What Modern Guidance Actually Says
For years, first aiders were taught one rule above all others: “Don’t move them!”
Back then, “immobilise the spine” meant collars, backboards, and keeping casualties perfectly still at all costs.
But modern research — and new guidance from both the Wilderness Medical Society (WMS, 2024) and the UK Faculty of Pre-Hospital Care (RCSEd, 2025) — has changed the way professionals and rescuers think about spinal care.
Today, the goal is Spinal Cord Protection (SCP) — not rigid immobilisation.
1. Protect the cord, not just the spine
The WMS (2024) guidelines focus on reducing painful or unwanted movement, rather than holding the body completely still.
In real-world terrain, “zero movement” is impossible — but calm, careful, coordinated handling makes a huge difference.
Good practice
Keep the spine as neutral as possible, without forcing it straight.
Pad and support naturally comfortable positions.
Avoid twisting or bending during any move.
Use a vacuum mattress or soft padding if available; a backboard is only for short transfers, not for transport or prolonged care.
(WMS 2024 – Spinal Cord Protection)
2. Self-extrication: often the safest option
If the person is alert, breathing normally, there is no suspician of lower limb or pelvic injury and can follow commands, the best option may be to let them move themselves — for example, climbing carefully out of a car or standing up from rough ground.
Why?
Research using motion sensors shows that self-extrication causes the least spinal movement — far less than when multiple rescuers try to lift or drag a casualty.
It’s also quicker, which reduces time exposed to cold, rain, or other hazards.
Key UK evidence
The Faculty of Pre-Hospital Care (RCSEd) 2025 Consensus and its U-STEP OUT guide recommend self-extrication as the first-line option when it’s safe.
UK ambulance services and the National Fire Chiefs Council have now built this into operational procedures.
The NICE NG41 Spinal Injury Guideline supports the same approach: move quickly and safely to a more secure location, using long boards only for short extrication, not transport.
How to coach it
“Look straight ahead, keep your head in line with your body. Move slowly, stop if you feel pain, pins and needles, or weakness.”
If they can do that, they should move themselves to safety while you watch and reassure.
3. When they can’t move themselves
If the person is unconscious, trapped, or clearly injured:
Use Spinal Motion Restriction (SMR) rather than immobilisation.
Support the head and neck manually.
Use padding or a vacuum mattress if available.
If you must use a long board, it’s a stretcher, not a bed — remove it as soon as practical.
Use a lift-and-slide instead of a traditional log-roll; studies show it causes less twisting.
If you have to choose between perfect alignment and breathing — airway and breathing come first.
Roll the casualty onto their side if vomiting or airway obstruction is a risk.
(WMS 2024; JRCALC Trauma Update 2024)
4. Collars: use with care
Rigid collars were once routine; they’re now largely phased out in UK ambulance and rescue practice.
Why?
They can raise intracranial pressure, make breathing harder, and hide airway problems.
They often increase total motion when fitting or when the patient struggles.
If you need to cue someone to stay still, a soft collar or folded towel under the neck can be helpful and more comfortable — but don’t force it.
(WMS 2024; UK Ambulance Service Policy Reviews 2023–24)
5. When not to restrict the spine
For penetrating trauma (stab or gunshot wounds), multiple studies show that immobilising the patient increases mortality because it delays hospital care and adds no proven benefit.
Modern wilderness and EMS guidelines recommend rapid evacuation, not SMR, in these cases.
(EAST Practice Management Guideline 2018; WMS 2024)
6. Other wilderness priorities
Spinal protection is only one part of the picture.
Don’t forget to:
Control bleeding first.
Maintain airway and breathing.
Prevent hypothermia — wrap early, insulate from the ground.
Monitor for changes in movement, sensation, and pain.
Reassure constantly — stress and shivering increase movement and risk.
Key Sources (2024–25)
Wilderness Medical Society (2024) – Clinical Practice Guidelines for Spinal Cord Protection in the Austere Environment
Faculty of Pre-Hospital Care (RCSEd, 2025) – Consensus Statement: Extrication Following a Motor Vehicle Collision (U-STEP OUT decision aid)
National Institute for Health and Care Excellence (NICE NG41) – Spinal Injury: Assessment and Initial Management
Joint Royal Colleges Ambulance Liaison Committee (JRCALC, 2024 Trauma Update) – Adds sections on self-extrication and scene-time reduction
National Fire Chiefs Council / UK Rescue Organisation (UKRO 2024) – Modern Extrication Framework
EAST Practice Management Guideline (2018) – No SMR/immobilisation for penetrating trauma
In short
“Don’t move them” is outdated.
Protect the cord, protect the airway, protect from the environment.
If the patient can move themselves safely — coach them, don’t carry them.
When they can’t — use gentle, padded, coordinated handling, not rigid immobilisation.
That’s modern spinal care in the wilderness: do less, but do it better.
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