The spinal cord, which contains nerve fibers in direct connection with the brain, is enclosed and protected by a bony structure known as the SPINAL COLUMN, or BACKBONE. The spinal column is made up of a number of small bones called the VERTEBRAE.

If the spine is fractured at any point, the spinal cord may be crushed, cut, or otherwise damaged so severely that death or paralysis can result. However, when the fracture occurs in such a way that the spinal cord is not seriously damaged, there is a good chance of complete recovery-PROVIDED THE VICTIM IS PROPERLY CARED FOR. Any twisting or bending of the neck or back whether due to the original injury or caused by careless handling later, is likely to cause irreparable damage to the spinal cord.

The primary symptoms of a fractured spine are pain, shock and paralysis. PAIN is likely to be acute at the point of fracture. It may radiate to other parts of the body. SHOCK is usually severe, but (as in all injuries) the symptoms may be delayed for sometime. PARALYSIS occurs when the spinal cord is seriously damaged. When the victim is unable to move his legs, feet, or toes, the fracture is most probably in his back When he cannot move his fingers, his neck is probably broken.

Remember, however, that a spinal fracture does not always injure the spinal cord, so the victim is not always paralyzed. Any person who has acute pain in the back or neck following an injury, should be treated as though a fracture of the spine has occurred. This remains true even though no other symptoms are present.

TREATMENT. First aid for all spinal fractures, whether of the neck or bath has two primary purposes: (1) to minimize shock and (2) to prevent further injury to the spinal cord.

You must keep the victim comfortably warm. Do NOT attempt to place the victim in the position normally used to treat shock. Any unnecessary movement may cause further injury to the spinal cord. Keep the victim lying flat. Do NOT attempt to lower the victim's head. To avoid further damage to the spinal cord, DO NOT MOVE THE VICTIM UNLESS IT IS ABSOLUTELY ESSENTIAL. But if you must transport the victim, DO NOT BEND OR TWIST HIS BODY; DO NOT MOVE HIS HEAD FORWARD, BACKWARD, OR SIDEWAYS; AND DO NOT, UNDER ANY CIRCUMSTANCES, ALLOW HIM TO SIT UP.

Figure 10-55.-Improvised frame for transporting victim with fractured spine.

When it is necessary to transport a person who has suffered a fracture of the spine, follow these general rules:

1. If the spine is broken at the NECK, the victim must be transported lying flat on his back with his face up. Place pillows or sandbags beside his head so it cannot be turned to either side. DO NOT PUT PILLOWS OR PADDING UNDER HIS NECK OR HEAD.

2. When you suspect the spine is fractured but do not know the location of the break treat the injury as though the victim has a broken neck. In other words, the victim should be lying on his back with his face up. When both the neck and back are broken, treat the victim in the same manner; that is, keep the victim on his back with his face up.

3. No matter where the spine is broken, USE A FIRM SUPPORT IN TRANSPORTING THE VICTIM. Use a rigid stretcher, or use a door, shutter, wide board, or a frame similar to that shown in figure 10-55. Pad the support carefully, and put blankets both under and over the victim. Use cravat bandages or strips of cloth to fasten the victim firmly to the support.

4. Hold the injured person by his clothing; then

slide or pull the victim onto the support. DO NOT ATTEMPT TO LIFT THE VICTIM UNLESS YOU HAVE ADEQUATE ASSISTANCE. Remember, any bending or twisting of the body is almost certain to cause serious damage to the spinal cord. When there are at least four (preferably six) people present to help lift the victim, they can probably accomplish the job without much movement of the victim's body. But a smaller number of people should NEVER attempt to lift the victim.

5. GET MEDICAL HELP AT ONCE.