Open Water Cervical Spine Injury

Acute, traumatic cervical spine injuries require a swift and coordinated response for optimal neurologic preservation. This presents a distinct challenge in open water sports where the environment poses unique dynamic hazards and the need for coordinated care. The patient in this case suffered a direct impact to his head and neck during the open water portion of a triathlon in the San Francisco Bay. Prehospital medical rescue teams promptly recognized the swimmer in distress, rapidly extracted him from the event, and transported him to the nearest trauma center. With severe distal weakness greater in the upper extremities than the lower extremities and a supporting Magnetic Resonance Imaging (MRI), he received prompt surgical treatment for acute central cord syndrome with improved neurologic recovery. Furthermore, this case report discusses the risks and benefits of Spinal Motion Restriction (SMR) in both an urban and aquatic environment in the context of evolving standards of care and EMS controversies.