Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA

Prehospital care of suspected spine-injured lacrosse athletes: a systematic search, evidence review, and consensus recommendations

Lacrosse has experienced significant growth in popularity worldwide and will return to the Summer Olympic Games in 2028. While there are published consensus recommendations for prehospital care of athletes with suspected spine injuries, there are currently no recommendations specific to lacrosse athletes with and without circulation, airway, or breathing (CAB) compromise. The document aims to determine evidence- and consensus-based best practices and provide implementation recommendations to guide healthcare professionals in the prehospital care of suspected spine-injured lacrosse athletes. We comprised a consensus group of 15 individuals with diverse clinical, research, and administrative experiences to ensure broad representation across lacrosse competition levels. Peer-reviewed scientific and medical research literature was systematically searched for articles on spine injury in lacrosse participants to derive evidence-based recommendations. Following a modified Delphi approach with three rounds of voting, the author panel developed ten consensus-based best practices and implementation recommendations related to the care of potentially spine-injured lacrosse athletes with and without CAB compromise. In addition, recommendations are provided to guide the implementation of key preparations before lacrosse participation, such as developing and distributing an emergency action plan, lacrosse-specific policies and procedures, and cardiopulmonary resuscitation and automated external defibrillator requirements. All recommendations obtained acceptable levels of agreeability, feasibility, and clarity from at least 80% of the panel. The recommendations provide prehospital care guidance for healthcare professionals and event organisers aimed at improving patient outcomes following suspected spine injury.

Equestrian Sports Safety: An Update on Safety Equipment and Event Medical Coverage

ABSTRACT

Equestrian sports are associated with high rates of major injury compared to collision and powered two-wheel sports. Advancements in rider and horse safety equipment and the implementation of comprehensive emergency action planning standards may help mitigate injuries, particularly in regard to the Olympic disciplines of dressage, show jumping, and three-day eventing covered in this review. Personal safety equipment to consider includes helmets, safety and air vests, and horse tack including safety stirrups, acoustic dampeners, and breakaway reins. Equestrian event medical coverage requires emergency action planning, partnership with local emergency medical services, and cooperation of interprofessional teams. Safety coordinators and medical providers may be tasked with providing first aid to spectators in addition to stabilizing and triaging crush trauma, traumatic brain injuries or spinal injuries, or fractures in competitors. Stationary and mobile medical units, proper medical equipment, acute spine stabilization protocols, and communication systems are critical components of equestrian medical coverage.

Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update)

ABSTRACT

Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.

Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update)

ABSTRACT

Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.

Catastrophic Sports Injuries: Causation and Prevention

➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.

Acute and Emergent Spinal Injury Assessment and Treatment

Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. Planning the process of transport for home venues before the start of the season and ensuring that a medical time out occurs at home and away games can reduce complications of transport decisions on the field of play and expedite transport of the spine-injured athlete.

On-field Emergencies and Emergency Action Plans

Sideline coverage can be an enjoyable experience and provide the opportunity to witness and evaluate an athlete's pathology at the time of injury. While the majority of on-field injury will likely be of low acuity, it is essential to develop an Emergency Action Plan (EAP) to deliver excellent medical care efficiently. The EAP should provide a written, standardized multidisciplinary approach involving key personnel. The EAP should be rehearsed on at least an annual basis and should highlight the initial assessment of the patient while also accounting for the various types of trauma that may occur on the field and appropriate field extrication procedures. As most players who have a true on-field emergency will not return to same-day play, a thorough understanding of how to deliver emergency care and transfer the player to a higher level of care is essential.

On-Field Management of Suspected Spinal Cord Injury

Acute spinal cord injuries in athletes are rare. However, on-field management of such injuries requires a well-planned approach from a team of well-trained medical staff. Athletes wearing protective gear should be handled with care; a primary survey should be conducted to rule out life-threatening injury while concomitantly immobilizing the spine. Treatment with steroids or hypothermia have not been shown to be beneficial, ultimately time to surgery provides the athlete with the best chance of a good outcome.

Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training

ABSTRACT

Patients present to primary care physicians with musculoskeletal complaints more often than they do for upper respiratory infections, hypertension, or diabetes. Despite this, instruction in musculoskeletal medicine for internal medicine residents represents less than 1% of their total didactic and clinical education time. We recognize the immense breadth of knowledge and skill required to train residents in the practice of internal medicine. This curriculum guideline defines a recommended training strategy, and supplies relevant resources, to improve musculoskeletal education among internal medicine residents to optimize patient care. This curriculum guideline was created by internists who are sports medicine specialists. Sports medicine physicians promote overall health and well-being while providing expertise in acute and chronic musculoskeletal conditions, as well as how disease affects exercise and using exercise as medicine for people with chronic disease.

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

INTRODUCTION

Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.

METHODS

A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.

RESULTS

The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved.

CONCLUSIONS

These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.