Opening the Airway When You Suspect a Spinal Injury

One of the more technical — but genuinely important — updates in the new resuscitation guidelines concerns airway management, specifically what to do when you suspect a casualty may have a spinal injury but they're also not breathing normally.

It's a scenario that used to create real hesitation for first aiders: do you prioritise protecting the spine, or do you prioritise getting oxygen into the casualty? The updated guidance gives a much clearer answer.

The old dilemma

Traditionally, first aiders were taught to be extremely cautious about moving the head and neck of anyone with a suspected spinal injury, out of concern that movement could worsen a spinal cord injury. This sometimes led to a kind of paralysis in decision-making — a fear of doing the "wrong" thing that could delay opening the airway.

What's changed

The updated guidelines are clear: keeping the airway open takes priority over strict spinal immobilisation. If a casualty isn't breathing normally, a blocked or closed airway will kill them faster than movement of the head and neck ever will. The advice now is to use the jaw thrust technique to open the airway — lifting the jaw forward without tilting the head back — while moving the head and neck as little and as carefully as possible.

The updated RCUK guidelines are clear that opening the airway takes priority over strict spinal immobilisation. First aid awarding bodies are, in turn, building this into how the technique is taught and assessed in regulated courses — meaning it's moving from an optional extra covered only in advanced training to a core, assessed part of standard first aid qualifications.

Why this matters

This is ultimately about resolving hesitation. In an emergency, uncertainty costs time, and time costs lives. By giving clear priority to airway management, the guidelines remove the ambiguity that could previously cause a well-meaning first aider to freeze or delay action.

It also reflects a broader theme running through the whole 2025 update: reducing barriers to bystander action. Across many of the changes — from the new advice on calling 999 earlier to guidance on defibrillator pad placement — the common thread is making the right action clearer and easier to take under pressure, rather than adding more to remember.

What this means for training

If you're a first aid instructor, this is a genuine shift in what needs to be taught and assessed, not just talked about. Learners need hands-on practice with the jaw thrust technique specifically in the context of a suspected spinal injury, ideally using a manikin that can realistically simulate jaw movement and resistance so the technique actually builds muscle memory.

For anyone who's already qualified, this is a good one to actively seek out as part of your next refresher or CPD activity — it's a genuinely different way of thinking about a scenario many people assume they already know how to handle.

The takeaway is simple: a person who isn't breathing needs an open airway, right now. Spinal care matters, but it comes second to that basic, life-saving priority.

Practise it until it's second nature

Technique updates like this one are best learned hands-on, with real feedback on your positioning and confidence under pressure. Basecamp First Aid builds the updated jaw thrust technique into all our relevant courses, taught by experienced instructors.

Get in touch via basecampfirstaid.com or email info@basecampfirstaid.com to book your next course or refresher.

Disclaimer: This article is for general information and educational purposes only and does not constitute medical advice. It reflects a summary of the Resuscitation Council UK 2025 Guidelines as understood at the time of writing; guidance may be updated, and implementation timelines can vary between awarding bodies and training providers. Always follow the specific instructions of your first aid course provider and the current guidance of the Resuscitation Council UK (resus.org.uk). In a real emergency, always call 999 (or your local emergency number) immediately.

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