ST. LOUIS (AP) — A national medical group that represents athletic trainers is calling for more rigorous standards to treat sports-related spine injuries, including the immediate removal of helmets and other equipment before a patient goes to the hospital.

A treatment protocol last revised in 1998 recommends that equipment worn by athletes with potential spinal cord injuries not be removed on the field. Advances in safety equipment technology are among the reasons cited by the National Athletic Trainers’ Association in its updated policy.

The group released its revised guidelines Wednesday at its annual convention in St. Louis. Adherence to the new standards is voluntary.

The trainers’ association estimates that more than 1,100 spinal cord injuries occur each year due to participation in sports and recreational activities.