Catastrophic neck injury is defined as a structural distortion of the cervical spinal column associated with actual (or potential) damage to the spinal cord. Although uncommon, this type of traumatic injury can lead to severe neurologic sequelae in the collision sport athlete. Emergency care is complicated by the helmet and shoulder pads worn by the athlete. A thorough understanding of the clinical anatomy, diagnostic considerations, and protocols for on-site evaluation and management is necessary to optimize outcome.