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How to Assess and Respond to Head and Spinal Injuries

Warning signs of a serious head, neck or spine injury, and why keeping the person still can protect them.

Last reviewed October 3, 2026 · Spiral Search editorial team

Suspect a spinal injury after any serious fall, crash, diving accident or blow to the head or neck. Call 911, and tell the person not to move.

General information, not medical advice. Reading a guide is not a substitute for a hands-on first aid or CPR class (American Red Cross, American Heart Association, and local fire-rescue departments offer them). If someone may be in danger, call 911 and follow the dispatcher.

Common causes

Motor vehicle crashes, headfirst dives into shallow water, falls from more than a person's own height, and high-impact sports.

Warning signs (call 911)

A significant cause of injury, or any change in alertness.
Weakness, tingling, numbness, or inability to move any part of the body.
Blood or clear fluid coming from the nose or ears.
Seizure, repeated vomiting, trouble breathing, or changes in vision.
Deformity of the head, neck or back.
Severe headache, a pupil larger than the other, slurred speech, or increasing confusion or drowsiness.
Loss of consciousness, even briefly.

What to do

Call 911. Make sure the scene is safe.
Tell the person NOT to move and to answer your questions out loud.
Keep the head, neck and spine in the position you found them. If you can safely do so, hold the head still with both hands, one on each side, without pulling.
Control severe bleeding with gentle pressure around, not on, a possible skull fracture; do not push on a visibly deformed or depressed area.
Watch breathing and alertness continuously. If they vomit, and cannot be kept still, roll them as a unit with help, keeping the head, neck and body aligned.
If they stop breathing, start CPR. Use the jaw-thrust if you are trained; otherwise tilt the head only as far as needed to open the airway.
Helmet: if the person is wearing a helmet, do not remove it unless you need to give CPR.
Do not give painkillers. They can mask the signs of a serious head injury.

Mild head injury or concussion

A bump on the head can cause a concussion even without losing consciousness. Watch for headache, dizziness, confusion, nausea, sensitivity to light and noise, or trouble with memory and balance. Any worsening signs, repeated vomiting, a seizure or increasing drowsiness mean call 911. After a concussion, rest and have a medical professional evaluate the person before returning to sports or work.

Triage tip

In a multi-victim scene, an unresponsive person with a possible head injury and abnormal breathing is high priority. See Triage and the ABCs.

Sources and further reading

American Red Cross – Head, neck and spinal injury