# Football Helmets



## Ewok Jerky (Oct 23, 2010)

scenerio-
football player down on the field after a hard hit. complains of neck pain 4/10. CSM intact X4, 124/80, 76, 20. denies any other pain or injury. you hold manual c-spine while facemask is removed, but a collar cannot be placed because of shoulder pads. what do you do? remove helmet? cut pads? tape everything down without a collar? something else?


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## CAOX3 (Oct 23, 2010)

Well depending on the injuries, if you have to remove the helmet you need to pad the head because the neck will be flexed due to the height of the shoulder pads.  Usually the helmet and shoulder pads will support the neck just tape the helmet down as you would a collar and head blocks.


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## EMTRyan88 (Oct 23, 2010)

I was taught that if its possible to remove the shoulder pads and helmet while maintaining C spine and comfort then do it. Alot of parents actually get mad at this though because the equipment is expensive if you have to cut it...Dont get me started on that...

At the same time though sometimes the helmet and pads can help maintain C spine so its really kind of a judgement call. I would try and get them off but if it starts to cause the pt too much discomfort just leave them on and maintain the C spine.


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## TransportJockey (Oct 23, 2010)

The times I've done a football standby and actually had to board a player we just unscrewed the facemask so we had airway access just in case, but left them in their helmet and pads.


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## SanDiegoEmt7 (Oct 23, 2010)

Remove the facemask.  Leave the shoulder pads and helmet in place, then secure to long board.  If one is unable to manage the airway adequately, helmet and shoulder pads should be removed with great care.

Depending on transport time, I would also greatly consider making this an ALS transport, if it isn't already.  The trauma teams I work with prefer and IV or two on all trauma candidates, and having ALS would be nice in case of decreased LOC and other complications.


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## VirginiaEMT (Oct 23, 2010)

beano said:


> scenerio-
> football player down on the field after a hard hit. complains of neck pain 4/10. CSM intact X4, 124/80, 76, 20. denies any other pain or injury. you hold manual c-spine while facemask is removed, but a collar cannot be placed because of shoulder pads. what do you do? remove helmet? cut pads? tape everything down without a collar? something else?



There are great videos about removing helmets, football and motorcycle, on Youtube. You can remove the pads by cutting the strings and straps which are easily replaced.


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## EMS/LEO505 (Oct 23, 2010)

jtpaintball70 said:


> The times I've done a football standby and actually had to board a player we just unscrewed the facemask so we had airway access just in case, but left them in their helmet and pads.



NM is still teaching this method, IE Mike and his friends from AAS and SCFD are teaching this still.


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## TransportJockey (Oct 23, 2010)

EMS/LEO505 said:


> NM is still teaching this method, IE Mike and his friends from AAS and SCFD are teaching this still.



It really makes sense. Even though you can't get a collar on them, if you use towel rolls to secure the head in place, they're not really moving their neck with the helmet and pads in place and they're laying down.


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## CAO (Oct 23, 2010)

Been taught the same thing.  Have access to the airway, and leave the pads and helmet on unless somebody trained to remove them properly is present and even then only if you need to.


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## Akulahawk (Oct 23, 2010)

And this is an area that I have quite a bit of expertise in. When you have a player go down on the field and you're suspecting a cervical injury, leave the pads and helmet in place. Use an anvil pruner (yes, for trees and shrubs) to remove the plastic facemask tie-downs. A screwdriver (electric or otherwise) or a trainer's angel induces too much movement in the cervical spine when you're cutting the plastic. Then you just take the mask straight off. Because of the pads, if you have enough personnel, lift the player straight up as a unit or use a scoop to lift him straight up about 1-2 inches to slide the board underneath (from the feet towards the head). Log-roll may be used with care. The pads will NOT allow a nice in-line roll, so the person at the head will have to be extremely careful about this. Once on the board, use blocks or a head-bed type device to lock the helmet into place after you've secured the body. Then use tape to secure the helmet in place. The helmet will support the head VERY well a they're usually well-fitted to the player. If intubation is required, standard in-line techniques used for cervical injury intubation will work just fine. 

This has been a part of my education since about 1991. Aside from having to intubate, I've had to do this a few times over the years.


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## TransportJockey (Oct 23, 2010)

Akulahawk, it didn't seem like unscrewing the face mask mounts moved teh helmet any extra... But I could be wrong. Any chance you've unscrewed one instead of prying or cutting?


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## Akulahawk (Oct 23, 2010)

jtpaintball70 said:


> Akulahawk, it didn't seem like unscrewing the face mask mounts moved teh helmet any extra... But I could be wrong. Any chance you've unscrewed one instead of prying or cutting?


I'd have to do some digging for the article, but a fairly decent study was done with an instrumented cadaver that was put in pads and helmet, secured on a long board, which was then tested with a screwdriver, electric screwdriver, trainer's angel, side snips, an anvil pruner, and so on. What caused the most cervical movement was a manual screwdriver followed by an electric screwdriver. What likely caused it was the pressure needed to prevent cam-out of the bit from the screw. The trainer's angel and sidesnips caused some spikes in movement from the snipping movement. The anvil pruner caused some, but not a whole lot. Care must be taken to limit any side movement during clipping. 

All those methods work. The anvil pruner causes the least movement.


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## emtchick171 (Oct 27, 2010)

We had a special class just on helmet removal for sports/biking injuries. Our instructor said if you remove the helmet, also remove shoulder pads (for football players)...due to the fact that the shoulder pads & helmet keep the spine in pretty much a straight line. However, if you must remove the helmet due to airway compromise...take the pads off. There is a nice tool called an Eject Helmet Removal System that works extremely well with the removal of any type helmet, if helmet removal is something that is a frequent issue in your district, you should consider investing in one! They work wonderfully!


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## JJR512 (Oct 27, 2010)

emtchick171 said:


> We had a special class just on helmet removal for sports/biking injuries. Our instructor said if you remove the helmet, also remove shoulder pads (for football players)...due to the fact that the shoulder pads & helmet keep the spine in pretty much a straight line. However, if you must remove the helmet due to airway compromise...take the pads off. There is a nice tool called an Eject Helmet Removal System that works extremely well with the removal of any type helmet, if helmet removal is something that is a frequent issue in your district, you should consider investing in one! They work wonderfully!



Are you referring to this: http://www.shockdoctor.com/product/eject-automotorcycle-emergency-helmet-removal-kit.aspx



> Packaged singly to be used as a replacement system or for an Eject user with multiple helmets. Eject® Helmet Removal System is a small air bladder that fits easily into any helmet, without changing its fit or feel. In the event of a crash, First Responders can help reduce the risk of secondary neck or spine injuries by inflating the Eject System, which gently lifts the helmet off a rider’s head.


From the copy, and from other descriptions there, it seems that the bladder is something that must be installed into the helmet _beforehand_. It's not something the EMT brings along and can use on any helmet; the helmet must already have the bladder installed in it. Is my interpretation correct?


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## emtchick171 (Oct 27, 2010)

JJR512 said:


> Are you referring to this: http://www.shockdoctor.com/product/eject-automotorcycle-emergency-helmet-removal-kit.aspx
> 
> 
> From the copy, and from other descriptions there, it seems that the bladder is something that must be installed into the helmet _beforehand_. It's not something the EMT brings along and can use on any helmet; the helmet must already have the bladder installed in it. Is my interpretation correct?





Yes, that is the correct system you found. The airbag/bladder is something that we keep on our trucks (at my service anyway). They do not have to be inserted prior to injury...they are very thin & slide into place...beginning at the PT's forehead just under the helmet, they are inserted and then slid into place (top of the head)...then you can either manually blow up the bladder, or there are CO2 cartridges that screw into the valve and cause the bladder to automatically inflate, lifting the helmet off the PT's head.

Also, some helmets are made with systems similar to the eject system already built into them.


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## Akulahawk (Oct 28, 2010)

Assuming the patient does not have any skull fractures... the eject system is just another method of removing a helmet. I do have an issue with a provider installing such a device under a helmet that was not previously fitted with one. You have little control or knowledge about the condition of the liner as you install the device. I'm sure it works fine, but the instructions do caution you not to use the device if there is structural damage to the crown of the helmet.

For Football players, if you must do CPR on them, you can leave the helmet and pads in place. Cut the sternal laces and begin compressions. Remove the facemask as detailed earlier in this thread. Once the face mask is removed, you have airway access, OTI by use of normal c-spine precaution techniques is possible. When you have time or an extra set of hands: cut the straps above the chest piece that attaches the shoulder pads in place. Cut or remove the straps along the side of the ribs. Lift the chest piece off. You now have excellent access to the chest while maintaining in-line stabilization.

If you do have to remove the helmet, removal can be eased by popping the padding below the ears out of the helmet.

It is in situations like this where knowing how the helmet and pads are constructed and fitted that can make a difference in determining whether or not you should remove the equipment at scene or later. Most, if not all, equipment that I'm familiar with is radiotransparent. You can shoot x-rays through it and get decent plain-films. If it'll fit in a CT scanner, you should also be able to get decent enough CT scans to determine if there's a fracture or vertebral body displacement...

By the way, helmet and pad removal can take longer than simply cutting off stuff.

Note: when doing Football standby's, you might also consider using longer straps than normal to accommodate the extra bulk of the pads.


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## MSDeltaFlt (Oct 28, 2010)

About the only time I would consider removing the helmet on scene would be it the player complained of upper T-spine pain or showed signs/symptoms of compromise to this area (dertomes: numbness at nipple line down, etc).  Because then you'd have to get the spinal cord into midline position, which means taking off the helmet in order to take off shoulder pads.  But those injuries are rare making those times when you'd need to do so would also be rare.  Therefore, just secure them in their pads to the board and you'll be fine.


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## the Happy Medic (Nov 7, 2010)

This is a scenario where athletic trainers and equipment managers are your friends and using the old standbys of blankets will come in handy.

Everyone above seems agreed on leaving everything in place, removing it will cause more movement simply to try to minimize movement afterwards.

Good scenario.


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## EMT11KDL (Nov 8, 2010)

beano said:


> scenerio-
> football player down on the field after a hard hit. complains of neck pain 4/10. CSM intact X4, 124/80, 76, 20. denies any other pain or injury. you hold manual c-spine while facemask is removed, but a collar cannot be placed because of shoulder pads. what do you do? remove helmet? cut pads? tape everything down without a collar? something else?



I know most of what I am going to say has already been stated.  

Little History on me.. I have worked many standbys for football with EMS.  I was also on the Athletic Training Staff as an EMT....

if the Face mask is removed you have access to the the patients mouth and you can access air way and do your air way management.  Removing the patients facemask is easy.  Just have to cut 4 plastic clips.  they are designed for this.  

with Putting a C-Collar on the Patient with pads. NO. do not.. use towel rolls or blocks and put them on the side of the helmet and tape everything down.  with the pads and the helmet the patients head is going to be level, and with the blocks you will keep inline stabilization.  Removing pads and the helmet can be difficult especially with ems personal.  We do not see it enough nor are many of us actually trained on properly removing the pads.  

If CPR is needed or access to the chest cut the uniform and cut the laces on the shoulder pads... this will give you the chance to examine the patient chest.


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## Akulahawk (Nov 8, 2010)

EMT11KDL said:


> I know most of what I am going to say has already been stated.
> 
> Little History on me.. I have worked many standbys for football with EMS.  I was also on the Athletic Training Staff as an EMT....
> 
> ...


Removing Football helmets and pads is definitely something that most people in EMS do not see every day and aren't familiar with how to do it safely. Particularly with Football players, generally speaking, leave the pads/helmet on. Secure the body well with straps or tape if you don't have straps. I prefer blocks, but rolled towels work well too. Use tape to secure the head. Apply the tape directly to the helmet. Those things are fitted and will hold the head stable much better than tape to bare skin will. Try to get a very close fit with the blocks or towel rolls to prevent any sliding. I do not recommend using a head-bed. They're usually NOT able to fit around the helmet anyway (at least the ones I'm familiar with). 

I did 2 years as an Assistant Athletic Trainer for a Junior College after completing my BS in Sports Med. All told, I have been providing Athletic Training services for about 8 years prior to beginning full time work as an EMT, and later, a Paramedic. Sports Medicine is a very specialized field.


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## EMSLaw (Nov 8, 2010)

FWIW, during the Cowboys-Eagles game tonight, there was a player taken off on a stretcher.  Likely LOC after a hit to the head.  

The only salient observation I wanted to make is that the EMTs, trainers, team doctors, and ballboys who were swarmed around him didn't use a c-collar, and did, indeed, cut the facemask clips and flip it up.  In my vast experience (a few calls to pop warner fields and a number of standbys at HS games), I have adopted the same approach. 

When I was playing, it took quite a bit of effort to get a helmet off.  I used to have marks on my head from the padding.  Nowdays, they seem to fly off all the time, but maybe that's just because at televised levels, they hit harder.  I do wonder, though, if you did have to remove the helmet, whether the air could be let out of the newer models to make them easier to remove?


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## alphatrauma (Nov 8, 2010)

EMSLaw said:


> FWIW, during the Cowboys-Eagles game tonight, there was a player taken off on a stretcher.  Likely LOC after a hit to the head.



*Go EAGLES*!


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## SanDiegoEmt7 (Nov 8, 2010)

[YOUTUBE]http://www.youtube.com/watch?v=4LkKLA21YPg[/YOUTUBE]


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## EMT11KDL (Nov 8, 2010)

Akulahawk said:


> Removing Football helmets and pads is definitely something that most people in EMS do not see every day and aren't familiar with how to do it safely. Particularly with Football players, generally speaking, leave the pads/helmet on. Secure the body well with straps or tape if you don't have straps. I prefer blocks, but rolled towels work well too. Use tape to secure the head. Apply the tape directly to the helmet. Those things are fitted and will hold the head stable much better than tape to bare skin will. Try to get a very close fit with the blocks or towel rolls to prevent any sliding. I do not recommend using a head-bed. They're usually NOT able to fit around the helmet anyway (at least the ones I'm familiar with).
> 
> I did 2 years as an Assistant Athletic Trainer for a Junior College after completing my BS in Sports Med. All told, I have been providing Athletic Training services for about 8 years prior to beginning full time work as an EMT, and later, a Paramedic. Sports Medicine is a very specialized field.



we did not use the head beds either.  I actually prefer Towels over the blocks.. I worked on the AT staff since 2007.  And I worked part time for ths current season.


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## Akulahawk (Nov 8, 2010)

EMSLaw said:


> FWIW, during the Cowboys-Eagles game tonight, there was a player taken off on a stretcher.  Likely LOC after a hit to the head.
> 
> The only salient observation I wanted to make is that the EMTs, trainers, team doctors, and ballboys who were swarmed around him didn't use a c-collar, and did, indeed, cut the facemask clips and flip it up.  In my vast experience (a few calls to pop warner fields and a number of standbys at HS games), I have adopted the same approach.
> 
> When I was playing, it took quite a bit of effort to get a helmet off.  I used to have marks on my head from the padding.  Nowdays, they seem to fly off all the time, but maybe that's just because at televised levels, they hit harder.  I do wonder, though, if you did have to remove the helmet, whether the air could be let out of the newer models to make them easier to remove?


With the newer models, you remove the pads below the ears (they just pop off) and you can then begin removal in the usual manner. If this does not work, you can slowly let the air out of the bladder. Remember that this may allow the head to extend a little, but it may also allow room to remove the helmet. If there is no bladder, the padding is poorly fit, or the padding is too tight within the helmet, extra care must be taken. Generally speaking though, standard removal techniques used for motorcycle helmets will work, even with tight fitting helmets. Just be VERY careful about getting enough hands available to do the job safely.

I recently reviewed some of the newer stuff and found that a presentation by some MD's missed some points about helmet removal. They claim that a cordless drill always produces less movement. Their presentation also had a nearly completely unpadded helmet. Yes, a cordless screwdriver is fastest. It can induce some movement. Anvil pruners, Trainer's Angels and so on are also fast, but how well they work depends upon where and how the plastic clips are held in place. It appears that the locations of these clips have changed since I last had to work on a football helmet, so given the variety of helmets available (old and new) I'm going to change my recommendation to that of make sure that you have a cordless drill charged and ready at all times that you're attending a football event (practice or game). Just make sure you keep the helmet securely in place while you're removing the screws and clips.

Here's a video done for an inservice (what looks like the Seahawks) about differences in their helmets and removal. Pay attention to the padding systems inside. Practicing this will cost some money to replace the plastic clips if you cut the clips off. If you have a team of people that will be the ones to do the standbys, it behooves you to try to get some practice in removal procedures every season.
[YOUTUBE]NxYUKyOT_7A[/YOUTUBE]

This next video may or may not run to completion, but pay attention to that they need 4 people to do this right (and it still wasn't completely right). The person assisting at the neck is doing a couple things that aren't easy to visualize, but he's cutting the chin straps off and popping the ear padding off of the helmet. He should have also removed those pads. They just slide right out as shown in the previous video.
[YOUTUBE]4WZx76cNGAo[/YOUTUBE]

Hockey, Field Hockey, Lacrosse, and other sports that may have players in padding and full face helmets, may not have as easy to remove equipment. Those helmets should be a bit more flexible. Remove the helmet like a full face motorcycle helmet, if necessary. Any shoulder padding should be cut so that you split the gear into an anterior piece and posterior piece. Once that happens, remove the gear like football pads. Presence of shoulder pads will, like football, require removal of both helmet and pads.

If you do not have to remove the helmet and pads, leave them on. Remember that you can often secure the player to the LSB better with the pads and helmet in place. With football, if you leave the gear in place, do not use a cervical collar. They won't fit and the gear is designed to maintain neutral spine while it is on and in place. If the player has a cowboy collar on, the collar will secure the head VERY well and limit movement.


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## Tigger (Nov 9, 2010)

*Hockey Equipment*

I realize this thread's original topic was about football equipment, but since many providers might also at some point be exposed to hockey equipment, I figured I would add a little bit of insight.

Hockey pads (and helmets to a degree) are much more slim and low profile than their football counterparts. They probably won't fit as well either, as players often prefer to wear them loose, especially when it comes to helmets. 

That said, if you have to spinal a hockey player, you'll certainly find that leaving the helmet on is the best course of action so long as it does not comprise a neutral alignment. So long as the pads are still properly positioned, no further padding is needed under the head, as the shoulder pads are not big enough to lift the torso high enough off the board to prevent neutral alignment, as the helmet adds some "height" to the head. 

The key difference between football and hockey helmets is how they are secured to the head. Many hockey helmets use straps extending from the mask to the helmet to keep the helmet. Because of this, cutting the straps on the helmet may cause it to become a bit loose. Obviously the mask needs to come off eventually, but if you do not need immediate airway access, it's probably best to leave the helmet intact until the player is secured to the board. 2 inch tape and blocks is our method of choice for securing the head.  An electric screw driver for the two screws securing the mask works well.

Should the player have lost his helmet during the play, we still chose to leave the pads, and instead pad under the head to maintain neutral alignment. The foam base that comes with those POS head wedge sets works well for this. A collar, even a no neck, will not fit the player with his pads on without necessary movement. A collar is kept handy should a ref get hit, their padding is not significant enough to get in the way of the collar.

Ice is obviously slippery, so make sure that someone has a grip on the board at all times so it doesn't slide away. When removing the player from the ice, it's preferable to get five people around the board and lift it straight up, and then slide the cot underneath. I probably don't need to mention this, but definitely don't try and raise the cot on the ice, wheel it off first. Also, those skates are sharp....


Sorry for the exceptionally long winded post...


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## bryncvp (Nov 17, 2010)

I will tell you this..as an athletic trainer (for 12 years) and EMT-Cardiac (RI ALS) at the Division I NCAA level...there is not a team physician at this level or in the pros that will allow you to remove the helmet in the case of a football player going down..UNLESS there is an airway issue. SOP is to cut the clips..swing the facemask up or remove it all togther..whether the athlete is conscious or not...maintain airway..secure Cspine with blocks, tape..whatever with the helmet on. Keep the shoulder pads in place because if you dont it will put the neck into flexion with a helmet on. I work for a school in the sports medicine department and we are part of the Big East Conference. We also have lacrosse and ice hockey (mens and womens) and that is also our SOP for those sports. My primiary role with the school is an athletic trainer so I do not run a rescue but the company we contract with is also under the understanding that this is the way it is to be done. Our athletic training staff and our physician staff put the SOP together and they serve as written orders...plus the docs are at all the games and assume responsiblity. Thats what we pay them for. 

As for the high school or other colleges..no idea..but this is the way school at this level and pros work..for the most part. I beleive it is even in the NCAA suggestions as part of their athlete healthy and safety standards.


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## Akulahawk (Nov 17, 2010)

bryncvp said:


> I will tell you this..as an athletic trainer (for 12 years) and EMT-Cardiac (RI ALS) at the Division I NCAA level...there is not a team physician at this level or in the pros that will allow you to remove the helmet in the case of a football player going down..UNLESS there is an airway issue. SOP is to cut the clips..swing the facemask up or remove it all together..whether the athlete is conscious or not...maintain airway..secure Cspine with blocks, tape..whatever with the helmet on. Keep the shoulder pads in place because if you dont it will put the neck into flexion with a helmet on. I work for a school in the sports medicine department and we are part of the Big East Conference. We also have lacrosse and ice hockey (mens and womens) and that is also our SOP for those sports. My primary role with the school is an athletic trainer so I do not run a rescue but the company we contract with is also under the understanding that this is the way it is to be done. Our athletic training staff and our physician staff put the SOP together and they serve as written orders...plus the docs are at all the games and assume responsibility. Thats what we pay them for.
> 
> As for the *high school or other colleges*..no idea..but this is the way school at this level and pros work..for the most part. I beleive it is even in the NCAA suggestions as part of their athlete healthy and safety standards.


The high school (and all in the area) where I interned and the college that I was an Assistant Athletic Trainer (and all the colleges in the league) had the same basic procedures. Being that it was the West Coast, in California, we didn't have Hockey. So at least we didn't have to worry about ice skate blades. 

Bryncvp is a current, experienced ATC. He is much "closer" to knowing how D1 and Pro level sports med programs currently do things than I am. Given that what he's stated here, it's clear to me that it's not much different than how I did things 10 years ago. 

For those of you that do sports stand-by's, get to know the trainers. Get introduced to the team physicians. When it comes to athletics, these folks have far better knowledge and skill in evaluating these injuries than you do. 

Be aware that their medical care is a closed system that only "opens" to you for transport. You might see some stuff that looks horrific, but if they don't call for you, don't step out on the field. I come from a similar background as bryncvp. I'm apt to pick up things that my partners won't in these situations and I know when it's likely that I'm going to have to go out on the field, well in advance of being summoned. 

Oh, and I remember WELL, the track that was at the Stanford Stadium. That track no longer exists. When I was last at the Stadium, there was just a single level of bleachers, and capacity was just about 85k. Now, with the renovations, there's two levels of bleachers and a reduced capacity to about 50k.


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## bryncvp (Nov 17, 2010)

Akulahawk is right...as an EMS provider, it would be great if you took the time to introduce yourself to the athletic trainer and team physician for the games you are at. Chances are, those people are so busy with pregame stuff that they dont have time to stop by and chit chat. Its never a bad idea to introduce yourself and point out where you are going to be. That will give you a chance to go over how they are going to call you out. Akulahawk is also right when it was mentioned that it is a closed system. We only use EMS when the athlete needs a transport. Most medical issues can be handled by the athletic trainer or the physician on site. But introduce yourself...always a good idea!!


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