Equipment Considerations

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Learn about First Aid & CPR – removing helmet from this video.

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One of the primary concerns during an on-site assessment of an injured individual is that of equipment, particularly with regard to removal of an athletic helmet. For an individual with a potential cervical spine injury, removal of a helmet may worsen the condition or lead to additional injury. The sports medicine team must make a critical decision in regards to equipment considerations. The removal of these equipment is done by any person on the sports medicine team or anyone who has completed first aid courses or a licensed first aider himself/ herself. But what is first aid and CPR?

Removal of any helmet should be avoided unless individual circumstances dictate otherwise. The following are the special considerations. One is removal of the face mask which allows full airway access. The face mask should be removed immediately when the decision is made to transport the injured individual, regardless of his or her current respiratory status. Second is that most injuries can be visualized with the helmet in place. Another is that neurologic tests can be performed with the helmet in place. The eyes may be examined, the nose and ears checked for fluid or blood, and the level of consciousness determined. Another one is that the individual can be immobilized on a spine board with the helmet in place. Also, when both a helmet and shoulder pads are worn, removing the helmet without removing the shoulder pads results in cervical hyperextension. Aside from that, many helmets are radiographically translucent. Therefore, a definitive diagnosis can be made before removal.

slowly remove the helmet and avoid too much movement from the neck
slowly remove the helmet and avoid too much movement from the neck

Guidelines for removal of any piece of protective equipment should be defined within the emergency medical plan. Situations in which helmets may need to be removed include: when the helmet and chin strap do not hold the head securely so that immobilization of the helmet does not necessarily immobilize the head; when the design of the helmet and chin strap is such that even after removal of the face mask, the airway cannot be controlled; when the face mask cannot be removed after a reasonable amount of time; when the helmet prevents immobilization for transportation in an appropriate position; and lastly, when extraordinary cases, such as when an automated external defibrillator (AED) is needed, occur. First aid AED tips can be found more during the training.

Use of a defibrillator requires that the individual’s chest be fully exposed and dry. Contact points for the defibrillator pads must be placed over the apex of the heart and inferior to the right clavicle. If the defibrillator pads touch wet shoulder pads, the defibrillator’s current could arc, leading to decreased effectiveness of the defibrillator; more important, the current could defibrillate the operator. As the use of AEDs becomes more common, standardized protocols for their use must be documented and regularly practiced before their actual use during an emergency situation.

Regardless of the injured individual’s condition, the helmet or shoulder pads must be removed at some point, whether at the site or in the hospital. Because of their familiarity with the equipment, athletic trainers often are asked to assist medical personnel with this procedure.

Kleiner DM, Almquist JL, Bailes J, et al. Prehospital Care of the Spine-Injured Athlete: A Document from the InterAssociation Task Force for Appropriate Care of the Spine-Injured Athlete. Dallas, TX: Inter-Association Task Force for Appropriate Care of the Spine-Inured Athlete; 2001.

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