EMS Management of Catastrophic Cheerleading Injuries

EMS management of catastrophic cheerleader injuries

This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail editor@EMSWorld.com.


  • Outline cheerleader injury rates
  • Discuss mechanism of injury
  • Review trauma triage
  • Discuss spinal cord injury management
  • Explain assessment and prehospital management of traumatic brain injuries


   Thirty years ago, cheerleading was limited to energetic toe touch jumps, splits, claps and pom-pom shaking. Today, cheerleading routines include more technical tumbling, partner stunts, multilevel pyramids, lifts, catches and tosses. Likewise, the number and severity of injuries seen at all levels of cheerleading has increased. With over 3.6 million cheerleaders in the United States, it is reasonable to believe that many EMS providers will have the opportunity to respond to an emergency at a cheerleading event at some point during their careers.1

Injury Rates

   Cheerleading begins at an early age. The All-Star Cheerleading organization lists its youngest age division as "5 years and younger." There are also youth recreational leagues, middle school, high school and collegiate divisions. Cheerleading is not limited to females, although only 4%-7% of cheerleaders in the United States are male.2

   According to Frederick O. Mueller, PhD, of the National Center for Catastrophic Sports Injury Research (NCCSIR), almost 26,000 cheerleaders presented to emergency departments in the United States for assessment of injuries in 2007,3 but this number only represented 22% of all injuries reported.4 Forty-eight percent of the injured cheerleaders were treated on scene or in an athletic trainer's office; 30% went to a physician's office or an urgent care center; and 98% of those who sought out emergency department care were treated and released.3 The article did not report the percentage of cheerleaders transported to the emergency department by EMS.

   A 2008 report from the NCCSIR claimed that fatal and life-altering injuries sustained while cheerleading were increasing at an alarming and unacceptable rate.3 Between 1982 and 2008 the report identified 10 deaths and 66 serious injuries, such as spinal cord injuries or head trauma, directly or indirectly related to cheerleading activities. The authors concluded that cheerleading was the leading cause of catastrophic injuries for all high school and college females and potentially more dangerous than football.

   Although the NCCSIR data was widely reported by the media, several cheerleading authorities refuted the information as inaccurate, incomplete and overstated. At the time, there was limited knowledge about the number of cheerleaders in the United States and what the overall injury rate was for the activity. Newer information demonstrates that high school and collegiate female cheerleaders suffer catastrophic injuries at a rate of 0.39 per 100,000 participants, compared with 1.41 for female gymnastics, 1.78 for male football, 2.76 for female ice hockey and 4.08 for male gymnastics.5 Other sources report that the overall injury rate for cheerleading is one injury for every 1,000 athletic encounters.4

Scene Survey

   As an EMS provider approaches the scene of an injury, he must assess the whole situation, which includes scene safety as well as mechanism of injury. While sports events and practices will generally not be considered dangerous environments, keep an eye open for ongoing activities that may produce fly balls, errant power kicks or players running out of bounds and into your scene.

This content continues onto the next page...