This document provides guidance on emergency care for cervical spine injuries in athletes. It discusses the anatomy of the cervical spine and types of spinal cord injuries. It outlines how to assess an athlete with a potential cervical spine injury on the field, including stabilizing the head and neck and activating EMS. It describes different methods for carefully moving an injured athlete, such as the log roll and straddle slide techniques. It also provides instructions for removing protective equipment like helmets and shoulder pads. It discusses potential complications like neurogenic shock and their treatment.

1. EMERGENCY CARE OF
CERVICAL SPINE
INJURIES

2. CERVICAL SPINE:
ANATOMY
• The anatomy of the cervical spine is complex,
designed to allow large ranges of motion in all
planes while still affording protection for the
spinal cord.
• The spinal column in the cervical spine consists
of the seven vertebrae and eight cervical nerves
and intervertebral discs.
• It functions in part to provide a framework for the
axial skeletal system and to protect the spinal
cord, which is housed within the column.

6. INJURIES TO SPINAL CORD
PRIMARY INJURIES
• Immediate effect on
function as a result of:
• ■ Compression
• ■ Stretching
• ■ Laceration
• ■ Concussion of the
spinal cord
SECONDARY INJURIES
• Delayed effect on
function, usually as a
result of progressive or
ongoing ischemia.
• ■ Spinal cord contusion
• ■ Spinal cord
compression
• ■ Spinal cord
hemorrhage

10. ON FIELD ASSESSMENT OF ATHLETE
WITH POTENTIAL CERVICAL SPINE
INJURY
• Determine mechanism of injury if possible
• While moving to athlete determine the level of
consciousness if possible
• Manually stabilize head and neck of athlete
• If athlete is unconscious activate EMS
• Check ABCs, this may require rolling a prone athlete
• Activate EMS, manage airway and begin rescue
breathing and CPR if necessary
• Perform secondary assessment
• Continuously monitor vitals of athlete

12. MANAGEMENT:
• The decision as to how and when to move the
athlete must be made on condition of victim,
availability of adequate assistance and proper
equipment.
• Careful planning can eliminate unnecessary
movements this is important because each
move can increase the risk of further injury.

13. • Log Roll Method
• Straddle Slide Method
• Log Roll from Prone Position
• Managing Protective Equipment

14. 1.LOG ROLL METHOD:
• 1. All commands will come from the rescuer controlling the
head of the athlete.
• 2. The athlete is positioned with arm overhead,straight
legs.
• 3. Rescuers and spine board are positioned.
• 4. The athlete is grasped by rescuers.
• 5. On command,the athlete is carefully rolled toward
rescuers until the command to stop is given;the athlete is
held against rescuers’thighs.
• 6. The spine board is positioned.
• 7. On command,the athlete is carefully rolled back to
supine position.

16. 2.STRADDLE SLIDE METHOD:
• 1. All commands will come from the rescuer controlling
the head of the athlete.
• 2. The athlete is positioned with straight legs, arms at
sides.
• 3. Rescuers and spine board are positioned. 4. The
athlete is grasped by rescuers.
• 5. On command,the athlete is carefully lifted straight
up until the command to stop is given.
• 6. The spine board is positioned.
• 7. On command,the athlete is carefully lowered back
down to the spine board.

18. 3.MANAGING THE PRONE ATHLETE:
• 1. All commands come from the rescuer controlling the head of the
athlete.
• 2. The athlete’s arms and legs are carefully straightened as directed.
• 3. Three (or four) rescuers are positioned on the side of the direction of
the roll with the spine board lying against their upper legs; one rescuer is
positioned on the opposite side of the athlete to help control the roll and
to help prevent the athlete from sliding as the board is lowered.
• 4. On command,the athlete is carefully rolled from prone to sidelying and
then down onto the spine board;the position of the head in relation to the
trunk is maintained throughout the roll.
• 5. The spine board is carefully lowered to the ground.
• 6. The head can then be slowly and incrementally returned to a neutral
position as discussed earlier in this chapter.
• 7. A rigid cervical collar should then be applied.Or,in cases where the
athlete is wearing a helmet,the face mask should be removed.

19. 4.MANAGING PROTECTIVE
EQUIPMENT:
• .When managing an athlete wearing a helmet,the face
mask should always be completely removed to allow
access to the athlete’s airway.
• Removal of the face mask will allow the rescuer to
effectively maintain control of the airway. The vast
majority of cervical spine injuries in football players
occur at the lower level of the cervical spine C5-C7. For
this reason respiratory distress is rare. In the event that
airway difficulties are present, all appropriate
procedures can be carried out with little difficulty once
the face mask is removed.There is no need toremove
the entire helmet to effectively manage the airway of
an injured athlete.

20. • A person wearing a motorcycle helmet or a
football helmetwithoutshoulder pads who is
supine will be forced into a position of cervical
hyperflexion because of the thickness of the back
of the helmet.Shoulder pads elevate the thorax
such that the spine will be in a neutral position
when an athlete wearing a helmet is
supine.Removing the helmet and not the
shoulder pads would therefore allow the cervical
spine of the athlete to fall into a position of
hyperextension

21. HELMET AND SHOULDER PAD
REMOVAL:
• 1. The athlete must be supine.It is understood that the face mask has
either already been removed,cannot be removed,or a decision has been
made to remove all equipment right away.
• 2. While lead rescuer maintains manual stabilization,the second rescuer:
■ Cuts the front of the jersey from waist to neck ■ Cuts the sleeves of the
jersey from arm holes to neck ■ Removes the jersey ■ Cuts all shoulder
pad straps and/or strings ■ Cuts any additional protective equipment that
is attached to both the shoulder pads and helmet ■ Cuts the chinstrap
• 3. If the helmet uses an internal air bladder as part of the fitting
system,the bladder should be deflated while the second rescuer works on
the jersey and shoulder pads.Athletic trainers should be prepared with the
correct tool to perform this procedure if the athletes in their care are
using this type of helmet.
• 4. Cheek pads are removed from the helmet using a tongue blade or other
flat,stiff object that will not cut the athlete’s face to unsnap the pads.

22. • 5. The second rescuer positions his or her hands to take over manual
stabilization:one hand at posterior cervical spine/occiput and the other at
the jaw of the athlete.
• 6. Other rescuers position themselves to lift the torso of the injured
athlete as a unit on command;these rescuers must be sure that their hand
placement will not interfere with removal of the shoulder pads.
• 7. In an order predetermined and rehearsed by the medical staff:the
second rescuer assumes primary control of manual stabilization and
becomes command giver;the torso of the athlete is carefully lifted several
inches and held still.
• 8. The first rescuer carefully removes the athlete’s helmet by gently
pulling and simultaneously rolling the helmet slightly forward as it is
pulled off.It is not recommended that the sides of the helmet be pulled
outward during helmet removal because this tends to tighten the helmet
at the forehead and occiput.
• .

23. • 9. The first rescuer quickly pulls the shoulder
pads out from beneath the athlete.
• 10. On command,the athlete is carefully
lowered back to the ground. 11. The first
rescuer reassumes control of manual
stabilization and management of the athlete’s
condition continues

26. FACE MASK REMOVAL
• Face mask removal may be accomplished by either
cutting or unscrewing the four plastic clips: two above
the forehead and one by each cheek
• It is generally accepted that the face mask
• should be entirely removed, rather than just cutting
the side clips and flipping the mask up .In this position,
the face mask presents an obstacle to efficient
management and is a hazard for accidental bumping
and subsequent head movement of the athlete.
Athletic trainers should be prepared with at least two
different tools for face mask removal in case the first
choice of tool is ineffective for any reason.

28. NEUROGENIC SHOCK
• A direct consequence of the large scale vasodilatation is pooling of
blood throughout the body, resulting in essentially what is known
as hypovolemia. Because of the lack of sympathetic response, heart
rate does not increase adequately to overcome the loss of
volume,and shock results.(For more information on shock, To treat
this,a fluid challenge is followed by the introduction of a
vasopressor such as dopamine. The fluid challenge is accomplished
by infusing 250 mL of IV fluid through a large-bore IV catheter. If the
response to this infusion is that of increased blood pressure, slower
heart rate, and better perfusion, then a second infusion should be
considered.If there is not a positive response to the first bolus of
fluid,then the administration of a vasopressor (dopamine) should
be considered. If the bradycardia persists, then the use of atropine
may be indicated to increase the heart rate.The dosages and
indications will be set by local protocol.