Appendix J – Spinal Injury Management

General Guidelines

Any athlete suspected of having a spinal injury should not be moved and should be managed as though a spinal injury exists. C-spine in-line stabilization should be maintained. The athlete's airway, breathing, circulation, level of consciousness and neurological status should be assessed. If the airway is impaired, maintain c-spine in-line stabilization while simultaneously using a modified jaw thrust maneuver to open the airway. EMS should be contacted. It is pertinent that the athlete be immobilized and not be moved unless absolutely essential to maintain airway, breathing and circulation. If the athlete must be moved, the athlete should be placed in a supine position while maintaining spinal immobilization. The rescuers should maintain inline stabilization and continue to monitor baseline vital signs and complete secondary evaluation while awaiting EMS.

Spine Immobilization Steps

1. If possible, a correctly sized rigid cervical collar should be placed on athlete prior to moving.
   • If no cervical collar is readily available, support cervical spine by positioning hands on side of head. Do not leave this position until instructed to do so by the EMS crew.
   • Have someone else prevent or treat for shock while you maintain your position at the head.
2. When moved, head and trunk should be moved as a unit by securing the athlete to a long spine board.
   • The 8 person lift maneuver should be the preferred method of choice but in the event that the spine-injured athlete is in the prone position then the Log Roll maneuver shoulder be performed.
   • The Log Roll is ideal when there are not enough rescuers available as it only requires a minimum of three (3) rescuers with preferably five to six (5-6) to perform the procedure.
3. The rescuer controlling c-spine stabilization will be in command of 8 person lift or the log roll maneuver and long spine board immobilization.
4. Once positioned onto long spine board, the athlete's torso and legs should first be secured, using spider straps or speed clips.
   • Athlete's arms should be left free from long spine board straps to facilitate vital sign monitoring and IV access.
   • Athlete's wrists may be secured together in front of the body with Velcro straps or tape once secured to long spine board.
5. Head should be secured last.
   • If necessary, padding should be applied under the athlete's head to fill any voids and maintain neutral in-line position.
   • The head should be secured with lateral restraint pads and then secured to board with tape over forehead and at chin.
6. Neurological status should be reassessed once athlete is secured.
7. Secondary survey should be completed with baseline vital signs (reassessed every 5 minutes), head-to-toe survey, and patient/ athlete history.