Helmet Removal

Updated: Mar 21, 2016
  • Author: James Cipolla, MD; Chief Editor: Jonathan P Miller, MD  more...
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Overview

Background

With each passing year, more individuals are playing contact sports and riding motorcycles. Therefore, healthcare workers involved in emergency care should be proficient in the procedure of helmet removal. [1, 2] Helmet removal, which requires minimal training, is a safe and quick procedure that gives providers access to a patient's airway and allows them to stabilize the patient's head and neck. [3, 4, 5, 6, 7]

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Indications

The indications for hospital helmet removal are as follows:

  • Suspected cervical spine injury
  • Suspected head injury
  • Inability to securely immobilize the neck prior to transport to another healthcare facility [8]

The following prehospital recommendations for helmet removal are based on the Inter-Association Task Force's Prehospital Care of the Spine-Injured Athlete: [9]

  • If the helmet and chin strap fail to hold the head securely [10]
  • If the helmet and chin strap design prevent adequate airway control, even after facemask removal
  • If the facemask cannot be removed
  • If the helmet prevents adequate proper immobilization for transport
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Contraindications

The major contraindications to helmet removal are paresthesia or neck pain during the removal procedure. Paresthesia suggests worsening stretch or pressure on nerve endings as they exit the spinal column.

Healthcare providers with minimal knowledge of helmet removal should use caution if attempting to remove a helmet.

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Best Practices

A cordless screwdriver is the most efficient tool for removing the screws attaching the facemask to the helmet because it can reduce the time needed for screw removal and help reduce spinal motion.

If the airway is unstable, facemask removal is all that is necessary to intubate the patient; the entire football helmet does not need to be removed for intubation. According to one study, face mask removal for the potential spine-injured American football player is safer than helmet removal for emergent airway access. [24] Face mask removal results in less motion in all three planes (sagittal, frontal, transverse), requires less completion time, and is easier to perform.

Fullface motorcycle helmets should be removed in the prehospital setting for the following reasons:

  • They can increase forward flexion of the neck when the patient is placed on a backboard.
  • The airway cannot be observed with a full helmet in place.
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