I love football! Ok… I mean American Football for those of you outside the US… Not that I don’t like soccer, certainly. But back to the point: I love football! Now it is football season again and life is good. EXCEPT for the fact now it means that we are seeing all of the young, armor-clad combatants being wheeled into our EDs with various injuries. We have discussed concussion and cervical spine injury previously, but we have not talked about an often-overlooked issue: how do you safely remove helmet and shoulder pads without endangering the Patient’s spine? It seems simple, but is it?
Well, thanks to a colleague at University of Virginia, Dr. Bill Woods, we find out exactly what we need to know!
a) Either remove both the helmet and shoulder pads or neither.
- Never remove one without the other as this may place the spine out of neutral alignment.
- The spine is in neutral position with a child on their back while wearing a properly fitting helmet and properly fitting shoulder pads.
b) How many people does it take to properly do the job? 8.
- 6 people lift the patient 3 inches off the bed
- 2 work together alternating holding the head from above and below the pads to remove the helmet and shoulder pads.
So, now that you know that it isn’t as simple as taking off the armor… what do you do?
c) Prior to removing the equipment:
- Orient your team of 8 and define their individual roles
- Remove the jersey – Cut it or bunch it up around their neck
- Undo the shoulder pad straps
- Remove the ear pieces from the helmet
- Deflate the air bladder (top of helmet) if the helmet has one
Now that you have prepared, what do you actually need to do?
- Lift the patient
- While one person holds the head from below, the other gently rocks the helmet off
- While one person holds the head from below the shoulder pads, the other slides the shoulder pads off the player’s head.
- Lower the player back to the bed, place in a c-collar and continue your trauma evaluation.
If you are on the field, what tools are required to remove the facemask if you want to leave the helmet in place but want access to the player’s airway?
Garden shears, wiresnips, or a screwdriver.
2nd BONUS MORSEL:
With great gratitude to Dr. Woods, we are able to see how this procedure is done.
Below is an article that supports keeping the helmet and shoulder pads on and simply imaging through them.
Waninger KN, rothman M, Foley J, Heller M. Computer Tomography is Diagnostic in the Cervical Imaging of Helmeted Football Players with Shoulder Pads. J Athl Train. 2004 Jul-Sep; 39(3): 217-222.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522142/