Spinal motion restriction, full spinal precautions and patient movement can look different across disciplines. A brief medical time-out can help turn those differences into a coordinated continuum of care.
The ambulance crew arrives on the field to find an athletic trainer already at the athlete’s head maintaining manual cervical stabilization.
The patient is supine. A cervical spine injury has not been ruled out. EMS begins its assessment and prepares a cervical collar.
Then come two questions that may reveal just how differently the disciplines have been trained.
“Are we putting them on a board?”
Maybe.
“If so, are we going to log roll?”
Maybe not.
Neither answer necessarily reflects a difference in competence or judgment. Athletic trainers and EMS clinicians are trained medical professionals working in different clinical environments under protocols that sometimes overlap and appear to point in different directions.
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Two clinical worlds meet on the field
EMS has increasingly moved away from routine spinal immobilization toward spinal motion restriction (SMR).
The joint position statement from the National Association of EMS Physicians, American College of Surgeons Committee on Trauma and American College of Emergency Physicians emphasizes minimizing unwanted spinal movement rather than attempting literal spinal immobilization. It also limits the routine role of the long backboard.
Sports medicine may approach the same patient through a different protocol framework. An athletic trainer unable to rule out a catastrophic cervical spine injury may be more inclined toward full spinal precautions and transfer to a rigid device.
Neither approach is inherently outdated or less cautious. Athletic trainers and EMS clinicians are distinct medical professionals, each working within the training, protocols and standards of their respective discipline while caring for the same patient.
The challenge is determining how those systems meet.
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Then there is the question of movement
If the decision is made to use a rigid device, another difference may emerge.
Many EMS clinicians were taught the coordinated log roll as the standard way to place a supine patient on a long spine board. Sports medicine has increasingly emphasized lift-and-slide or multiperson lift techniques for the supine athlete.
There is biomechanical evidence behind that preference. Studies involving destabilized cervical spines have demonstrated greater lateral flexion and axial rotation during log rolling than with some lift-and-slide techniques. In a football-specific cadaver study comparing three transfer techniques, the multiperson lift produced the least movement across the unstable cervical segment.
That does not mean the log roll is inherently dangerous, and rolling remains necessary in some circumstances, particularly with a prone patient.
But if the patient is already supine, it is reasonable to ask whether rotation is necessary.
The lift is not foreign to EMS
The lift-and-slide is not exclusive to athletic training.
Cooney’s “EMS Medicine” discusses log-roll and lift-and-slide techniques in spinal injury management. EMT educational material addressing the spine-injured athlete specifically teaches a multiperson lift-and-slide, and describes either the EMT or athletic trainer maintaining spinal alignment as directing the maneuver. EMS literature has also described five- and six-rescuer variations.
Some EMS systems incorporate the concept directly into protocol. Imperial County EMS Agency in California permits either a log roll or multiperson lift when moving a patient requiring SMR, while also reflecting the modern SMR model and generally discouraging routine backboard use.
The lift is another contemporary EMS patient-movement option.
The equipment does not solve every problem
Split and scoop-type devices can reduce the movement required compared with placing a conventional long spine board beneath a patient, but they do not always eliminate movement.
On a hard, noncompliant surface, positioning the cranial portion beneath a supine patient’s head and upper torso may still require controlled lateral movement or some degree of roll.
The limitation does not make the device ineffective. It reinforces that no single device or movement technique is ideal for every situation.
A scoop may make sense with limited personnel, a lift when enough trained rescuers are available, and a controlled log roll because of patient position or circumstances.
The goal is to minimize unnecessary movement.
A medical time-out
One practical way to manage the overlap between EMS and athletic training protocols is a brief medical time-out.
A natural point is immediately after cervical collar application, when indicated. By then, the athletic trainer has often provided initial stabilization and EMS has joined the assessment.
Before further movement occurs, pause for a few seconds.
The EMS crew chief and athletic trainer can confirm: Does the patient’s presentation call for EMS-style SMR or full spinal precautions? Are we placing the patient on a rigid device? If so, which device? Given the patient’s position, surface, protective equipment and available trained personnel, what is the most appropriate transfer technique?
Then move.
The time-out does not create a new protocol. It creates a communication point between two existing ones.
When the protocols lead in different directions
There may still be occasions when athletic training protocol favors full spinal precautions, while EMS protocol supports SMR without long-board immobilization.
That should not become a contest over which clinician is correct. It can simply become a clear transition in responsibility: “EMS is assuming primary patient care.”
There is value in stating that transition out loud. The phrase establishes a common operating picture: the patient is moving from joint care into EMS primary care, and the governing protocol framework is transitioning with it.
It marks the transition into the EMS treatment and transport phase without diminishing the athletic trainer’s clinical role or the care provided before that handoff.
The continuum is straightforward: Athletic training → joint AT/EMS care → EMS primary care
That is not one discipline overriding another. It is a clinical handoff.
Don’t meet each other during the emergency
Athletic-event EMS coverage should be more than parking an ambulance at the stadium.
A potential catastrophic cervical spine injury is a poor time for an EMS crew to discover how the athletic trainer approaches spinal precautions. It is an equally poor time for an athletic trainer to discover that the EMS system no longer routinely places the same patient on a long spine board. Neither group should discover during the emergency that one intends to log roll while the other intends to lift.
Athletic trainers and EMS clinicians are both essential members of the athlete’s emergency care team. They bring different scopes of practice, protocols and clinical responsibilities developed in different environments.
The answer is to train together, understand each other’s protocols and determine in advance how they will intersect when both disciplines are caring for the same patient.
That creates something more valuable than event standby coverage.
It creates a clinical partnership.
One patient, two protocols, one continuum
Athletic trainers know the athlete, the sport, the equipment and the injury environment. EMS brings prehospital assessment, resuscitation and transport capabilities along with a direct connection to the broader emergency and trauma system.
Neither discipline needs to surrender its clinical identity.
SMR or full spinal precautions? Log roll, lift or scoop?
Those decisions should be addressed deliberately rather than discovered in the seconds before patient movement. One patient may temporarily exist in two clinical worlds. The goal is to make the transition between them seamless.
And everyone should know what comes next before anyone says, “On three.”
