page_title: Helmet removal (sports)
section_title: Potential for inadvertent injury
hierarchical_section_title: Helmet removal (sports) / Potential for inadvertent injury
caption_attribution_description: English: 4 common tools used in face mask removal
context_page_description: In organized athletics, few situations give rise to greater anxiety than the 'downed athlete'.
  Obvious causes include head and neck injury, or both, with no immediate means of excluding neck injury in the athlete who may be unable to give a history.
  Compounding the problem is the potential for the athlete's airway being compromised.
  Such a situation requires effective triage with the possibility of the athlete's injury being worsened or its effects being made permanent, if the initial steps taken are not appropriate.
  Paradoxically, the equipment designed to prevent or mitigate injury, such as helmets, face masks, neck rolls and shoulder pads, contributes to the complexity of the steps needed to be taken.
  Finally, environmental challenges, such as the difficulty of first responders moving on an ice arena, or maneuvering an ambulance through inadequate access routes, will add to the problem if not previously addressed by inspection of facilities and, in the best circumstances, rehearsal.
context_section_description: There is a hierarchy of serious consequences of athletic injury, at the top of which is head and neck injury.  Consequently, when a potential head or neck (or combined injury) is observed, the level of anxiety in training and medical staff rises.  This concern relates to the possibility of the bony and protective structures of the neck, the cervical spine and its ligaments, having been fractured and torn, but the nerve cord escaping initial injury, only to be injured inadvertently by responders' efforts to assist the player.
  The consequence of injury to the nerve cord is, in the worst of circumstances, quadriplegia.
  This is an inappropriate time for practice conflicts to arise and the potential is real, although the less so the more organized the situation. For example, Emergency Medicine Technicians (EMTs) and Paramedics are trained to remove helmets while athletic training staff and the NCAA believe that the helmet should be left in place, unless the athlete's airway is compromised and cannot be managed otherwise.
  
  This potential conflict relates to the design of the helmet used in the situation to which each of the parties most frequently responds. With EMTs and paramedics, it is most often motor vehicle accidents. With athletic training staff, it is exclusively athletic events unless acting in the role of 'Good Samaritan'. Helmets worn by motorcyclists and four-wheel operators are usually of an integral design making removal of the face mask either impossible or extremely difficult. Consequently, management of a compromised airway demands removal of the helmet.
  On the other hand, helmets worn in football and ice hockey, are designed specifically so that the face mask may be quickly removed, although the technique for its removal will vary by helmet design. Accordingly, potential and serious difference in practice should be avoided by good communication between athletic training staff and first responders prior to the start of the event.
  Certified athletic training staff are familiar with the helmet model currently in use by their athletes, are expert in its removal, and carry the equipment needed to do so, and there is no substitute for familiarity and practice.  At the same time, investigation and development of improved, face mask release systems is ongoing.
  
  The National Collegiate Athletic Association in its advice to athletic trainers and team physicians, contained in the NCAA Sports Medicine Handbook, advises that the helmet should never be removed from an injured athlete, conscious or unconscious, with a suspected or potential head or neck injury during pre-hospital management. In this advice, certain assumptions are made. The first is that the facemask can be removed so that airway care, if needed, can be carried out. The second is that the helmet fits securely so that supporting the helmet will support the athlete's head and neck. The advice accepts that helmet removal may be necessary if an ill-fitting helmet prevents the head and neck from being secured safely for emergency transport. It is also accepted that helmet removal may be necessary if, for some reason or another, the facemask cannot be removed in a reasonable time. There is general agreement that should helmet removal be required, it should only be carried out by trained personnel. The NCAA also asserts that the injured athlete should be maneuvered to a spine board for transport as a 'single unit' using a lift/slide maneuver or log-roll technique.
caption: Removal tools
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