National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

Abstract

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.

Cervical Spine Motion during Transfer and Stabilization Techniques

“…2,3 To minimize spinal cord damage, current guidelines for pre-hospital management of cervical spine injured patients dictate they should be stabilized prior to transport to a medical facility. [7][8][9] Further, cervical spine stabilization is recognized as a research priority in both adult and pediatric prehospital research. 10,11 During pre-hospital management, patients with suspected cervical spine injuries are transferred and secured onto a stable surface (e.g.…”

“…10,11 During pre-hospital management, patients with suspected cervical spine injuries are transferred and secured onto a stable surface (e.g. vacuum mattress, spine board 9 ) by a team of rescuers. Although a spine board is used for transfer to hospital in most of North America, the vacuum mattress is often used within Quebec and Europe.…”

“…12,18 The two main methods of transferring a patient onto a stable surface are the log roll (LR) and the lift-and slide. Although the lift-and-slide results in less motion compared to the LR [19][20][21][22][23] , the current standard of care in the paramedic context is to transfer a patient onto a spine board using a standard LR technique 9 conducted with 1-3 assistants depending on availability. 9 This is because the lift-and-slide is often not feasible given it requires 6-8+ persons, and several feet of space around the patient on all sides 9,22 .…”

Emergent Access to the Airway and Chest in American Football Players

“…7,12 Furthermore, the magnitudes of the differences were not only statistically different but were clinically meaningful, as evidenced by the effect sizes reported in Table 3. As such, if the goal is to defer the head and neck motion associated with helmet removal until the patient is in the emergency department, health care providers should remove the face mask rather than the helmet from a fully equipped football player in the prehospital setting.…”

“…Another commonly recommended step for helmet removal that our participants were not required to perform was to attempt to remove the cheek pads. 7 The style of helmets that we used does not allow for cheek-pad removal when worn by an athlete. Eliminating these steps allowed helmet removal to be performed faster than it would have been if those steps had been performed.…”