In a suspected cervical spine injury with an awake athlete, what immobilization approach should you take on-field?

• A. Apply a rigid cervical collar immediately and move the athlete carefully.
• B. Maintain manual in-line stabilization of the head and neck, minimize movement, and involve EMS; avoid neck movement unless necessary and trained to immobilize.
• C. Roll the athlete onto the back and transport without stabilization.
• D. Remove all immobilization and transport with minimal care.

Answer: (B)

Protecting the cervical spine starts with preventing movement. The best on-field approach is to hold the athlete’s head and neck in a neutral position with manual in-line stabilization, minimize any movement, and call EMS so they can apply proper immobilization and transport. This keeps the spine aligned while you assess and prepare for safe transport, reducing the risk of worsening a potential injury. Only move or reposition if you are trained to immobilize and it’s an absolute necessity (like airway management), and then use techniques that maintain spinal alignment. Do not remove stabilization or move the neck without proper immobilization in place. Involve EMS early so they can apply a collar and secure the athlete for transport.