necessary. If transportation is necessary, keep the victim lying down.  In any significant head or facial injury, assume injury to the cervical spine. Immobilization of the cervical spine is indicated.  Be sure that the victim is kept comfortably warm, but not too warm.  Do not give the victim anything to drink. DO NOT GIVE ANY MEDICATIONS. See that the victim receives a medical officer’s attention as soon as possible. Spinal Fractures If the spine is fractured at any point, the spinal cord may be crushed, cut, or otherwise damaged so severely that death or paralysis will result. However, if the fracture occurs in such a way that the spinal cord is not seriously damaged, there is a very good chance of complete recovery, provided that the victim is properly cared for. Any twisting or bending of the neck or backwhether due to the original injury or carelessness from handling lateris 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 some time. Paralysis occurs if the spinal cord is seriously damaged. If the victim cannot move the legs, feet, or toes, the fracture is probably in the back; if the fingers will not move, the neck is probably broken. Remember that a spinal fracture does not always injure the spinal cord, so the victim is not always paralyzed. Any person who has an acute pain in the back or the neck following an injury should be treated as though there is a fractured spine, even if there are no other symptoms. Emergency treatment for all spinal fractures, whether of the neck or of the back, has two primary purposes: (1) to minimize shock, and (2) to prevent further injury to the spinal cord. Keep the victim comfortably warm. Do not attempt to keep the victim in the position ordinarily used for the treatment of shock, because it might cause further damage to the spinal cord. Just keep the victim lying flat and do NOT attempt to lower the head. To avoid further damage to the spinal cord, DO NOT MOVE THE VICTIM UNLESS IT IS ABSOLUTELY ESSENTIAL! If the victim’s life is threatened in the present location or transportation is necessary to receive medical attention, then, of course, you must move the victim. However, if movement is necessary, be sure that you do it in a way that will cause the least possible damage. DO NOT BEND OR TWIST THE VICTIM’S BODY, DO NOT MOVE THE HEAD FORWARD, BACKWARD, OR SIDEWAYS, AND DO NOT UNDER ANY CIRCUMSTANCES ALLOW THE VICTIM TO SIT UP. If it is necessary to transport a person who has suffered a fracture of the spine, follow these general rules:  If the spine is broken at the neck, the victim must be transported lying on the back, face up. Place pillows or sandbags beside the head so that it cannot turn to either side. DO NOT put pillows or padding under the neck or head.  If you suspect that the spine is fractured but do not know the location of the break, treat the victim as though the neck is broken (i.e., keep the victim supine). If both the neck and the back are broken, keep the victim supine.  No matter where the spine is broken, use a firm support in transporting the victim. Use a rigid stretcher, or a door, shutter, wide board, etc. Pad the support carefully, and put blankets both under and over the victim. Use cravat bandages or strips of cloth to secure the victim firmly to the support.  When placing the victim on a spineboard, one of two acceptable methods may be used. However, DO NOT ATTEMPT TO LIFT THE VICTIM UNLESS YOU HAVE ADEQUATE ASSISTANCE. Remember: Any bending or twisting of the body is almost sure to cause serious damage to the spinal cord. Figure 4-42 shows the straddle-slide method. One person lifts and supports the head while two other persons each lift at the shoulders and hips, respectively. A fourth person slides the spineboard under the patient. Figure 4-43 shows the proper procedure in performing the log-roll method. The victim is rolled as a single unit towards the rescuers, the spineboard is positioned, and the victim is rolled back onto the spineboard and secured in place. If there are at least four (preferably six) people present to help lift the victim, they can accomplish the job without too much movement of the victim’s 4-52