Manual Inline Support (MILS)


The words Manual Inline Support (abbreviated to MILS) refer to the positioning of the first responders hands alongside the injured person’s head to prevent movement in any direction.

In most situations, the first responder will be at the head of the injured person, although sometimes circumstances and positioning of an injured person will necessitate them being in a different position. The principle remain the same, which is to place the hands firmly along the side of the injured person’s head but not to apply traction, remembering that some injuries to the spine can be caused by distracting forces and traction could indeed worsen this scenario.

In the water or in circumstances where access to the injured person’s whole body is not easy or convenient for the first responder, other grips can be used to maintain the head in the neutral position including what is referred to as the “Vice Grip” or the “NeckSafe grip”  or various modifications of these to provide the same manual immobilisation and support.

Once again, the principle is to maintain support and prevent movement in any direction.

  • Neck in neutral position
    • Hands alongside face on both sides
    • Firm hold


Here we see the vice grip, extended arms grip and the NeckSafe grip utilised in the aquatic environment, and the principles remain the same for potential spinal cord injuries on land where access to the injured person is restricted.

Vice grip


Extended arms grip


NeckSafe grip


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