Football Helmets

[EMSLaw]

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?

 

[alphatrauma]

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!

 

[SanDiegoEmt7]

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

 

[EMT11KDL]

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.

 

[Akulahawk]

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.

 

[Tigger]

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...

 

[bryncvp]

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.

 

[Akulahawk]

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.

 

[bryncvp]

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!!