Feature Story
The protocol for moving injured players from the
ice
Question:
I have had several questions about the
best protocol to evaluate and remove injured athletes from the ice. This is a
good question because the correct treatment of a potentially injured athlete
can be very important to their ultimate outcome.
Answer:
In the evaluation of an injured athlete,
especially one that was checked from behind or that was checked into the boards
or tripped into the boards, it is first important to evaluate the basics of any
safety evaluation. In this case, evaluation of the ABC’s is an essential first
step for evaluation of these injured athletes. The ABC’s
stand for Airway, Breathing, and Circulation. If an athlete is unconscious,
it is important to make sure that they are breathing and also to check their
pulse. For any athlete who does not appear to have the normal ABC’s, the basics
of CPR should be initiated and this is beyond the ability to describe it in
this article.
For those athletes who are conscious and
alert, one of the first and most important things to ask them about is where
they hurt. Athletes with any head, neck or back pain should be evaluated very
carefully and not moved without assistance. For those athletes who may have a
feeling like they have lost their breath or who have extremity pain, it is
reasonable at this point to assist them with rolling onto their back so that
they can be better evaluated.
One of the most important things to do in
injured hockey players, when they are unconscious or alert with neck or head
pain, is not to remove their helmet. This is because the 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.
We have done studies in our lab at the
In athletes who do 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
into the supine position on 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 also.
For those athletes who note that they may
have had a blow to their chest or simply lost their breath, it is reasonable to
allow them to catch their breath prior to attempting to move them.
It is reasonable to assume that anyone
who has hit their head has a concussion until proven otherwise. Athletes who
have a headache, neck pain, who are disoriented and appear confused should not
be allowed to be back into competition. It is important to ask them if they
know which rink they are in, what period it is, what the score is and other
questions which help to determine how alert they may be.
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 to get off the ice if possible, can be considered.
In all cases, in those athletes who may have head or neck pain, however trivial
it may seem, it is reasonable to wait for emergency
medical services to assist in getting them off of the ice to make sure that
there are no significant injuries present.
Dr. Rob LaPrade,
MD, PhD, is the team physician for the