In a suspected spinal injury during transfer, which sequence should be followed?

• A. Remove immobilization to speed transfer.
• B. Proceed without stabilization.
• C. Immobilize without stabilization.
• D. Manual in-line stabilization, then cervical collar, and immobilize to spine board.

Answer: (D)

Maintaining the spine in a neutral, aligned position during transfer is essential to prevent worsening a suspected spinal injury. The best approach starts with manual in-line stabilization, keeping the head and neck in line with the spine while you control movement. Once that stable position is maintained by a responder holding the head steady, apply a cervical collar to immobilize the neck further. After the collar is in place, transfer the patient onto a spine board and secure them with straps to keep the head, neck, and torso immobilized in that same position. Throughout the move, avoid twisting, bending, or flexing the spine, and coordinate with your partner to minimize any movement.

This sequence ensures continuous protection of the spinal axis from recognition through immobilization. Alternatives that remove immobilization, skip stabilization, or immobilize without maintaining stabilization all allow movement of the head and neck, increasing the risk of further injury during transfer.