# Sport Helmet Removal



## bryncvp (Jul 7, 2010)

Going along with the motorcycle helmet thread..

As an athletic trainer (sports medicine..not personal training) I use to work with a equipment intensive sports that had shoulder pads, a helmet and a facemask/sheild (lacrosse, football and ice hockey) We (athletic trainers) are taught, and this goes along with every team physician I know, that we leave the helmet in place and backboard as is using the shoulder pads and helmet to maintain inline cervical spine stablization...we also are to remove the face mask/sheild in case we need to secure an airway. Usually an athlete would go down after being hit, complain of neck pain and/or some extremity numbness...A & O x 3...back board them and off they go...I am sure we have all seen this on TV with an athlete. 

My question is this...what do you all in the EMS world think about that (yes I am also an EMT, but I am asking as an ATC)? Usually there is a team doc present and they are paid to take responsibilty...if not..I would fire ours...so of course we have to follow what the doc says...oh and he is going with the athlete in the truck to the ED. 

But what about smaller college or highschools where a team doc is not present and only an athletic trainer..OR there is just you as EMS. Do you think leaving the helmet in place is the best thing to do or do you think removing it and then using a collar, pads, etc is the best? 

Has anyone ever worked with an athletic trainer (ATC) at a sporting event? Has anyone encounter 'turf war's with an ATC at a sporting event? Thoughts?


----------



## bryncvp (Jul 7, 2010)

Forgot to add this...of course you remove the helmet if there is an airway issue and the helmet is not allowing you to secure it...but remove it as carefully as possible while maintaining Cspine security.


----------



## reaper (Jul 7, 2010)

Already mentioned my response in the other thread.

Leave in place, remove face guard and package as is.


----------



## firecoins (Jul 7, 2010)

bryncvp said:


> Has anyone ever worked with an athletic trainer (ATC) at a sporting event? Has anyone encounter 'turf war's with an ATC at a sporting event? Thoughts?



When I get to the hospital, things need to be done in line with protocols. If the ATC does things along those lines, great. If he doesn't, he can speak to medical control.  Let him make his case.


----------



## skivail (Jul 7, 2010)

*Stays On*

Helmet stays on unless I need to visualize the head.  If it comes off the cavity behind the head is filled with blankets to maintain a straight spine.  The helmet also always comes with to the ER.


----------



## Akulahawk (Jul 7, 2010)

Speaking as one who has had the same training as bryncvp: I leave the helmet in place UNLESS I can not remove the facemask. You can do all the advanced airway stuff you need to with the helmet in place. As long as the helmet is properly fitted, you actually get better immobilization with the helmet and pads in place than you do with them off... Also, unless the athlete is being taken to MRI or CT where the tunnel or opening is smaller than the width of the pads, you can "shoot through" the equipment. 

I've been on both ends of the ATC/EMT issue at events. From my perspective, Paramedics have little clue as to what an ATC knows, or can do. They have little clue what kind of witness to injury an ATC is. They also have little clue as to just how accurate an ATC can be in injury evaluation. They also have little clue as to how well an ATC can package injured athletes for transport. EMT's are worse. 

From both standpoints, I ensure that transport knows their role and what is their signal to proceed out onto the field. Unfortunately, I'm a bit biased as I do have both perspectives. As an ATC, I ensured that the standby ambulance knew that they were NOT to come out onto the field unless they were specifically called. As the standby medic, I made sure my partner knew that too, and knew what the signal was for the ambulance. 

With these events, as long as the team doc transports with the athlete, the team doc maintains medical control, and this is hashed out before anything happens, and is well understood. IMHO, an ideal setup would be to maintain a closed medical system (including transport) from the field to the ED, so that specifically educated/trained Paramedics can utilize a wider range of skills as well as permit the ATC to continue care.


----------



## bryncvp (Jul 7, 2010)

@ Akul. I was hoping to find another ATC/EMT on here. Quick question about CEU's....does the NATA national conference count towards any CEU requirement for the Registry? If so, how do you document it??


----------



## Akulahawk (Jul 8, 2010)

I've only had to deal with the State re-licensure process, so I'm not entirely certain how the Registry would handle it. I think it would depend upon whether or not they track some kind of approval numbers... In the case of California, whatever stuff the Conference puts on that is directly applicable to patient care, would be generally acceptable to them. The NREMT folks... they may have a section on the renewal sheet that allows for CEU's from non-EMT but patient care OK stuff. I'd get your CE's as normal, and put the extra CE you'd get from attending the NATA conference as an add-on and ask the Registry people what they do for CEU's generated from non-EMS courses...


----------



## bryncvp (Jul 10, 2010)

@Akul

Closed Medical System? I assume that is where the team doc acts as medical control?? Can a team doc act as medical control for me? I am going through the ALS level certification class this summer which allows me to do more interventions (IV therapy, etc) that would be helpful to an ATC...not that we need med control to administer an IV, but giving one to a kid at halftime is a bit different than a cardiac pt...could our team doc sign off on that as something I could give in a non-emergent situation??


----------



## firecoins (Jul 10, 2010)

ANy goctor can act as medical control provided 2 things.  1. They accept responsibility of the patient until they get to the ER and 2. They do not ask youu to do anyhthing out of scope which you are responsible for.


----------



## Scout (Jul 10, 2010)

I would think the idea of remove everything you need to but not much more seems to suffice.

Your going to have to ask what can be gained by the removal of these items? What do you need access to? Eyes, nose mouth, ears. Once I can see these I'm happy.

Same for shoulder pads, If the arms are working good chance the shoulder/collar bone is fine too.

I'm not a big fan of strip and cut in every trauma situation. The other thing the SportsMed guys have that the street EMTs don't is they usually see the MOI.


----------



## Akulahawk (Jul 10, 2010)

Scout said:


> I would think the idea of remove everything you need to but not much more seems to suffice.
> 
> Your going to have to ask what can be gained by the removal of these items? What do you need access to? Eyes, nose mouth, ears. Once I can see these I'm happy.
> 
> ...


Something else the Sports Med folks have is excellent knowledge about where to look for injury (and where it won't be) based on what the MOI is. Also, they're also usually quite knowledgeable about where to cut sports equipment to maintain inline cervical/spinal stability. Don't be surprised if an athlete can still use their shoulder after a collar bone is fractured. Many are used to playing with pain, so they might not actually be all that unusual for them. Now if the Coracoid Process or the Acromion Process is fractured, you'll see quite a bit of shoulder weakness... but the GH joint itself probably won't be unstable.


----------



## Akulahawk (Jul 10, 2010)

bryncvp said:


> @Akul
> 
> Closed Medical System? I assume that is where the team doc acts as medical control?? Can a team doc act as medical control for me? I am going through the ALS level certification class this summer which allows me to do more interventions (IV therapy, etc) that would be helpful to an ATC...not that we need med control to administer an IV, but giving one to a kid at halftime is a bit different than a cardiac pt...could our team doc sign off on that as something I could give in a non-emergent situation??





firecoins said:


> ANy Doctor can act as medical control provided 2 things.  1. They accept responsibility of the patient until they get to the ER and 2. They do not ask you to do anything out of scope which you are responsible for.



That's the basic idea behind a Closed Medical System. The team doc would function as med control for you and/or provide specific protocols for you to follow that aren't outside your scope of practice. Here's the kicker. Your team doc may be able to enter into an agreement with the EMS Agency to authorize you to function BOTH as an ATC and EMT-Cardiac under protocols your team doc provides, as long as he's medically responsible.

In my case, if I were working as an Athletic Trainer who is a Paramedic, I'd be able to evaluate an athlete's injury out on the field, begin appropriate immediate post-injury care, provide pain control if needed... and even  begin appropriate ALS care of athletes that are heat illness victims, all without having to initially call-in the transport personnel. If transport is necessary, the transport team would simply continue care that I've started as that stuff wouldn't be outside their scope.

The problem is the hat-switching. If I'm working as an ATC, I can do a LOT of stuff that's outside the scope of Paramedics but if I'm working as a Paramedic, I can't do the stuff that I can do as an ATC... if I'm working the same event as both. It doesn't eliminate the need for transport... but for the other 6 days of the week where transport is 6-10 minutes away, that may prove significant.


----------

