Spinal Injuries After a Fall or Crash: A Bystander's Guide to Preventing Further Harm

The Critical Minutes After Impact

Spinal Injuries After a Fall or Crash: A Bystander’s Guide to Preventing Further Harm – Imagine the scene: a scooter swerves on a busy Bali street, and the rider goes down. Or a surfer misjudges a wave and is driven into the reef below. The immediate, human impulse is to rush in, to help the person up, to get them out of the way. But in cases of a potential spinal injury, this well-intentioned act can be the most dangerous one of all.

Recognizing the Red Flags

In any emergency, it is safest to assume a spinal injury exists until it is medically proven otherwise. This principle of high suspicion should guide every action. Bystanders should be trained to look for two types of clues: those from the accident itself and those from the injured person.

Clues from the Accident (Mechanism of Injury)

Certain types of accidents carry such a high risk for spinal trauma that an injury should be suspected immediately, regardless of whether the person is complaining of pain. Adrenaline can effectively mask even severe pain, and a person may insist they are fine when they are critically injured. The physics of the accident is a more reliable indicator for a bystander than the victim’s initial feelings.

Always suspect a spinal injury after:

Any car or scooter crash, or an accident involving substantial force to the back or head.
A fall from a significant height.
A diving accident, especially into shallow water.
A surfing accident that involves impact with the sea floor, which is a known risk in Bali’s powerful waves.
Any direct, forceful blow to the spine.
Any head injury that causes even a brief change in the person’s level of consciousness.

Clues from the Person (Signs and Symptoms)

In addition to the type of accident, specific physical signs and symptoms are clear warnings of a potential spinal cord injury. If an injured person displays any of the following, immediate emergency medical help is required:

Pain and Pressure: Severe pain or intense pressure in the neck, head, or back.
Paralysis or Weakness: Weakness, incoordination, or an inability to move any part of the body. Paralysis of the lower body is known as paraplegia, while paralysis affecting all four limbs is called tetraplegia or quadriplegia.
Altered Sensation: Numbness, tingling, or a complete loss of feeling in the hands, fingers, feet, or toes.
Loss of Control: A loss of bladder or bowel control is a critical sign of a serious spinal injury.
Odd Positioning: The neck or back is visibly twisted or positioned at an unnatural angle.
Difficulty Breathing: Any trouble breathing after an injury can indicate damage high in the neck, affecting nerves that control the diaphragm.

The Golden Rule of Spinal First Aid: DO NOT MOVE THE VICTIM

If there is one rule that supersedes all others, it is this: unless the person is in immediate, life-threatening danger, do not move them. The reason for this rule is grounded in the difference between primary and secondary injury.

Primary vs. Secondary Damage

Think of the spinal column as a flexible suit of armor made of bone, protecting the delicate bundle of nerves—the spinal cord—running inside it. The initial impact from the accident causes the primary injury, such as a fractured vertebra or a bruised spinal cord. This damage has already been done.

The real danger a bystander can influence is the secondary injury. This is the damage that occurs after the initial impact, caused by improper movement. When an unstable spine is moved, fractured bones can shift and press on, or even sever, the delicate nerve tissue. Shockingly, research shows that up to 25% of traumatic spinal cord injuries occur not during the accident itself, but during handling or transport afterward. A bystander’s mission is not to fix the primary injury, but to do everything possible to prevent a catastrophic secondary one.

The Consequences of Movement

Twisting, compressing, or bending an injured spine can dramatically worsen the outcome. It can turn an incomplete injury, where some function and sensation remain below the injury site, into a complete and permanent one, with a total loss of function. The simple act of sitting someone up or trying to make them more comfortable can lead to irreversible paralysis.

A Detailed Guide to Critical Inactions: What You Must Never Do

Knowing what not to do is just as important as knowing what to do. Here are the absolute prohibitions when providing aid for a suspected spinal injury.

DO NOT Bend, Twist, or Lift the Person’s Head or Body

The primary goal is to maintain the spine in a “neutral alignment”—the exact position in which the person was found. Do not try to judge what looks “straight” or “normal.” Any movement can cause further harm.

DO NOT Try to Straighten the Neck or Back

Even if the person’s neck or back appears twisted, do not attempt to realign it. A bystander cannot know the nature of the fracture, and trying to straighten the spine could cause the sharp edges of a broken bone to sever the spinal cord.

DO NOT Remove a Helmet or Protective Pads

A helmet provides excellent stabilization for the head and neck. Attempting to remove it without proper training can cause dangerous movement of the cervical spine. It should be left on for medical professionals to remove. The only exception is if the helmet is blocking the person’s airway and they are not breathing, but this is a last resort best left to paramedics.

DO NOT Give the Person Food or Drink

An injured person may complain of thirst, especially if they are going into shock. However, giving them anything to drink is dangerous. They may have trouble swallowing or lose consciousness, leading to choking or aspirating fluid into their lungs. Furthermore, the patient will likely need emergency surgery, which requires an empty stomach to avoid complications with anesthesia.

DO NOT Allow the Person to Get Up or Walk

The injured person may feel they are okay and try to stand up. They must be calmly but firmly instructed to remain completely still. Walking on an unstable spinal fracture can cause immediate and catastrophic damage.

Safe and Effective Support: The Correct Way to Help

While most of the focus is on inaction, there are a few critical, positive steps a bystander should take.

Step 1: Ensure Scene Safety and Call for Help

Before approaching an injured person, ensure the scene is safe for everyone. Check for traffic, fire, or other hazards. Your safety is paramount. Then, immediately call for professional medical help. The BIMC Hospital – Kuta emergency number is +62 361 761 263. Provide a clear location and a brief description of the accident.

Step 2: Manually Stabilize the Head and Neck

If possible, kneel at the person’s head. Gently place your hands on both sides of their head to hold it steady, preventing it from moving side-to-side or front-to-back. Keep the head and neck aligned with the spine in the position they were found. This single action is one of the most effective ways to prevent secondary injury.

Step 3: Reassure and Monitor

Speak to the person in a calm, reassuring voice. Tell them that help is on the way and that the best thing they can do is stay still. Continue to monitor their breathing and consciousness. If they stop breathing, CPR may be needed. However, the standard technique must be modified: do not tilt the head back to open the airway. Instead, use your fingers to gently grasp the jaw and lift it forward, or if untrained, perform chest compressions only.

The Exception: When You MUST Move Someone

There are very rare situations where moving a person is necessary to save their life, such as from a burning vehicle or rising water. If you must move them, it is critical to do so as a single unit, keeping the head, neck, and back in a straight line. This “log-roll” technique ideally requires at least two people: one to maintain stabilization of the head and neck while the other helps roll the body.

From Your Hands to Specialized Care at BIMC Hospital – Kuta

A bystander’s actions are the first, and perhaps most important, link in a professional chain of survival. The careful stabilization provided at the scene directly impacts the success of the advanced medical care that follows.

The Professional Handover

When paramedics arrive, they will take over with professional equipment, including a rigid cervical collar and a spine board, to fully immobilize the patient for safe transport. The work you have done to keep the person still makes this transition safer and more effective.

Stillness is the Strongest Action

In the chaotic aftermath of an accident, it can feel like you need to do something. But when a spinal injury is possible, the most powerful, life-saving intervention is to enforce stillness. By preventing movement, you protect the spinal cord and give medical professionals the best possible chance for a successful outcome.

When you witness an emergency in Bali, stay calm, keep the person still, and call for help. BIMC Hospital – Kuta is ready to provide expert emergency care, 24/7.

BIMC Hospital Kuta

Jl. Bypass Ngurah Rai No. 100X, Kuta, Badung, Bali 80361

Call Centre 24 Hours +62 811 960 8500

Emergency Call 24 Hours: +62 361 761 263/ +62 812 386 5548 (WA)

https://bimcbali.com/bimc-hospital-kuta

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