The object of immobilizing the neck is, of course, to prevent damage to the spinal cord in case there is a fracture of the spine resulting from some sort of accident. A significant percentage of neck fractures have no symptoms the victim can feel or signs the rescuer can detect. Neck fractures are not diagnosed in the field; they are presumed from the forces and mechanisms of injury the patient was exposed to. Lack of precautionary immobilization or improper handling and immobilization techniques injure and kill people every year.

There are three basic devices that are used to immobilize the neck prior to moving the patient. But before applying any device, it is necessary to prevent the patient's neck from being moved. First, simply tell the patient, if conscious, not to move. Second, hold the patient's head in place to prevent it from moving in relation to the rest of the body.

The first device to be applied is a cervical collar, commonly called a "C-collar." It is a rigid collar applied around the patient's neck. It is not the same as a soft foam "whiplash" collar. It is not particularly effective at preventing head and neck movement, but it does somewhat limit the range of that movement, and it may serve as a reminder to a patient not to move. Therefore, it is necessary to continue holding the head until the other two devices are applied. Applied correctly, it is uncomfortable. It used to come in a variety of sizes, but now usually comes in three adjustable size ranges: Adult, Pediatric, and Infant.

The remaining devices are a long spine board (LSB), or "backboard," which somewhat resembles a surfboard with holes along the sides for feeding straps through,and a cervical immobilization device (CID), which secures the head in place, sometimes referred to by a variety of brand names. The patient, wearing a c-collar but still being held by the head, is moved to the LSB using specific techniques designed to keep the head and body in line. The patient is secured to the LSB with straps, and then the head is secured in the CID, which is in turn affixed to the LSB. The patient now, hopefully, is pretty much entirely immobilized and can't move his neck or back, and can be safely moved by carrying the LSB to the ambulance or whatever.

But, for 1st aiders and first responders, the question is whether or not you need to move the patient at all. Manual c-spine control i.e., holding the head in place, is the appropriate standard of care, assuming you don't need to move the patient before the ambulance arrives.

However, if you do need to move the patient, it is usually because of some immediate hazard, like like a car fire encroaching upon the patient. In such cases, you probably will need to move the patient from danger ASAP, and may not have time to apply immobilization equipment. If you can apply a c-collar quickly first, great. If not, do what you have to do, and try to minimize movement of the head, preferably by someone else helping you by holding it as you drag the patient to safety.

The two things I would encourage you NOT to do, if you can avoid doing so, is to apply a c-collar then let go of the head, or to move the patient unnecessarily.

Spinal immobilization is not rocket science, but it does require some equipment, training, and hands-on experience. It also takes more than one rescuer get a patient onto a LSB and CID.

In disaster situations, or where "professional" help is otherwise unavailable, you can improvise. A door, reasonably flat surfboard, plywood sheet, or similar object can do for a backboard. The patient can be duct-taped to it, which actually works better when using stuff like doors that are wider than the patient, or straps can be improvised. Try not to use ropes or other thin material that will cut into the patient's flesh, cut off circulation, and do additional damage.

A couple of rolled up towels or other objects can be placed alongside the patient's head to keep it from moving, and taped in place, including a tape across the patient's forehead. Pinch the tape together lengthwise were it contacts the patient's forehead, so it doesn't adhere. The c-collar can be omitted. They are marginal performers at best, and improvised c-collars are likely to be worse than useless. This is one thing a SAM splint cannot do.

Jeff