Surprisingly, considering the mechanism of injury, very few riders seem to sustain cervical spine injuries unless severely injured. However a high index of suspicion must be maintained. If you are not confident or experienced at assessing the C Spine then always play it safe and immobilise. Remember clearing the C spine is not a high priority as long as it is correctly immobilised.

Adequate C spine immobilisation at the track must be either

1) Manual in line immobilisation by a competent person or
2) Appropriately sized hard collar, head blocks and straps with immobilised torso on a spine board

Anything else is suboptimal.

Clinical Clearance of the C Spine

The c spine may be clinically cleared by senior, experienced clinicians if the following preconditions are met:

1) GCS 15 and appropriate
2) Not under influence of drugs or alcohol (not an issue in racers)
3) No significant distracting injuries e.g long bone fractures
4) No neurological impairment that may be explained by C spine injury (i.e abnormal tone, power, reflexes)
5) No midline palpable c-spine tenderness, deformity or steps


If these preconditions are met then cautious mobilisation of the spine may proceed. Close observation during immobilisation is essential. With helmet off and c spine imobilised by a colleague I ask the rider to slowly look left then right. If okay then I ask them to put their chin on their chest. If there is no pain or neurology I consider the neck clear. If any pain or symptoms were to develop later then immobilisation must be immediately reinstituted.
(adapted from the Intensive Care Society Guidelines 2005)

"IF IN DOUBT, GET THE HEAD BLOCKS OUT"

"Why not just immobilise every fallen rider and send them to hospital?"

- collars may cause pressure sores
- collars are uncomfortable
- immobilisation makes treatment of the patient more difficult (especially airway management)
- waste of resources
- would make race meetings difficult to run as every rider would need ambulance transportation to hospital
- bad medicine