312016May

On-Field Evaluation of Athletes with Potential Head & Neck Injuries

The on-field evaluation of an athlete with head and/or neck injuries is critical in preventing potentially catastrophic problems. The appropriate care of these patients begins with a plan involving trainer, physicians, and emergency medical personnel. It is extremely important to have all necessary equipment available. This would include a spine board with straps, small garden pruners (ratchet or anvil type) for removing face masks, screwdriver, emergency shears, oxygen and rigid cervical collars. The following guidelines are for the evaluation and management of these athletes.

 

No Altered Consciousness?
Make an accurate diagnosis of level of consciousness
Assess airway, breathing, and circulation (ABC’s)
Do not remove the face mask or helmet unless respiratory difficulty at this point.
Do not move the patient until the assessment is complete, unless there is difficulty with the airway, breathing or circulation.
If movement is required, one person stabilizes the head while a team “log rolls” the patient supine.
If transportation is required, be sure to secure the body to the spine board with straps or tape before securing the head. Secure the head to the board with tape or straps. Sandbags are not recommended due to their weight, which shifts against the cervical spine, if log rolling is necessary due to vomiting. Rolled towels, blankets or foam blocks are good alternatives.
Face mask removal should be performed before transport to an emergency facility.
Helmet removal is usually not preferred or required with the following exceptions:
1. The head is not held securely within the helmet.
2. The airway cannot be controlled even with face mask removal.
3. The face mask cannot be removed in an adequate period of time prior to transport
Helmet removal is facilitated by removing check pads and/or deflating air padding.
In the event of helmet removal, use a rolled towel under the head to prevent cervical hyperextension.

 

Altered Consciousness
Make an accurate diagnosis of level of consciousness (concussion-alteration of cerebral function)
Assess airway, breathing, and circulation (ABC’s)
Assume the athlete has a cervical spine injury until proven otherwise (see above guidelines).
Perform a brief neurological assessment (determine Glasgow coma score, orientation).
If cervical injury can be ruled out and confusion and orientation have improved, the patient may sit.
Assist the athlete to the sideline and continue the assessment if strength and coordination allows, otherwise proceed with transport as outlined above.
The athlete should be observed for a minimum of 15 minutes with serial neurological evaluations.
The athlete may return to play the same day if:
1. Signs and symptoms are cleared within 15 minutes or less at rest and exertion.
2. Normal neurological evaluation.
3. No documented loss of consciousness.
The athlete is excluded from same day participation if:
1. Signs and symptoms do not clear in 15 minutes at rest or exertion.
2. Documented loss of consciousness.
BEWARE of the athlete with vomiting after suspected head injury or new headaches in the first 48 – 72 hours after a concussion (these require further medical evaluation).

These procedures were created based on the information provided in the guidelines produced by the Inter-Association Task Force for Appropriate Care of the Spine and the Concussion in Sports manuscript published in the Sept./Oct. 1999 issue of the American Journal of Sports Medicine.©
© January 2000

American Orthopaedic Society
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