Bones, joints, head and spine

A teenager comes off a skateboard and holds her wrist. A friend turns an ankle on a kerb. A child walks into a doorframe, cries, then seems fine. A rider lies on a verge saying her neck hurts. These are some of the commonest injuries a bystander meets, and most aren't emergencies. A few are, and the difference often doesn't show in the first minute.

This lesson is about telling them apart, and about what to do with your hands while you wait: support a broken bone rather than straighten it, cool a sprain without freezing it, know which signs after a knock on the head mean an ambulance, and keep an injured neck still without making the airway pay for it. It's also the lesson where the evidence is thinnest, and where one piece of first aid that was standard for decades has been dropped.

The US has a graded guideline for all four injuries: the AHA and American Red Cross's 2024 first aid guideline, sections 9.4 to 9.7.¹ RCUK's 2025 first aid guideline covers the neck and concussion, and has no section on fractures or sprains.² So UK advice on bones and joints comes from the NHS, St John Ambulance and the British Red Cross, and on head injury from the NHS and from NICE's guideline NG232, which is written for health services rather than bystanders.^3956413

Broken bones

What the guideline and the UK pages ask of a bystander:

1. Bleeding first. A fracture is open when the broken bone comes through the skin, and closed when it doesn't (American Red Cross).⁸ An open fracture with severe bleeding gets the bleeding recommendations (AHA/Red Cross 2024, COR 1, LOE C-EO): lesson 9's pressure, and a tourniquet if pressure fails.¹ St John adds that you press around the wound, not on a bone that is sticking out.⁵
2. Keep it still, supported. Leave a misshapen limb in the position found, "unless straightening the fracture is necessary to facilitate safe and prompt transport" (AHA/Red Cross 2024, COR 2b, LOE C-EO).¹ St John has you hold the joint above and below the injury and pad around it; the British Red Cross says to support it with the person's hand, a cushion or clothing, and if they won't let you touch it, to encourage them to hold it themselves.⁵⁶
3. Rings and watches off, as soon as possible (St John), because fingers, wrist or hand can swell (NHS).⁵³
4. Cover an open wound with a clean dressing (AHA/Red Cross 2024, COR 2b, LOE C-EO).¹
5. Leave a dislocation alone. The British Red Cross: "Never attempt to put dislocations back in place", since you may cause further damage.⁶

The guideline says splinting, holding a broken limb still, "can be useful to reduce pain, reduce risk for further injury, and facilitate transport" (COR 2a, LOE C-EO).¹ For a bystander that means improvising: the NHS suggests a towel as a sling for a broken arm.³ Anything more is a skill for a class.

Why not straighten it? It seems kind. The guideline's supporting text weighs it both ways: straightening an angled fracture might ease pain and improve blood flow, but it risks injury to nerves, blood vessels and other soft tissue, and can turn a closed fracture into an open one, and the writing group found no study that had tested whether first aid providers can do it safely.¹

When it needs an emergency call

"If a fractured extremity is blue, purple, or pale, the emergency response system should be activated immediately." (AHA/Red Cross 2024, COR 1, LOE C-EO).¹ The supporting text's reason: that colour may mean the limb is not getting enough blood, which threatens the limb. It also warns that a broken long bone such as the thigh bone can bleed heavily.¹

In the US:

• Emergency call: a limb that is blue, purple or pale (AHA/Red Cross 2024, COR 1, LOE C-EO). The American Red Cross page marks more signs for immediate emergency treatment: a deformed limb, grating, coldness, numbness or tingling, bleeding or bone through the skin, an injury to the head, neck, spine, pelvis or upper leg, a pop or snap at the time, a serious cause of injury, severe or multiple injuries, or signs of shock.¹⁸
• Otherwise: avoid painful use and get medical attention (AHA/Red Cross 2024, COR 1, LOE C-EO).¹

In the UK:

• Emergency call: 999 or 112 for an open fracture, a long bone, or a suspected broken back, neck or pelvis (St John). 999 or A&E for a numb or tingling arm, a bone through the skin, or an arm at an odd angle (NHS). 999 if they can't move themselves or are in a lot of pain (British Red Cross).⁵³⁶
• Otherwise: smaller bones still go to A&E or an urgent treatment centre, but less urgently, and can go with a friend (St John).⁵

The NHS adds: don't drive yourself to A&E, and don't eat or drink, in case the bone needs surgery.³ And if a person with a fracture shows signs of shock, lesson 9's table decides the legs. In the US the leg raise is only for someone with no trauma or injury, so not here (AHA/Red Cross 2024, COR 2b, LOE C-LD).¹ In the UK, St John's fractures page: "do not raise the legs if either are suspected to be broken or there is injury to the pelvis or a hip."⁵

"But she can move it." Both Red Crosses answer that: being able to move a limb, or stand on it, does not rule out a break, and the British Red Cross says only an X-ray can tell.⁶⁸

The skate park

A 15-year-old at a skate park in Richmond, Virginia, lands on her outstretched hand. Her wrist is swollen and sore and she's cradling it. She can wiggle her fingers, which are pink and warm. No wound.

Danger (lesson 2): off the bowl, away from the other boarders.

Emergency call? Not on colour: the AHA's blue, purple or pale test is not met.¹ Nothing is out of shape and no bone shows, and the American Red Cross lists pain and swelling without the mark it uses for immediate emergency treatment.⁸ One question first: did she hear or feel a pop or snap? The American Red Cross marks that for an emergency call.⁸ If not, it's medical care soon, with a parent or another adult driving.

In the UK, a crack heard at the time would send her to 999 or A&E (NHS). Otherwise the NHS wrist page says get medical advice as soon as possible; St John sends long bones by ambulance without saying which bones count.⁹³⁵

Support. She's already holding it, which the British Red Cross suggests when a person prefers to.⁶ A folded jacket under the forearm and a sweatshirt as a sling will do for the car. Her watch comes off before the wrist swells (St John; NHS).⁵³

Cold, wrapped. The NHS broken-arm page: an ice pack in a tea towel "for up to 20 minutes every 2 to 3 hours"; the American Red Cross, a cold pack in a thin towel for no more than 20 minutes.³⁸

Sprains and strains

A sprain is an injury to a ligament at a joint; a strain, to a muscle or tendon (American Red Cross; the NHS's version is similar).⁸⁹ In the first minutes they can look like a fracture, and the guideline's supporting text says that uncertainty is common, and that limiting use of the limb avoids making either worse.¹ So the first line is the same: someone with a painful limb injury that limits use should avoid painful activity and get medical attention (AHA/Red Cross 2024, COR 1, LOE C-EO).¹ The NHS sends people to 999 or A&E for a crack heard at the time, an odd shape, numbness or pins and needles, or skin gone blue, grey or cold, and to 111 if they cannot take weight or it's very painful.⁹

Cold: the guidance says yes, and disagrees on how long

The guideline says it can be useful to "apply cold (such as with ice and water surrounded by a damp cloth) to an acute sprain or strain for pain and swelling" (COR 2a, LOE C-LD).¹ Every guideline and first aid page read here uses cold, and all of them wrap it; the one dissent, from PEACE and LOVE's authors, comes below. On the length, they differ.

AHA/Red Cross 2024, section 9.6;¹ American Red Cross;⁸ NHS, Sprains and strains;⁹ St John, Sprains and strains;⁵ British Red Cross, Strains and sprains.¹⁰

That's 10 to 30 minutes, and the spread runs inside each country as well as between them. The AHA says its range is what experts recommend, 20 to 30 minutes three or four times a day, and adds "without direct contact on the skin to avoid cold injury". The British Red Cross says only that anything over 10 minutes "can cause further damage", without saying what kind. The UK pages give no source for their figures. Follow the figure your own country's class uses; 20 minutes, wrapped, sits inside every range but the British Red Cross's.

The supporting text says cold eases pain and swelling early, and in a trial of 74 people with sports injuries it improved pain scores over the following weeks. But it "has not been demonstrated to improve function or time to recovery".¹ Ice is for comfort.

Compression is weaker still. The guideline says a compression wrap may be considered after an ankle sprain, for comfort, without cutting off circulation (COR 2b, LOE C-LD), and its supporting text reports a systematic review in which wraps "did not reduce swelling or pain" during recovery.¹ ILCOR's suggestion allows either: "We suggest either application of a compression bandage or no application of a compression bandage for adults with an acute closed ankle joint injury (weak recommendation, very low–certainty evidence)." (ILCOR 2025, carrying its 2019 recommendation).⁷ PEACE and LOVE's authors, noting conflicting studies, think compression after an ankle sprain "seems to reduce swelling".¹¹ The NHS includes a supporting bandage; the British Red Cross says it must not become tight.⁹¹⁰ The American Red Cross's check: the skin beyond the injury should keep its temperature, colour and feeling, with no numbness or tingling.⁸

Heat has no defenders here. The American Red Cross: "No. This is a myth." Heat is often used for long-standing conditions such as arthritis, it says, but is not the best treatment for a fresh injury.⁸ The NHS says avoid heat for the first couple of days.⁹

RICE, PRICE, and PEACE and LOVE

St John and the British Red Cross teach RICE: Rest, Ice, Comfortable support, Elevate.⁵¹⁰ The NHS teaches PRICE for the first 2 to 3 days: Protection, Rest, Ice, Compression, Elevation.⁹ And in 2020 two physiotherapists, Blaise Dubois and Jean-Francois Esculier, proposed PEACE and LOVE in an editorial in the British Journal of Sports Medicine. It's an argument by two clinicians, not a guideline.¹¹

They tell the history themselves: the acronyms evolved "from ICE to RICE, then on to PRICE and POLICE".¹¹ Their complaint is that all of these stop at the first days. PEACE covers those days (Protect, Elevate, Avoid anti-inflammatories, Compress, Educate), and LOVE the weeks after (Load, Optimism, Vascularisation, meaning pain-free exercise that raises blood flow, and Exercise).¹¹ They protect the injury for 1 to 3 days and keep rest short, because long rest can weaken the tissue.¹¹

Two letters are the disagreement.

Anti-inflammatories. Dubois and Esculier's case: inflammation is part of how damaged soft tissue repairs, so damping it with drugs may harm long-term healing, the more so at higher doses. They grant that anti-inflammatories help pain and function, and still conclude: "Standard of care for soft-tissue injuries should not include anti-inflammatory medications."¹¹ The NHS's case: paracetamol for pain, and ibuprofen gel, mousse or spray to bring swelling down, then ibuprofen tablets if needed, with a pharmacist's advice.⁹ St John offers paracetamol or ibuprofen, and never aspirin under 16.⁵ The AHA/Red Cross guideline does not address painkillers for sprains.¹

Ice. Dubois and Esculier: "there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries"; they allow that it may be mostly a painkiller and argue it "could potentially disrupt inflammation" and so impair repair.¹¹ The guideline's side is its 2a for cold, for pain and swelling, with its own statement that cold has not been shown to speed recovery.¹ So neither side claims ice heals a sprain faster.

This is a contested question, and nothing read here settles it; trials that followed recovery over weeks, with and without the drug or the ice, would. Your part as a bystander is narrower. In the first minutes both camps protect the injury, support it and raise it. Whether the person later takes ibuprofen is theirs to decide with a pharmacist or doctor.

Head injuries

Concussion: off the field, and seen

The AHA/Red Cross guideline calls concussion a mild traumatic brain injury, caused by something that moves the head and brain rapidly back and forth.¹ RCUK's signs: trouble thinking or remembering; headache, vision changes, dizziness, nausea or vomiting, seizures, sensitivity to light or noise; and changes in mood or behaviour, such as sleepiness or confusion.² The ERC's 2025 chapter, which RCUK's text adapts, says the signs vary and can come late, and there is no agreed definition.¹² The AHA: "To date, there is no validated scoring system for concussion identification in the first aid setting."¹

So both countries skip the diagnosis and act on the suspicion.

• AHA/Red Cross 2024: "A person with signs and symptoms of a concussion should be immediately removed from activity (play/sports) and not allowed to return to activity until evaluated by a health care professional." (COR 1, LOE B-NR).¹
• RCUK 2025: "Remove the person from physical activities." Then refer them to a healthcare professional.² The ERC recommends that anyone with a suspected concussion, whatever the cause, be removed from physical activity and seek immediate medical review.¹²

They agree, and the US evidence level, B-NR, is the highest in this lesson: everything else here is C-LD or C-EO.¹

When a head injury needs a call

The US guideline lists signs; the American Red Cross page and the UK lists also count how it happened.

In the US:

• AHA/Red Cross 2024 (COR 1, LOE C-EO): call EMS for signs of a severe head injury, "such as loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp".¹
• The American Red Cross page: 911 for any of the signs it marks for immediate emergency treatment. They include a significant cause of injury, head or neck pain, nausea or vomiting, confusion or a change in behaviour, fluid from the nose or ears, bruising round the eyes or behind the ears, and a damaged helmet. Its list of causes includes a fall from more than the person's own height, diving head first into shallow water, a vehicle collision and a blow in high-impact sport. Its FAQ adds calling 911 for a persistent headache or a change in vision.⁸

In the UK:

• The NHS page, 999 if someone who hit their head: was knocked out and hasn't woken; can't stay awake or keep their eyes open; has a seizure; "has fallen from a height of more than 1 metre or 5 stairs" (about 3 ft 3 in); has vision or hearing problems; has a black eye without hitting the eye; has clear fluid from the ears or nose; is bleeding from the ears or bruised behind them; has new numbness or weakness; has trouble walking, balancing, understanding, speaking or writing; was hit at high speed; has something in a head wound or a dent in the head; is under 1 with a bruise, swelling or large cut on the head; or has changed behaviour.⁴
• The NHS page, 111 if they're being sick, feel dizzy, take a blood thinner, were drinking or taking drugs at the time, or have other worrying symptoms; call 111 about a child under 5.⁴
• The British Red Cross page: 999 if they become sleepy, vomit or seem confused, or if you suspect concussion, among others.⁶

Behind the NHS page sits NICE's NG232, which tells services such as NHS 111 what to do with a caller. It sends an ambulance for, among others, anyone not fully conscious, any seizure, or a high-energy injury, which includes "a fall from a height of more than 1 m or more than 5 stairs" and a bicycle collision.¹³ It sends people to an emergency department for, among others, a knockout they've recovered from, "any vomiting episodes since the injury", intoxication, and anticoagulant or antiplatelet treatment, which are blood thinners, "(except aspirin monotherapy)", meaning aspirin taken on its own.¹³

Vomiting is on the US emergency lists, the British Red Cross's 999 list and St John's signs of a serious head injury, which it sends to 999; the NHS page sends it to 111, and NICE then tells 111 to send the person to an emergency department.^1865413 Everyone wants them seen; the NHS page takes the phone route. Blood thinners and alcohol are on the UK lists and not on the US guideline's. Both St John and the British Red Cross add being over 65 and having nobody to look after them as reasons to seek advice, the British Red Cross a past brain injury and St John past brain surgery.⁴¹³⁵⁶ Neither the NHS page nor the parts of NICE read here explains the route.

The guideline's supporting text gives the reason for these signs: they go with a higher risk of life-threatening injury inside the skull, such as bleeding around the brain or swelling of it.¹ The ERC adds that if the first injury is missed, further damage to the brain can follow, with a worse outcome.¹²

Afterwards

"Keep them awake all night" is a familiar instruction. For a minor head injury looked after at home (sent home from hospital, or not needing to go), the NHS says "you or your child do not need to stay awake if you're tired".⁴ That's for a person already judged not to need hospital; someone who can't stay awake is on the 999 list. The NHS also wants an adult with them "for at least the first 24 hours", and no contact sport "for at least 3 weeks".⁴

Painkillers are a real difference, about different moments.

American Red Cross;⁸ NHS.⁴

The American line is about the person in front of you, whose injury nobody has judged yet. The NHS line sits under home care, after it has been. Neither page says what it would advise in the other's moment. For the bump itself, the British Red Cross and St John suggest something cold wrapped in a cloth, the British Red Cross "for up to 20 minutes".⁶⁵

The neck and back

When to suspect it

RCUK: suspect a neck injury in someone who fell or dived from a height, was crushed by machinery or a heavy object, or was in a road or sporting accident.² St John adds a collapsed rugby scrum, a fall from a horse or motorbike, and an injury to the head or face.⁵ The damage that matters is to the spinal cord: St John says the person may lose feeling or power below the injury.⁵

If they're awake: still, and holding their own neck

AHA/Red Cross 2024, section 9.4;¹ American Red Cross;⁸ RCUK 2025;² ERC 2025.¹²

Both want stillness. St John's page, reviewed in April 2025, has a bystander hold the head instead, kneeling behind it, with rolled blankets either side, "no matter how long it takes".⁵ No source read here supports moving an awake person into a position they do not want.

Collars and boards

For decades the answer to a possible spinal injury was a rigid collar and a long spine board, a rigid board the length of the body, for fear that moving the person would worsen the injury.¹

What the guidance says now:

• AHA/Red Cross 2024: "We recommend against the routine use of rigid cervical collars and long spine boards for spinal immobilization by first aid providers." (COR 3: Harm, LOE C-LD).¹
• ILCOR, a recommendation first made in 2015 and kept in 2025: "We suggest against the use of cervical collars by first aid providers (weak recommendation, very low–certainty evidence)."⁷
• RCUK and the ERC leave collars and similar devices to responders with specialised training, such as lifeguards, under their own protocols.²¹² The AHA says its recommendations are for the general public, with exceptions for first aid providers with extra training and special duties.¹

The costs are in ILCOR's 2025 review of 66 studies: collars do reduce neck movement, "but lead to impaired respiratory and swallowing function as well as increased intracranial pressure", which is pressure inside the skull.⁷ The AHA adds discomfort and pressure sores.¹ Its background is blunt about how the old practice began: it was "driven more by legal considerations and unproven theories than by concrete scientific or clinical evidence".¹

That's the AHA's judgement of its own field's history. Read it beside ILCOR's caution: most of the 66 studies used healthy young volunteers or cadavers, so they may not carry over to injured people, and the task force thinks trained responders such as ski patrols and lifeguards might be capable of using collars, and wants a formal synthesis of the evidence before changing its recommendation.⁷ This is evidence changing practice, with its limits stated. The people who fitted collars for decades were following the guidance of their time.

One more US line: against routine spinal immobilisation for penetrating trauma such as a knife or gunshot wound (AHA/Red Cross 2024, COR 3: Harm, LOE C-LD), which the supporting text links to higher mortality.¹ For a bystander, lesson 9's bleeding control comes first.

When moving comes first

"Never move someone with a neck injury, whatever happens" is a misconception. The guidance read here names these exceptions.

1. Danger. The AHA's "unless safety considerations warrant movement"; the ERC's lay guide, "Do not move the person unless they are in an unsafe situation"; St John, unless they are in immediate danger.¹¹⁴⁵
2. The airway. "Airway opening, if required, always has priority over in-line immobilisation" (RCUK 2025).²
3. CPR. Anyone who needs CPR goes on their back (AHA/Red Cross 2024, COR 1, LOE C-LD; lesson 7).¹ The American Red Cross page's exceptions to staying where they are: safety, CPR, and bleeding you cannot otherwise control.⁸

The American Red Cross adds two: keep a child in their car seat, and leave a helmet on, unless you need to move them or take it off for CPR.⁸

If they won't respond

Lesson 7's line holds. The ERC and RCUK: "In cases of agonal breathing or trauma, do NOT move the person into the recovery position." (ERC 2025; RCUK 2025).²¹² The ERC's evidence text says what instead: "Persons with a known trauma should be kept in supine position", on the back.¹² The AHA/Red Cross 2024 positioning table has no row for an injured person who won't respond; its background says the recovery position "may not be ideal if there are injuries to the spine, hip, or pelvis; if breathing is abnormal; or if CPR is needed."¹ St John's spinal page, reviewed in April 2025 before the October guidelines, turns a spinal casualty whose airway can't be kept open into a "spinal recovery position", which it describes on a page this course hasn't read; RCUK and the ERC now say not to use the recovery position after trauma.⁵²¹² It's a real difference inside the UK. This course follows the 2025 guidelines, and the call handler can guide you.

So, for someone lying still after a fall or a crash:

1. Safe? (lesson 2).
2. Responding? If not, the call, in the order lesson 2 gave for your country, on speaker.
3. Breathing normally? Quiet and regular at an ordinary pace is normal. RCUK treats slow, laboured breathing and gasping as signs of cardiac arrest, and says if in doubt, start CPR; snoring and gurgling are on lesson 2's list too.¹⁵ Then it is CPR on their back, whatever the neck.
4. Breathing normally: in the UK, leave them on their back and watch their breathing (ERC 2025; RCUK 2025).¹²² RCUK describes kneeling behind the head and using "the head or trapezius squeeze technique to maintain a neutral in-line position", which means holding the head so that it stays in line with the body, with a jaw thrust to open the airway if needed.² St John describes the jaw thrust in lay terms: fingertips at the angles of the jaw, lifting it gently, without tilting the neck.⁵ RCUK expects a first aider to do this, and a class teaches the grip. In the US there's no graded line for this (lesson 7): the positioning caution leans against moving them, and the call handler decides, including for someone you find on their side.¹
5. Face down: RCUK says check the airway and hold the neck steady; if the airway needs opening, ask others to help roll them onto their back as one unit, the neck kept in line with the body.²
6. Breathing stops being normal at any point: CPR.

The lane

A Sunday morning on a narrow lane outside Hereford. A rider has been thrown when her horse shied at a tractor. She's on her back on the verge, awake, in a riding helmet. Her neck hurts; she can move her fingers and toes. The horse is loose up the lane, and cars are still coming round the bend.

1. Danger: traffic and a loose horse. Lesson 2's rule is that you don't become a second casualty; making a road safe belongs to Car Basics, later this term. She's on the verge, not the road, so nothing here calls for moving her.

2. The call. 999 on speaker. A fall from a horse is one of St John's reasons to suspect a spinal injury, and for a suspected spinal injury St John says call 999 or 112.⁵ Say where you are: the lane, the nearest village, a landmark.

3. Still. She's awake and alert, so encourage her to hold her own neck comfortably and steadily, and don't force her into anything (RCUK 2025).² St John would have you hold her head instead, fingers spread so you don't cover her ears, because she needs to hear you.⁵

4. The helmet stays on. That's the American Red Cross's step; no UK page read here mentions helmets.⁸ No collar, no rolled towel round her neck (ILCOR 2025; RCUK 2025).⁷²

5. Watch her breathing and responses. The American Red Cross page adds keeping her from getting cold or overheated.⁸

Now the part that goes wrong.

What people get wrong

"If you can move it, it isn't broken." An X-ray is needed to say (British Red Cross: "the only accurate way"; American Red Cross: "usually required").⁶⁸

"Straighten it so it heals straight." Support it as found; straighten only if needed for safe transport (AHA/Red Cross 2024, COR 2b). Never put a dislocation back (British Red Cross).¹⁶

"Heat on a fresh sprain." A myth, says the American Red Cross; the NHS says avoid heat at first.⁸⁹

"Ice speeds healing." It eases pain and swelling, but it hasn't been shown to shorten recovery (AHA/Red Cross 2024), and PEACE and LOVE's authors question it altogether.¹¹¹

"Keep a person with a head injury awake all night." Not for a minor injury at home (NHS). Someone who can't stay awake needs 999.⁴

"Put a collar on them." Not for first aiders without specialised training (AHA/Red Cross 2024, COR 3: Harm, for routine use; ILCOR 2025, weak recommendation against).¹⁷

"Never move someone with a neck injury, whatever happens." Move them for danger, the airway and CPR.¹²⁸

Practice

Where to learn with your hands

Holding a head still without covering the ears, opening an airway without moving the neck, tying a sling that carries an arm: a class teaches these with a volunteer and an instructor, and a page can't. Lesson 16 lists where to find one. In between, the British Red Cross and American Red Cross first aid apps have step-by-step advice and quizzes, and the British Red Cross's broken-bone page points to a quiz in its app.⁶¹⁶ This course read the apps' pages, not the apps. The videos on these pages have not been watched against the guidance, so none is embedded.

Connections

Lesson 2's danger check opened both worked examples, and its breathing test decided the rider's gasps. Lesson 4's grading key read a section that is all C-EO, and a COR 3: Harm for the practice that was dropped. Lesson 7's trauma line and the ERC's "kept in supine position" carried over to the neck. Lesson 9's bleeding control comes before an open fracture, and its leg-raise table decides shock with a fracture. Strength and Fitness lesson 8's cold water after training is a different question from cold on an injury.

Lesson 12 turns from injuries to the two emergencies inside the body a bystander meets most: heart attack and stroke. Car Basics, later this term, can assume you know the road-scene danger check and to keep an injured person still, with the airway first.

Go deeper

• Hewett Brumberg and colleagues, 2024 AHA and American Red Cross Guidelines for First Aid, Circulation, free. Sections 9.4 to 9.7; the supporting text holds the reasons, including the AHA's account of why collars were dropped. Read in full here from an archived copy.
• Dubois and Esculier, Soft-tissue injuries simply need PEACE and LOVE, British Journal of Sports Medicine, 2020, free, two pages. The case against routine anti-inflammatories and ice in its authors' words. Read in full here from an archived copy.
• RCUK, 2025 Resuscitation Guidelines: First aid, the "Cervical spinal motion restriction" and "Concussion" sections. Short and free; read in full here.

Sources

1. E. K. Hewett Brumberg, M. J. Douma, K. Alibertis and colleagues, "2024 American Heart Association and American Red Cross Guidelines for First Aid", Circulation 150, 2024, e519 to e579. **Read level: full, direct, from the Internet Archive capture 20260502024223**; sections 9.4 to 9.7, their recommendations (printed as text in that capture), grades and supporting text, re-read from the same capture on 2026-09-25. The positioning background (section 5) is from the Internet Archive capture 20260329073336. On the archived web page the concussion table carries the heading "First Aid for Presyncope", a copy slip; the recommendations under it are the concussion ones.
2. Resuscitation Council UK, 2025 Resuscitation Guidelines: First aid, 27 October 2025 . Read level: full, direct; the recovery position, cervical spinal motion restriction and concussion sections re-read on 2026-09-25.
3. NHS, Broken arm or wrist, last reviewed 26 May 2023 . Read level: full, direct; re-read on 2026-09-25.
4. NHS, Head injury and concussion, last reviewed 29 May 2025 . Read level: full, direct; re-read on 2026-09-25.
5. St John Ambulance, Spinal cord injury, Broken bones and fractures, Sprains and strains and Head injury, clinically reviewed 28 April 2025 . Read level: full, direct; all four re-read on 2026-09-25.
6. British Red Cross, Head injury and Broken bone, undated. **Read level: full, direct**; both re-read on 2026-09-25.
7. T. Djärv, M. J. Douma and colleagues for the ILCOR First Aid Task Force, "2025 International Consensus on First Aid Science With Treatment Recommendations", Circulation 152, 2025. **Read level: full, direct, from the accepted manuscript on ilcor.org**; the spinal motion restriction and compression bandage sections, including every passage used here, checked on 2026-09-25 against the typeset text at ahajournals.org.
8. American Red Cross, Head, neck, and spinal injury and Muscle, bone and joint injury, undated . Read level: full, direct (live pages, 2026-09-24); both re-read on the live site on 2026-09-25.
9. NHS, Sprains and strains, last reviewed 23 April 2024 . Read level: full, direct; re-read on 2026-09-25.
10. British Red Cross, Strains and sprains, undated . Read level: full, direct; re-read on 2026-09-25.
11. B. Dubois and J.-F. Esculier, "Soft-tissue injuries simply need PEACE and LOVE", British Journal of Sports Medicine 54, 2020, 72 to 73 . Read level: full, direct, from the Internet Archive capture 20241221192948 (the journal's site refuses automated readers). An editorial, not a guideline.
12. T. Djärv, J. Rogers, F. Semeraro and colleagues, "European Resuscitation Council Guidelines 2025 First Aid", Resuscitation 215 (suppl 1), 2025, 110752 . Read level: full, direct, on the publisher's page; the cervical spinal motion restriction and concussion sections, concise guideline and evidence text, read on 2026-09-25.
13. NICE, Head injury: assessment and early management (NG232), 18 May 2023 . Read level: partial, direct (sections 1.1 to 1.3 and "Terms used"); re-read on 2026-09-25. Recommendations 1.2.1 to 1.2.3 and the definition of a high-energy head injury.
14. European Resuscitation Council, The ERC Guidelines 2025 on Resuscitation for Everyone, 2025 . Read level: full, direct (first aid pages 52 to 61). The line on moving a person only if unsafe.
15. Resuscitation Council UK, 2025 Resuscitation Guidelines: Adult basic life support, 27 October 2025 . Read level: full, direct. Slow, laboured and other abnormal breathing as signs of cardiac arrest, and "If there is any doubt".
16. American Red Cross, mobile apps page, and British Red Cross, first aid apps page. **Read level: both pages full, direct.**