A.B.C. stands for Airway, Breathing, and Circulation. If an athlete is unconscious, it is important to verify they are breathing and also to check their pulse. For any athlete who does not appear to have the normal ABC’s, CPR should be initiated immediately by qualified providers.
For athletes who are conscious and alert, one of the first and most important things to ask them is where they hurt before moving them. Athletes with any head, neck, or back pain should be evaluated very carefully and not moved without stabilization of the spine. One of the most important things for injured hockey players when they are unconscious or alert with neck or head pain is not to remove their helmet. A helmet provides important support to their spine and, if they do have a neck fracture, it can cause motion of the fracture which could lead to permanent nerve damage or paralysis.
We have done studies which demonstrate that the most significant risk of increased motion in the cervical spine occurs at the mid-level of the neck when the helmet is removed. This is the exact level at which the majority of ice hockey spinal fractures occur. Thus, it is important to leave the helmet on to make sure that, if the athlete does have a neck fracture, the fracture does not move and cause paralysis. In athletes who have neck pain and are on their face in the prone position, they should not be moved until people trained and comfortable with proper log rolling technique can help move them onto their back. At all times, the neck should be stabilized and the helmet should be left in place. This same protocol should be followed in athletes who have low back pain because they may have a thoracic or lumbar spine injury.
For athletes who have no head or neck pain, but may have lost their breath or have extremity pain, it is reasonable at this point to assist them with rolling onto their back so that they can be better evaluated. If a significant extremity injury is suspected on initial assessment, it is often best to remove the player from the rink before doing a more complete assessment.
Anyone who has hit their head has a concussion until proven otherwise. Athletes who have a headache or neck pain or who are disoriented and appear confused should not be allowed back into competition. It is important to ask them if they know the location, period, score, and other questions which help to determine how alert and oriented they are.
To summarize this important topic, in any athlete who may have had a head or neck injury, it is important to leave their helmet on. For athletes who may have isolated extremity pain, splinting of the extremity and assisting them off the ice should be considered. In any athlete who may have head or neck pain, however trivial it may seem, it is reasonable to wait for emergency medical services to assist them off of the ice to make sure that there are no significant neck or skull injuries present.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to editor@letsplayhockey.com.
