# removing motorcycle helmets



## Simusid (Jul 7, 2010)

I'm not a motorcycle rider and have not tried on a helmet in decades.  I recall that they fit very snugly.  I'd like to hear your strategy or technique for removing helmets on scene.  We never did a patient scenario that involved a helmeted patient.

So assume that you and your partner arrive on scene to find an unconscious male patient, supine, and in respiratory distress.  The MOI requires C-Spine immobilization.   How do you begin to manage the helmet while controlling c-spine?

My first thought is to slide my hands up under the helmet along the cheeks to try and push the helmet up rather than pulling from the top.  I'd try to maintain the neutral position as much as possible but does removing a helmet require any anterior/posterior movement?

Also, given the same situation, suppose you were the only responder (you're in your POV and the guy wipes out in front of you).  Is it possible to do this alone?


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## MMiz (Jul 7, 2010)

Here are some good videos:

http://www.youtube.com/watch?v=9JWiw0HFpDo
http://www.youtube.com/watch?v=vtjn5u4P-CQ


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## Simusid (Jul 7, 2010)

MMiz said:


> Here are some good videos:
> 
> http://www.youtube.com/watch?v=9JWiw0HFpDo
> http://www.youtube.com/watch?v=vtjn5u4P-CQ



Thanks!   Those were excellent videos.  I need to stop doing just plain google text searches and start including video searches when I want tutorials and walkthroughs!

Gary H.


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## LucidResq (Jul 7, 2010)

Techniques of Helmet Removal from Injured Patients

From the American College of Surgeons Committee on Trauma.


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## livewiremaxx (Jul 7, 2010)

I havent watched those videos as I am replying from my cell data connection - but basically if the head is imobilized and doesnt move withing the helmet at all and airway if free and clear you can leave it on.  however if it moves around and or you need access to do airway management then spread the helmet apart at the base of the helmet while parner is holding the head underneath it.  remove the helmet going stright back, if you need to you might need to pull upward from the back while pulling away.  Then retake Cspine from the parnter. 

Better yet, find a used helmet at a garage sale and practice it


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## WolfmanHarris (Jul 7, 2010)

livewiremaxx said:


> but basically if the head is imobilized and doesnt move withing the helmet at all and airway if free and clear you can leave it on.



This is something I seem to see/hear a lot of from American providers and I don't quite understand it. The helmet has to come off eventually, why would I leave a potential complication in place and hope for the best. Not to mention that the pronounced bulge on the back makes neutral alignment more difficult. I mean unless there's deformity and intrusion in the helmet itself, I'm definitely taking it off and even if there is, I might still find it necessary to take it off.


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## bryncvp (Jul 7, 2010)

@ Wolf

But why risk it? If the airway is secure and you can maintain C -Spine security, why not leave it on until you get an Xray and clear the C-Spine? Why take the risk? What about towels under the upper back as you log roll them to put the neck more in neutral...similar to c-spine stablization on an small kid?


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## WolfmanHarris (Jul 7, 2010)

bryncvp said:


> @ Wolf
> 
> But why risk it? If the airway is secure and you can maintain C -Spine security, why not leave it on until you get an Xray and clear the C-Spine? Why take the risk? What about towels under the upper back as you log roll them to put the neck more in neutral...similar to c-spine stablization on an small kid?



Why wait until the airway's crap and the patient's crashing to have access?


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## reaper (Jul 7, 2010)

Only leave in tact, if it is an open face helmet.

The ones left on most of the time is football helmets. That is due to shoulder pads. More difficult to remove pads, so leave all in place, unless there is a reason to remove. With a football helmet, you can remove the face guard with a screwdriver or just cut the tabs that hold it on.


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## Akulahawk (Jul 7, 2010)

reaper said:


> Only leave in tact, if it is an open face helmet.
> 
> The ones left on most of the time is football helmets. That is due to shoulder pads. More difficult to remove pads, so leave all in place, unless there is a reason to remove. With a football helmet, you can remove the face guard with a screwdriver or just cut the tabs that hold it on.


The power screwdriver and the "Trainer's Angel" both produce a fair amount of head movement. What works REALLY well is just a simple anvil pruner...

If you need chest access, cut the laces up the middle of the pads, then the cloth at the top of the chest pieces, leaving the back plate in place. 

Motorcycle helmets, if they're the open face, you can leave the helmet in place. A full-face helmet should be removed, following the procedures in the video above.


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## firetender (Jul 8, 2010)

If the policy has changed, I'd like to know about it, but at Daytona Speedway the helmet is never removed or manipulated at the scene unless immediate danger of airway loss, the motorcycle rider is transported with helmet on to the Pit Hospital where the helmet is CUT OFF!

I never removed a helmet from a biker unless absolutely necessary or completely sure of the absence of spinal injury. In the controlled and supported environment of the ER such things could happen. 

I'd be interested in any studies saying leaving the helmet on post-accident is contraindicated.


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## zmedic (Jul 8, 2010)

Speaking to Daytona, I'd expect that helmets worn by pros may be more form fitting and therefore harder to take off than what is being worn by the local weekend warrior. Anyone know about this?


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