Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

Abstract

<jats:sec> <jats:title>Introduction</jats:title> <jats:p>Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.</jats:p> </jats:sec>

Spinal Cord Injury Management Policies in High School Sports as Reported by Athletic Administrators

“…Finally, a notable paradigm shift in emergency medicine over the past decade has been to forego the routine use of a rigid spine board for immobilization and transport in suspected spine injury (33,34). Accordingly, professional associations and state EMS jurisdictions are allowing for alternative methods for controlling spinal motion during emergency management or discouraging use of a rigid spine board for emergency transport altogether (14,35). Because of the corresponding time frame for these changes, our questionnaire sought to determine AA’s knowledge of the method used for the emergency transportation of suspected cervical spine injuries.…”

“…These data were collected before the release of a 2020 consensus document that involved a systematic review and a Delphi panel–based model for generating 45 new recommendations on the care of the spine-injured athlete (14). Although the findings in this paper provide a starting point for the understanding of the adoption and implementation of a SCIM policy, future research should aim to evaluate the incorporation of the newer recommendations into high school SCIM policies.…”

“…A leading cause of death and catastrophic injury in sport is due to cervical spine injury (12), with more than 250 new sport-related cervical spine injuries per year (13). A comprehensive policy for the immediate care of a potential severe head or cervical spine injury is necessary to avoid or reduce negative neurologic outcomes (14)(15)(16)(17)(18). Because of the potentially serious nature of the injury, and the need for sensitive and exquisite emergency management, a comprehensive spinal cord injury management (SCIM) policy should specify the emergency equipment to be used and the location of such equipment, require the maintenance of protective equipment and the practice of its removal, require the practice of stabilization skills on a regular basis by healthcare professionals, and require documentation of such.…”

Development and Implementation of an Emergency Action Plan in Football

“…For a player with suspected cervical spine injury, equipment should be removed by personnel trained to do so to minimize cervical spine movement (Fig. 2) [9]. With advances in helmet, facemask, chin strap fasteners, and shoulder pad materials, it is imperative that the team medical staff and ERT stay current on available equipment removal tools and techniques.…”

“…Previous research has examined the use of several transfer procedures on cervical spine motion, including the 6-to-8-person lift or log-roll technique (Fig. 7) [9]. For exertional heat stroke (rectal temperature above 104° and symptoms of central nervous system dysfunction), the ERT must be prepared to quickly transfer an athlete from the field to an area for cold water immersion, as rapid whole-body cooling is essential for survival.…”