National Athletic Trainers' Association Releases Consensus Recommendations and Best Practices for Emergency Prehospital Care of Spine-Related Injured Athletes in American Football

Wednesday, June 24, 2020

DALLAS, TX – Sports at every level are re-evaluating the safety of play going into this summer and fall. In addition to COVID-19 considerations, the awareness of the critical nature of athlete safety and emergency preparedness is at an all-time high. Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. This injury can have devastating and long-lasting effects on athletes and their families. Evidence-based care is essential to maximize the potential for positive outcomes.

Two articles stemming from meetings of the Spine Injury in Sport Group (SISG) were published today in the Journal of Athletic Training, the National Athletic Trainers’ Association (NATA) scientific publication. The first, Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football Players, outlines best practices and practical applications. Consensus Recommendations on the Prehospital Care of the Injured Athlete with a Suspected Catastrophic Cervical Spine Injury, outlines the Delphi process, which identified eight key questions to be answered by systematic review and was used to come to a consensus. The review screened 1,544 studies, 49 of which were included in the final full-text review. Additionally, a high-quality training film was created to complement the recommendations and to visually communicate the guidelines across medical professions and other key stakeholders.

To mirror the diverse health care professions that may be involved in a spine injury, the SISG consisted of 25 health care professionals in athletic training, emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry and research. The National Athletic Trainers’ Association (NATA), The Sports Institute at UW Medicine, National Collegiate Athlete Association (NCAA) and the Harborview Injury Prevention and Research Center (HIPRC) were instrumental in the process and creation of materials.

Key Recommendations

  1. Athletic programs should have an emergency action plan (EAP) developed in conjunction with local emergency medical services agencies specific to pre-hospital spine-injury care. Best practices are for an athlete with a suspected spinal injury to be transported to a designated Level 1 or 2 trauma center as quickly and safely as possible.


  1. Sports medicine teams should conduct a pre-event medical time out before each athletic event (practices and competitions). Participating in these “time outs” should include medical personnel from both teams, EMS personnel and game officials.
  2. When feasible, those with the highest level of training and experience in removal techniques should participate in equipment removal. Athletic trainers are recognized as the medical professional with the most training and experience in athletic equipment removal.
  3. Removal of the helmet and shoulder pads can occur in the emergency room or on the field. There are potential advantages to on-field removal prior to transport to the hospital, such as improved airway management, access to the chest for CPR, and expedited care of the athlete. The decision to remove equipment before transport should be based on a variety of factors, such as the medical status of the injured athlete, type of equipment worn, number of onsite rescuers and training and experience of on-the-field and emergency room rescuers in equipment removal.
  4. If a spine board is used in the care of an athlete with a suspected cervical spine injury, non-athlete data recommends that time on the board be minimized, however, the board is left in place for transport to the hospital.
  5. If feasible, spine-injured athletes should be transported to a medical facility that can deliver immediate and definitive care in the event the athlete has a significant cervical spine injury. This includes: an emergency department with certified emergency medicine physicians; personnel trained in equipment removal; advanced imaging services; spine surgeon consultation in house or readily available; 24/7 operating access; and critical care monitoring and rehabilitation services.

“When an athlete is suspected to have a spine injury, every moment and every movement counts,” said NATA President, Tory Lindley, MA, ATC. “It is imperative that no matter the level of play, from peewee to professional, there is a health care professional, such as an athletic trainer, that creates venue-specific action plans, leads medical time outs and establishes relationships with allied medical professionals to ensure the best possible outcome for the athlete.”

“I have enacted emergency protocols for the pre-hospital care of a spine-injured athlete several times during my career and have seen first-hand the monumental and lasting effects that it can have on both the athlete and family,” said Co-Chair of SISG and Senior Associate Athletic Director, University of Georgia, Ron Courson, ATC, PT, NRAEMT. “My experience has driven home the paramount importance of having rehearsed and evidence-based protocols ready to implement.”

“The Spine in Sport Group consisted of over 200 years of professional medical experience. With such an impressive group of subject matter experts, we wanted to ensure that each voice counted. We implemented the Delphi process to ensure that science spoke the loudest rather than the person with the most impressive title or loudest voice,” said Co-Chair of SISG and Clinical Associate Professor, Department of Emergency Medicine, University of South Carolina School of Medicine-Greenville, Jim Ellis, MD, FACEP.

“The care of the spine-injured athlete is dependent upon the collaboration of medical professionals from athletic trainers, to EMTs/paramedics, team and emergency physicians and beyond. It was deemed critical that in addition to the articles, we created a high-quality visual component to allow for efficient and effective training across disciplines,” said Co-Chair of SISG and Senior Medical Advisor and Co-Founder The Sports Institute at UW Medicine, Stanley A. Herring, MD.


About NATA: National Athletic Trainers’ Association – 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 45,000 members of the athletic training profession.  Visit for more information.

About The Sports Institute at UW Medicine

The Sports Institute at UW Medicine works to expand participation and safety in sports. Since its founding, The Sports Institute has led first-of-its-kind efforts to legislate safe return to play across all 50 states and to advance best practices in sports safety. Based in Seattle, The Sports Institute partners across sectors and convenes experts, evidence-based approaches and research to encourage play and to make sports safer. The Sports Institute is a proud member of the UW Medicine community, one of the world’s leading centers for patient care, medical education and research.

About Harborview Injury Prevention and Research Center

The Harborview Injury Prevention & Research Center (HIPRC) is a worldwide leader in injury cause and prevention research. Founded in 1985, we are affiliated with the University of Washington and Harborview Medical Center in Seattle. We are committed to public engagement and strive to partner with impacted communities in achieving injury prevention and health equity across the lifespan. Efforts span the continuum of medical care, from epidemiological research to determine injury causes, to acute care of trauma patients, to rehabilitation in the hospital and home.

HIPRC is a joint initiative of the University of Washington School of Medicine and Harborview Medical Center. It is also a CDC-funded Injury Research and Control Center, or ICRC. The ICRC network is funded by the CDC’s National Center for Injury Prevention and Control to find ways to prevent injury and violence. HIPRC is the only ICRC in the western half of the United States




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