The National Athletic Trainers’ Association recently released new guidelines for treating athletes with potential spinal cord injuries on the field, a decision applauded by a sports medicine expert at Baylor College of Medicine.
“The NATA made significant changes to what was previously recommended and practiced with an injured athlete at a sporting event,” said Dr. Theodore Shybut, sports medicine expert and assistant professor of orthopedic surgery at Baylor. “These new guidelines are based on science and expertise. While these practices fortunately apply to only a small subset of injuries encountered at sporting events, practicing these recommendations provides optimal care to athletes with potentially devastating injury.”
The two main changes relate to technique for spine boarding the athlete and to timing of removal of the athlete’s protective equipment. In terms of protecting the potentially injured spine, in the past, a technique called logrolling was used to position the injured athlete onto a back board for transfer. Also, protective equipment such as helmet and shoulder pads was typically left on the injured athlete, with the thought that they provided stability to the cervical spine during transport. In addition, equipment was left on to avoid potentially aggravating the injury on the field with the thought that removal in the theoretically more controlled hospital setting would be best.
The new recommendations stem from studies that evaluated spinal motion during simulated injuries in cadavers and found that an eight-person lift better minimizes the motion of the cervical spine. The recommendation is to perform this type of lift if possible instead of logrolling. The NATA guidelines also emphasize a change in terminology from “spinal immobilization” to “spinal motion restriction” recognizing that complete immobilization is not possible during transfers and equipment removal.
“It’s important to realize that in cases where the injured athlete is face down you have to get them face up to ensure airway access and properly assess the athlete; in those cases, you may have to logroll them. Also, the eight-person lift is only possible if you have enough people who are trained to do this safely,” said Shybut. “The logroll is not something that you absolutely cannot do, but the eight-person lift is the preferred technique because less c-spine motion occurs.”
The new guidelines now call for safe, controlled removal of equipment such as shoulder pads and helmets of the injured athlete prior to transfer.
“The rationale for this change is that the people who are the best equipped to remove the equipment, understand how the equipment works and are able to remove it with the least amount of trauma, are the sports medicine providers on the sidelines,” said Shybut. “Hospital based providers are not necessarily experts at removing sports protective equipment. In addition, if for some reason EMS needs to get access to the athlete’s chest during the transfer it’s difficult to do with the equipment on.”
Shybut emphasizes the importance of having a good team of sports medicine experts on the field during athletic events to help with these types of injuries. He stresses the need for emergency action planning so that the care team can rehearse equipment removal and spine boarding to prepare in advance for encountering spine injuries.
Baylor’s sports medicine team has developed emergency action plans and has recently trained providers in practicing emergency transfers and equipment removal in line with the NATA guidelines.