Football Injuries

[jwk]

Input please...

Yesterday at our high school, a senior football player went down in a pile, sustaining a neck injury.

The paramedics / EMT's that arrived on the scene wanted to remove his helmet right off the bat. The certified trainer on the scene told them NO, that they should leave the helmet on. The EMT's actually called the police and were going to have her arrested for interfering. Fortunately she called the team doctor and he told the paramedics in no uncertain terms to leave the helmet on and transport him.

Why would the paramedics even consider taking off the helmet? Is there some aspect of paramedic training that now says the helmet should be removed or are these guys not too bright?

Keep in mind that among other things I'm an ex-paramedic, and I know what I would have done had I been on the field.

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[OSUdoc08]

Input please...

Yesterday at our high school, a senior football player went down in a pile, sustaining a neck injury.

The paramedics / EMT's that arrived on the scene wanted to remove his helmet right off the bat. The certified trainer on the scene told them NO, that they should leave the helmet on. The EMT's actually called the police and were going to have her arrested for interfering. Fortunately she called the team doctor and he told the paramedics in no uncertain terms to leave the helmet on and transport him.

Why would the paramedics even consider taking off the helmet? Is there some aspect of paramedic training that now says the helmet should be removed or are these guys not too bright?

Keep in mind that among other things I'm an ex-paramedic, and I know what I would have done had I been on the field.

My most recent BTLS renewal class--taken last year, states that the helmet is to be removed if loose, and to remain on if snug.

 

[jwk]

My most recent BTLS renewal class--taken last year, states that the helmet is to be removed if loose, and to remain on if snug.

They should all be snug if fitted properly. Thanks for the quick response. I'll be discussing this with the appropriate higher-ups in the next week or so.

 

[dgmedic]

Yeah, really the only time they should take it off, obviously, is if they need to control the airway in some way. I would suggest (and what we do) is have the EMS have a little continuing ed with the trainer(s)/physicians. If it is imperative that the helmet be removed, the medics should be trained how to remove it properly (removing ear padding, bla bla bla). The trainer/physician will not be by their side the whole time, so it is important for them to know for the ride to the hospital. That's my view.

 

[Oats]

I would say that the only time it should be removed in the field is if the pt. has airway compromise and requires intubation. Otherwise, I'd never touch it. CYA, life over limb, etc, etc. Let the ED deal with it.

 

[Febrifuge]

My EMT-B class a year ago had a few hours devoted to the subject of sports injuries and especially helmets. I guess my instructor (a Paramedic for 20 years+ and counting) is smarter than the guys that showed up to the game that day.

I agree with the emerging consensus: unless there is an airway problem, the helmet is actually helping provide C-spine stabilization. Someone wearing shoulder pads should have the extra flexion that a helmet gives. Take off the helmet, put 'em on a long board, and the neck is extended too far.

And unless you're carrying the right kind of cutters (pruning shears work best) and know just where to cut the basket of the helmet, you can't remove the helmet without a lot more movement. These guys would seem to be not too bright.

 

[FoughtFyr]

The exception here would be the new "air pad" helmets. These use inflatable air cells to "snug" the helmet down. Schools love them as they are easy to "custom fit" to more than one player. However, the cells can lose air during transport. Even if fully inflated on arrival. These should be removed prior to transport - ALWAYS. This goes double if the patient will be flown.

- H

 

[docB]

You can usually get the facemask off with trauma shears or a screwdriver without significant movement if you've done it once or twice.

 

[Krazed_Medic]

You can usually get the facemask off with trauma shears or a screwdriver without significant movement if you've done it once or twice.

yeah, what docB says, it's not hard to get to the airway if the need arises.

 

[jwk]

The exception here would be the new "air pad" helmets. These use inflatable air cells to "snug" the helmet down. Schools love them as they are easy to "custom fit" to more than one player. However, the cells can lose air during transport. Even if fully inflated on arrival. These should be removed prior to transport - ALWAYS. This goes double if the patient will be flown.

- H

So far you're the first that says remove it. I see your point with the air helmets (change in pressure could cause a change in orientation of the neck), but those aren't what we're using here. The BTLS course says leave them on. Taking it off when the shoulder pads are still on will lead to hyperextension of the neck, which should be avoided at all costs. Taking the helmet off in and of itself is not easy and requires two people who know exactly what they're doing. If it's my kid, the paramedics absolutely will NOT remove his helmet.

 

[FoughtFyr]

So far you're the first that says remove it. I see your point with the air helmets (change in pressure could cause a change in orientation of the neck), but those aren't what we're using here. The BTLS course says leave them on. Taking it off when the shoulder pads are still on will lead to hyperextension of the neck, which should be avoided at all costs. Taking the helmet off in and of itself is not easy and requires two people who know exactly what they're doing. If it's my kid, the paramedics absolutely will NOT remove his helmet.

Hey now, don't misunderstand me. I am only saying remove one, very specific, type of helmet. As an overall rule, LEAVE THEM ON.

I do agree with DocB, get the face shield off, better airway control.

- H

 

[docB]

If you're having trouble with the facemask you can always use a Sawzall or a Hurst saw. If you're the old salty type who doesn't believe in all this newfangled stuff just use a Halligan bar.

Of course I'm kidding. Don't thy these at home, in the field or anywhere else for that matter!

 

[jwk]

Hey now, don't misunderstand me. I am only saying remove one, very specific, type of helmet. As an overall rule, LEAVE THEM ON.

I do agree with DocB, get the face shield off, better airway control.

- H

No problem - I see that you're talking about a particular helmet design. I appreciate all the feedback, since I'm going to be having a chat with the medical director of this particular EMS company.

 

[beanbean]

One possible explanation for why the medics wanted to remove the helmet is that used to be what EMTs were taught to do a long, long time ago. When I took my class 19 years ago we were taught to remove helmets. If these medics were from the 'old school' perhaps they have not kept up with training and protocol changes - inexcusable!

 

[bandaidsNhoses]

Yeah I believe it was old skool training- thought methodology to always remove the helmet right away to "assess the airway" & to admin a cervical collar. Most modern schools of thought say the shoulder pads conbined with helmet will provide an excellant base layer/cervical collar & just pad the voids. They're designed not to allow too much movement to prevent such injuries in the first place. Also companies like Ferno have specially designed backboard attachments to clip onto their new stretchers to facilitate the extra wide/long longboards for sports injuries. Also lots of studies have been performed to determine complications of the football players' protective gear vs not during spinal immobilization. Net result: just leave it on if it's on already:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=164343

Also, some Protocols the Univ of Georgia Sports Medicine developed for their trainers:

http://www.nata.org/committees/cuatc/cuatc_emergency/spineinj.htm

-chrisC

 

[shabby]

I just came across this posting while doing some research regarding football facemask removal tools. You may want to check out the document published by the NATA (National Athletic Trainers' Association) on behalf of the Inter-Association Task Force for the Spine Injured Athlete. It is a set of guidelines and recommendations in redards to appropriate care for the spine injured athlete, or more specifically, a helmeted football player with a suspected spine injury. There is also a good video distributed by Human Kinetics that summarizes the main points regarding facemask removal versus helmet removal. The link to the document should appear below:
http://www.nata.org/downloads/0684602NATAPreHospital.pdf