Protocol 3: Spine Clearance

In an urban context, all patients that are involved in a traumatic event that may have caused a spine injury are treated as though they have an injured spine. In a wilderness context however, spine clearance can mean the difference between a self- or assisted evacuation (and potentially putting many other rescuers at risk).

Spine assessment criteria allow rescuers in a wilderness or remote setting to determine the need and justification for spinal stabilization or other protective measures in the presence of an uncertain or positive mechanism for spine injury (MOI).

This evaluation focuses on patient reliability, signs of spinal column injury, and neurological function. Adequate time must be allowed for the evaluation. An assessment that the spine is CLEAR means that there is no significant spine injury. Repeat examinations may be necessary.


Assess the mechanism of injury.
If a positive or uncertain mechanism of injury exists, protect the spine from further trauma by whatever method is feasible and available.
Do a thorough evaluation including a full SAMPLE history as well as a focused physical head-to-toe examination.

To clear the spine, the patient must meet all of the following criteria:
  a)  Patient must be reliable, cooperative, sober, and alert.
  b)  Patient must be free of spine pain and tenderness.
  c)  Patient must have normal motor/sensory function in all four extremities:
       • Finger abduction or finger or wrist extension against resistance (check both hands)
       • Foot plantar flexion/extension (check both feet)
       • No complaint of numbness and sensation intact to sharp and dull stimuli in all four extremities
       • If reduced function in one extremity can be attributed to a specific local injury, that should not preclude clearing the spine.

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.
Arrange proper evacuation. If possible, fully immobilize the patient's spine using as much padding as possible to accomplish both patient comfort and spine stability. Evacuate to definitive care the safest way possible.


The Spine Assessment protocol has been authorized for use by Center for Wilderness Safety WEMT and WFR certified individuals (with authorization from the governing organization of the individual).


Last Updated: Nov. 2019

These protocols were written by Jeffrey Isaac, PA-C (of Wilderness Medical Associates International) and have been edited and authorized by the executive medical and curriculum directors Kathryn Vaughn, MD, FAWM & Jennifer Kay, RN, BNS, CCRC, CCRP, WALS, for use by Center for Wilderness Safety, Inc.


NOTICE: Due to the Coronavirus, our offices are CLOSED and our staff are working remotely.
ALL COURSES HAVE BEEN CANCELLED through August 2020. Need to reach us? Email