Football Helmets

[Ewok Jerky]

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?

 

[CAOX3]

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.

 

[EMTRyan88]

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.

 

[TransportJockey]

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.

 

[SanDiegoEmt7]

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.

 

[VirginiaEMT]

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.

 

[EMS/LEO505]

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.

 

[TransportJockey]

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.

 

[CAO]

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.

 

[Akulahawk]

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.

 

[TransportJockey]

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?

 

[Akulahawk]

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.

 

[emtchick171]

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!

 

[JJR512]

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?

 

[emtchick171]

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.

 

[Akulahawk]

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.

 

[MSDeltaFlt]

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.

 

[the Happy Medic]

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.

 

[EMT11KDL]

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.

 

[Akulahawk]

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.

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.