Watch For:** **Spinal Injury Indicators** — If you see any of these, suspect a spinal injury - [ ] Pain in the neck or back - [ ] Numbness, tingling, or loss of sensation in the arms, legs, or fingers - [ ] Inability to move arms or legs ("I can't feel my legs") - [ ] Deformity — the neck or back looks misaligned - [ ] Bruising or swelling on the head, neck, or upper back - [ ] Loss of bladder or bowel control - [ ] Altered consciousness or confusion after a head impact - [ ] Victim found unconscious in the water after a diving or falling incident > **Tip** > > When in doubt, **assume a spinal injury.** If there is any chance the victim hit their head — even if they say they feel fine — treat it as a spinal injury until medical professionals can assess them. The consequences of being wrong are too severe. ### Requirement 15b: Supporting Faceup Victim 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). ![A rescuer standing behind a faceup victim in waist-deep water, hands cradling the victim's head with forearms bracing the shoulders, victim floating at the surface in a straight line](https://ik.imagekit.io/doulacoop/tr:w-800/mbu-assets/merit-badges/lifesaving/guide/spinal-stabilization-faceup?v=adfc8296) ### Requirement 15c: Turning Facedown Victim 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 **Do's and Don'ts** — Absolute rules when managing a suspected spinal injury - [ ] DO call 911 immediately — this is a medical emergency beyond your training to fully manage - [ ] DO keep the victim still — movement is the enemy - [ ] DO support the head and neck at all times - [ ] DO keep the victim in the water until professional help arrives (the water supports the body and reduces movement) - [ ] DO NOT bend, twist, or rotate the victim's neck - [ ] DO NOT pull the victim out of the water unless they are in immediate danger or not breathing (and you must perform CPR) - [ ] DO NOT remove a helmet (cycling, skiing) if the victim is wearing one — it provides stabilization - [ ] DO NOT let bystanders move the victim > **Did You Know?** > > Aquatic spinal injuries are most common among males aged 15 to 24. The single most frequent scenario is diving headfirst into a body of water that is shallower than expected. Many public pools have eliminated diving boards from shallow ends specifically because of this risk. > **Be Prepared! A Diver Hits the Bottom and Floats Up Facedown** > > At a lake, someone dives off a rock into shallow water. They float to the surface facedown and are not moving. > > - **Assume spinal injury.** The mechanism (diving + impact) makes it likely. > - **Call 911 immediately.** Send a bystander. > - **Wade carefully** to the victim. Do not create waves. > - **Perform the vice grip turn** — rotate them faceup while keeping head, neck, and body aligned. > - **Support in the faceup position.** Check for breathing. > - **If not breathing**, you must remove them from the water and begin CPR — keeping the spine as straight as possible during extrication. > - **Wait for EMS.** Maintain stabilization until paramedics take over. [Mayo Clinic — Spinal Cord Injury First Aid](https://www.mayoclinic.org/first-aid/first-aid-spinal-injury/basics/art-20056677): First aid guidelines for spinal cord injuries, including when to suspect one and how to immobilize the victim. --- - Previous: [Submerged Victim Recovery](https://merit-badge.university/merit-badges/lifesaving/guide/req14/index.md) - Next: [CPR & Rescue Breathing](https://merit-badge.university/merit-badges/lifesaving/guide/req16/index.md)