Cervical Spine Injury Policy Adoption: Describing High Schools' Readiness Using the Precaution Adoption Process Model

Context: Best practices to manage cervical spine injury (CSI) in sport have been published, yet knowledge of their use is unknown. Objective: To explore adoption of CSI management policies by high school (HS) athletic trainers (ATs) and their associated behaviors, barriers, and facilitators. Design: Cross-sectional study. Setting: Online survey platform. Patients or Other Participants: Athletic trainers providing medical services to US HSs. Main Outcome Measure(s): The precaution adoption process model was used in an online questionnaire to determine the stage of adoption by ATs for each CSI management policy component. Components obtained from the National Athletic Trainers' Association position statement on acute management of an athlete with a CSI included immediate care, emergency tools to remove equipment, and maintenance of equipment -removal skills. Questions assessed AT demographics, HS characteristics, and facilitators and barriers to policy adoption. Data are presented as proportions and associations determined through chi(2) analysis (P < .05). Results: A total of 508 ATs' responses were included. Of these ATs, 33.1% reported adoption of incomplete policies (<3 components of a CSI management policy, n = 168; 95% CI = 29.0%, 37.1%), and 66.9% reported adoption of comprehensive policies (n = 339; 95% CI = 62.9%, 71.0%). A significant association was found between coordination of CSI policies with emergency medical services (EMS) and adoption of the policy components for comprehensive immediate CSI care (chi(2)1 = 49.56, P < .001), emergency tools for athletic equipment removal (chi(2)1 = 41.49, P < .001), and the practice and maintenance of equipment -removal skills (chi(2)1 = 86.12, P < .001). Approximately two-thirds (66.5%) reported that a positive relationship with EMS (n = 338; 95% CI = 62.4%, 70.7%) was a facilitator, whereas 42.5% reported challenges with local EMS as a barrier (n = 216; 95% CI = 38.2%, 46.9%). Conclusions: Immediate care and emergency tool policy components had the highest rates of adoption. Higher rates of adoption in this project were associated with coordination of CSI policies with local EMS. Athletic trainers also reported challenges in coordinating with EMS. Interventions to improve collaboration, training, and interprofessional respect between ATs and EMS personnel may improve policy adoption.