by James Hubbard, M.D., M.P.H.

Your camping friend went for firewood and hasn’t come back. You find her at the bottom of a steep ditch. She’s lying there groaning and has a big scrape on her forehead. You’ve read my post on when to suspect a broken neck or back and run back to get your rigid cervical collar. Wait. You left it at home? You better read on, and watch my video to boot.

Knowing when and how to immobilize the neck and back, make a neck brace, and move the person without moving the spine can make the difference between paralysis and a normal recovery.

Here are some tips on how to make a neck brace:

  • The neck brace must be firm. By itself, a soft cervical collar’s not going to work. The neck can move too much. The SAM splint I mentioned in my post and video on how to make a splint is a good choice. Of course, a commercial rigid neck brace is ideal. If nothing else, wrap clothing, a jacket, or a sleeping bag around the neck. Hold it in place with an elastic bandage, or a belt maybe.
  • The neck brace must fit. It obviously can’t be too tight, but it can’t be too loose either. The brace must start at the upper chest and support the chin. It must fit so that the chin can’t move up or down and the head can’t twist or tilt from side to side.
  • It must have smooth enough edges so that it won’t cut into the skin. You could use tin or some sort of malleable metal, but be sure to bend or pad the sharp edges.
  • The brace must keep the head in a neutral position, as if the person were standing with good posture and looking straight ahead.

Make sure the airway’s open in someone not fully alert. The person likely will be on their back, and the back of the tongue is likely to relax and block the airway. You can open the airway by doing any one of these three things:

  • Using a commercial plastic airway device.
  • Placing the fingers of both of your hands at the person’s jaw just below the ears and jutting the jaw forward (being careful not to move the neck).
  • As a last resort, taking a piece of cloth, grabbing the tongue, and pulling. Safety pin the tongue to the lower lip. Yes, it’s barbaric, but it could save a life.

To open the airway in someone without a neck injury, you could hyperextend the neck (tilt the head backward) or move them on their side.  With a possible neck injury you can still move them on their side, but it must be very carefully.

With or without a brace (hopefully with one), you must move the whole body in one plane. This works better the more help you have. One holds the head, another the shoulders, another the hips, and another the feet. Move everything as one, as if the person already had a board underneath. In fact, do put a backboard under them as soon as you can.

Having the person on their side can shift the tongue enough not to block the airway and is also a good position in case they vomit (not uncommon). You can help keep them their side by stuffing soft material behind their legs, hips, back, shoulders, neck, and head, and firmly tying these body parts and the stuffing to a backboard.