To Move or Not to Move: On-the-Field Management of Neck Injuries

Evaluating neck injuries can be one of the most difficult assessments a coach may be asked to perform. Mistakes could result in paralysis or death. It is critical for all coaches to understand and recognize the signs and symptoms of serious head and neck trauma.

Helmets
If the athlete is wearing a helmet, DO NOT REMOVE IT. When handling an injured athlete who is wearing a football helmet, the caregiver must have a method for freeing the face mask to perform CPR. There are many commercial products available for this purpose. These products are designed to cut the clips that hold the face mask on to the helmet. A sharp utility knife could be used with caution. Cut the two lower clips, then flip up the face mask.

The Unconscious Athlete
Whenever an athlete is found to be unconscious, it should be assumed that the individual also has suffered a neck injury. The athlete SHOULD NOT be moved. Immediately immobilize the head and neck, and assign someone to call EMS. At this point, check the athletes ABC (Airway, Breathing, Circulation). If breathing, continue to monitor him or her, do not move, and wait for EMS to arrive.

An athlete who is unconscious, face down and not breathing presents a unique set of problems. This situation requires moving the individual into a position in which CPR can be administered. A log roll method is used to accomplish this. The body is moved as a unit, similar to rolling a log. The person at the head is in charge of initiating the count on which the others will begin the "rolling" process. Immediately upon rolling the individual over, the ABCs should be assessed. When the possibility of a neck injury exists, care should be taken when opening the airway. Proceed with rescue breathing or CPR as indicated by the assessment. Continue until EMS arrives.

An unconscious athlete in any position who is breathing should not be moved. The head and neck should be immobilized. Continue to monitor the airway, breathing and circulation, and wait for the arrival of EMS.

The Conscious Athlete
If the athlete is conscious and complaining of back/neck pain, the head and neck should be immediately immobilized. Calm the athlete down and instruct them to remain still. Begin by getting a thorough history of what happened. Try to get a clear picture of the mechanism of injury. For example, was the head up or down on impact, or were they hit directly on the top of the head? Question them regarding radiating pain, numbness and/or tingling into their extremities. Call EMS.

If there are no complaints of radiating pain, numbness, etc., continue by checking sensation. Can they feel you touching their skin? Lightly touch along the arms and legs. If at any time they indicate to you that they are unable to feel this stimuli, EMS should be activated. Continue your evaluation by having the athlete move his/her toes, fingers, ankles and elbows. With the athlete still lying down, check their grip strength, elbow and ankle strength. If all of these activities have been performed normally, you may have the athlete sit up. He or she may be removed from the field/court and should be examined by a physician before further participation. If there are any difficulties with motion and/or strength, the head and neck should be immobilized and the athlete transported by EMS.

Exercise Caution
Proper handling of neck injuries requires the ability of the caregiver to evaluate the athlete on the spot. Radiating pain, numbness, altered sensation, inability to move and muscle weakness are all signs of a possible spinal cord injury. If there is any question in your mind, the athlete should not be moved.

Mark Schauer, MS, ATC, works in Cleveland Clinic Sports Health.