Spine Assessment + Clearance

Spine Patient Evacuated via Stokes CarryIn an urban context all patients that are involved in a traumatic event that may have caused a spine injury are treated as though they are spine injured.

In a wilderness context, clearing a potential spine injury when there is a positive mechanism for such an injury requires careful evaluation that focuses on patient reliability, nervous system function, and spinal column stability. Adequate time must be allowed for the evaluation.

  1. Assess for mechanism of spine injury. If positive or uncertain mechanism exists, protect the spine by whatever method is available. This could include but is not limited to hand stabilizing in the in-line position.
  2. Do a thorough evaluation including a history and physical examination. To rule out a spine injury the patient must meet all of the following criteria:
    1. Patient must be reliable. The patient must be cooperative, sober, and alert, and must be free of other distracting injuries significant enough to mask the pain and tenderness of the spine injury.
    2. Patient must be free of significant spine pain and tenderness consistent with a spinal injury.
    3. Patient must have normal motor/sensory function in all four extremities:
      • Finger, hand, or wrist motion (check both hands).
      • Ankle or great toe motion (check both feet).
      • Normal sensation to pain and light touch in all four extremities.
      • If reduced function in one particular extremity can be attributed with certainty to a condition unrelated to a potential spine injury (wrist fracture, for example), that deficit alone will not preclude ruling out a spine injury, because the motor/sensory assessment contain built-in redundancy.
  3. If the spine cannot be cleared, spine injury remains on the problem list and must be appropriately managed and followed up as part of patient care and evacuation. This may include stabilization and carry, assisted self-extrication, or other means of reducing the risk of further injury pending medical evaluation and treatment.



The above mentioned Wilderness Medical Field Protocol has been authorized by Center for Wilderness Safety Inc. for those who hold current WEMT, WFR or WAFA certification issued by CWS, provided they meet the requirements of the authorization criteria listed under the overall Protocols.

Download the Wilderness Medical Protocols (PDF)

Download • Wilderness Medical Field Protocols

These protocols were written by Jeffrey Isaac, PA-C of WMA, and have been edited and authorized by the executive medical and curriculum directors Kathryn Vaughn, M.D., William Incatasciato, M.D. and Jennifer Kay, RN, BSN for use by Center for Wilderness Safety, Inc.Last Revised: February 2021