NATA’s Position Statement

Acute Management of the Cervical Spine – Injured Athlete

Planning and Rehearsal

Have Emergency Action Plan (EAP) in place

This should include clear delineation of people’s roles, location of equipment (spine boards, AEDs, etc), and clear communication between all parties involved. Make sure to introduce yourself to the EMS providers at games.

Assessment

Presence of the following findings, alone or in combination, heightens suspicion of C-Spine injury

• Unconsciousness or altered level of consciousness
• Bilateral neurologic findings or complaints
• Significant midline spine pain with or without palpation
• Obvious spinal column deformity

Stabilization

• Ensure Cervical Spine is in neutral position and apply stabilization to minimize movement during management of the injury
• Don’t apply traction
• If not in neutral, realign to minimize secondary injury to spinal cord and to allow for optimal airway management.
• Contraindications for moving to neutral position
  • Movement causes increased pain
  • Physically difficult to reposition
  • Resistance encountered
  • Patient expresses apprehension

Airway

• Immediately attempt to expose the airway, removing any existing barriers
• Jaw-thrust is recommended over head-tilt
• Advanced airway management techniques are recommended (laryngoscope, endotracheal tube)

Transfer and Immobilization

• Manual stabilization converted to immobilization (cervical collars, foam blocks).
• Resume manual stabilization after application of external devices.
• For supine athlete, a lift and slide technique (6-plus person lift, straddle lift and slide) has been reported to produce less motion at the head and cervical spine than the log-roll technique.
• For prone athlete, must use log-roll

Equipment-Laden Athletes

• Removal of helmet and shoulder pads should be deferred until transported to emergency medical facility, unless there are special circumstances.
  • If the helmet doesn’t fit properly
  • If equipment prevents neutral alignment of the cervical spine or airway access
• Removal of helmet and shoulder pads in football and hockey should always be all-or-nothing endeavor.
• If helmet is not on and shoulder pads are difficult to remove, must pad to ensure neutral alignment
• Facemasks should be completely removed if needed to access airway
• Emergency department personnel should be familiar with athletic equipment removal
• ED’s should use CT rather than plain radiographs as the primary diagnostic test for C-Spine injuries in helmeted athletes.

Face Mask Removal

• Use combined-tool approach
• The 2 side straps should be removed first, followed by the top straps
• A powered screwdriver is usually quickest facemask removal method. However, a backup cutting tool should be available if screws are stripped or cannot be removed.
• Many new helmets have Quick Release technology. Make sure you have the proper tool for these helmets.
• If facemask can’t be removed in a reasonable amount of time, then remove helmet. Once this is done, remove shoulder pads or use padding to maintain neutral alignment
• Athletic trainers and emergency responders, as well as emergency department personnel should all be familiar with equipment removal, and it should be rehearsed on a regular basis

Prone Log-Roll Technique

Lift and Slide Technique - Includes the 6-plus-person lift and the straddle lift and slide

Straddle lift and slide

• Rescuer 1 stabilizes c-spine
• 3 rescuers straddle athlete (torso/hips/legs)
• Rescuers 2-4 lift athlete about 6” off ground while rescuer 5 slides board beneath athlete

Repositioning after transfer to spine board

• Athlete should always be moved at an angle. Never move perpendicular to long axis of spine board.

Strapping to the board

• Straps 1 and 2: X at chest and across shoulders
• Strap 3: across chest
• Straps 4 and 5: across pelvis
• Strap 6: Across thighs
• Strap 7: Across mid-lower legs

Helmet and shoulder pad removal

Would only be removed if access to the chest is needed (CPR) or if equipment prevents neutral alignment

• Helmet
  • Remove chin strap and then cheek pads.
  • The rescuer at the head removes helmet while stabilization is done from the front under the chin.
  • Once helmet is removed a cervical collar is placed on the athlete
• Shoulder Pad Removal
  • Jersey is cut away – cut through midline as well as out through each sleeve
  • Cut through strings or disconnect or cut through plastic buckles.
  • Can be slid out by rescuer at head while stabilization is transferred to another rescuer
  • Can be cut in back and then separated and slid out on each side.

*New Rip-Cord shoulder pads are designed for easy removal with the pull of a cord