This is the page you read while it is happening. The protocol below is the next 10 minutes when you suspect a spinal injury.
The thing this protocol prevents: a temporary injury that becomes permanent because the wrong move was made in the first minutes. Cervical-spine injuries that arrive at the hospital with stable spinal anatomy have dramatically better outcomes than those that arrive with displacement caused by movement after the initial trauma.
Recognize.
The mechanism. Head-first or feet-first contact with the ground or a fixed object. Diving into shallow water. Direct blow to the head, neck, or back from a fall, collision, or impact. Cheer or gymnastics fall from height.
The kid’s status. Not moving on their own. Reports neck pain, tingling, numbness, or weakness in the arms or legs. Cannot move arms or legs. Has noticeable difficulty breathing.
If any of those are present, treat as a possible spinal injury until ruled out by hospital imaging.
Do not move the kid.
The most important step. Even if you are sure they are fine. Even if the kid says they want to get up. Stabilize the head in the position you find it.
How: kneel above or beside the kid’s head. Place one hand on each side of the head, just behind the ears. Apply gentle inward pressure to keep the head from rotating. Maintain neutral neck alignment.
Do not lift the head. Do not turn the head to face you. Do not put a pillow under the head.
Stay in this position until emergency medical services (EMS) arrives. This may be 10 to 15 minutes. Your hands do not move during that time.
Call 911.
Immediately. State “suspected spinal injury at [location].” Dispatch will send spinal-precautions equipment (cervical collar, backboard, log-roll capable team).
Confirm address and gate access. EMS access to the field is part of every program’s emergency action plan; the team manager or coach should know the access point.
The helmet question.
For football-equipped athletes, the helmet stays on. National Athletic Trainers’ Association (NATA)‘s position statement is direct: do not remove the helmet at the field for a suspected spinal injury. The helmet and shoulder pads form a unit that maintains cervical alignment. EMS removes them together at the hospital, with trained personnel, on a backboard.
For sports without helmets (cheer, gymnastics, swim), the head is stabilized directly by hand.
The face-mask question.
If the football player is breathing and the airway is clear, do not touch the face mask.
If the athlete is not breathing or has airway compromise, the face mask can be removed (cut, with a tool kept in the team’s first-aid bag) without removing the helmet itself. The mask comes off; the shell stays on. This is a NATA-published technique that requires training.
Prone (face-down) and breathing fine.
Stabilize the head in the prone position. Wait for EMS. They will perform a coordinated log-roll to supine.
Prone and not breathing.
The exception to “do not move.” Airway is the priority. Coordinated log-roll to supine, maintaining cervical alignment, with the most adults possible (4 to 5 ideal). Begin rescue breathing or cardiopulmonary resuscitation (CPR).
This is the scenario where training matters most. If you are not trained, hold cervical alignment and wait. Untrained log-rolling can cause additional spinal injury.
Conscious and talking.
Tell the kid not to move. Tell them what is happening. Do not promise outcomes. Do not say “you’ll be fine” because you do not know.
What you can say: “Help is on the way. Stay still. Look at me. Tell me if anything changes.”
Documentation.
After the kid is in EMS care, document the mechanism of injury for the receiving hospital. What happened, what hit what, from what angle, how the kid landed, how long they were down, when symptoms started. The receiving emergency physician needs this.
For coaches and team managers.
A pre-season EAP (emergency action plan) addresses spinal injury specifically. Practice the scenario at the start of every season. Rehearse the call to 911, the head stabilization, the EMS access, the parent notification.
For high-risk sports (football, cheer, hockey, lacrosse-boys, gymnastics, diving, swimming), the EAP should specify which adults are designated for head stabilization, which adult calls 911, which adult meets EMS at the access point.
Prevention is the better topic.
Most cervical-spine injuries in youth sports are preventable through tackling technique (heads-up tackling, no spearing in football), age-progression rules (no checking below age 12 in hockey), diving rules (no diving in shallow water, no diving from pool deck), and equipment standards.
But this is the protocol for when prevention failed.
The honest read. Spinal injuries in youth sports are rare. The kids who recover most fully are the ones who arrived at the hospital with stable spinal alignment because the adults at the field knew the protocol. The kids who don’t are often the ones moved by well-meaning adults who did not know to wait. Stabilize. Call 911. Wait.