Emergency Care of

Cervical Spine Injuries

Injuries to the spinal cord can be devastating, often
because they are fatal or result in significant lifelong
disabilities.
Injuries to the spinal cord of athletes have been
reduced in recent decades by placing greater emphasis
on the prevention of such injuries by education.
Anatomy
Mechanisms of Injury
Athletes who are subjected to extremes of these
motions or to axial forces of either loading or
distraction are at high risk of experiencing permanent
neurological deficit, paralysis, or death.
Injuries to the Spinal Cord
Injuries to the spinal cord can occur from a variety of
mechanisms and may be categorized as either primary
or secondary.
Primary injuries are those that occur as a direct result
of a traumatic event for which the effects are
immediate (e.g.,a compression, stretching, or
transection of the spinal cord).
Neuropraxia & Concussion of the spinal cord is a
condition that,, results in immediate but temporary
disruption of the spinal cord function. The spinal cord
usually returns to normal function with no lasting
adverse effects.
A secondary injury is one in which the effect of the
initial injury is not immediately apparent.
Swelling and ischemia have developed as a result of
the trauma.
Transection
Transection of the spinal cord occurs when the spinal
cord is either completely or partially severed.
For example, injury below the T1 level will result in
incontinence and paraplegia and injuries in the
cervical region will result in quadriplegia,
incontinence, and possible respiratory paralysis.
Central cord syndrome is most commonly seen as the
result of a hyperextension injury.
Brown-Sequard’s syndrome is caused by a penetrating
injury that severs one side of the spinal cord.
Spinal shock is a temporary condition triggered as the
body’s response to injury. It is identified when the
body becomes flaccid and without sensation, causing
the athlete to be unable to move and appear to be
paralyzed below the level of the injury.
May be accompanied by loss of bladder and bowel
control and, in males, priapism. It is common for
hypotension to be present as a result of vasodilation
(also known as vasodilatation).
Assessment
Manual stabilization of the cervical
spine. Hands should be on both sides of the
head with fingers spread to provide the most
control over head and neck movements.
Traction is not recommended.
Application of a rigid cervical
collar. Manual stabilization is maintained while
the second rescuer applies the collar.
A: Bilateral comparison of grip
strength. B: Finger abduction/adduction.
C:Wrist extension. D: Finger extension
A: Soft brush, repeated over as many dermatomes
as possible. B: Sharp pin, repeated
over as many dermatomes as possible.
Lower-extremity motor function
testing. A:“Pushing on the gas pedal” (ankle
plantarflexion). B: Pulling toes toward the head
(ankle dorsiflexion).
When returning the head to a neutral position, it is
critical to stop the movement at the first sign of
resistance, athlete apprehension, or increased pain;
failure to do so may cause further damage to the
cervical spinal column and/or spinal cord.
Individuals with spinal cord injuries lose their ability
to maintain normal body temperature; changes may
be noted during evaluation, especially below the level
of the injury.
Deterioration of any vital signs is indicative of an
emergent situation.
If not managed appropriately, an otherwise stable
cervical spine injury may become unstable as a result
of improper handling, thus placing the athlete at
significant risk for a catastrophic outcome.
Management
During the management process, after moving the
athlete, always reassess ABCs and sensory and motor
function.
The decision as to how and when to move the athlete
must be made based on the condition of the victim,
the availability of adequate assistance, and proper
equipment.
The key factor throughout any procedure is to move
the athlete as a unit, maintaining the head and neck in
neutral alignment.
Specific equipment required for
spine boarding procedure: long spine board
with handles, rigid cervical collar, head immobilization
device, straps.
The Log Roll Method
The Log Roll Method
 Five rescuers are involved: one at the
head maintaining manual stabilization
and directing the procedure, one
controlling the spine board, and three
positioned to roll the athlete. The
rescuer controlling the spine board
ensures that the straps are out of the way
and will not be
trapped under the athlete.The hands of
the rescuers rolling the athlete are
reaching under the athlete; clothing is
not grasped because it tends to slip
during the roll.The knees of the rescuers
rolling the athlete will block the athlete
from sliding toward the rescuers during
the roll.The arm of the athlete on the
side of
the direction of the roll is abducted as
high as possible. On command, the
athlete is carefully rolled as a unit toward
the three rescuers until the
“stop”command is given.
Once the athlete is rolled to
one side, the spine boardis
pushed into position
against the athlete, angled
upward, and held firmly in
that position. On
command, the athlete is
then carefully rolled back
onto the spine board, which
is lowered to the
ground.The athlete is now
supine on the spine board.
The Straddle Slide Method
The Straddle Slide Method
Five rescuers are involved: one at the
head maintaining manual
stabilization and directing the
procedure, one controlling the
spine board, and three positioned to
lift the athlete.The hands of the
rescuers lifting the athlete are
reaching under the athlete; clothing
is not grasped because it tends to
slip during the lift. On command,
the athlete is carefully lifted as a
unit until the “stop”command is
given. Notice in
this photo that the face mask has been
removed prior to placing the athlete on
the spine board.
 Once the lift has stopped, the
rescuer controlling the spine board quickly
slides the spine board beneath the athlete
until it is appropriately positioned under the
athlete.At that point, the rescuer controlling
the head will tell the rescuer controlling the
spine board to stop. In this photo, the spine
board is appropriately positioned under the
athlete when the head immobilization device
is centered beneath the athlete’s helmet. Once
the spine board is positioned, on command
the athlete will be carefully lowered as a unit
down to the spine board.
Managing the Prone Athlete
Managing the Prone Athlete
Lead rescuer initially uses
a crossed-arm technique
for manual stabilization.
Once the athlete is rolled
to supine, the lead
rescuer’s arms will have
been uncrossed.
 One rescuer is positioned opposite the
direction of the roll to help control the
athlete’s position and prevent sliding of
the athlete and/or the spine board. The
other three rescuers rest the spine board
against their upper legs; this holds the
spine board in an upwardly angled
position and also allows the rescuers to
use their knee and upper leg to hold the
spine
board tight against the athlete. The three
rescuers reach across the athlete for a
firm hold on the athlete’s body (not the
clothing).On command, the athlete is
rolled toward the three rescuers and onto
the spine board
Once the athlete is on the spine
board, it is carefully lowered to
the ground. During the
roll and lowering of the spine
board, the rescuer on the
opposite side helps to control
the roll and to prevent the
athlete from sliding toward
that edge of the spine board.
Notice that the lead rescuers
arms are now uncrossed,
allowing for simplified manual
stabilization.
Immobilization
 Head immobilization device.
 Firm blocks on either side of the
head prevent motion in rotation
or lateral flexion.
 These blocks are easily adjustable
to provide for a tight fit against
different sizes of head or helmet.
 Two straps across the forehead
and chin of the athlete prevent
movement in the direction of
flexion. Instead of straps, strong
tape can be used for this same
purpose.
The Lift and Transfer
Once the athlete is secured to the spine board, it is safe
to lift and transfer the spine board.
The spine board should have handles along its
perimeter, and these handles should be easy to grasp
even if the spine board is resting on a flat surface.
The lift must occur smoothly and on command. In
some cases, the spine board will need to be walked a
short distance, and this must also be carefully
coordinated and occur on command so that everyone
carrying the board is starting and stopping their
movements simultaneously.
Managing Protective Equipment
When managing an athlete wearing a helmet, the face
mask should always be completely removed to allow
access to the athlete’s airway.
The mechanism of injury in a football player is
generally axial loading or an extreme motion in one
direction, such as hyperextension.
The ears can be visualized through the ear holes, and
the neck can be palpated and pupils checked without
difficulty with the helmet in place.
The vast majority of cervical spine injuries in football
players occur at the lower level of the cervical spine
C5-C7.
airway difficulties are present,all appropriate procedures
can be carried out with little difficulty once the face
mask is removed.
There is no need to remove the entire helmet to
effectively manage the airway of an injured athlete.
A:With helmet in place, the position of the
cervical spine is essentially neutral. B:With the
helmet removed but shoulder pads remaining
in place, significant cervical extension occurs.