Trauma: head and spine
Governing: Table A-VI/4-1 'spinal injuries'; RCUK First Aid Guidelines 2025, cervical spinal motion restriction and concussion; MIN 718 (SCMG 24th edition). Builds on: L1.1.
Head injury
| Presentation | Signs |
|---|---|
| Concussion | Brief confusion or loss of memory, headache, dizziness, nausea or vomiting, visual change, sensitivity to light or noise, emotional or behavioural change (RCUK 2025) |
| Compression (bleeding inside the skull) | Worsening headache, falling level of response, unequal pupils, weakness down one side, slowing pulse; may follow a lucid interval |
| Skull fracture | Deformity, bruising round the eyes or behind the ear, clear fluid or blood from nose or ear |
The single most useful thing you can do is observe and record, at regular intervals, the level of response, the pupils (size, equality, reaction to light), pulse and breathing. A casualty who is getting worse needs evacuation; the trend is the evidence the TMAS doctor needs.
Anyone knocked out, however briefly, or showing concussion signs, comes off duty and is not left alone. RCUK 2025: remove from physical activity and refer to a healthcare professional; at sea that means TMAS.
Spinal injury: when to suspect it
RCUK 2025 lists falls or dives from height, crush by machinery or a heavy object, road traffic and sporting accidents. On a yacht, add:
- falls down companionways and into open hatches or the engine room;
- tender and jet-ski collisions, towable and wakeboard accidents;
- diving from the upper deck into shallow water;
- being struck by a swinging davit load.
Pain in the neck or back, tingling, numbness or weakness in the limbs, or loss of bladder control all point to cord involvement.
Spinal motion restriction
| Situation | RCUK 2025 approach |
|---|---|
| Alert, cooperative | Encourage them to hold their own neck still in a comfortable position. Never force a position. |
| Unresponsive, on their back | Kneel at the head, hold head and neck in line; open the airway with a jaw thrust |
| Unresponsive, face down | Check the airway; if you must turn them, roll as a unit with helpers |
| Collars and boards | Used selectively by those specifically trained, under their protocols |
The airway always comes first. If a casualty is vomiting or cannot keep an airway, turn them, keeping head, neck and body aligned, with a log-roll by three or four people.
MIN 718 notes that the SCMG 24th edition revised its spinal immobilisation section. Use the ship's copy as the working reference and follow the TMAS doctor's instructions on collars and extraction.
Extraction
In the water, RCUK 2025 says spinal precautions should not delay removing someone who needs resuscitation. Otherwise, float the casualty to a platform, support the head, and use a scoop stretcher or rescue board if carried. Plan the route out of the engine room or crew area before moving anyone.
WARNING — The lucid interval A crew member who hit his head, seemed fine and went to his bunk may be found unrousable hours later. Wake and check anyone with a head injury at intervals through the night.
TIP — Water sports briefing Put spinal injury management in the water-toys risk assessment and the tender crew's drills, not just the medical folder.