Guidelines

Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete

Mission of the Task-Force

To develop guidelines for the pre-hospital management of the physically active with suspected spinal injury.

Background

The Inter-Association Task Force met in Indianapolis, Indiana, in May 1998, and again in Dallas, Texas in January 1999.

More than twenty-five professional sports medicine organizations were represented at each meeting. These included: National Athletic Trainers' Association, National Athletic Trainers' Association Secondary School Athletic Trainers Committee, American Association of Neurological Surgeons, American Osteopathic Academy of Sports Medicine, Professional Football Athletic Trainers' Society, National Registry of Emergency Medical Technicians, National Federation of State High School Associations, National Association of Emergency Medical Services Physicians, National Football League Physicians Society, American Chiropractic Association Council on Sports Injuries & Physical Fitness, American Orthopaedic Society for Sports Medicine, National Collegiate Athletic Association Committee on Competitive Safeguards and Medical Aspects of Sports, American Academy of Pediatrics Committee on Sports Medicine and Fitness, United states Olympic Committee, American Medical Society for Sports Medicine, National Athletic Trainers' Association College and University Athletic Trainers' Committee, National Association of Emergency Medical Technicians, National Operating Committee on Safety and Equipment, Orthopaedic Trauma Association, American Physical Therapy Association Sports Physical Therapy Section, American Academy of Family Physicians, National Association of Intercollegiate Athletics, American Academy of Orthopaedic Surgeons Committee on the Spine, American College of Sports Medicine, North American Spine Society, Physiatric Association of Spine, Sports & Occupational Rehabilitation.

The mission of the first meeting was to develop guidelines for the pre-hospital management of the physically active individual with a suspected spinal injury. The purpose of the second meeting was for the task force to discuss equipment concerns with the manufacturers, and to develop a plan for producing and disseminating educational materials. The task force is committed to developing and disseminating educational materials.

Guidelines and Recommendations

The following guidelines and recommendations were developed by the Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete:

General Guidelines

• Any athlete suspected of having a spinal injury should not be moved and should be managed as though a spinal injury exists.
• The athlete's airway, breathing and circulation, neurological status and level of consciousness should be assessed.
• The athlete should not be moved unless absolutely essential to maintain airway, breathing and circulation.
• If the athlete must be moved to maintain airway, breathing and circulation, the athlete should be placed in a supine position while maintaining spinal immobilization.
• When moving a suspected spine injured athlete, the head and trunk should be moved as a unit. One accepted technique is to manually splint the head to the trunk.
• The Emergency Medical Services system should be activated.

Face Mask Removal

• The face mask should be removed prior to transportation, regardless of current respiratory status.
• Those involved in the pre-hospital care of injured football players should have the tools for face mask removal readily available.

Football Helmet Removal

The athletic helmet and chin strap should only be removed...

• if the helmet and chin strap do not hold the head securely, such that immobilization of the helmet does not also immobilize the head.
• if the design of the helmet and chin strap is such that even after removal of the face mask the airway can not be controlled, or ventilation be provided.
• if the face mask can not be removed after a reasonable period of time.
• if the helmet prevents immobilization for transportation in an appropriate position.

Helmet Removal

Spinal immobilization must be maintained while removing the helmet.

• Helmet removal should be frequently practiced under proper supervision.
• Specific guidelines for helmet removal need to be developed.
• In most circumstances, it may be helpful to remove cheek padding and/or deflate air padding prior to helmet removal.

Equipment

Appropriate spinal alignment must be maintained.

• There needs to be a realization that the helmet and shoulder pads elevate an athlete's trunk when in the supine position.
• Should either be removed, or if only one is present, appropriate spinal alignment must be maintained.
• The front of the shoulder pads can be opened to allow access for CPR and defibrillation.

This task force encourages the development of a local emergency care plan regarding the pre-hospital care of the athlete with a suspected spine injury. This plan should include communication with the institution's administration and those directly involved with the assessment and transportation of the injured athlete.

All providers of pre-hospital care should practice and be competent in all of the skills identified in these guidelines before they are needed in an emergency situation.

Recommendations

• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete commends the current and ongoing commitment of helmet and face guard manufacturers for integrating safety in the development of their products.
• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete encourages manufacturers to continue to support research promoting helmet and face guard safety.
• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete recommends that manufacturers provide information to purchasers on the best methods for the emergency removal of the face guard.
• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete recommends that NOCSAE develop equipment standards that would allow for the emergency removal of helmets and face guards.
• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete recommends that helmets and face guards that meet current NOCSAE standards be worn by all football, lacrosse, baseball, and softball players.
• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete recommends that football helmet face guards be attached by loop straps, and not bolted on, in order to facilitate appropriate emergency management by medical personnel (from the May 1998 meeting in Indianapolis, Indiana).
• The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete recommends that loop straps be made of material that is easily cut, and that the producers of loop straps provide appropriate tools to cut/remove the loop straps that they manufacture (from the May 1998 meeting in Indianapolis, Indiana).

Conclusions

These guidelines should assist providers of pre-hospital emergency care with a plan for the safe and effective management of an athlete with a suspected spine injury. The techniques and skills presented in these guidelines must be practiced and rehearsed. Each provider of pre-hospital emergency care should be aware of each other's roles and responsibilities. Cooperation and respect among the various providers is also needed.

The National Athletic Trainers Association is developing a position stand written by members of the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. Publication is expected in late 1999.

Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete, Attention: Douglas M. Kleiner, PhD, ATC, Chair, Athletic Training Education Program, University of North Florida, 4567 St. Johns Bluff Road South, Jacksonville, Florida, 32224-2645, Phone (904)620-2841, Fax (904)620-2848, e-mail: dkleiner@gw.unf.edu or c/o National Athletic Trainers Association, 2953 Stemmons Freeway, Dallas, Texas 75247.

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