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Without X-rays and a physician to read them, it is difficult to determine if a spine injury exists. In the absence of professional help, the following mechanisms (causes) of injury could point to a possible spine injury:

- Positive mechanisms (violent impact forces capable of damaging the spine) such as:1. High velocity vehicle crashes.

2. Fall from 20-foot roof.

3. High velocity gunshot wound near the spine.

- Negative mechanisms (forces that don't injure the spine) such as:

1. Rock is dropped onto the victim's foot.

2. Twisted ankle occurs while running over rough terrain.

3. Gunshot wound limited to the elbow.

- Uncertain mechanisms (the spine may or may not be injured):

1. Victim trips over a lamp cord and falls to the floor.

2. Third-grader loses her balance and falls about 2-3 feet from the teeter-totter at school.

3. Low-speed "fender bender" car accidents in the parking lot of the local convenience store.

Of the 6,000 to 10,000 spinal cord injuries reported yearly, motor vehicle accidents account for 35 to 45 percent, and falls for 25 to 30 percent. Most of the rest are related to sports, especially football, rugby, ice hockey, soccer, diving, gymnastics and wrestling. Nevertheless, catastrophic neck injuries are infrequent in sports. Actually, fewer than 10 football players each year have sustained permanent injury to the cervical spinal cord since 1977.

First aid

First, do no harm! Do not move the victim except from immediate danger. An estimated 50 percent of neurologic damages are created after the initial contact or accident.

If the victim has collapsed, have him or her lie there until a brief initial evaluation is completed.

When a neck injury is suspected in an unresponsive victim, use the ABCs of first aid care (airway open? victim breathing? pulse present?).

Airway management is of primary importance. Lifting the chin without tilting or moving the head is the first step in opening the airway in a victim with a suspected spine injury. If this is unsuccessful, the head is tilted (bent back) slowly and gently until the breaths can go in. Another method involves the jaw thrust. In this method, the first aider places his or her fingers behind the angle of both sides of the victim's jaw and lifts up, bringing the lower jaw forward.

In a victim with a helmet (e.g., motorcycle, football), do not remove the helmet because the jostling may cause severe neurologic complications.

Once the airway is opened, rescue breaths may be necessary.

In assessing circulation, first check for a cartoid pulse on the neck next to the Adam's apple. If it is absent, begin chest compressions in accordance with cardiopulmonary resuscitation (CPR) guidelines.

To evaluate disabilities, check the nerves and spinal cord by: having the victim squeeze your hand and press his or her foot against your hand; wiggle fingers and toes; and press the victim's fingers and toes for sensation.

For such an exam to be accurate, the victim should be reliable. In other words, he or she should be calm, cooperative, sober and alert. If the victim has a brain injury, is intoxicated, has an abnormal mental status, or distracting injuries, checking the nerves and spinal cord as described above provides unreliable information.

It is essential that proper equipment be available for transporting the victim. This includes a cervical collar and backboard (also known as a spineboard). First aiders will not ordinarily have these or the training in their proper application. However, a first aider can stabilize the spine against any movement. A full discussion about spine splinting methods is beyond the scope of this article, but the following principles can help:

The ground is the stablest support found so keep the person as you find him and wait for an ambulance to arrive (usually 10 to 20 minutes). Apply supports to the sides of the body much like book ends or shims along the victim's entire body. Keep the victim of a car crash in the car and stabilize the head and neck even with your hands if the victim is sitting upright. In most cases do not fear an explosion since they occur in less than 1 percent of all motor vehicle crashes.

The best way to handle spine injuries is to be prepared for them.