Assume cervical spine injury in all patients with a major mechanism of injury.

Immobilization is required in all patients with:

• Significant distracting injuries
• Confusion or lack of cooperation, or who are under the influence of drugs or alcohol
• Reduced level of consciousness
• Any spinal pain, weakness, altered or absent sensation
• History of past spinal problems

Immobilize the neck immediately using your hands, then keep the neck immobilized until cervical spine injury is excluded.