Sprains, splints, and spinal injury

01 — The RICE protocol for sprains

Rest, Ice, Compression, Elevation. The standard first response for a sprain or strain.

A sprain is a stretch or tear of a ligament (the tissue connecting bones at a joint). A strain is a stretch or tear of a muscle or tendon. Both produce pain, swelling, and reduced mobility. The RICE method is the widely recommended first aid response for these injuries, endorsed by the American Red Cross, Cleveland Clinic, and Mayo Clinic.

Seek medical attention if the person cannot bear weight, if the joint appears deformed, if there is severe swelling or bruising, or if symptoms do not improve within 48 to 72 hours. These signs may indicate a fracture rather than a sprain.

02 — Improvised splints

A splint immobilizes an injured bone or joint in the position it was found. Almost any rigid object can serve as one.

The purpose of a splint is to prevent movement of the injured area during transport to medical care. You are not setting the bone or correcting alignment. You are holding everything still.

Effective improvised splint materials include a straight stick or branch, a rolled-up magazine or newspaper, a board or piece of rigid cardboard, an umbrella, or a tightly rolled towel for finger and wrist injuries. The material needs to be rigid enough to prevent bending at the injury site.

• Pad the rigid material with cloth, a towel, or clothing to prevent pressure on the skin and reduce discomfort.
• Secure the splint above and below the injury with strips of fabric, belts, neckties, or tape. Do not tie directly over the fracture site.
• Immobilize the joint above and below a fracture. For a forearm break, the splint should immobilize both the wrist and the elbow.
• Do not attempt to straighten the limb. Splint it in the position you found it.
• Check circulation below the splint periodically: skin color, warmth, sensation, and pulse. If the area becomes cold, numb, or blue, the splint is too tight.

03 — Recognizing a spinal injury

Neck or back pain, tingling in the extremities, and loss of movement after a fall or collision are the warning signs.

A spinal injury can damage the spinal cord, the bundle of nerves running through the vertebrae that connects the brain to the rest of the body. Damage can cause permanent paralysis. The signs to watch for, according to the American Red Cross and Mayo Clinic:

• Severe pain or pressure in the neck, head, or back.
• Tingling, numbness, or loss of sensation in the hands, fingers, feet, or toes.
• Weakness or inability to move the arms or legs.
• Loss of bladder or bowel control.
• An oddly positioned or twisted neck or back.
• Head injury with an ongoing change in consciousness or alertness.

Suspect a spinal injury after any fall from a significant height, any vehicle crash, any diving accident into shallow water, any direct blow to the head or spine, and any incident where a helmet is cracked or damaged. When in doubt, assume a spinal injury until medical professionals can assess.

04 — When you must not move an injured person

If you suspect a spinal injury, keep the person still in the position you found them. Movement can cause permanent paralysis.

The correct first aid response to a suspected spinal injury:

• Call 911 immediately.
• Tell the person not to move. Ask them to respond verbally to your questions rather than nodding or turning their head.
• Keep the person in the position in which you found them. Do not attempt to straighten the head or neck.
• If available, place rolled towels or clothing on both sides of the head and neck to limit movement until paramedics arrive.
• If the person is wearing a helmet, leave it on unless you need to access the airway for CPR.
• Monitor breathing. If the person stops breathing, begin CPR, but use a jaw-thrust maneuver rather than tilting the head back to open the airway.
• If you must roll the person (because they are vomiting or choking on blood), use at least two people and keep the head, neck, and back aligned as a single unit.