Players with suspected neck injuries may no longer be fitted with a neck brace in the NRL after a report stated the practice did not "outweigh harms such as increased pressure injuries".
The NRL has made recommendation to club doctors after a guideline was handed down by the Australian Resuscitation Council, which stated "the use of semi-rigid cervical collars by first-aid providers is not recommended".
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In a report obtained by Fairfax Media, the use of the cervical collar does not "outweigh harms such as increased intracranial pressure, pressure injuries or pain and unnecessary movement that can occur with the fitting and application of a collar".
Instead of the brace the council stated that "manual support of the head in a natural, neutral position, limiting the angular movement" should be undertaken. The report goes on to say that for "healthy adults padding under the head may optimise the neutral position".
NRL chief medical officer Paul Bloomfield said while the use of neck braces was not banned, there is a push to move away from it.
"I wouldn't call it a massive shift because the guidelines talk about not applying semi-rigid collars in the pre-hospital setting," Bloomfield said. "It doesn't say you can't do it. It's been in the workings for a year or so. The collar is a warning device and you can still move in the collar.
"It's not the NRL's guidelines, it's the council's guidelines. We are adopting the guidelines. In some cases there may be still some reasons to apply the collar correctly. As a general rule, they may not apply it."
The first instance of the new guidelines in use was when Manly prop Jake Trbojevic was injured during the Auckland Nines. Whereas in the past he may have been fitted with a neck brace, his neck was instead given support by a trainer as he was taken from the field in a medicab. Spinal boards will still be used.
"You'll see a trainer holding a player's head," Bloomfield said. "They hold their traps with their forearms on either side of the head. That locks their neck in line with the rest of their body."
Chief medical officers at NRL clubs underwent a two-day course on managing trauma from cardiac arrests to neck and head trauma last November. Orange-shirt trainers at each club have also undergone a compulsory course as the NRL has this year implemented a concussion management course and a spinal management and advanced resuscitation course which is compulsory before any orange-shirt trainer steps onto the field.
They were also shown the new spinal injury treatment at the course earlier this year. "We have reviewed the guidelines," Bloomfield said. "Everyone has been trained and knows about the guidelines from the doctors to the trainers."