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If someone has hurt their back, this is one time where as a first aider we could cause more injury to them. The spine itself is bone, inside is the spinal cord. Now, bones can heal, although it could cause long-term problems, the spinal cord cannot be repaired. If someone's damaged their spinal cord in the lower side of the back in the lumbar region, then this can cause a complete paralysis in the lower legs or just loss of feeling or other problems.

If it happens in the top of the spine, this can also affect the control systems, like breathing. So we need to be really, really careful. If someone has fallen down, and in this example, someone's fallen down the stairs, we need to make sure this person does not move.

So get them to look straight in front of them and not to move their head, and then you can take your hands around either side and just hold the head still. Try not to cover their ears, because you do not want to take the sense of their hearing away from them, and try and relax them as much as possible. We'd leave them in this position. The only thing you can do if it's needed, you just move the head slightly into the neutral position, so bringing it from a side, back into a neutral position if you need to do that.

The only times you would need to move somebody would be if they are not breathing and we need to do CPR, or maybe if we need to leave them in a position, say, they are at the bottom of the stairs and we are on our own and we need to go somewhere and we think they are going to vomit, we do not want to leave them on their back. If we leave them on their back, they could drown on the vomit and that could kill them. So what we are going to try and do is leave them where they are.

If they are in imminent danger, burning building, burning car, then yes, you would want to move them out of that danger. But in this example, they are at the bottom of the stairs, so we need to make sure the scene is safe and the emergency service is called. We do not want people running down the stairs or coming through, so make sure everyone keeps out of the way. Also, as people have spinal injury, maybe they can't control their temperature, especially if they are lying on a cold floor, so wrap them up in a blanket where you can, but try and avoid moving that patient.

Spinal injury generally is usually a case where we treat as if they have got spinal injury until we know otherwise, and the only place we will know that is a hospital. So the first aid is to immobilize them in the position we found them. When the paramedics arrive, they are going to immobilise them onto boards and move them without actually moving their body, to the hospital. In the hospital, they are going to do the x-rays.

In most cases, including this scenario, we will always assume the worst. By assuming the worst, then we can treat the person as if they have got a spinal injury. So we are treating this person's spinal injury, the paramedics are going to do exactly the same, and then when they get to the hospital, the hospital can then decide through x-rays and further tests whether this person has actually hurt their back. But from a first aid point of view, we've at least kept that person as safe as possible from any other injury.