# Remove Motorcycle Helmet?



## Aprz (Oct 16, 2011)

Heh, I guess this was a tiny debate on the forum before (http://emtlife.com/showthread.php?t=18844), but me and my partner talked about this yesterday when a motorcyclist drove by our ambulance really fast. I was pro-removing the helmet, and he was anti-removing the helmet. He said he'd c-spine with the helmet on.

Most motorcycles helmets I've seen and played with, you have no access to the mouth; you can only see their eyes and the upper portion of their nose. Some of them are really tight and your head is probably not gonna get rattled in there, but there are also some where it is gonna rattle in. I'm thinking if you want to do a rapid trauma assessment, you're gonna completely miss the head assessment wise, you're gonna even miss some signs like the patient grimacing when you palpate other parts of the body, you're gonna delay airway management if needed, and c-spine could be compromised because you don't know if the helmet is fitted to the patient head or not. If you were trained on removing helmets and you do it appropriately, it is as much risk as moving the patient onto a backboard. I think it's more of a risk to leave the helmet on, not only for c-spine, but for airway, and not be able to assess the head, than to take it off.

My partner was anti-removing it. He probably didn't tell me he thinks about it, but his main point was why remove it? It's a unnecessary risk, and he believes that c-spine wouldn't be compromised with it on. Let the hospital remove it.

What do you guys think?


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## Cup of Joe (Oct 16, 2011)

The way I learned it, only football helmets are to stay on the patient.  The front of the helmet (the grill) should be removed.

As to removing a motorcycle helmet, one person should grab the mandible and the back of the neck, and the other should slide the helmet off the patient's head.  Obviously, one EMT should hold manual stabilization until the patient is fully immobilized. 

A motorcycle helmet that covers the face would make it difficult at best to maintain the patient's airway should they need it, or assist their breathing should they need it.  You can't even assess the head if the helmet is still on.  I agree that the helmet should come off.

EDIT:  I might also add that a helmet compromises the neutral, in-line position of the spine during immobilization.


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## Shishkabob (Oct 16, 2011)

Paralysis doesn't matter if they're dead.


The reason why football helmets tend to stay on is the shoulder pads.  When you remove the helmet but keep the shoulder pads on, that extends the neck backwards as the shoulders are now higher than the helmetless head. 

Unless you're treating a motorcycle rider wearing a leather tracksuit with a speedhump in the back, this isn't an issue.  Even my padded jacket doesn't raise my shoulders much.


Be advised though, that some motorcycle helmets (such as mine) have inflatable cheek pads, and that you should deflate them first as to make removal easier.  The ones that have those type of cheek pads usually have a notice to emergency personnel for it.  Here's a pic of mine.


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## fast65 (Oct 16, 2011)

Well, I'd much rather run the risk of compromising C-spine by removing it, than leaving it on and risking a delay in airway management if it's needed. Let's not forget what's more important here; cervical spine immobilization is completely irrelevant if your patient doesn't have an airway and you don't have access to it.

Linuss, how do you deflate those cheek pads? Is there like little valve or are you just cutting a slit in them?


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## Shishkabob (Oct 16, 2011)

See the words "Depress air-release valve behind chinskirt here" with the bullseye?

You depress the air-release valve behind the chinskirt there 




It's a little ball-bearing type thing at the chin that you push in.  You can't cut the cheekpads because they're behind the padding.   This is a feature really only on the more expensive helmets, but I don't expect any first responders to know which helmets those are, so just look for the warnings.


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## Aprz (Oct 16, 2011)

Aw, sweet. Didn't know about cheekpads. Thanks for sharing that Linus.


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## fast65 (Oct 16, 2011)

Linuss said:


> See the words "Depress air-release valve behind chinskirt here" with the bullseye?
> 
> You depress the air-release valve behind the chinskirt there
> 
> ...



Now I see it, obviously I'm not a stickler for details 


Sent from my iPhone using Tapatalk


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## BlakeFabian (Oct 16, 2011)

I was taught to leave the helmet in place, unless it obstructs your care of the Pt's Airway. Removing it may compromise C-Spine.


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## Aprz (Oct 16, 2011)

BlakeFabian said:


> I was taught to leave the helmet in place, unless it obstructs your care of the Pt's Airway. Removing it may compromise C-Spine.


That's what my partner claimed he was taught, and I was saying "maybe you're thinking of just football helmets?"


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## DesertMedic66 (Oct 16, 2011)

In EMT class we were taught always remove the helmet. Just because there is no airway compromise now doesn't mean it won't happen. 

My event training also says to remove the helmet. 

Except for football helmets. If they are wearing shoulder pads then leave the helmet on. If they are just wearing the helmet then take it off. 

One person slowly slides their hand up to keep support on the head and to stablize C-spine. The other person slowly pulls the helmet off while pulling on the sides to allow for extra room. Alot of new racing helmets are designed with a "air bladder". You connect a BP pump or a CO2 cartridge and it basically pulls the helmet most of the way off. There is also a tool that some ambulances carry that does that exact samething. It's just an air bladder that you slide in above their head and then pump it up.


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## BEorP (Oct 16, 2011)

BlakeFabian said:


> I was taught to leave the helmet in place, unless it obstructs your care of the Pt's Airway. Removing it may compromise C-Spine.



How do you expect to keep the neck neutral alignment when someone has a motorcycle helmet on?


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## fast65 (Oct 16, 2011)

BlakeFabian said:


> I was taught to leave the helmet in place, unless it obstructs your care of the Pt's Airway. Removing it may compromise C-Spine.



Leaving it in place may compromise...life?

Like firefite said, just because there's no airway compromise now, doesn't mean there won't be in the very near future. I personally am not going to risk such an event by leaving the helmet on, airway management isn't an area where you want to be behind the eight ball.

If I brought someone into the ED in full c-spine precautions with a motorcycle still on, I would certainly have my judgement, and my sanity questioned by the entire ED staff.


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## DesertMedic66 (Oct 16, 2011)

fast65 said:


> Leaving it in place may compromise...life?
> 
> Like firefite said, just because there's no airway compromise now, doesn't mean there won't be in the very near future. I personally am not going to risk such an event by leaving the helmet on, airway management isn't an area where you want to be behind the eight ball.
> 
> If I brought someone into the ED in full c-spine precautions with a motorcycle still on, I would certainly have my judgement, and my sanity questioned by the entire ED staff.



Exactly. We run calls for a huge motorcycle riding place "Occitto wells" (spelling?) and all the patients get the helmets removed. If you have the patient fully C-spined in a motorcycle helmet and their airway takes a dump you are now going to have to take them out of C-spine to remove the helmet.


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## fast65 (Oct 16, 2011)

firefite said:


> Exactly. We run calls for a huge motorcycle riding place "Occitto wells" (spelling?) and all the patients get the helmets removed. If you have the patient fully C-spined in a motorcycle helmet and their airway takes a dump you are now going to have to take them out of C-spine to remove the helmet.



Oddly enough, I got yelled at by a FF the other day because I was forgoing C-spine to manage a pt's airway...he didn't understand that posturing, trismus, and snoring respirations are bad. But, I digress.


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## DesertMedic66 (Oct 16, 2011)

fast65 said:


> Oddly enough, I got yelled at by a FF the other day because I was forgoing C-spine to manage a pt's airway...he didn't understand that posturing, trismus, and snoring respirations are bad. But, I digress.



Snoring? Ehhh that patient must just be sleeping. An posturing... Well odviously they are pointing at something haha


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## fast65 (Oct 16, 2011)

firefite said:


> Snoring? Ehhh that patient must just be sleeping. An posturing... Well odviously they are pointing at something haha



But of course, the car wreck was just so much work he decided to take a nap 

But anyways, motorcycle helmets should come off, lest you risk a crashing airway or missing something on an assessment.


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## MSDeltaFlt (Oct 16, 2011)

Here's the deal.  Follow your protocols. And when they're vague, do risky maneuvers when there's obviously documetable risks to leaving it on there. Either way contact OLMC and make d@MN sure the two of you are on the same page.

Because when you start manipulating C-spine, and removing helmets manipulate C-spine, you need to be able to prove in black and white that what you did or didn't do was the right thing.


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## usalsfyre (Oct 16, 2011)

Generally unless your patient is unconscious they're going to pull the helmet off well prior to your arrival. If they're unconscious it's definitely got to come off anyway.


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## Tigger (Oct 16, 2011)

BlakeFabian said:


> I was taught to leave the helmet in place, unless it obstructs your care of the Pt's Airway. Removing it may compromise C-Spine.



Leaving it on is more likely to compromise c-spine, plus there is that whole inability to manage the airway thing.

Neutral in line stabilization is not going to be possible with the vast majority of helmets. Think about a normal patient requiring c-spine precautions. When supine, the patient is in neutral alignment. A helmet is going to put the patient into extension and depending on how large the helmet is, this might seriously compromise said neutral alignment. Aside from the airway aspect, that is one more reason for the helmet to come off.

The spinal extension issue is why most athletic helmets are left on, with the mask removed for airway management. Shoulder pads elevate the neck too far off the board, so if the helmet comes off a significant amount of padding has to be placed under the head. Giving the manipulation required with removing the helmet and padding, it's easier to just leave it on.


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## dstevens58 (Oct 16, 2011)

Just went over this last week in medic class.  Remove the helmet (in a proper manner, maintaining c-spine precautions), airway is the most important and should things go in the sewer quickly, it's better to do with a few hands of support than by yourself in the back of a moving ambulance.


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## FourLoko (Oct 17, 2011)

We practiced it in our EMT course so I'm voting with the "remove it" crowd


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## Aprz (Oct 17, 2011)

I should've turned this into a poll. I asked this at the station, and the majority said no, don't remove it. I asked this on an online facebook group composed of CPR-certified, EMTs, Paramedics, RNs, etc... that volunteer at concerts their opinion, and the majority said yes. It looks like on this forum, the majority is yes so far.

I think it's 9 yes and 1 no so far on this forum. On the facebook group, 4 yes, 2 no. At my station, I only asked 3 people, all 3 said no. A total of 13 yes and 6 no.


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## Handsome Robb (Oct 17, 2011)

It's comin' off. Some said it earlier about why we leave football helmets on and keeping a neutral position.


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## Tigger (Oct 17, 2011)

NVRob said:


> It's comin' off. Some said it earlier about why we leave football helmets on and keeping a neutral position.



And hockey helmets as well. For those of you with a lacrosse presence in your area, those helmets are better just taken off because of how difficult a mask removal is. Furthermore, lacrosse shoulder pads are very thin, so leaving the helmet on will not allow for neutral alignment. Motorcycle helmet type removal seems to be the best practice for these helmets.

Not muck access to mask attachment points. 
http://www.cascadehelmets.com/CPV


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## the_negro_puppy (Oct 17, 2011)

Remove it. We are trained to remove helmets properly and its one of the first things we do. Once the helmet is removed you immediately apply a c-collar if possible after doing your usual checks.


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## Akulahawk (Oct 17, 2011)

Tigger said:


> And hockey helmets as well. For those of you with a lacrosse presence in your area, those helmets are better just taken off because of how difficult a mask removal is. Furthermore, lacrosse shoulder pads are very thin, so leaving the helmet on will not allow for neutral alignment. Motorcycle helmet type removal seems to be the best practice for these helmets.
> 
> Not muck access to mask attachment points.
> http://www.cascadehelmets.com/CPV


Football helmets can stay on. Hockey helmets can stay on if they're properly fitted and will provide a good in-line stabilization in conjunction with the pads. Lacrosse helmets should come off because of the facemask and airway problems. Tigger is correct, the pads are very thin, but you should take those off too if you take the helmet off. Anytime you take a helmet off, be prepared to also remove shoulder pads. If you can show that Lacrosse pads do, in fact, keep the player in neutral spine with the helmet off, _then_ you can leave them on _and_ you will have a valid point as to why you elected to leave them on.


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## adamjh3 (Oct 17, 2011)

Had a pt. This weekend at a football game we c-spined. Because of his ALOC we removed the helmet in anticipation of possible airway issues. In all you have to look at how the spine is, if the head is elevated remove the helmet. With football players get rid of the shoulder pads when you get rid of the helmet. Helmet first, support the head while pulling the pads.

Sent from my DROIDX using Tapatalk


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## epipusher (Oct 17, 2011)

What the PHTLS stance on this? I'm curious and lazy.


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## Tigger (Oct 17, 2011)

Akulahawk said:


> Football helmets can stay on. Hockey helmets can stay on if they're properly fitted and will provide a good in-line stabilization in conjunction with the pads. Lacrosse helmets should come off because of the facemask and airway problems. Tigger is correct, the pads are very thin, but you should take those off too if you take the helmet off. Anytime you take a helmet off, be prepared to also remove shoulder pads. If you can show that Lacrosse pads do, in fact, keep the player in neutral spine with the helmet off, _then_ you can leave them on _and_ you will have a valid point as to why you elected to leave them on.



Our experiences have shown that the vast majority of lacrosse pads will not effect neutral alignment. If it can be avoided, we try not to remove pads since that process might cause more movement than needed.

For our hockey players, we try to keep the helmet on so long as it is not absurdly loose. If we have to take it off, we keep a special pad on hand from an old head wedge set that is the right height to ensure neutral alignment. Their pads generally do not allow the use of a c-collar wither, though lacrosse pads do not pose this problem.

We're also trialing using a vacuum splint to mold around the neck and head, early indications look like this could be a better way to go. I know the local FD and ambulance are already doing it too.


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## Fish (Oct 17, 2011)

BlakeFabian said:


> I was taught to leave the helmet in place, unless it obstructs your care of the Pt's Airway. Removing it may compromise C-Spine.



If done right and carefully it does not compromise Cspine, and unless the persons clothing.protective gear makes the spine in a nuetral line it will cause curveature of the spine to leave it on.


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## guttruck (Oct 20, 2011)

IMO if the pt. was in a MVA/MVC  there is probably going to be some type of trauma, but on the other hand I have been on scene of a motorcycle MVA/MVC and the motorcycle driver walked away w/o a scratch. No I have been taught that if you don’t have a airway you don’t have a pt. So I am in favor of taking the helmet off carefully. I am totally in favor of calling medical direction/or the local trauma center for further guidance.


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## BrushBunny91 (Oct 26, 2011)

For polling purposes I was recently instructed to remove motorcycle helmets.


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## EMT11KDL (Oct 26, 2011)

here is my two cents, and no i did not read all the comments.. It depends on the helmet.  If I can manage the airway without removing it, than NO i will not remove the helmet.  But If I cannot manage the airway, yes i am going to remove it.  Best way to get practice on this, is go get a few different styles and have your agency practice helmet removal and find out what works best with the different styles..


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## ksmith3604 (Oct 26, 2011)

The theme of this seems to be remove the helmet and airway management is priority.  This is how I think of it...the helmet is going to come off at some point bottom line.  Whether you pull it off in the field or the ER pulls it off....the patient isn't going to wear that helmet until they are discharged....may as well pull it off, if they decompensate and airway becomes compromised, you don't have to jack with the helmet because its already removed.  I can see both sides of this argument.


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## Tigger (Oct 30, 2011)

EMT11KDL said:


> here is my two cents, and no i did not read all the comments.. It depends on the helmet.  If I can manage the airway without removing it, than NO i will not remove the helmet.  But If I cannot manage the airway, yes i am going to remove it.  Best way to get practice on this, is go get a few different styles and have your agency practice helmet removal and find out what works best with the different styles..



What if you can manage the airway but the helmet interferes with the neutral alignment of the spine?

Sent from my out of area communications device.


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## EMT2B (Nov 2, 2011)

Here's my two cents.  In my EMT-B class, we have been instructed to consider manual C-spine, and to do a DCAPBLSTIC check starting at the top of the head.

I was in an MVA in 2009.  I put my motorscooter into the back of a car.  The EMTs on-scene did NOT remove my helmet.  I had a 3/4 or "open-face" helmet on.  The EMTs just duct-taped my helmet to the backboard.  They did not even try to take it off.  As a matter of fact, my helmet stayed on until I was taken in to X-ray almost an hour after arriving at the hospital.

I think (since I'm still in the class portion of EMS, not the field work portion) that I would probably remove the helmet if possible.  Especially considering the fact that the patient could have injuries to the head that are hidden by the helmet.


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## Shishkabob (Nov 2, 2011)

EMT2B said:


> The EMTs just duct-taped my helmet to the backboard.  They did not even try to take it off.  As a matter of fact, my helmet stayed on until I was taken in to X-ray almost an hour after arriving at the hospital.



For a 3/4 helmet, yes, it tends to stay on.  The 'issue' with full-face non-modular helmets is that it can impede the airway, assessment of the airways, and control of the airway, which is why full-face get removed.


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## usalsfyre (Nov 2, 2011)

It's still gonna be very difficult to achieve neutral alignment with a helmet.


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## Shishkabob (Nov 2, 2011)

usalsfyre said:


> It's still gonna be very difficult to achieve neutral alignment with a helmet.



Agreed.  Didn't say I LIKED the idea, but alas that's what happens a lot.


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## usalsfyre (Nov 2, 2011)

Linuss said:


> Agreed.  Didn't say I LIKED the idea, but alas that's what happens a lot.



So is it wrong to point our here that the same people who jump up and down to defend immobilization are the same ones who seem to to counterproductive stuff like this ?


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## guttruck (Nov 3, 2011)

Most departments have sog's about this and if they don't ide ask your medical director what he wants done


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## usalsfyre (Nov 3, 2011)

And if your SOP or medical director is making a poor recommendation?


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## Shishkabob (Nov 3, 2011)

Honestly, at the 3 agencies I've worked at (2 with progressive protocols), none have ever said a word about motorcycle helmets.


Guess that comes with trusting your field crews to use their judgment over having set rules for every situation.


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## Handsome Robb (Nov 3, 2011)

My protocols are to remove any helmet that could potentially interfere with patient care.



usalsfyre said:


> It's still gonna be very difficult to achieve neutral alignment with a helmet.



Difficult but possible. I know your way smarter than I am, just making a statement. 


Personally I'm gonna remove the helmet whether it's full faced, 3/4 or a brain bucket.

When it comes to full face helmets, I'd rather get it off and dealt with than leave it on and accommodate it during immobilization.  I don't want to be stuck behind the 8-ball and have to chase my tail and remove it en-route without proper assistance.


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## Thriceknight (Dec 18, 2011)

Cup of Joe said:


> The way I learned it, only football helmets are to stay on the patient.  The front of the helmet (the grill) should be removed.
> 
> As to removing a motorcycle helmet, one person should grab the mandible and the back of the neck, and the other should slide the helmet off the patient's head.  Obviously, one EMT should hold manual stabilization until the patient is fully immobilized.
> 
> ...



I would do the same thing. Life over Limb. Simple.


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## spike91 (Dec 19, 2011)

Very glad this topic came up. Had a motorcycle MVA a few weeks ago, off duty call where I ended up being one of two EMTs on scene for two patients (both in decent shape, all things considered) awaiting ambulances. In this instance I didn't remove the motorcycle helmet. The damage to the helmet was limited to scratches and a missing eye mask. The pt had adequate, unlabored respirations and medical complaints limited to multiple abrasions and back pain. I took a minute to look over the helmet, and being the only assistance I had was a bystander I didn't care to **** around with it; I backboarded him with the helmet on (it wasn't interfering with the neutral position) and allowed them to take it off at the ER. No one questioned the decision; it was appropriate given the pt. 

In the future, I'll probably lean more towards removing the helmet given some of the discussion here; however, I don't think leaving a helmet on is indefensible under certain circumstances.


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## Tigger (Dec 19, 2011)

NVRob said:


> Difficult but possible. I know your way smarter than I am, just making a statement.



Eh I am not even sure it is possible. The helmet is lifting the head higher than neutral, so to correct this the head would have lower than the surface of the backboard and I am not sure how I would go about doing that in any sort of useful of efficient way.


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## Tigger (Dec 19, 2011)

spike91 said:


> Very glad this topic came up. Had a motorcycle MVA a few weeks ago, off duty call where I ended up being one of two EMTs on scene for two patients (both in decent shape, all things considered) awaiting ambulances. In this instance I didn't remove the motorcycle helmet. The damage to the helmet was limited to scratches and a missing eye mask. The pt had adequate, unlabored respirations and medical complaints limited to multiple abrasions and back pain. I took a minute to look over the helmet, and being the only assistance I had was a bystander I didn't care to **** around with it; I backboarded him with the helmet on (it wasn't interfering with the neutral position) and allowed them to take it off at the ER. No one questioned the decision; it was appropriate given the pt.
> 
> In the future, I'll probably lean more towards removing the helmet given some of the discussion here; however, I don't think leaving a helmet on is indefensible under certain circumstances.



Removing the helmet is not a one person task so it makes sense for the lone provider to not attempt it.

That said I don't think there is a helmet out there will not effect neutral alignment. There is a reason that pads we place under the patient's head are so thin, most people are in neutral alignment when lying supine with proper head positioning. 

Also, while the patient was not showing any signs of airway issues at the time, that could easily change. Riding supine and backwards while strapped down in an ambulance could easily induce vomiting, and the helmet could be an issue if suction is needed.

At least with athletic helmets one has shoulder pads providing neutral alignment and a removable face piece.


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