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The helmeted person who becomes injured presents unique challenges to prehospital healthcare providers, athletic trainers, and Emergency Department personnel in providing initial stabilization and management. Greater numbers of people are wearing helmets due to the 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

Helmets vary in size, type, and accessories on the basis of the user's activity (Figure 192-1). 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. Motorcyclists and racers wear full-face helmets with or without retractable or removable visors. 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. 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.

Figure 192-1.

Types of helmets. A. Simple skull helmet. B. Football helmet. C. Partial face covering helmet. D. Full face covering helmet. E. Full face covering helmet.

Athletes playing football and hockey wear protective shoulder padding in addition to protective helmets. Their facial injuries tend to be less severe.2 With the helmets and shoulder padding, their cervical spines, in comparison to those of helmeted motorcyclists without shoulder padding, are more adequately stabilized.2,3 Helmet removal with and without shoulder pad removal has been shown to result in head and cervical spine movement.4,5 This can increase the risk of spinal cord damage in the helmeted patient with a cervical spine injury.2,3

Current recommendations for helmet removal are to leave the helmet in place until the patient arrives in the Emergency Department or Trauma Unit.24,610 The only exception permitting the removal of a helmet in the field is when it significantly delays lifesaving measures or if airway access is obstructed.2,3,6 This may occur in the unconscious and/or apneic patient. Prehospital healthcare 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, guard, and chin strap of the helmet.6,7

The type and fit of protective equipment, the mechanism of injury, the patient's age, and the patient's physical development all influence cervical spine injury. There is a greater risk of injury when the helmet is too loose. It has been noted that ...

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