Package For Transport

There are various injury scenarios for which the medical team may elect to immobilize an injured athlete to rigid support to aid in the prevention of secondary injury and facilitate movement during safe handling management.  In athletics, packaging for transport is commonly required during injury scenarios involving potential neurological injury or altered mental status when the athlete cannot be definitively cleared of neurological injury in the pre-hospital environment.  In this section of the emergency action plan, the  package for transport procedures for non-emergent, neurological, and life-threatening injury scenarios is reviewed.  This protocol has been developed by the medical staff to reflect standing orders for care of athlete’s requiring immobilization to rigid support prior to transport to an appropriate medical facility.  This protocol 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.

Long Spine Board Immobilization vs. Spinal Motion Restriction

Non-Neurological Injury

When immobilization of an athlete with a non-neurological injury is indicated, the medical team will first properly protect the injured area from further injury by placing in an immobilizer, brace, or splint that protects the injured area by immobilizing the joint above and below the injury.  The medical team will then care for the athlete by monitoring vital signs and carrying out appropriate BLS/ALS first-aid.  When the athlete is stable enough to transport , the medical team will choose the appropriate transfer technique to position the injured athlete on rigid support.  The athlete will then be immobilized to rigid support using appropriate straps and immobilization devices while also ensuring that the injured area is appropriately padded.  Once immobilized, the medical team will check all distal pulses to ensure that circulation has not been disrupted by immobilization.

Neurological Injury

Thankfully, cervical spine injuries in athletics are rare.  Typically, cervical spine injuries in athletics are most often associated with an axial load mechanism of injury, and will, generally, result in immediate and obvious signs and symptoms of neurological injury.  However, there is also the potential for neurological injury involving the cervical spine that does not present with obvious signs and symptoms.  Therefore,  the axial load mechanism of injury, alone, warrants the most conservatives measures and that the medical team complete the SMC Progressive Spine Injury Assessment© or other similar on-field assessment that includes a systematic processes that uses accepted clinical criteria for clearing the athlete of injury to the cervical spine.  Athletes who cannot be clinically cleared of cervical spine injury during on-field assessment will be transferred to rigid support using an appropriate transfer protocol, immobilized to the rigid support with spine injury precautions, and transported to an appropriate medical facility for definitive evaluation and care.  The Package and Transport protocols are detailed in this section.

Indications for immobilization to rigid support and transport to an appropriate medical facility include, but are not limited to:

Prior to transferring the athlete to rigid support, the medical team will consider the appropriateness of removing all equipment from the equipment-laden athlete.  If equipment removal is warranted, the medical team will follow the procedures outlined in the equipment removal section of this document.  If equipment is removed prior to transfer, a cervical collar shall be applied prior to transfer.

With the athlete properly positioned on rigid support:

A-Man
Maintain stabilization of the athlete’s head and neck in cervical neutral position.  Communicate with the athlete to ensure the athlete remains calm and understands the situation.  Monitor the athlete for changes in mental status, consciousness, vital sign status, and changes in subjective symptoms. Directs and oversees the medical team in completion of the following tasks:

B- and C-Man

  1. Pack and fill the athlete’s head in cervical neutral position by placing towels to fill voids between the cervical spine and support;
  2. Remove the face mask from the athlete’s helmet to expose the airway using the face mask removal procedures outlined in this document;

C- and D-Man: Prepare the immobilization devices

E- and F-Man: Prepare the gurney

A- and B-Man

  1. Secure the head to support using appropriate cervical immobilization devices (CID);
  2. Pack and fill any voids between the athlete’s helmet and CID;
  3. Secure the athlete’s trunk and lower extremities to rigid support using appropriate immobilization devices;
  4. Apply appropriate vital sign and patient monitors.

C- and D-Man: Aid B- and C-Man in immobilizing athlete

E- and F-Man: Position the gurney at the athlete’s feet

B- and C-Man

  1. Positioned at corresponding Critical Care Triangle position on either side of the athlete’s shoulder, grasping the support handles at he shoulders and mid-thigh.

D- and E-Man

  1. Positioned on either side of the athlete grasping the support handles at mid-thigh and feet.

On A-Man direction the medical team lifts the athlete on rigid support to the height of the gurney.  F- and G-Man slide the gurney in from the athlete’s feet until the A-Man tells them to stop.  The athlete is then secured to the gurney and loaded into the ambulance.

Considerations

There are variations to this procedure that the medical team must consider, in real time; decisions will be made as the situation dictates and in accordance with the Primary Objectives Approach®.  Current expert opinion suggests that complete equipment removal in the pre-hospital environment prior to transport is warranted when:

  1. There has been a medical situation for which completion of critical care tasks required manipulation of some or all of the protective equipment;
  2. There is concern regarding stability of the athlete’s vital signs;
  3. an escort well versed in proper equipment removal techniques is unavailable to accompany the injured athlete to the receiving facility.

Depending on the injury situation, current status of the athlete, and expert opinion of the medical team, the medical team may elect to:

  1. Transport the athlete while secured to rigid support with the face mask removed.  This will require that a trained escort is available to accompany the injured athlete to the receiving facility to aid emergency room personnel with proper equipment removal.
  2.  Transfer the athlete to rigid support, remove the face mask, cut the jersey, shoulder pad strings and straps, and undergarment; then secure the athlete to rigid support and transport with the equipment left in place.  This will require that a trained escort is available to accompany the injured athlete to the receiving facility to aid emergency room personnel with proper equipment removal.
  3. Secure the athlete to rigid support with the face mask removed, move the athlete to a more controlled environment- such as a stadium tunnel or ambulance- and remove the equipment prior to transport.

Finally, the medical team will decide upon the most appropriate medical receiving facility to which the athlete will be transported.