First Aid · Musculoskeletal Injuries
The goal of musculoskeletal first aid is specific: stabilize the injury, reduce swelling, and prevent further damage until the person can receive proper medical evaluation. The RICE method, splinting, spine protection, and knowing when and how to move someone — all here.
Sprains & strains
A sprain is a stretch or tear of a ligament — the tough connective tissue that links bone to bone at a joint. A strain is a stretch or tear of a muscle or tendon. Both cause pain, swelling, and limited movement. The ankle is the most commonly sprained joint; it happens stepping off a curb, landing from a jump, or walking on uneven ground.
The first-aid treatment for sprains and strains follows the same four-step RICE framework. The goal is to limit swelling and protect the injured structure from further damage in the immediate aftermath — not to accelerate healing, which takes time regardless of what you do in the first hour.
Stop the activity immediately. Do not try to "walk it off" if the injury is painful. Weight-bearing on a significant sprain can worsen the tear and cause additional micro-damage to the surrounding ligaments. Help the person sit or lie down in a comfortable position. If they need to move, provide support and keep weight off the injured limb.
Apply a cold pack or a bag of ice wrapped in a thin cloth to the injury for 15–20 minutes at a time, several times a day for the first 48–72 hours. Cold limits swelling by causing blood vessels to constrict, and it reduces pain.
Two important rules: Always place a thin cloth between the ice and skin — direct contact with ice can cause frostbite on injured tissue. And keep each application to 20 minutes maximum; longer doesn't help and can damage tissue.
Wrap the injured area with an elastic bandage to apply gentle, even compression. This helps control swelling. Start wrapping below the injury and work upward — on an ankle, start at the toes.
The wrap should be snug but not tight. Check regularly: if the person feels numbness or tingling, or if the skin below the wrap turns blue or feels cold, the wrap is too tight. Remove it immediately, let circulation return, then re-wrap more loosely.
Prop the injured area above the level of the heart whenever possible — especially when resting or sleeping. Elevation reduces swelling by encouraging fluid to drain away from the injury site rather than pooling in the tissue.
For an ankle: several pillows under the leg while lying down. For a wrist: arm elevated on a folded jacket or pack. Elevation is often skipped because it's inconvenient — but it's one of the most effective parts of the protocol.
When to seek medical care
Cannot bear weight on the limb at all
Joint looks visibly deformed or angulated
Heard or felt a distinct snap or pop at injury
Severe pain out of proportion to the mechanism
Numbness or tingling below the injury
Significant swelling that appears within minutes
Pain directly over a bone rather than over a joint
No improvement after 24–48 hours of home care
If in doubt, treat as a fracture until imaging says otherwise. There is no reliable way to distinguish a severe sprain from a fracture without an X-ray.
The remote location factor
A sprained ankle at the trailhead — car ten yards away, cell service available — is a manageable inconvenience. The same injury two miles from the trailhead at 4 PM as clouds build is a different calculation entirely.
Before any outdoor outing, think through: how far are we from the car, and what would we do if someone couldn't walk out? That three-minute conversation prevents a lot of improvisation.
Suspected fractures
A fracture is a break in the continuity of a bone. Fractures range from a hairline crack (stress fracture) to a complete break through the bone, and from closed (skin intact) to open (bone visible through the skin). You usually cannot tell which type you're dealing with without imaging — which is exactly why the rule exists: if you're not sure, treat it as a fracture.
Open fractures — where bone is visible or the skin is broken at the fracture site — are medical emergencies. Call 911. Do not push the bone back in. Cover the wound with a clean dressing and immobilize.
Signs that suggest fracture over sprain
Visible deformity — abnormal angulation or a limb that looks "wrong"
A snap, crack, or grinding sensation at the time of injury
Tenderness directly over a bone when pressed — not just over the joint
Complete inability to bear any weight or move the limb at all
Rapid, significant swelling appearing within minutes of the injury
Skin broken at the injury site, or bone visible
Call 911 or arrange transport to medical care
A suspected fracture of the femur (thigh bone), pelvis, or spine, or any open fracture, requires emergency services. Other suspected fractures typically need urgent care or an emergency room for imaging.
Leave the injury in the position you found it
Do not attempt to straighten a deformed bone or reduce a dislocation. Moving a fracture before it is stabilized causes additional pain and can damage blood vessels or nerves near the fracture site.
Check circulation before doing anything else
Check warmth, skin color, and sensation in the fingers or toes beyond the injury. Numbness, tingling, paleness, or cold skin below a fracture suggests compromised circulation — a medical emergency. Report this information to emergency services.
Immobilize the injury with a splint
Splinting is covered in full detail in the section below. The principle: secure the joints above and below the injury so the fracture site cannot move. Immobilization reduces pain and prevents further damage during transport.
Check circulation again after splinting
Recheck warmth, color, and sensation below the injury after the splint is in place. A splint that is too tight or applied at a bad angle can compromise circulation. If the person reports new numbness or tingling after splinting, loosen it and recheck.
The circulation check
Check these three things in the fingers or toes below any fracture or tight bandage, both before and after splinting:
Color
Should be normal skin color. Pale, blue, or gray suggests compromised blood supply.
Sensation
Ask: "Can you feel me touching here?" Numbness or tingling suggests nerve compression.
Movement
Ask: "Can you wiggle your fingers/toes?" Should be possible even with a splinted arm or leg.
Also check temperature — the skin distal to a good bandage or splint should feel warm, not cold. Cold or absent pulse below an injury is an emergency.
Open fractures
If bone is visible through the skin, or the skin is broken at the fracture site, this is an open fracture. Cover the wound with a sterile dressing. Do not push bone back in. Do not irrigate the wound. Immobilize and call 911.
Open fractures carry a high infection risk because bone is exposed to contamination. They require surgical treatment.
Splinting
A splint immobilizes a fracture by securing the joints above and below the injury site — preventing the broken bone from moving and causing further damage. It is not a treatment for the fracture; it is safe passage to the people who will treat it.
A good splint can be built from almost anything rigid — a SAM splint from your first-aid kit, a folded magazine, a straight stick, a tent pole, a trekking pole. The materials matter less than the technique.
Gather your materials
You need a rigid support (SAM splint, folded magazine, stick, board) and something to secure it (bandages, strips of cloth, cravat triangular bandage, tape). You also need padding — a folded shirt, gauze, or cloth between the rigid material and the skin to prevent pressure sores.
Check CSM before you start
Color, sensation, and movement in the fingers or toes below the injury. This is your baseline — you need to know what normal looks like before you apply the splint so you can detect any change after.
Position the splint — joint above, joint below
The splint must extend beyond the joints above and below the fracture site. For a forearm fracture: extend from the palm to above the elbow. For a lower leg fracture: extend from the foot to above the knee. Do not move the limb to fit the splint — shape the splint to fit the limb.
Pad between the splint and the skin
Place padding between the rigid material and the skin, especially at bony prominences. This distributes pressure and prevents sores during transport.
Secure with bandages or ties — snug, not tight
Apply bandages or cloth strips at two or three points — above the injury, at the injury, and below — to hold the splint in place. Snug enough to prevent movement, not tight enough to cut off circulation. Tie above and below the fracture site, not directly over it.
Check CSM again
Recheck color, sensation, and movement after splinting. If anything has changed — new numbness, tingling, cold skin, or color change — the splint may be too tight. Loosen the ties, wait for circulation to normalize, and re-secure more loosely.
Improvised splint materials
In the field, rigid splinting material is often improvised from what's available. The goal is anything that holds the bone still:
Sling for arm and shoulder injuries
A triangular bandage tied as a sling suspends the forearm across the chest for arm, elbow, wrist, and collarbone injuries. The basic principle: support the arm at roughly 90° at the elbow with the hand slightly elevated above the elbow.
An improvised sling can be made from a shirt, jacket, or scarf. The arm should feel supported and the person should not be fighting the sling to keep their arm in position.
Neck & spine
The spinal cord runs through the vertebrae of the back and neck, carrying signals between the brain and the entire body. Damage to the spinal cord can result in permanent paralysis or death. Because the bones that protect the cord can be fractured without being displaced — meaning the cord is at risk of damage from movement even if the injury looks stable — the principle of "if in doubt, treat as spinal" is one of the most important rules in trauma first aid.
The goal is simple: keep the person's head, neck, and spine aligned and still until emergency medical personnel can properly assess and stabilize the injury.
When to suspect spinal injury
Fall from a significant height (more than standing height)
Vehicle crash — car, motorcycle, bicycle, ATV
Being struck in the head or neck
Diving into shallow water
Significant body impact — heavy machinery, sports collision
Person found unconscious following any trauma
Complaint of neck or back pain after trauma
Numbness, tingling, or weakness in arms or legs after injury
Do not move the person unless there is immediate life-threatening danger
If the person is in a safe location and not in immediate danger, leave them where they are. The risk of additional spinal cord damage from unnecessary movement is greater than the benefit of repositioning.
Hold the head in the position you found it
Do not attempt to straighten the neck or bring the head to a "normal" position. Place your hands gently on either side of the head and hold steady — maintaining whatever position you found it in. This is called in-line stabilization.
Keep the entire spine aligned
The head, neck, and back should maintain their relationship to each other. Think of the spine as a single rigid structure — any movement in one part risks the whole. Do not allow the person to twist, bend, or nod their head, even to confirm they're okay.
Have a second person stabilize while you provide other care
Assign one person whose sole job is manual in-line stabilization of the head and neck. This frees you to check breathing, control bleeding, or perform other assessments without compromising spinal protection.
If the person vomits, log-roll as a unit
If a person with a suspected spinal injury vomits and you must turn them to prevent aspiration, use the log-roll technique to maintain spinal alignment. This requires multiple helpers — see the Moving an Injured Person section below for the full technique.
The exception: life over spine
A person in cardiac arrest is dying. A potential spinal injury is a risk. This is not a balanced calculation — cardiac arrest requires CPR immediately, even if spinal injury is suspected.
Current resuscitation guidelines acknowledge this: when a person needs CPR and spinal injury is possible, begin CPR. Minimize unnecessary movement of the head and neck while doing so, but do not delay life-saving care in the name of spinal precautions.
The same logic applies to an airway that cannot be managed without repositioning. Life first, then spinal alignment.
What to say to the person
A conscious person with a suspected spinal injury is often frightened and may try to sit up, look around, or move. Your job is to keep them still through calm, continuous communication.
"I need you to keep very still for me. We're going to keep your head supported. Help is on the way. You're doing well — just don't move your head or neck. Tell me if anything changes."
Repeat the instruction to stay still calmly and regularly. A person who understands why they shouldn't move will cooperate better than one who is simply told not to.
Moving an injured person
The default is never move someone. The exception is when leaving them in place creates a greater immediate risk than moving them — and that exception requires a specific technique, not just urgency.
When to move
Move an injured person only when staying put is more dangerous than the risks of movement. Legitimate reasons to move:
Discomfort, inconvenience, or an awkward position are not reasons to move a potentially spinal-injured person. "Getting them somewhere more comfortable" while waiting for an ambulance is not a good reason to move.
When NOT to move
If the person is in a stable location without immediate environmental danger, keep them still and wait for emergency medical personnel. Moving a spinal-injured person without proper equipment and training can convert a survivable injury into a permanent one.
Emergency drag
The emergency drag is used when you need to move someone quickly — getting them out of traffic, away from fire, out of a burning room — and have no time for a controlled technique. It is fast and rough. Use it only when the alternative is worse.
Stand at the person's head. Reach under their arms and grasp their wrists, crossing their arms across their chest.
Cradle their head between your forearms to provide as much neck support as possible — the drag will move the head and neck, so minimize this as much as you can.
Drag them straight backward — keeping the body aligned — away from the hazard. Move only as far as necessary to reach safety.
Stop as soon as you are clear of the hazard. Reassess the person and call 911 if you haven't already.
Log roll
The log roll is used when a person with suspected spinal injury must be repositioned — most commonly to prevent aspiration when vomiting, or to access the person's back for examination. It requires at least three helpers, preferably four. The person who controls the head gives all commands.
Head person kneels at the person's head, places hands on either side of the head to maintain in-line stabilization. This person gives all commands throughout the roll.
Body helpers (two or three) kneel on the side the person will roll toward. One at the shoulders, one at the hips, one at the legs. Hands placed on the near side of the person, ready to guide the roll.
The head person gives the command: "On my count — one, two, three, roll." Everyone rolls together, keeping the spine aligned. The head person turns the head in sync with the body — no independent neck rotation.
Move only to the necessary degree — just enough to clear the airway, examine the back, or place a board under the person. Roll back on command the same way.
Moving as a unit
When a person with a suspected spinal injury must be transported a short distance without a stretcher — lifting over a small obstacle, moving from a vehicle, or carrying to an extraction point — the entire body must move as a single rigid unit. This is not a casual carry.
Assign a head person. One helper controls the head and neck throughout — their hands do not leave the head until the person is set down safely.
Place remaining helpers along the body — at the shoulders, hips, and legs. More helpers means better spinal alignment during the lift.
The head person gives all commands. On "lift," everyone lifts together — keeping the spine level. On "move," everyone moves together. On "lower," everyone lowers together.
The body should remain level and horizontal throughout. If the terrain is uneven, the helpers adjust their height to keep the spine flat — the person does not tilt with the ground.
The one rule behind all of this
Every spinal movement technique has one person controlling the head and giving every command. This is non-negotiable. When multiple people are moving a body and each makes independent judgments, the spine flexes and rotates. When one person calls every move and everyone else follows, the spine stays aligned. Identify the head person before you start and make sure everyone knows it.
Practice matters more than reading
The log roll and unit movement techniques read simply but require practice to execute well under pressure. Doing it once in your living room with someone cooperative is worth more than reading this page three times.
Wilderness First Aid (WFA) courses cover patient packaging and movement in hands-on detail. For anyone who spends significant time in the backcountry or leads groups outdoors, a WFA certification is worth the investment.
The two-person carry
For a conscious, cooperative person with no suspected spinal injury who cannot walk — a severe ankle sprain, for example — a two-person carry works well over short distances. One person supports under the arms, one supports under the knees. The person helps by keeping arms around the first rescuer's shoulders. Move slowly and communicate throughout.
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