The relative incidence of catastrophic cervical spine injury in sports is low compared to other injuries. However, the potential catastrophic and life-altering consequences of spine injury cause understandable concern regarding the prehospital management and care of the cervical-spine-injured athlete. This is complicated when injured athletes participate in equipment-intensive sports, such as football, where helmets and facemasks are potential barriers to obtaining immediate access to the athlete's airway. Cervical spine injuries in these cases necessitate delicate and precise management, often involving the combined efforts of multiple health-care providers. The outcome of a catastrophic cervical spine injury is dependent on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment.