Cervical spine injury

FIFA SKILL ZONE FILM

FIFA's own film of the full set piece. Tap play — needs a connection.

CLEARING THE CERVICAL SPINE

FIFA: the spine is cleared only if all 6 are met.

1. No midline tenderness
2. Glasgow Coma Scale (GCS) 15
3. No distracting injury
4. No neurology
5. No concerning mechanism (e.g. fall onto the head, axial load)
6. Active range of movement: 45° lateral rotation to each side — the player moves, not the clinician

• Start manual in-line stabilisation (MILS) and palpate for midline tenderness.
• An alert, conscious player splints their own neck — an early collar is not required.
• Clearing can wait until the primary survey is done. The collar goes on as part of extrication.
• FOCUS red flags for the neck: midline tenderness, restricted active movement, unexplained limb weakness or sensory change, numbness / tingling.

THE SET PIECE — BY COLOUR

Colours match the FIFA Pre-Match Emergency Action Plan roles. May flip all positions depending on the site of injury and hazards.

1. 1

   SUSPECTED CERVICAL SPINE INJURY — CANNOT BE RULED OUT CLINICALLY

   BLACK

   Team leader. Focus on good communication. Ensure the ambulance is called.

   ORANGE

   Immobilise the cervical spine (MILS).

   RED

   A (c-spine) B C assessment.

   GREEN

   Bring the FIFA bag. Assist as directed by the team leader.

   BLUE

   Bring oxygen.

   WHITE

   Bring the scoop and splints. Assist as directed by the team leader.

2. 2

   AIRWAY ASSESSMENT

   ORANGE

   Jaw thrust (immobilise the spine).

   RED

   Apply an airway adjunct and / or trauma mask if needed.

   BLUE

   Oxygen at 15 L/min to the trauma mask.

3. 3

   BREATHING ASSESSMENT

   ORANGE

   Immobilise the spine. Inform if any airway issues.

   RED

   Respiratory rate. 2 hands on 3 places.

4. 4

   CIRCULATION ASSESSMENT

   ORANGE

   Immobilise the spine. Inform if any airway issues.

   RED

   Pulse rate. 2 hands on 3 places.

5. 5

   DISABILITY ASSESSMENT

   ORANGE

   Immobilise the spine. Inform if any airway issues.

   RED

   AVPU (alert, voice, pain, unresponsive). 2 pupils. Motor and sensation in 3 places.

6. 6

   SET UP TO EXTRICATE AS PER THE FIFA SET PIECE

   Scoop and basket below the feet, in line with the player.

   ORANGE

   Immobilise the spine. Inform if any airway issues. Lead the log roll.

   RED

   Size and apply the collar, then reassess the airway. Chest in the log roll.

   BLUE

   Pelvis in the log roll.

   WHITE

   Legs in the log roll.

   GREEN

   Prepare to assist / apply the extrication device.

7. 7

   EXTRICATION DEVICE APPLIED

   ORANGE

   Immobilise the spine until blocks and tape are on — then you can remove your hands.

   RED

   Apply straps. Apply blocks, then tape. Reassess.

   BLUE

   Apply straps.

   WHITE

   Apply straps.

8. 8

   UTILISE THE BASKET (IF PRESENT) — EXTRICATE USING 6 PEOPLE IF POSSIBLE

Hands On 1, 2, 3: 1 observation, then 2 hands on 3 places — for B, C and D.

COLLAR AND HEAD BLOCKS

1. Maintain MILS throughout.
2. Size: neutral head, line from the chin back to the sternomastoid, measure fingerbreadths down to trapezius.
3. Between two sizes → start with the SMALLER one (too big extends the neck).
4. Position the posterior section; support the chin in the chin piece. Secure without over-tightening.
5. Check the mouth can still open, then reassess the airway.
6. Blocks placed evenly, fixed to the device, then tape. Keep access to the airway and ears.

MILS → SIZE → COLLAR → STRAPS → BLOCKS → TAPE → RELEASE

• Contraindication: airway obstruction — keep MILS instead until the airway is dealt with.
• A collar alone does not immobilise. Keep MILS until blocks and tape are on.
• Follow local guidance — some countries no longer use collars.

LOG ROLL AND EXTRICATION

Head (Orange)

MILS. Controls the move: explains the signal and says how far — 90° log roll, or a 15–20° tilt for a scoop.

Chest (Red)

One hand on the far shoulder, one on the hip.

Pelvis (Blue)

One hand on the waist, the other under the knee.

Legs (White)

One hand under the lower leg, the other under the ankle.

Fifth person (Green)

Places the scoop or board.

Extrication order

1. Size and fit the collar — check the mouth can still open.
2. Log roll or tilt onto the scoop — Orange leads the count.
3. Apply straps — the first, centre strap lined up with the sternum.
4. Apply head blocks and fix them to the device, then tape.
5. Only now can MILS be released.
6. Slide the basket under the scoop and extricate with 6 people if possible.

For trauma: scoop stretcher and basket, set up below the feet in line with the player — basket 2–3 lengths away. A scoop moves the player only ~15° instead of a 90° log roll.

MORE FILMS

Assessment, set-up, collar, log roll and scoop. Each film opens on its owner's website.

FIFA POSTER AND DOWNLOADS

Tap to open full size and zoom in.

• FIFA Set-Piece Protocol — cervical spine injury (poster)
• Medical Set Piece — Protocols for on-field interventions (9 MB)
• Medical Set Piece — Roles within the PEAP (role cards)
• FIFA Emergency Care Manual (PDF, 45 MB)

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