Cervical Spine Injury Assessment Procedural Overview

These procedures have been developed by the medical staff to reflect standing orders for acute assessment of athlete’s experiencing signs and symptoms of a cervical spine injury (CSI).  This protocol is a summary drawn from the team’s comprehensive emergency action plan, and is intended to summarize the medical team’s preparation for and initial response to the identified condition.  This protocol summary is intended to serve only as a guideline.  The following procedures are not intended to substitute for prudent autonomous medical decision-making required during actual care and management of a sick or injured individual.  Please see the comprehensive emergency action plan for a formal write-up and reference material.


Emergency Management Checklist
BLS SCI Management Supplies ALS SCI Management Considerations SCI Considerations
  • AED
  • BVM ventilator
  • Seal Quick™ resuscitator mask
  • Magill forcepts
  • Manual suction device
  • Oxygen
  • Non-rebreather mask
  • Heart rate / blood pressure monitor
  • Pulse-oximeter
  • Pro-Strap
  • Pack and fill towels
  • Defibrillator/monitor
  • ECG
  • SGD
  • Laryngoscope
  • ET
  • Stylette
  • Mechanical suction device
  • Airway tube securing device
  • etCO2 monitor
  • ACLS medications
  • Emphasis is on repositioning a potentially CSI athlete to cervical neutral within the first 2 minutes of the injury followed by completion of an efficient step-by-step process to make appropriate transport decisions;
  • Once a clear indication for the need to transport has been made, the medical team will focus on monitoring and supporting the injured athlete’s vital signs while deciding on the safest handling measures.


Critical Content Overview

The acute assessment of a potentially CSI athlete is not intended to diagnose or judge the extent of injury.  Rather, the acute assessment of a potentially CSI athlete that is alert, conscious, and stable focuses on clinical criteria indicating the need to transport the athlete via EMS to an appropriate medical receiving facility.  Once the decision to transport has been made, the medical team will need to address issues regarding the most appropriate safe handling measures, including the potential need for equipment removal and immobilization strategies.

Complicated Differential Diagnosis
Brachial Plexus Injury Cervical Spine Injury
  • Lateral bending of the neck, never from an axial load.
  • Axial load
  • Athlete will be in pain, but not overly apprehensive about being cared for.
  • Athlete may be very apprehensive or scared to move.
  • Maybe extreme initially, but will be generally confined to the upper trap and affected upper extremity.  Pain will begin to resolve in relatively short order.
  • Pain level is not a good indicator of extent of injury.  Even minor pain directly over mid-line of the cervical spine is of concern.
  • Point tenderness unilaterally, usually off mid-line of the cervical spine in the upper trap/shoulder region.
  • Point tenderness along mid-line of cervical spine, along spinous processes;
  • Rigid cervical spasm;
  • Palpable deformation;
  • Bony block.
Neurological Symptoms
  • Generally confined to unilateral upper extremity
  • May present unilaterally, but bi-lateral neurological symptoms certainly require transport, especially when combined with axial load MOI;
  • Inc when attempting to place in cervical neutral.


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