My interest in Spinal injury dates from Helicopter retrieval of injured patients during the late 1980s.

From 1987 to 1990, I worked as the Chief Medical Officer with the Westpac Rescue Helicopter Service, flying over 1,000 hours and treating hundred of trauma and medical cases. During his time with the Helicopter Service, I also introduced International Retrieval to their capabilities, and became their official representative to Government, the National Health and Medical Research Council (NH & MRC), major sporting bodies including the Rugby League and Rugby Union, Nursing and Ambulance Training Colleges and made numerous television and radio appearances as the "public face" of the Rescue Service.

Awarded a prestigious Churchill Fellowship to study Trauma Management in European Emergency Services in 1989, I was also enlisted in the Royal Australian Air Force Specialist reserve and had the opportunity both here and abroad to review Acute Spinal Injury Management.

My focus on Spinal Cord Injury (SCI) and it’s acute management was prompted both by the number of these injuries I would see (in one notable weekend, 3 separate neck injuries from football) and a growing realisation that pre-hospital education in this area was sadly lacking.

As a doctor, I had received almost no specific instruction in handling a spinal injury which had just happened, and the equipment available at the time was rudimentary.

I became more involved in responses to the scene of accidents, and was disappointed at the lack of consistency in ambulance officer education in these skills and the varying levels of awareness and application of spinal injury prevention principles.

In a landmark study in Victoria in 1988, Dr. Joe Toscano found that almost 25% of all admissions to a major State Spinal Unit over 18 months suffered an increase in the severity of their SCI after the initial collision, fall or incident and before arrival at a Spinal Unit.

These findings alarmed many, particularly those in the paramedical and ambulance fraternities, and spurred me to write a book specifically designed to address Secondary Prevention……accepting that these injuries would still occur despite road safety advances and education regarding football and water sports.

In 1990 I published a "Guidebook for the Management of Acute Spinal Injuries" for medical and rescue personal, as well as lecturing locally and Internationally on this topic.

The book was designed for First Responders, be they Basic Life Support (BLS: General Duties Ambulance, Red Cross, Surf Lifesavers, State Emergency Services, St. Johns Ambulance, Sports Trainers and Coaches etc) or trained in Advanced Life Support (ALS: Physicians, Paramedics, Nurses etc).

It was fully funded by CIG Medishield, and reprinted twice over the next 3 years.

A video education programme was made with the assistance of the NSW Rugby League called " NeckSafe^® " based on the NeckSafe^® Lecture Programme initiated by me to spread the Secondary Prevention message.

Another major step forward came with the widespread adoption of the semi-rigid cervical collar by both BLS and ALS agencies.

In association with Dr. John Yeo, one of the most respected advocates of Spinal Injury Prevention in Australia with whom I worked closely, I was also involved in the development and field testing of new devices for the Acute Management of Spinal Injuries such as the Russell Extrication Device (R.E.D.) and the growing range of equipment such as scoop stretchers and head immobilisation devices.

The priorities of resuscitation have always been "ABC": Airway, Breathing and Circulation, and if possible these should be supplemented by the words "with adequate cervical spine control".

SCI in the aquatic environment is often associated with beaches in Australia, the most common scenarios being that of the individual being propelled head-first into the sand in shallow water by the force of a wave ("dumped" by the wave), or a mistimed or misjudged head-first plunge into shallow water, a sand-bank or submerged rock, with attendant flexion and rotation of the cervical spine.

Aquatic SCI’s also occur in still water, in pools, rivers and dams with the sufferer diving head-first into water of untested or underestimated depth.

Whilst working on a new International Surf Sports circuit, "Oceanman", I developed a new technique for the Acute Management of Spinal Injuries in the Aquatic Environment, the NeckSafe® Aquatic Spinal Management Technique, based on a supine "eyes upward" approach and utilising additional spinal stabilisation equipment such as semi-rigid collars, floating rescue stretchers and spinal boards.

This technique can be applied to both the surf and still water scenarios mentioned above, and in the former case is appropriate for the patient at the shore-line or in deeper water.

It is also appropriate for both conscious and unconscious patients, and makes provision for the airway to be maintained at all times with safety and the patient’s face to be continuously observed.

In 1999, the NSW Sporting Injuries Committee provided a $20,000 Grant to increase the dissemination of the NeckSafe^® Courses and in that year alone over 400 sports trainers, physiotherapists, lifeguards, doctors and First Responders received initial or recurrent training in this field.

As the new millenium dawns, NeckSafe^® is becoming more firmly entrenched in the minds and on the agendas of all those associated with pre-hospital care, and I have decided to revise and reprint the NeckSafe^® book with up-to-date information on the latest techniques and equipment.

If as a result of all the efforts over the past 10 years, even a single SCI can be prevented, then all the work will have been worthwhile.

DR ADRIAN COHEN MB., B.Sc. (Hons) Founder & CEO www.adriancohen.com.au Advanced Trauma Life Support TacMed Certificate IV Workplace Trainer/Assessor Churchill Fellow