On-field management of a suspected cervical spine injury in an awake athlete, which practice is preferred?

• A. Apply a hard cervical collar immediately and move the athlete.
• 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. Remove all mouthguard and allow to speak to determine orientation.
• D. Roll the athlete onto the stomach to facilitate breathing.

Answer: (B)

Stabilize the spine first. When there’s a suspected cervical spine injury and the athlete is awake, the priority is to prevent any movement of the head, neck, and spine to avoid worsening potential damage to the spinal cord. Using manual in-line stabilization keeps the head and neck in a neutral position with minimal motion until proper immobilization can be applied by trained personnel.

Involve emergency medical services so they can apply definitive immobilization devices (like a rigid collar and backboard) and transport safely. This approach balances protecting the spinal axis with maintaining airway and breathing, especially since the athlete is conscious and may attempt to move or speak.

Avoid neck movement unless it’s absolutely necessary and you are trained to immobilize—improper or untrained movement can convert a stable injury into a more serious one. Removing a mouthguard to check orientation or rolling the athlete onto the stomach would increase risk to the airway and the spine, respectively, and should not be done.

So the best on-field practice is manual in-line stabilization, minimizing movement, and calling EMS for appropriate immobilization and transport.