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This Article Full Text Full Text (PDF) Waninger Appendixes Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Waninger, K. N. Search for Related Content PubMed PubMed Citation Articles by Waninger, K. N. Related Collections Spine Football Ice hockey

Management of the Helmeted Athlete With Suspected Cervical Spine Injury

From the Department of Emergency Medicine, Saint Luke’s Hospital, Bethlehem, Pennsylvania

^* Address correspondence to Kevin N. Waninger, MD, 211 North Barrington Court, Newark, DE 19702 (e-mail: knwaninger{at}aol.com).

Improper handling of an unstable neck injury may result in iatrogenic neurologic injury. A review of published evidence on cervical management in the helmeted athlete with a suspected spinal injury is discussed. The approach to the neck-injured helmeted athlete and the algorithms for on-field and emergency department evaluations are reviewed. The characteristics of the fitted football helmet allow safe access for airway management, and helmets and shoulder pads should not be initially removed unless absolutely necessary. Prehospital and emergency personnel should be trained in the indications for removal and in proper helmet, shoulder pad, and facemask removal techniques. If required, both helmet and shoulder pads should be removed simultaneously. Radiographs with equipment in place may be inadequate, and the value of computed tomography and magnetic resonance imaging in these helmeted patients has been studied. If adequate films cannot be obtained with equipment in place, helmet and shoulder pads may need to be removed before radiographic clearance. A plan should be formulated to prepare for such unexpected clinical scenarios as cervical spine injuries, and skills should be practiced. Airway and cervical spine management in these helmeted athletes is an area of ongoing research.

Key Words: helmet removal • cervical spine • football • ice hockey • trauma • sports • injury