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Derek Wolfe And On-The-Field Neck Injuries

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cspine 7-12-2009

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Written by Dr. Dave Hnida, CBS4 Medical EditorFew things as frightening as a neck injury: to the player, his family, teammates, the crowd and … the medical staff.

As medical staff, you worry about what happened to the neck, and then worry about how you are going to help that player without causing more injury.

One wrong movement as you check and then transport the player, and you can wind up causing paralysis.

By now, you’ve probably heard that Derek Wolfe checked out okay, and flew back to Denver with the team. But there was enough concern to stop play for nine minutes, and cautiously but quickly get him to a hospital.

Here’s the way it generally works when someone goes down, all the while keeping in mind that a player may have an injury that you can make worse. They may be able to move an arm or leg — which is reassuring — but not full-blown proof that the neck is fine.

This is a typical scenario, which is often tweaked:

You start with the basics.

ABC. Airway. Breathing. Circulation. A spinal cord injury can injure the nerves that control breathing. You talk to the player and hope the answers regarding pain or numbness are what you want to hear.

You remove the mouthguard. You then remove the facemask with tools so you have access to the airways, if needed.

The helmet and shoulder pads stay on.

You quickly make sure there are no other serious injuries.

When you’re finally ready to move, you need a minimum of five, preferably six people to move the player. The typical movement is a “log roll” of the player onto a rigid back board. One person is in charge — the one at the head of the board who makes sure the head and neck don’t move out of alignment.

Thick foam blocks are placed on each side of the head, and the head is taped securely to the board.

At the emergency department, things start from near-scratch. Hospital doctors and neurosurgeon/orthopedist perform a fresh head-to-toe evaluation. While that’s being done, sometimes a portable X-ray is taken of the neck to check for obvious fractures or dislocations.

But an X-ray misses a lot. That’s why players are then transported to the CAT scanner where more detailed images can be taken. The pads and helmet are still on.

If the CAT scan is clear, the helmet and pads might then be removed so an MRI can follow. Taking off the helmet and pads is a practiced science — you don’t just yank them off, they come off simultaneously. And it’s a removal that gets practiced over and over beforehand so it’s done correctly in real life.

By the way, the reason we know about the proper techniques and timing of helmet and pad removal is kind of interesting. Researchers used cadavers and CAT scanners in a lab setting to measure the amount of movement when the spine is moved a certain way — as either a helmet or shoulder pads are removed. So, there is a lot of science behind handling these injuries.

The MRI looks at the disks, nerves, ligaments, and other structures to make sure they are OK.

All the while, you continue to eyeball the patient, and repeat exams are done.

(The rule in medicine is “treat the patient, not the images,” even though the images from the CAT scan and MRI are invaluable.)

Medical staff attends to Derek Wolfe during the Broncos preseason game in Seattle on Aug. 17, 2013. (credit: CBS)

Medical staff attends to Derek Wolfe during the Broncos preseason game in Seattle on Aug. 17, 2013. (credit: CBS)

And that why Derek Wolfe got to fly home with the team — his scans were good, and his exam was stable, allowing him to travel back to Denver so quickly.

That’s when everyone let out a big sigh of relief.

RELATED: Derek Wolfe Says He’ll Be Back On The Field Soon

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