If the athlete is not breathing, start rescue breathing. For a football or ice hockey player, rescue breathing or CPR can be done with the helmet and shoulder pads in place once the face mask has been removed. Open the airway with a jaw-thrust maneuver, not neck hyperextension. If breathing is absent after 3 to 5 seconds, give respirations. Similarly, CPR must be started if the athlete has no carotid pulse.
Circulation is maintained through chest compressions.
If the patient has profuse bleeding, apply direct pressure with a sterile or clean dressing if possible. The major artery supplying the area can also be compressed. In transporting the patient to the emergency department or trauma center, protective equipment should be left on because spinal alignment is closest to normal when the helmet and shoulder pads are in place. The head and neck should be stabilized at all times, and a spine board should be used. Transport can cause displacement of unstable cervical spine injuries and even lead to permanent spinal cord sequelae.