Cervical Spine Injuries in the Outdoors: What You Need to Know

Stay Prepared. Stay Wild. That’s more than a tagline for us—it’s a mindset. One of the most dangerous injuries an outdoor adventurer can face is a cervical spine injury (C-spine). Whether you’re hunting, hiking, climbing, or riding an ATV through rugged terrain, a fall or impact to the head and neck can be life-altering. Let’s break down what you need to know to protect yourself and your crew.

Why Cervical Spine Injuries Matter

• High stakes: Cervical spine injuries account for up to 50% of all spinal injuries seen in trauma patients.

• Devastating outcomes: Roughly 55% of spinal cord injuries involve the cervical spine, and these are the ones most likely to cause paralysis or death.

• Outdoor context: Falls from height (tree stands, rock faces), ATV accidents, and blunt trauma (falling branches, rolling rocks) are common outdoor causes. Even a simple trip on uneven terrain can be enough if the force is right.

Real-Life Outdoor Scenarios

• The Hunter in a Tree Stand: A 47-year-old hunter falls 15 feet when his stand strap fails. He’s awake and talking but complains of neck pain and tingling in his hands. Without careful immobilization and assessment, moving him could worsen a spinal cord injury.

• The Trail Runner: A young runner trips on roots, strikes her head, and is briefly unconscious. She wakes up, says she feels fine, and wants to keep going. But should she? Without proper assessment, a dangerous cervical injury could be missed.

• The Climber’s Fall: A climber’s rope catches awkwardly, and although he walks away, he has midline tenderness at the neck. Ignoring it could risk catastrophic deterioration hours later.

The NEXUS Criteria: Your Field Guide for Decision-Making

In emergency medicine, we use the NEXUS C-spine criteria to help determine whether a patient needs imaging or can be safely cleared without it. While you won’t have a CT scanner on the trail, understanding these criteria can help you recognize red flags and avoid making the injury worse.

A patient must meet ALL of the following to be “cleared”:

1. No posterior midline cervical tenderness
   – Press gently along the spine. Any pain? Assume injury.

2. No focal neurological deficit
   – Numbness, weakness, tingling, difficulty moving arms/legs = red flag.

3. Normal level of alertness
   – Confused, drowsy, or intoxicated? Don’t risk it.

4. No evidence of intoxication
   – Alcohol or drugs make exam unreliable.

5. No painful distracting injury
   – If there’s a big leg fracture or major bleeding elsewhere, they may not notice neck pain.

Bottom line: If any of these are positive—or if you’re uncertain—treat it as a cervical spine injury until proven otherwise.

Field Management of Suspected Cervical Spine Injury

• Immobilize the neck: In the outdoors you won’t have a rigid collar, but you can improvise with a SAM splint, rolled clothing, or by keeping the head in neutral position with padding.

• Minimize movement: Avoid twisting or bending. Logroll only if absolutely necessary for airway or bleeding control.

• Call for help: Early evacuation is key—time matters.

• Stay calm, stay steady: Your goal isn’t to fix the injury—it’s to prevent it from getting worse.

Takeaway

Cervical spine injuries are low frequency but high consequence. Knowing the NEXUS criteria and recognizing when not to move someone can be the difference between recovery and lifelong paralysis.

When you’re out in the wild, gear and knowledge work together. Carry tools like a SAM splint in your PrepEM Wild kit, but more importantly, carry the awareness to use them.

Be the asset—not the liability.
Stay Prepared. Stay Wild.