Remove Motorcycle Helmet?

[Aprz]

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?

 

[Cup of Joe]

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.

 

[Shishkabob]

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.

 

[fast65]

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?

 

[Shishkabob]

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.

 

[Aprz]

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

 

[fast65]

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.

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


Sent from my iPhone using Tapatalk

 

[BlakeFabian]

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.

 

[Aprz]

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?"

 

[DesertMedic66]

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.

 

[BEorP]

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?

 

[fast65]

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.

 

[DesertMedic66]

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.

 

[fast65]

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.

 

[DesertMedic66]

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

 

[fast65]

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.

 

[MSDeltaFlt]

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.

 

[usalsfyre]

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.

 

[Tigger]

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.

 

[dstevens58]

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.