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I am an experienced EMT just starting to work with young children (ages eight to 12) in football leagues in our local community. I'm familiar with the guidelines for adults injured on the field. What do they say about children with neck injuries? Do we transport them with or without the helmet?
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It has been assumed that the adult guidelines of keeping all protective gear on during transport applies to children, too. But EMTs, athletic trainers, and physicians are giving this a second thought.
Studies show that young children have an increased head-to-torso size ratio compared to adults. Variable growth rates make this ratio different from child to child. Maybe this ratio difference doesn't matter but until recently, we had no evidence to support or negate the idea.
But thanks to a group at the University of Virginia, we now have some reliable recommendations for emergency transportation for children ages eight to 14. They X-rayed a group of 31 young athletes involved in football. Three radiographic views were taken.
The base of the skull and cervical spine were the main focus areas. The child was placed supine (on his back) and X-rayed without the protective equipment. The second X-ray was taken in the same position with shoulder pads only. The third view was with helmet and shoulder pads.
Two physicians independently measured angles of the cervical spine. They used the standard Cobb measurement for C1 to C7 and the Gore measurement from C2 to C7. The angles were then compared among the three radiographic views. Each child's height, weight, and age were factored into the analysis.
Based on their findings, the authors recommended transporting pediatric patients with a potential neck injury with helmet and shoulder pads in place. The equipment aligns the cervical spine better than just one or the other. These guidelines only apply to football players. Further study is needed to identify the best way to manage and/or transport ice hockey or lacrosse players with cervical spine injuries.
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