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Guidelines Presented at NATA’s 66th Annual Convention

Source: The National Athletic Trainers' Association

St. Louis, June 24, 2015 – At NATA’s 66th Clinical Symposia and AT Expo in St. Louis today, leading health care professionals released an executive summary of a new inter-association consensus statement on “Appropriate Care of the Spine Injured Athlete.” This is an update to the original 1998 consensus statement guidelines in light of recent changes in literature for pre-hospital treatment protocols and a discussion among task force and spine trauma researchers. A copy of the executive summary is available at http://www.nata.org/access-read/public/consensus-statements

“Traumatic spinal cord injury (SCI) is a devastating condition that merits concerned focus,” said Task Force Chair, Lead Author and NATA Vice President MaryBeth Horodyski, EdD, ATC, FNATA. “These updated recommendations are critical to ensure proper and immediate care of the athlete and to reduce or prevent catastrophic outcomes. The athletic trainer and other members of the sports medicine team must work together to ensure clear and immediate communication. Establishing an Emergency Action Plan for use and review by the sports medicine team is essential.”

“The athlete with a suspected spinal cord injury presents medical providers with challenges that are not common with the general population. Equipment worn for protective purposes presents a treatment barrier for basic or advanced life support to the airway and chest. Removal of equipment prior to transport is one of our most important updated recommendations,” she added.

There are approximately 12,500 new cases of SCI reported each year in the U.S., and nine percent of these cases are due to participation in sports and recreational activities. Immediate recognition of risk combined with treatment in the pre-hospital setting and appropriate emergency department management are critical.

The task force originally met at the Andrews Institute earlier this year and comprises 21 sports and health organizations (see list at end of press release). In addition to Horodyski, speakers at this morning’s press event included task force members Ron Courson, ATC, PT, NREMT-I, senior associate athletic director for sports medicine at the University of Georgia; Jim Ellis, MD, FACEP, emergency physician/associate team physician for the Atlanta Falcons, representing the American College of Emergency Physicians; and Glenn Henry, MA, PMDC, dean of Life Sciences at Athens (Georgia) Technical College.

Executive Summary Select Highlights: Appropriate Care of the Spine Injured Athlete
**Asterisked recommendations are updates to the original statement

Recommendation 1: It is essential that each athletic program have an Emergency Action Plan (EAP) developed in conjunction with local EMS.
• Preparation is essential and should include education and training, maintenance of emergency equipment and supplies, appropriate use of personnel and formation and implementation of an EAP.
• Ideally, an athletic trainer should be on site during all sporting events. If medical personnel are not present, sports administrators should develop procedures for implementing the EAP and ensuring that all coaches are trained as first responders to ensure appropriate care prior to the arrival of trained medical personnel.

Recommendation 2: It is essential that sports medicine teams conduct a “Time Out” before athletic events to ensure EAPs are reviewed and to plan the options with the personnel and equipment available for that event.

Recommendation 3: Proper assessment and management of the spine injured athlete-patient will result in activation of the EAP in accordance with the level or severity of the injury.

**Recommendation 4: Protective athletic equipment should be removed prior to transport to an emergency facility for an athlete-patient with suspected cervical spine instability.

**Recommendation 5: Equipment removal should be performed by at least three rescuers trained and experienced with equipment removal at the earliest possible time. If fewer than three people are present, the equipment should be removed at the earliest possible time after enough trained individuals arrive on the scene.
Rationale for Equipment Removal
• In the past, it was recommended that protective equipment (e.g., helmets and shoulder pads in football, hockey and lacrosse) be left in place for transport and removed upon arrival in the hospital Emergency Department.
• It is essential and now recommended that, when appropriate, in an emergency situation with equipment-intensive sports (e.g., helmets and shoulder pads in football, hockey and lacrosse), the protective equipment be removed prior to transport to the hospital.
• Rescuers should be able to recognize when is it NOT appropriate to remove equipment on field of play and have a plan to best manage the patient. The rationale for consideration of equipment removal on the field includes:
• Advances in equipment technology
• Equipment removal should be performed by those with the highest level of training – often the athletic trainer who may have greater exposure to equipment removal training than other medical team members or hospital emergency staff.
• Expedited access to the athlete-patient for enhanced provider care
• Chest access is prioritized

Recommendation 6: Athletic protective equipment varies by sport and activity; and styles of equipment differ within a sport or activity. Therefore, it is essential that the sports medical team be familiar with the types of protective equipment specific to the sport and associated techniques for removal of the equipment.

Recommendation 7: A rigid cervical stabilization device should be applied to spine injured athlete-patients prior to transport.
• A rigid cervical collar should be applied at the earliest and most appropriate time possible during pre-hospital procedures. The medical team needs to continue manual in-line stabilization even after the rigid cervical collar is applied.

**Recommendation 8: Spine injured athlete-patients should be transported using a rigid immobilization device.
• Sports medical care teams must now recognize the concepts of spinal motion restriction (SMR) as compared to spinal immobilization. SMR implies that true spinal immobilization cannot be obtained even with the patient securely strapped to a spine board.
• Recent literature has raised concern regarding the use of the long spine board due to potential harmful effects after extended period of time on the board. However, in the case of a potentially spine injured athlete it is recommended that a long spine board or other immobilization device be used for transport.

**Recommendation 9: Techniques employed to move the spine injured athlete-patient from the field to the transportation vehicle should minimize spinal motion.
• The spine injured athlete-patient should be transferred to the long spine board or vacuum mattress using a technique that limits spinal motion. In the case of a supine positioned athlete, the medical team should use the 8-person lift (previously described as the six-plus lift) to move the athlete-patient to the long spine board.

Recommendation 10: It is essential that a transportation plan be developed prior to the start of any athletic practice or competition.

**Recommendation 11: Spine injured athlete-patients should be transported to a hospital that can deliver immediate, definitive care for these types of injuries.
• The choice of the most appropriate hospital should be determined and written in the EAP.

Recommendation 12: It is essential that prevention of spine injuries in athletics be a priority and requires collaboration between the medical team, coaching staff and athletes.

Recommendation 13: The medical team must have a strong working knowledge of current research, as well as national and local regulations to ensure up-to-date care is provided to the spine injured athlete-patient.

Recommendation 14: It is essential that future research continue to investigate the efficacy of devices used to provide spinal motion restriction.

“These guidelines are designed to reduce error and catastrophic injury, ensure the best protocols are in place and remain current with literature,” concluded Horodyski. “We encourage continued research on the spine injured athlete as techniques, equipment and procedures continue to evolve. Most important is the communication among the sports medicine team members and the immediate care of the athlete to ensure prompt and appropriate treatment.”

Task force member organizations include: American Academy of Family Physicians; American Academy of Neurology; American Academy of Orthopaedic Surgeons – Committee on the Spine; American Academy of Pediatrics – Committee on Sports Medicine and Fitness; American College of Emergency Physicians; American College of Sports Medicine; American College of Surgeons – Committee on Trauma; American Medical Society for Sports Medicine; American Orthopaedic Society for Sports Medicine; Canadian Athletic Therapists’ Association; College Athletic Trainers’ Society; National Association of EMS Physicians; National Association of EMTs; National Association of Intercollegiate Athletics; National Association of State EMS Officials; National Athletic Trainers’ Association; National Collegiate Athletic Association; National Federation of State High School Associations; North American Spine Society; Professional Football Athletic Trainers Society; and the United States Olympic Committee.

Additional speaker information or interviews are available upon request. For more information please visit: www.nata.org

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport
Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 39,000 members of the athletic training profession. Visit www.nata.org.

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