What immediate advice should be given to a patient who has just sustained a whiplash injury?

Immediate Management of Whiplash Injury

Patients with acute whiplash injury should be advised to remain as still as possible until assessed, avoid cervical collars, and begin early active mobilization rather than rest or immobilization. 1

Initial Assessment and Spinal Precautions

Suspect Cervical Spine Injury If:

• Motor vehicle collision involvement (driver, passenger, or pedestrian) 1
• Pain or tenderness in the neck or back 1
• Tingling in the extremities 1
• Sensory deficit or muscle weakness involving the torso or upper extremities 1
• Age ≥65 years 1
• Not fully alert or is intoxicated 1

Immediate Positioning and Stabilization

If spinal injury is suspected, have the person remain as still as possible in the position found and await EMS arrival. 1 The 2015 American Heart Association guidelines specifically recommend against routine application of cervical collars by first aid providers, as evidence shows more actual harm than benefit. 1

Manually stabilize the head to minimize motion of the head, neck, and spine until EMS arrives. 1 This means supporting the head with your hands on both sides to prevent movement, not using immobilization devices which may be harmful when applied by first aid providers. 1

Critical Actions

Activate Emergency Response

Immediately activate the emergency response system (call 911) for any whiplash injury. 1 Even seemingly minor whiplash injuries can have serious underlying cervical spine damage that requires professional evaluation. 2, 3

Positioning Considerations

• If the area is unsafe, move the person to safety only if it is safe for you to do so 1
• Do not attempt to move or reposition the neck 1
• Leave the person in the position found unless CPR is needed or the area is unsafe 1
• If the person becomes unresponsive with absent or abnormal breathing, position supine and begin CPR 1

What NOT to Do

Do not apply cervical collars - The 2015 guidelines explicitly state this causes harm without proven benefit in first aid settings. 1

Do not attempt to straighten or manipulate the neck - This risks secondary spinal cord injury that could result in permanent neurological damage including quadriplegia. 1

Do not recommend rest or immobilization as treatment - Research consistently shows that "rest makes rusty" and active interventions are superior to passive immobilization. 4, 5

Early Management Advice (After Medical Clearance)

Once serious injury has been ruled out by medical professionals:

Advise patients to maintain usual activities and avoid prolonged immobilization. 4 Active treatments show beneficial effects on pain outcomes, while rest and collar immobilization are not recommended. 4, 5

Early active mobilization within pain tolerance is preferred over passive treatments. 4, 5 Most acute whiplash cases respond well to conservative treatment with symptom resolution within weeks to months. 2

Common Pitfalls to Avoid

• Over-immobilization: Cervical collars and prolonged rest lead to worse outcomes and increased chronicity 4, 5
• Delayed activation of EMS: Symptoms may not appear for hours after injury, but structural damage may be present 3, 6
• Assuming no injury based on lack of immediate symptoms: Irritative lesions from hemorrhage or swelling may not manifest for 2-3 weeks 6
• Attempting field diagnosis: First aid providers cannot conclusively identify spinal injury, so maintain high suspicion with appropriate mechanism 1

Protection from Environmental Exposure

Protect the injured person from hypothermia or hyperthermia due to exposure while awaiting EMS. 1 Use blankets or available materials to maintain normal body temperature without moving the person unnecessarily.