A - PREHOSPITAL AND EMERGENCY

On arrival at the scene of the incident, use a prioritizing sequence to assess individuals with suspected trauma, for example <C>ABCDE:

1. catastrophic hemorrhage
2. airway with in-line spinal immobilization (for guidance on airway management, refer to the NICE guideline on major trauma)
3. breathing
4. circulation
5. disability (neurological)
6. exposure and environment

At all stages of the assessment:

1. protect the individual's cervical spine with manual in-line spinal immobilization, particularly during any airway intervention and
2. avoid moving the remainder of the spine.

(NICE 2016, p.8; Level C)

Assess the individual for spinal injury, initially taking into account the factors listed below. Check if the individual:

1. has any significant distracting injuries
2. is under the influence of drugs or alcohol
3. is confused or uncooperative
4. has a reduced level of consciousness
5. has any spinal pain
6. has any hand or foot weakness (motor assessment)
7. has altered or absent sensation in the hands or feet (sensory assessment)
8. has priapism (unconscious or exposed male)
9. has a history of past spinal problems, including previous spinal surgery or conditions that predispose to instability of the spine.