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INTRODUCTION

The helmeted person who becomes injured presents unique challenges to athletic trainers, prehospital health care providers, and Emergency Department personnel in providing the initial stabilization and management. Greater numbers of people are wearing helmets due to the helmet laws and increasing public awareness for the prevention of head injuries associated with recreational and athletic activities. This practice will limit the most severe outcomes from head trauma. However, the helmeted patient is not immune from life-threatening head and neck injuries. Secondary injury due to improper helmet removal can adversely affect patient outcome.1,2

Helmets vary in size, type, and accessories based on the user’s activity (Figure 229-1). They consist of a hard plastic, polycarbonate, and/or fiberglass shell over either a layer of foam covered by material, inflatable air bladders, or both. Bicyclists, kayakers, roller bladers, skateboarders, and skaters wear simple skull helmets. These helmets cover the top of the skull like a hat and have a strap that is snapped or clipped under the chin to maintain the helmet in position. Football, lacrosse, and hockey players use open-faced helmets. These may have clear visors and/or face cages whose bases are screwed into the helmets. Motorcyclists and racers often wear full-face helmets with or without retractable or removable visors.

FIGURE 229-1.

Types of helmets. A. Simple skull helmet. B. Football helmet. C. Partial face covering helmet. D. Full face covering helmet without a face shield. E. Full face covering helmet with a face shield.

Athletes playing football and hockey wear protective shoulder padding in addition to helmets. Because of the shoulder padding, their cervical spines are more adequately stabilized in comparison to those of helmeted motorcyclists without shoulder padding.3,4 Helmet removal with and without shoulder pad removal has been shown to result in head and cervical spine movement.5,6 This can increase the risk of spinal cord damage in the helmeted athlete with a cervical spine injury.3,4

Current recommendations for sports-related helmet removal, such as in ice hockey and football, are to leave the helmet in place until the patient arrives to an Emergency Department or Trauma Unit.3-5,7-13 The exception permitting the removal of an athlete’s helmet in the field is when the helmet significantly delays lifesaving measures or if airway access is obstructed.3,4,7,14 This may occur in the unconscious and/or apneic patient. Prehospital health care providers should be able to maintain an adequate airway, stabilize a patient’s cervical spine, and control associated hemorrhage with removal of only the face plate, face guard, and chin strap of the helmet.7,8,12,13

ANATOMY AND PATHOPHYSIOLOGY

The type and fit of protective equipment, the mechanism of ...

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