Prescott High School
Protocols and Procedures: Cervical Spine Injuries
Introduction: Catastrophic Cervical spine injuries are defined as “a structural distortion of the cervical spinal column associated with actual or potential damage to the spinal cord.” This is a life threatening and altering injury that needs appropriate attention. The outcome of catastrophic cervical spine injuries is dependent on the efficiency of the management process and the timeliness of the transfer to a controlled environment for diagnosis and treatment. At Prescott High School all necessary precautions, protocols and procedures will be followed as outlined in this document by the Athletic Trainer, Team Physician, Coaches, and Administrative personnel (the following individuals will be referred to as the “Sports Medicine Team” for the duration of this document). Good Samaritans from the stands will not be allowed to participate unless they are a Healthcare Professional and cleared or asked by the Team Physician or Certified Athletic Trainer.
Summary: The level of consciousness and airway will be assessed and maintained.
Neutral alignment in the cervical spine will be created and maintained.
Victims with a suspected cervical spine injury will be stabilized and transferred properly to the appropriate emergency care facility.
Athletes wearing sport specific equipment will me managed appropriately.
Protocols and Procedures:
- The Sports Medicine Team will be familiar with cervical spine injury prevention, assessment, treatment, and care.
- The Sports Medicine Team will be familiar with the safety rules in place to prevent cervical spine injuries in specific sports and take action to ensure such rules are followed.
- The Sports Medicine Team will be familiar with necessary protective equipment for different sports. Said equipment will be properly maintained, fitted and used.
- Athletes will be educated on proper techniques of their sport used to prevent cervical injury. Example of head up tackling/hitting in football to avoid axial loading.
- Athletes will be educated on the danger of moving or “helping up” an injured teammate.
- It will be suggested that athletes with congenital spinal stenosis especially in the cervical spine and Klippel-Feil syndrome or fusion of different spinal segments of the neck, not participate in athletics.
Planning and Rehearsal
- A school wide venue specific Emergency Action Plan (EAP) will be maintained and followed in all emergency situations, including cervical spine injuries.
- This EAP will be reviewed and rehearsed annually with the Sports Medicine Tea. It is suggested that this take place before the first varsity football game.
Cervical Spine Injury Assessment
- Suspected cervical spine injury victims will be assessed for the following and the spinal injury management protocols will be activated with any positive findings: Airway, Breathing, and Circulation (ABCs), Level of Consciousness (LOCs), Bilateral neurological findings (motor and sensory assessment of spinal and cranial nerves), Significant midline spine pain with or without palpation, and Obvious spinal column deformity.
- Victims with a stinger or burner, which is weakness, numbness associated with the C5-C6 nerve roots, should be differentiated from spinal damage. Athletes with a stinger or burner will not be allowed to participate until spinal damage is ruled out and strength and ROM returns.
- Athletes sustaining any type of spinal injury will be evaluated and cleared by a physician before being allowed to return-to-play.
- When potential Spine injury is suspected the Sports Medicine Team will ensure that cervical spine is in a neutral position and should immediately apply and maintain manual cervical spinal stabilization until the victim is appropriately placed and secured to a spine board.
- The head and trunk will be move as one unit.
- Rescuers will NOT apply cervical spine traction that could result in further injury.
- If the spine is not in neutral position the Sports Medicine team will appropriately realign the cervical spine to minimize secondary injury to the spinal cord and allow for optimal airway management. However this will not be performed if: movement causes increased pain, neurological symptoms, muscle spasm, airway compromise, it is physically difficult to reposition, or resistance is encountered during the attempt.
- It will be presumed that unconscious victims have sustained cervical spine injuries and therefore will be treated as such.
- The airway should be exposed and assessed immediately. If equipment (facemasks) needs to be removed, this will be done immediately.
- The jaw-thrust maneuver will be used in the case of a suspected spine injured victim.
- ABCs management will commence as needed causing as little movement of the victim as possible.
Transfer and Immobilization
- The athlete will not be moved until secured on a full body immobilization devise or if it is absolutely essential to maintain ABCs.
- Manual Stabilization of the head should be converted to external devises such as cervical collars or foam block, when possible.
- A long spine board or other full-body immobilization device should be used to transport the victim.
- For prone victims the log-roll technique will be used in transferring directly to an immobilization device.
- In the case of a prone victim that is conscious and breathing normally and if there is not sufficient personnel to log-roll the athlete to a supine position the victim will be manually spinal stabilized until EMS arrives to help with this process.
- The athlete’s head and body will be strapped on to the full body immobilization devise tightly so that they can be rolled if they start to vomit.
- The athlete should be loaded into the ambulance feet first to avoid axial loading while braking.
- The removal of the helmet and or shoulder pads may be performed by the Sports Medicine Team if deemed necessary. It is possible that this action will be deferred until the victim has been transported to the appropriate emergency medical facility if the appropriate personnel aren’t available on site.
- If it is recommended that the helmet be removed one person will maintain stabilization on the head and heck and another will maintain stabilization from the chin and back of the neck. All padding that can be removed from the helmet will be removed and the chin strap will be cut off. The air bladder will be deflated. The helmet will slide off the occiput with slight forward rotation and traction to the helmet.
- If the helmet is removed then the shoulder pad will be removed at the same time or towels or padding will be placed under the head. If the decision is made to remove the shoulder pads it will be done in the following procedure: all straps and laces will be cut. As one rescuer maintains spinal stabilization on the chin and posterior neck and head the athlete is lifted and the helmet is removed then the shoulder pads removed and the victim is lowered.
- In the Football victim, if the helmet was dislodged in the play, then care will be taken to maintain spinal neutrality. Towels or padding should be place under the head as needed or the shoulder pads removed.
- In most cases for victims wearing helmets it is inappropriate to apply a cervical collar; however a cervical vacuum immobilization device is recommended in the fully equipped football player.
- Sports Medicine Team members should be familiar with all appropriate equipment including and not limited to the following: external defibrillators, bag-valve-masks, pruning shears, electric and regular screw-drivers, scissors, pliers, cervical collars, spine boards, stabilization straps, etc.
- Facemasks will be completely removed from the helmet once the decision to immobilize and transport the athlete has been made.
- In the case of a prone victim that is conscious and breathing normally and if there is not sufficient personnel to log-roll the athlete to a supine position the victim will be manually spinal stabilized until EMS arrives to help with the process. Therefore the facemask will be removed once the victim is rolled to a supine position.
- The first method of facemask removal will be to use an electric screwdriver, if this is not possible the FM Extractor, or dremel tool will be used.
- Helmets will be inspected at the beginning of the season, before they are issued to players, for corrosion of the screws that would make removal difficult. If the screws are corroded they will be changed.
- If the facemask can not be removed in a reasonable amount of time the helmet will be removed and towels or padding placed under the head or the shoulder pads will be removed as well.