What techniques can be used when transporting an athlete with a suspected musculoskeletal injury?

1. National Spinal Cord Injury Statistical Center. Spinal Cord Injury: Facts and Figures at a Glance. Birmingham: University of Alabama, Birmingham; 2006. p. 2. [Google Scholar]

2. Nobunaga A, Go B.K, Karunas R.B. Recent demographic and injury trends in people served by the Model Spine Cord Injury Case Systems. Arch Phys Med Rehabil. 1999;80(11):1372–1382. [PubMed] [Google Scholar]

3. Mueller F, Cantu R. National Center for Catastrophic Sport Injury Research: Twenty-Fourth Annual Report: Fall 1982–Spring 2006. Chapel Hill: University of North Carolina; 2008. [Google Scholar]

4. Mueller F.O, Cantu R.C. Annual Survey of Catastrophic Football Injuries, 1977–2006. Chapel Hill: University of North Carolina; 2006. [Google Scholar]

5. Boden B.P, Tacchetti R.L, Cantu R.C, Knowles S.B, Mueller F.O. Catastrophic cervical spine injuries in high school and college football players. Am J Sports Med. 2006;34(8):1223–1232. [PubMed] [Google Scholar]

6. Mueller F.O, Cantu R.C. Annual Survey of Catastrophic Football Injuries, 1977–2005. Chapel Hill: University of North Carolina; 2005. [Google Scholar]

7. Tator C.H, Carson J.D, Edmonds V.E. Spinal injuries in ice hockey. Clin Sports Med. 1998;17(1):183–194. [PubMed] [Google Scholar]

8. Frymoyer J.W, Pope M.H, Kristiansen T. Skiing and spinal trauma. Clin Sports Med. 1982;1(2):309–318. [PubMed] [Google Scholar]

9. Hagel B.E, Pless B, Platt R.W. Trends in emergency department reported head and neck injuries among skiers and snowboarders. Can J Public Health. 2003;94(6):458–462. [PMC free article] [PubMed] [Google Scholar]

10. Keene J.S. Thoracolumbar fractures in winter sports. Clin Orthop Relat Res. 1987;216:39–49. [PubMed] [Google Scholar]

11. Levy A.S, Smith R.H. Neurologic injuries in skiers and snowboarders. Semin Neurol. 2000;20(2):233–245. [PubMed] [Google Scholar]

12. Prall J.A, Winston K.R, Brennan R. Spine and spinal cord injuries in downhill skiers. J Trauma. 1995;39(6):1115–1118. [PubMed] [Google Scholar]

13. Reid D.C, Saboe L. Spine fractures in winter sports. Sports Med. 1989;7(6):393–399. [PubMed] [Google Scholar]

14. McCoy G.F, Piggot J, Macafee A.L, Adair I.V. Injuries of the cervical spine in schoolboy rugby football. J Bone Joint Surg Br. 1984;66(4):500–503. [PubMed] [Google Scholar]

15. Scher A.T. Catastrophic rugby injuries of the spinal cord: changing patterns of injury. Br J Sports Med. 1991;25(1):57–60. [PMC free article] [PubMed] [Google Scholar]

16. Scher A.T. Rugby injuries to the cervical spine and spinal cord: a 10-year review. Clin Sports Med. 1998;17(1):195–206. [PubMed] [Google Scholar]

17. Secin F.P, Poggi E.J, Luzuriaga F, Laffaye H.A. Disabling injuries of the cervical spine in Argentine rugby over the last 20 years. Br J Sports Med. 1999;33(1):33–36. [PMC free article] [PubMed] [Google Scholar]

18. Noguchi T. A survey of spinal cord injuries resulting from sport. Paraplegia. 1994;32(3):170–173. [PubMed] [Google Scholar]

19. Silver J.R, Silver D.D, Godfrey J.J. Injuries of the spine sustained during gymnastic activities. Br Med J (Clin Res Ed) 1986;293(6551):861–863. [PMC free article] [PubMed] [Google Scholar]

20. Torg J.S. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. Med Sci Sports Exerc. 1985;17(3):295–303. [PubMed] [Google Scholar]

21. Bailes J.E, Herman J.M, Quigley M.R, Cerullo L.J, Meyer P.R., Jr Diving injuries of the cervical spine. Surg Neurol. 1990;34(3):155–158. [PubMed] [Google Scholar]

22. Boden B.P, Pasquina P, Johnson J, Mueller F.O. Catastrophic injuries in pole-vaulters. Am J Sports Med. 2001;29(1):50–54. [PubMed] [Google Scholar]

23. Boden B.P, Tacchetti R, Mueller F.O. Catastrophic cheerleading injuries. Am J Sports Med. 2003;31(6):881–888. [PubMed] [Google Scholar]

24. Boden B.P, Tacchetti R, Mueller F.O. Catastrophic injuries in high school and college baseball players. Am J Sports Med. 2004;32(5):1189–1196. [PubMed] [Google Scholar]

25. Toscano J. Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia. 1988;26(3):143–150. [PubMed] [Google Scholar]

26. Masini M, Alencar M.R, Neves E.G, Alves C.F. Spinal cord injury: patients who had an accident, walked but became spinal paralysed. Paraplegia. 1994;32(2):93–97. [PubMed] [Google Scholar]

27. Cusick J.F, Yoganandan N. Biomechanics of the cervical spine 4: major injuries. Clin Biomech (Bristol, Avon) 2002;17(1):1–20. [PubMed] [Google Scholar]

28. Banerjee R, Palumbo M.A, Fadale P.D. Catastrophic cervical spine injuries in the collision sport athlete, part 1: epidemiology, functional anatomy, and diagnosis. Am J Sports Med. 2004;32(4):1077–1087. [PubMed] [Google Scholar]

29. Mueller F.O, Cantu R.C. National Center for Catastrophic Sport Injury Research: Twenty-Second Annual Report, Fall 1982–Spring 2004. Chapel Hill: University of North Carolina; 2005. [Google Scholar]

30. Heck J.F, Clarke K.S, Peterson T.R, Torg J.S, Weis M.P. National Athletic Trainers' Association position statement: head-down contact and spearing in tackle football. J Athl Train. 2004;39(1):101–111. [PMC free article] [PubMed] [Google Scholar]

31. Andersen J, Courson R.W, Kleiner D.M, McLoda T.A. National Athletic Trainers' Association position statement: emergency planning in athletics. J Athl Train. 2002;37(1):99–104. [PMC free article] [PubMed] [Google Scholar]

32. Crosby E. Airway management after upper cervical spine injury: what have we learned. Can J Anaesth. 2002;49(7):733–744. [PubMed] [Google Scholar]

33. Sanchez A.R, II, Sugalski M.T, LaPrade R.F. Field-side and prehospital management of the spine-injured athlete. Curr Sports Med Rep. 2005;4(1):50–55. [PubMed] [Google Scholar]

34. Domeier R.M, Frederiksen S.M, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005;46(2):123–131. [PubMed] [Google Scholar]

35. Domeier R.M, Swor R.A, Evans R.W, et al. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma. 2002;53(4):744–750. [PubMed] [Google Scholar]

36. Holly L.T, Kelly D.F, Counelis G.J, Blinman T, McArthur D.L, Cryer H.G. Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. J Neurosurg. 2002;96(suppl 3):285–291. [PubMed] [Google Scholar]

37. Iida H, Tachibana S, Kitahara T, Horiike S, Ohwada T, Fujii K. Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma. 1999;46(3):450–452. [PubMed] [Google Scholar]

38. Cantu R.C. The cervical spinal stenosis controversy. Clin Sports Med. 1998;17(1):121–126. [PubMed] [Google Scholar]

39. Crosby E.T. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293–1318. [PubMed] [Google Scholar]

40. De Lorenzo R.A. A review of spinal immobilization techniques. J Emerg Med. 1996;14(5):603–613. [PubMed] [Google Scholar]

41. Gabbott D.A, Baskett P.J. Management of the airway and ventilation during resuscitation. Br J Anaesth. 1997;79(2):159–171. [PubMed] [Google Scholar]

42. Lennarson P.J, Smith D, Todd M.M, et al. Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization. J Neurosurg. 2000;92(suppl 2):201–206. [PubMed] [Google Scholar]

43. Bivins H.G, Ford S, Bezmalinovic Z, Price H.M, Williams J.L. The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine. Ann Emerg Med. 1988;17(1):25–29. [PubMed] [Google Scholar]

44. Ghafoor A.U, Martin T.W, Gopalakrishnan S, Viswamitra S. Caring for the patients with cervical spine injuries: what have we learned. J Clin Anesth. 2005;17(8):640–649. [PubMed] [Google Scholar]

45. Kaufman H.H, Harris J.H, Jr, Spencer J.A, Kopanisky D.R. Danger of traction during radiography for cervical trauma. JAMA. 1982;247(17):2369. [PubMed] [Google Scholar]

46. Lennarson P.J, Smith D.W, Sawin P.D, Todd M.M, Sato Y, Traynelis V.C. Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. J Neurosurg. 2001;94(suppl 2):265–270. [PubMed] [Google Scholar]

47. Chang D.G, Tencer A.F, Ching R.P, Treece B, Senft D, Anderson P.A. Geometric changes in the cervical spinal canal during impact. Spine. 1994;19(8):973–980. [PMC free article] [PubMed] [Google Scholar]

48. De Lorenzo R.A, Olson J.E, Boska M, et al. Optimal positioning for cervical immobilization. Ann Emerg Med. 1996;28(3):301–308. [PubMed] [Google Scholar]

49. Kang J.D, Figgie M.P, Bohlman H.H. Sagittal measurements of the cervical spine in subaxial fractures and dislocations: an analysis of two hundred and eighty-eight patients with and without neurological deficits. J Bone Joint Surg Am. 1994;76(11):1617–1628. [PubMed] [Google Scholar]

50. Muhle C, Bischoff L, Weinert D, et al. Exacerbated pain in cervical radiculopathy at axial rotation, flexion, extension, and coupled motions of the cervical spine: evaluation by kinematic magnetic resonance imaging. Invest Radiol. 1998;33(5):279–288. [PubMed] [Google Scholar]

51. Muhle C, Weinert D, Falliner A, et al. Dynamic changes of the spinal canal in patients with cervical spondylosis at flexion and extension using magnetic resonance imaging. Invest Radiol. 1998;33(8):444–449. [PubMed] [Google Scholar]

52. Muhle C, Wiskirchen J, Weinert D, et al. Biomechanical aspects of the subarachnoid space and cervical cord in healthy individuals examined with kinematic magnetic resonance imaging. Spine. 1998;23(5):556–567. [PubMed] [Google Scholar]

53. Tierney R.T, Maldjian C, Mattacola C.G, Straub S.J, Sitler M.R. Cervical spine stenosis measures in normal subjects. J Athl Train. 2002;37(2):190–193. [PMC free article] [PubMed] [Google Scholar]

54. Tierney R.T, Mattacola C.G, Sitler M.R, Maldjian C. Head position and football equipment influence cervical spinal-cord space during immobilization. J Athl Train. 2002;37(2):185–189. [PMC free article] [PubMed] [Google Scholar]

55. Aprahamian C, Thompson B.M, Finger W.A, Darin J.C. Experimental cervical spine injury model: evaluation of airway management and splinting techniques. Ann Emerg Med. 1984;13(8):584–587. [PubMed] [Google Scholar]

56. Goutcher C.M, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95(3):344–348. [PubMed] [Google Scholar]

57. Johnson D.R, Hauswald M, Stockhoff C. Comparison of a vacuum splint device to a rigid backboard for spinal immobilization. Am J Emerg Med. 1996;14(4):369–372. [PubMed] [Google Scholar]

58. Banerjee R, Palumbo M.A, Fadale P.D. Catastrophic cervical spine injuries in the collision sport athlete, part 2: principles of emergency care. Am J Sports Med. 2004;32(7):1760–1764. [PubMed] [Google Scholar]

59. Holley J, Jorden R. Airway management in patients with unstable cervical spine fractures. Ann Emerg Med. 1989;18(11):1237–1239. [PubMed] [Google Scholar]

60. Lord S.A, Boswell W.C, Williams J.S, Odom J.W, Boyd C.R. Airway control in trauma patients with cervical spine fractures. Prehosp Disaster Med. 1994;9(1):44–49. [PubMed] [Google Scholar]

61. Brimacombe J, Keller C, Kunzel K.H, Gaber O, Boehler M, Puhringer F. Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg. 2000;91(5):1274–1278. [PubMed] [Google Scholar]

62. Criswell J.C, Parr M.J, Nolan J.P. Emergency airway management in patients with cervical spine injuries. Anaesthesia. 1994;49(10):900–903. [PubMed] [Google Scholar]

63. Hauswald M, Sklar D.P, Tandberg D, Garcia J.F. Cervical spine movement during airway management: cinefluoroscopic appraisal in human cadavers. Am J Emerg Med. 1991;9(6):535–538. [PubMed] [Google Scholar]

64. Donaldson W.F, III, Heil B.V, Donaldson V.P, Silvaggio V.J. The effect of airway maneuvers on the unstable C1–C2 segment: a cadaver study. Spine. 1997;22(11):1215–1218. [PubMed] [Google Scholar]

65. Gerling M.C, Davis D.P, Hamilton R.S, et al. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med. 2000;36(4):293–300. [PubMed] [Google Scholar]

66. Majernick T.G, Bieniek R, Houston J.B, Hughes H.G. Cervical spine movement during orotracheal intubation. Ann Emerg Med. 1986;15(4):417–420. [PubMed] [Google Scholar]

67. Chandler D.R, Nemejc C, Adkins R.H, Waters R.L. Emergency cervical-spine immobilization. Ann Emerg Med. 1992;21(10):1185–1188. [PubMed] [Google Scholar]

68. Dasen K.R. On-field management for the injured football player. Clin J Sport Med. 2000;10(1):82–83. [PubMed] [Google Scholar]

69. Hamilton R.S, Pons P.T. The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization. J Emerg Med. 1996;14(5):553–559. [PubMed] [Google Scholar]

70. Podolsky S, Baraff L.J, Simon R.R, Hoffman J.R, Larmon B, Ablon W. Efficacy of cervical spine immobilization methods. J Trauma. 1983;23(6):461–465. [PubMed] [Google Scholar]

71. Luscombe M.D, Williams J.L. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J. 2003;20(5):476–478. [PMC free article] [PubMed] [Google Scholar]

72. Del Rossi G, Horodyski M, Heffernan T.P, et al. Spine-board transfer techniques and the unstable cervical spine. Spine. 2004;29(7):E134–E138. [PubMed] [Google Scholar]

73. Del Rossi G, Horodyski M, Powers M.E. A comparison of spine-board transfer techniques and the effect of training on performance. J Athl Train. 2003;38(3):204–208. [PMC free article] [PubMed] [Google Scholar]

74. Del Rossi G, Horodyski M.H, Conrad B.P, Di Paola C.P, Di Paola M.J, Rechtine G.R. The 6–plus-person lift transfer technique compared with other methods of spine boarding. J Athl Train. 2008;43(1):6–13. [PMC free article] [PubMed] [Google Scholar]

75. Del Rossi G, Heffernan T.P, Horodyski M, Rechtine G.R. The effectiveness of extrication collars tested during the execution of spine-board transfer techniques. Spine J. 2004;4(6):619–623. [PubMed] [Google Scholar]

76. Donaldson W.F, III, Lauerman W.C, Heil B, Blanc R, Swenson T. Helmet and shoulder pad removal from a player with suspected cervical spine injury: a cadaveric model. Spine. 1998;23(16):1729–1733. [PubMed] [Google Scholar]

77. Prinsen R.K, Syrotuik D.G, Reid D.C. Position of the cervical vertebrae during helmet removal and cervical collar application in football and hockey. Clin J Sport Med. 1995;5(3):155–161. [PubMed] [Google Scholar]

78. Metz C.M, Kuhn J.E, Greenfield M.L. Cervical spine alignment in immobilized hockey players: radiographic analysis with and without helmets and shoulder pads. Clin J Sport Med. 1998;8(2):92–95. [PubMed] [Google Scholar]

79. Sherbondy P.S, Hertel J.N, Sebastianelli W.J. The effect of protective equipment on cervical spine alignment in collegiate lacrosse players. Am J Sports Med. 2006;34(10):1675–1679. [PubMed] [Google Scholar]

80. Mihalik J.P, Beard J.R, Petschauer M.A, Prentice W.E, Guskiewicz K.M. Effect of ice hockey helmet fit on cervical spine motion during an emergency log roll procedure. Clin J Sport Med. 2008;18(5):394–398. [PubMed] [Google Scholar]

81. Ransone J, Kersey R, Walsh K. The efficacy of the Rapid Form Cervical Vacuum Immobilizer in cervical spine immobilization of the equipped football player. J Athl Train. 2000;35(1):65–69. [PMC free article] [PubMed] [Google Scholar]

82. Copeland A.J, Decoster L.C, Swartz E.E, Gattie E.R, Gale S.D. Combined tool approach is 100% successful for emergency football face mask removal. Clin J Sport Med. 2007;17(6):452–457. [PubMed] [Google Scholar]

83. Gale S.D, Decoster L.C, Swartz E.E. The combined tool approach for face mask removal during on-field conditions. J Athl Train. 2008;43(1):14–20. [PMC free article] [PubMed] [Google Scholar]

84. Swartz E.E, Armstrong C.W, Rankin J.M, Rogers B. A 3-dimensional analysis of face-mask removal tools in inducing helmet movement. J Athl Train. 2002;37(2):178–184. [PMC free article] [PubMed] [Google Scholar]

85. Swartz E.E, Decoster L.C, Norkus S.A, Cappaert T.A. The influence of various factors on high school football helmet face mask removal: a retrospective, cross-sectional analysis. J Athl Train. 2007;42(1):11–20. [PMC free article] [PubMed] [Google Scholar]

86. Swartz E.E, Norkus S.A, Cappaert T, Decoster L. Football equipment design affects face mask removal efficiency. Am J Sports Med. 2005;33(8):1210–1219. [PubMed] [Google Scholar]

87. Swartz E.E, Norkus S.A, Armstrong C.W, Kleiner D.M. Face-mask removal: movement and time associated with cutting of the loop straps. J Athl Train. 2003;38(2):120–125. [PMC free article] [PubMed] [Google Scholar]

88. Peris M.D, Donaldson W.F, III, Towers J, Blanc R, Muzzonigro T.S. Helmet and shoulder pad removal in suspected cervical spine injury: human control model. Spine. 2002;27(9):995–999. [PubMed] [Google Scholar]

89. Hanson J.A, Blackmore C.C, Mann F.A, Wilson A.J. Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening. Am J Roentgenol. 2000;174(3):713–717. [PubMed] [Google Scholar]

90. Li A.E, Fishman E.K. Cervical spine trauma: evaluation by multidetector CT and three-dimensional volume rendering. Emerg Radiol. 2003;10(1):34–39. [PubMed] [Google Scholar]

91. Schleehauf K, Ross S.E, Civil I.D, Schwab C.W. Computed tomography in the initial evaluation of the cervical spine. Ann Emerg Med. 1989;18(8):815–817. [PubMed] [Google Scholar]

92. Quencer R.M, Nunez D, Green B.A. Controversies in imaging acute cervical spine trauma. Am J Neuroradiol. 1997;18(10):1866–1868. [PMC free article] [PubMed] [Google Scholar]

93. Davidson R.M, Burton J.H, Snowise M, Owens W.B. Football protective gear and cervical spine imaging. Ann Emerg Med. 2001;38(1):26–30. [PubMed] [Google Scholar]

94. Veenema K, Greenwald R, Kamali M, Freedman A, Spillane L. The initial lateral cervical spine film for the athlete with a suspected neck injury: helmet and shoulder pads on or off. Clin J Sport Med. 2002;12(2):123–126. [PubMed] [Google Scholar]

95. Waninger K.N, Rothman M, Heller M. MRI is nondiagnostic in cervical spine imaging of the helmeted football player with shoulder pads. Clin J Sport Med. 2003;13(6):353–357. [PubMed] [Google Scholar]

96. Guest J.D, Vanni S, Silbert L. Mild hypothermia, blood loss and complications in elective spinal surgery. Spine J. 2004;4(2):130–137. [PubMed] [Google Scholar]

97. Martinez-Arizala A, Green B.A. Hypothermia in spinal cord injury. J Neurotrauma. 1992;9(suppl 2):S497–S505. [PubMed] [Google Scholar]

98. Hurlbert R.J. The role of steroids in acute spinal cord injury: an evidence-based analysis. Spine. 2001;26(suppl 24):S39–S46. [PubMed] [Google Scholar]

99. Boden B.P. Direct catastrophic injury in sports. J Am Acad Orthop Surg. 2005;13(7):445–454. [PubMed] [Google Scholar]

100. Nightingale R.W, McElhaney J.H, Richardson W.J, Best T.M, Myers B.S. Experimental impact injury to the cervical spine: relating motion of the head and the mechanism of injury. J Bone Joint Surg Am. 1996;78(3):412–421. [PubMed] [Google Scholar]

101. Nightingale R.W, McElhaney J.H, Richardson W.J, Myers B.S. Dynamic responses of the head and cervical spine to axial impact loading. J Biomech. 1996;29(3):307–318. [PubMed] [Google Scholar]

102. Nightingale R.W, Camacho D.L, Armstrong A.J, Robinette J.J, Myers B.S. Inertial properties and loading rates affect buckling modes and injury mechanisms in the cervical spine. J Biomech. 2000;33(2):191–197. [PubMed] [Google Scholar]

103. Penning L. Kinematics of cervical spine injury: a functional radiological hypothesis. Eur Spine J. 1995;4(2):126–132. [PubMed] [Google Scholar]

104. Amevo B, Aprill C, Bogduk N. Abnormal instantaneous axes of rotation in patients with neck pain. Spine. 1992;17(7):748–756. [PubMed] [Google Scholar]

105. Yoganandan N, Pintar F, Butler J, Reinartz J, Sances A, Jr, Larson S.J. Dynamic response of human cervical spine ligaments. Spine. 1989;14(10):1102–1110. [PubMed] [Google Scholar]

106. Nightingale R.W, Richardson W.J, Myers B.S. The effects of padded surfaces on the risk for cervical spine injury. Spine. 1997;22(20):2380–2387. [PubMed] [Google Scholar]

107. Penning L. Some aspects of plain radiography of the cervical spine in chronic myelopathy. Neurology. 1962;12:513–519. [PubMed] [Google Scholar]

108. Torg J.S. Cervical spinal stenosis with cord neurapraxia and transient quadriplegia. Sports Med. 1995;20(6):429–434. [PubMed] [Google Scholar]

109. Osterholm J. The catecholamine hypothesis of spinal cord injury. In: Wilkins R, editor. The Pathophysiology of Spinal Cord Trauma. Springfield, IL: Thomas; 1978. pp. 41–45. [Google Scholar]

110. Osterholm J. The histopathology of the wounded spinal cord. In: Wilkins R, editor. The Pathophysiology of Spinal Cord Trauma. Springfield, IL: Thomas; 1978. pp. 17–28. [Google Scholar]

111. Osterholm J, Alderman J, Irvin J. The biochemistry of spinal cord injury. In: Wilkins R, editor. The Pathophysiology of Spinal Cord Trauma. Springfield, IL: Thomas; 1978. pp. 66–87. [Google Scholar]

112. National Operating Committee for Standards on Athletic Equipment. About NOCSAE: history and purpose. http://www.nocsae.org/about/history.html. Accessed April 12, 2008.

113. National Collegiate Athletic Association. Football Rules and Interpretations. Indianapolis, IN: National Collegiate Athletic Association; 2008. p. 32. [Google Scholar]

114. National Operating Committee for Standards on Athletic Equipment. Standard Performance Specification for Recertified Football Helmets. Overland Park, KS: National Operating Committee on Standards for Athletic Equipment; 2004. pp. 1–2. [Google Scholar]

115. Torg J.S, Vegso J.J, O'Neill M.J, Sennett B. The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma. Am J Sports Med. 1990;18(1):50–57. [PubMed] [Google Scholar]

116. Boden B.P, Prior C. Catastrophic spine injuries in sports. Curr Sports Med Rep. 2005;4(1):45–49. [PubMed] [Google Scholar]

117. Tator C.H, Provvidenza C.F, Lapczak L, Carson J, Raymond D. Spinal injuries in Canadian ice hockey: documentation of injuries sustained from 1943–1999. Can J Neurol Sci. 2004;31(4):460–466. [PubMed] [Google Scholar]

118. Torg J.S, Vegso J.J, Sennett B, Das M. The National Football Head and Neck Injury Registry: 14-year report on cervical quadriplegia, 1971 through 1984. JAMA. 1985;254(24):3439–3443. [PubMed] [Google Scholar]

119. Kleiner D.M, Almquist J.L, Bailes J, et al. Prehospital Care of the Spine-Injured Athlete: A Document From the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. Dallas, TX: National Athletic Trainers' Association; 2001. [Google Scholar]

120. Balady G.J, Chaitman B, Foster C, Froelicher E, Gordon N, Van Camp S. Automated external defibrillators in health/fitness facilities: supplement to the AHA/ACSM Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities. Circulation. 2002;105(9):1147–1150. [PubMed] [Google Scholar]

121. Swartz E.E, Nowak J, Shirley C, Decoster L.C. A comparison of head movement during back boarding by motorized spine-board and log-roll techniques. J Athl Train. 2005;40(3):162–168. [PMC free article] [PubMed] [Google Scholar]

122. Weller J, Robinson B, Larsen P, Caldwell C. Simulation-based training to improve acute care skills in medical undergraduates. N Z Med J. 2004;117(1204):U1119. [PubMed] [Google Scholar]

123. Martin M, Scalabrini B, Rioux A, Xhignesse M.A. Training fourth-year medical students in critical invasive skills improves subsequent patient safety. Am Surg. 2003;69(5):437–440. [PubMed] [Google Scholar]

124. Cooper D.J, Ackland H.M. Clearing the cervical spine in unconscious head injured patients: the evidence. Crit Care Resusc. 2005;7(3):181–184. [PubMed] [Google Scholar]

125. Hankins D.G, Rivera-Rivera E.J, Ornato J.P, Swor R.A, Blackwell T, Domeier R.M Turtle Creek Conference II. Spinal immobilization in the field: clinical clearance criteria and implementation. Prehosp Emerg Care. 2001;5(1):88–93. [PubMed] [Google Scholar]

126. Demetriades D, Charalambides K, Chahwan S, et al. Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls. J Trauma. 2000;48(4):724–727. [PubMed] [Google Scholar]

127. Ross S.E, O'Malley K.F, DeLong W.G, Born C.T, Schwab C.W. Clinical predictors of unstable cervical spinal injury in multiply injured patients. Injury. 1992;23(5):317–319. [PubMed] [Google Scholar]

128. Ching R.P, Watson N.A, Carter J.W, Tencer A.F. The effect of post-injury spinal position on canal occlusion in a cervical spine burst fracture model. Spine. 1997;22(15):1710–1715. [PubMed] [Google Scholar]

129. Carlson G.D, Gorden C.D, Oliff H.S, Pillai J.J, LaManna J.C. Sustained spinal cord compression, part I: time-dependent effect on long-term pathophysiology. J Bone Joint Surg Am. 2003;85(1):86–94. [PubMed] [Google Scholar]

130. Eismont F.J, Clifford S, Goldberg M, Green B. Cervical sagittal spinal canal size in spine injury. Spine. 1984;9(7):663–666. [PubMed] [Google Scholar]

131. Delamarter R.B, Sherman J, Carr J.B. Pathophysiology of spinal cord injury: recovery after immediate and delayed decompression. J Bone Joint Surg Am. 1995;77(7):1042–1049. [PubMed] [Google Scholar]

132. Askins V, Eismont F.J. Efficacy of five cervical orthoses in restricting cervical motion: a comparison study. Spine. 1997;22(11):1193–1198. [PubMed] [Google Scholar]

133. James C.Y, Riemann B.L, Munkasy B.A, Joyner A.B. Comparison of cervical spine motion during application among 4 rigid immobilization collars. J Athl Train. 2004;39(2):138–145. [PMC free article] [PubMed] [Google Scholar]

134. McCabe J.B, Nolan D.J. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med. 1986;15(1):50–53. [PubMed] [Google Scholar]

135. Rosen P.B, McSwain N.E, Jr, Arata M, Stahl S, Mercer D. Comparison of two new immobilization collars. Ann Emerg Med. 1992;21(10):1189–1195. [PubMed] [Google Scholar]

136. Bednar D.A. Efficacy of orthotic immobilization of the unstable subaxial cervical spine of the elderly patient: investigation in a cadaver model. Can J Surg. 2004;47(4):251–256. [PMC free article] [PubMed] [Google Scholar]

137. Torg J.S, Guille J.T, Jaffe S. Injuries to the cervical spine in American football players. J Bone Joint Surg Am. 2002;84(1):112–122. [PubMed] [Google Scholar]

138. Gastel J.A, Palumbo M.A, Hulstyn M.J, Fadale P.D, Lucas P. Emergency removal of football equipment: a cadaveric cervical spine injury model. Ann Emerg Med. 1998;32(4):411–417. [PubMed] [Google Scholar]

139. Laprade R.F, Schnetzler K.A, Broxterman R.J, Wentorf F, Gilbert T.J. Cervical spine alignment in the immobilized ice hockey player: a computed tomographic analysis of the effects of helmet removal. Am J Sports Med. 2000;28(6):800–803. [PubMed] [Google Scholar]

140. Palumbo M.A, Hulstyn M.J, Fadale P.D, O'Brien T, Shall L. The effect of protective football equipment on alignment of the injured cervical spine: radiographic analysis in a cadaveric model. Am J Sports Med. 1996;24(4):446–453. [PubMed] [Google Scholar]

141. Swenson T.M, Lauerman W.C, Blanc R.O, Donaldson W.F, III, Fu F.H. Cervical spine alignment in the immobilized football player: radiographic analysis before and after helmet removal. Am J Sports Med. 1997;25(2):226–230. [PubMed] [Google Scholar]

142. National Operating Committee on Standards for Athletic Equipment. Standard Performance Specification for Newly Manufactured Football Helmets. Overland Park, KS: National Operating Committee on Standards for Athletic Equipment; 2003. pp. 1–5. [Google Scholar]

143. Aprahamian C, Thompson B.M, Darin J.C. Recommended helmet removal techniques in a cervical spine injured patient. J Trauma. 1984;24(9):841–842. [PubMed] [Google Scholar]

144. Ray R, Luchies C, Bazuin D, Farrell R.N. Airway preparation techniques for the cervical spine-injured football player. J Athl Train. 1995;30(3):217–221. [PMC free article] [PubMed] [Google Scholar]

145. Jenkins H.L, Valovich T.C, Arnold B.L, Gansneder B.M. Removal tools are faster and produce less force and torque on the helmet than cutting tools during face-mask retraction. J Athl Train. 2002;37(3):246–251. [PMC free article] [PubMed] [Google Scholar]

146. Decoster L.C, Shirley C.P, Swartz E.E. Football face-mask removal with a cordless screwdriver on helmets used for at least one season of play. J Athl Train. 2005;40(3):169–173. [PMC free article] [PubMed] [Google Scholar]

147. Ray R, Luchies C, Frens M.A, Hughes W, Sturmfels R. Cervical spine motion in football players during 3 airway-exposure techniques. J Athl Train. 2002;37(2):172–177. [PMC free article] [PubMed] [Google Scholar]

148. Waninger K.N, Richards J.G, Pan W.T, Shay A.R, Shindle M.K. An evaluation of head movement in backboard-immobilized helmeted football, lacrosse, and ice hockey players. Clin J Sport Med. 2001;11(2):82–86. [PubMed] [Google Scholar]

149. Woodring J.H, Lee C. Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma. 1993;34(1):32–39. [PubMed] [Google Scholar]

150. Spain D.A, Trooskin S.Z, Flancbaum L, Boyarsky A.H, Nosher J.L. The adequacy and cost effectiveness of routine resuscitation-area cervical-spine radiographs. Ann Emerg Med. 1990;19(3):276–278. [PubMed] [Google Scholar]

151. Gerrelts B.D, Petersen E.U, Mabry J, Petersen S.R. Delayed diagnosis of cervical spine injuries. J Trauma. 1991;31(12):1622–1626. [PubMed] [Google Scholar]

152. Davis J.W, Phreaner D.L, Hoyt D.B, Mackersie R.C. The etiology of missed cervical spine injuries. J Trauma. 1993;34(3):342–346. [PubMed] [Google Scholar]

153. Poonnoose P.M, Ravichandran G, McClelland M.R. Missed and mismanaged injuries of the spinal cord. J Trauma. 2002;53(2):314–320. [PubMed] [Google Scholar]

154. Griffen M.M, Frykberg E.R, Kerwin A.J, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan. J Trauma. 2003;55(2):222–227. [PubMed] [Google Scholar]

155. Waninger K.N, Rothman M, Foley J, Heller M. Computed tomography is diagnostic in the cervical imaging of helmeted football players with shoulder pads. J Athl Train. 2004;39(3):217–222. [PMC free article] [PubMed] [Google Scholar]

156. Guest J.D, Dietrich W.D. Spinal cord ischemia and trauma. In: Tisherman S.A, Sterz F, editors. Therapeutic Hypothermia. Dordrecht, The Netherlands: Kluwer Academic Publishers; 2005. pp. 101–118. [Google Scholar]

157. Couzin J. Medicine: the big chill. Science. 2007;317(5839):743–745. [PubMed] [Google Scholar]

158. Yu C.G, Jimenez O, Marcillo A.E, et al. Beneficial effects of modest systemic hypothermia on locomotor function and histopathological damage following contusion-induced spinal cord injury in rats. J Neurosurg. 2000;93(suppl 1):85–93. [PubMed] [Google Scholar]

159. Chatzipanteli K, Yanagawa Y, Marcillo A.E, Kraydieh S, Yezierski R.P, Dietrich W.D. Posttraumatic hypothermia reduces polymorphonuclear leukocyte accumulation following spinal cord injury in rats. J Neurotrauma. 2000;17(4):321–332. [PubMed] [Google Scholar]

160. Green B.A, Khan T, Raimondi A.J. Local hypothermia as treatment of experimentally induced spinal cord contusion: quantitative analysis of beneficient effect. Surg Forum. 1973;24:436–438. [PubMed] [Google Scholar]

161. Busto R, Dietrich W.D, Globus M.Y, Ginsberg M.D. Postischemic moderate hypothermia inhibits CA1 hippocampal ischemic neuronal injury. Neurosci Lett. 1989;101(3):299–304. [PubMed] [Google Scholar]

162. Green E.J, Pazos A.J, Dietrich W.D, et al. Combined postischemic hypothermia and delayed MK-801 treatment attenuates neurobehavioral deficits associated with transient global ischemia in rats. Brain Res. 1995;702(1–2):145–152. [PubMed] [Google Scholar]

163. The Miami Project to Cure Paralysis. Clinical trials initiative: therapeutic hypothermia for acute spinal cord injury and traumatic brain injury. http://216.235.203.137//Page.aspxpid339. Accessed May 10, 2008.

164. Bracken M.B, Shepard M.J, Collins W.F, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405–1411. [PubMed] [Google Scholar]

165. Kwan I, Bunn F. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20(1):47–53. [PubMed] [Google Scholar]

166. Mazolewski P, Manix T.H. The effectiveness of strapping techniques in spinal immobilization. Ann Emerg Med. 1994;23(6):1290–1295. [PubMed] [Google Scholar]

Page 2

Combined High School and College Catastrophic Injury Data in Select Sports Derived From the National Center for Catastrophic Sport Injury Research, Fall 1982 Through Spring 20073,a