Road Accidents & Suspected Spinal Injury
India loses more people to road crashes than almost anywhere in the world, and bystanders reach the scene long before an ambulance. Careless movement of a spine-injured casualty can cause permanent paralysis.
When to call an ambulance immediately
- Neck or back pain after the crash, or tenderness over the spine
- Numbness, tingling, or weakness in the arms or legs
- Loss of bladder or bowel control
- Any high-energy mechanism: a fall from height, ejection from a vehicle, or a high-speed collision
- Unconsciousness, confusion, or a head injury with vomiting
- Obvious limb deformity, or bleeding that will not stop
What to do
Work through these in order. If you are alone, put your phone on speaker so the 108 call handler can guide you while your hands stay free.
- 1
Protect yourself and the scene first
Park safely, switch on hazard lights, and set a warning at a distance on a highway. Watch for oncoming traffic, fuel spills and live electrical wires. You cannot help anyone if you are hit yourself.
- 2
Call 108 with a clear location
Give a precise landmark or a highway marker, the number of casualties, and whether anyone is trapped or unconscious. Ask the caller to send a second person to flag the ambulance down.
- 3
Do not move them unless there is immediate danger
Fire, drowning, or oncoming traffic justify moving someone. Nothing else does. If you must move a casualty, drag them in a straight line along the body axis, supporting the head and keeping the spine aligned, and never bend or twist the neck.
- 4
Support the head and neck in a neutral position
Kneel behind the person and hold the head gently with both hands so the nose stays in line with the navel. Ask them not to nod or turn. Keep holding until the ambulance crew takes over.
- 5
Airway before spine, if you must choose
If an unconscious person is not breathing because the airway is blocked, open it with a jaw thrust rather than a head tilt. A protected spine in a person who has died of a blocked airway helps nobody, so the airway wins.
- 6
Control bleeding and cover them
Firm direct pressure on any heavy bleeding. Splint an obviously broken limb by supporting it where it lies rather than straightening it. Cover the person with a blanket, because trauma casualties get cold fast and cold blood clots badly.
- 7
Helmets stay on
Leave a motorcycle helmet in place unless the airway is obstructed and you cannot manage it otherwise. If it truly must come off, it takes two trained people, one holding the head steady throughout.
Never do these
Most of these are well-intentioned and widely believed. All of them make the situation worse.
- Never pull someone out of a vehicle by the arms or head because you want to help quickly. This is how bystanders convert a survivable injury into lifelong paralysis.
- Never sit an injured person up, prop them against a wall, or walk them to a vehicle.
- Never give food or water, because they may need surgery under anaesthetic.
- Never straighten a deformed limb or push a protruding bone back in.
- Never crowd the casualty. Ask onlookers to make space and to control traffic instead.
- Never remove a helmet casually to see the face.
Once the immediate danger has passed
- Under Indian law, good-faith bystanders who help at a road crash are protected, cannot be compelled to give their details, and cannot be held liable for the outcome. Fear of legal trouble is not a reason to walk past.
- Note the vehicle number and the time of the crash. It will matter for the police report and for insurance.
- Anyone with a head injury who vomits, becomes drowsy, or has a worsening headache in the following forty-eight hours must be reassessed urgently.
Frequently asked
Can I be harassed by police or hospitals for bringing in an accident victim?
No. The Good Samaritan protections upheld by the Supreme Court and codified in the Motor Vehicles Act mean a bystander who helps cannot be forced to disclose their identity, cannot be made to pay for treatment, and is shielded from civil and criminal liability. Hospitals must begin treatment regardless.
Should I take them in my car instead of waiting?
If an ambulance can reach you in reasonable time, waiting with proper spinal care is usually safer. If you are remote and someone is bleeding heavily, transport may be the right call, but keep the spine supported and take a second person to hold the head.
Reviewed and written by
Dr. Poonam Sekhon Chahal, MBBS, MEM
Senior Emergency Physician, Manipal Hospital, Patiala · Certified in ACLS, ATLS, PALS and PoCUS