Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

Improper handling of an unstable neck injury may result in iatrogenic neurologic injury. A review of published evidence on cervical management in the helmeted athlete with a suspected spinal injury is discussed. The approach to the neck-injured helmeted athlete and the algorithms for on-field and emergency department evaluations are reviewed. The characteristics of the fitted football helmet allow safe access for airway management, and helmets and shoulder pads should not be initially removed unless absolutely necessary. Prehospital and emergency personnel should be trained in the indications for removal and in proper helmet, shoulder pad, and facemask removal techniques. If required, both helmet and shoulder pads should be removed simultaneously. Radiographs with equipment in place may be inadequate, and the value of computed tomography and magnetic resonance imaging in these helmeted patients has been studied. If adequate films cannot be obtained with equipment in place, helmet and shoulder pads may need to be removed before radiographic clearance. A plan should be formulated to prepare for such unexpected clinical scenarios as cervical spine injuries, and skills should be practiced. Airway and cervical spine management in these helmeted athletes is an area of ongoing research.

The rotational head motion seen inside standard immobilized lacrosse and ice hockey helmets is similar to that seen in football helmets. This supports the safety of prehospital stabilization of the potential cervical spine-injured ice hockey and lacrosse athletes with in-line stabilization and helmet in place. Extrapolation of data may not be applicable to other helmet designs, and future studies are needed to determine the safety of emergency procedures in all helmet designs.

Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.

No abstract