Failure of a Cordless Screwdriver to Remove Lacrosse Helmet Facemasks

Facemask removal (FMR) is essential when potential cervical spine injuries occur in athletes wearing helmets. Used football helmets produce high failure rates of screw removal; however, research on lacrosse helmets is lacking. This study aimed to determine the frequency of FMR failure in lacrosse helmets worn at least 1 season. The authors collected used helmets from 4 colleges (n = 172) and 4 high schools (n = 133). A trial consisted of removing all screws (N = 1215) securing the facemask to the helmet shell using a cordless screwdriver. FMR failure rates were calculated with 95% confi dence intervals (CI). Facemask removal failed in 68 of 305 helmets (22.3% [95 % CI, 17.0-27.59]), whereas 96 of 1215 individual screws failed (7.9% [95% CI, 6.329.48]). On the basis of these results, athletic trainers should have a secondary cutting tool immediately available, and they should perform routine helmet checks throughout the season to identify faulty hardware. [Athletic Training & Sports Health Care. 2014;6(2):90-96. ] The helmet of a potential cervical spine–injured football or ice hockey athlete should remain in place, unless cervical immobilization is compromised or access to the airway is unavailable.1 Because the helmet removal process is complex, leaving the helmet in place may reduce the chances of further cervical movement, which may occur during helmet removal.2 Thus, facemask removal (FMR) is necessary to gain access to the athlete’s airway should rescue breathing be required. Health care professionals responsible for emergency care of athletes should be familiar with the equipment of their particular sport and the tools required to gain access to the airway should catastrophic injury occur.1 The majority of previous research evaluating the effectiveness of FMR tools has been completed on football helmets.3-11 Although studies suggest helmet removal as the standard of care for the potential cervical spine–injured lacrosse athlete,12,13 1 study recommends that the facemask of lacrosse helmets should be left in place to reduce cervical motion.14 Other research has shown that the amount of head motion inside a lacrosse helmet is similar to that of football and ice hockey helmets, thus supporting immobilization with the helmet left in place.15 The National Athletic Trainers’ Association position statement for the cervical spine–injured athlete1 states that health care professionals may elect to leave lacrosse equipment in place as long as an airway can be secured because it is unknown how much cervical movement occurs during equipment removal. However, the helmet and shoulder pads may need to be removed if a neutral cervical alignment cannot be maintained.1 Therefore, a consensus has yet to be reached on how to care for the potential cervical spine–injured lacrosse athlete wearing a helmet. Furthermore, lacrosse has been identifi ed as one of the fastest growing sports in North America,16 thus raising levels of concern about FMR techniques for lacrosse helmets. Although cataDr Bowman and Dr Bradney are from the Department of Athletic Training, Lynchburg College, Lynchburg, Virginia; and Mr Cohick is from Roper St. Francis Healthcare, Charleston, South Carolina. Received: October 24, 2013 Accepted: February 19, 2014 Posted Online: March 13, 2014 This work was supported by research grant 05-09 from the National Operating Committee on Standards for Athletic Equipment (NOCSAE). The opinions expressed herein are those of the authors and do not necessarily refl ect the views of the NOCSAE. The authors thank Thomas P. Dompier for his statistical consultation. The authors have disclosed no potential confl icts of interest, fi nancial or otherwise. Address correspondence to Thomas G. Bowman, PhD, ATC, PES, Department of Athletic Training, Lynchburg College, 1501 Lakeside Drive, Lynchburg, VA 24501; e-mail: Bowman.t@lynchburg.edu. doi:10.3928/19425864-20140306-05