Update Regarding the NATA Executive Summary on the Care of the Spine Injured Athlete
On June 24, 2015, the NATA released a press release in advance of the NATA's 66th Clinical Symposia and AT Expo that was an Executive Summary of a future consensus statement titled"Appropriate Care of the Spine Injured Athlete" written by its Inter-Association Core Writing Group (IACWG) which included members from several medical organizations, including the NATA and AMSSM. As described within the press release, "This is an update to the original 1998 consensus statement guidelines in light of recent changes in literature for pre-hospital treatment protocols and a discussion among task force and spine trauma researchers." It is worth noting that the final version of this consensus statement has not yet been released by the NATA and that the press release announcement was a preliminary Executive Summary.
Several important items are included within the Executive Summary - most importantly stressed is the need to have an established and well-rehearsed Emergency Action Plan (EAP) for our teams. What has gained a tremendous amount of attention is "Item #4" within the Executive Summary that addresses the potential practice of on-the-field removal of protective helmets and shoulder pads.
We recognize this has caught several AMSSM members who are team physicians at all levels of competition by surprise, as there has not been a significant number of poor outcomes reported in the literature as a result of the current practice of removing protective equipment within a controlled environment such as an emergency center. Because of the timing of this announcement immediately prior to the fall competitive season we recognize that our members and their respective athletic training staff may not be ready to change their current policy on protective equipment removal within their respective EAPs. The NATA and leaders of the IACWG currently feel that "Item #4" will be included within the final written document when completed this fall.
As a result of concerns expressed by several organizations, AMSSM members included, and at the request of the IACWG, the NATA released a statement August 5, to its members, modifying the existing language within "Item #4" on the pre-released Executive Summary. Specifically, the previous statement was "...equipment should be removed prior to transport". The statement has been changed to "when appropriate, protective equipment may be removed prior to transport."
Both the NATA and AMSSM recognize that helmet/shoulder pad removal procedures are difficult and for the safety of the athlete should only be done by those professionals who have been trained on how to use proper technique. We agree with the NATA in that there are, "variations in state emergency medical system protocols nationally, the availability of qualified EMS systems and hospital emergency departments locally, the differences in personnel and resources at various venues and levels of competition, and the uniqueness inherent in each situation and with each patient. These, along with medical-legal liability issues, lead us to conclude that it is prudent to state that health care providers make the decision regarding equipment removal on-site based on the individual circumstances of the case."
Until additional information is provided within the final version of the Inter-Association Consensus Statement titled "Appropriate Care of the Spine Injured Athlete" AMSSM will continue to support and recommend the practice of its team physician/members using their best clinical judgment to decide if helmet removal should be done emergently on the field or within the more controlled environment of an emergency department.
Click here to view the updated NATA press release as of August 5, 2015.