First aid question - full face helmet

[billvon 2,396]

So here's a question that came up at our last first-aid DZ meeting.
Someone lands very hard. They're unconscious, lying on their backs. They're wearing a full face helmet. Their breathing seems very shallow, pulse is OK, no major bleeding. What do you do?
First, most full face helmets have faceplates that open/come off pretty easily, so you can at least do that. In some cases (my helmet, for example) that's not enough to ensure a patent airway. We have a cable saw that may be able to cut away the chin piece without too much motion, but that requires a lot of effort and a sawing motion that the victim might not be able to tolerate.
The extremes seem easy. Breathing fine, good pulse - leave it on to prevent further spinal damage. No breathing - it has to come off, with as much stabilization of the CV spine as possible (of course.) The question becomes - what do you do when their breathing seems labored or shallow, or you can't tell? Leave it on, and risk asphyxiation? Use a saw and risk cord damage? Try to pull it off and risk a different kind of cord damage?
We didn't come up with a good answer, but it's a question worth considering before it happens.
-bill von

[SkydiveMonkey 0]

If they're having trouble breathing, I'd say get someone to hold their neck / head as still as possible, and then remove the helmet. Depends on what's happening at the time.
You shouldn't put a knife in the toaster - but you're an adult now !!!

[nacmacfeegle 0]

I guess SkyMedic would know what to do, must be similar to motorcycle smashes, did you think about a battery powered dremel, or similar? Just thinking out loud....
I think it would be difficult to pull a helmet off without moving the head, but cutting the 'jaw guard' off would be relatively straightforward.
Interested to see what everyone else thinks.
D

[skybytch 259]

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The question becomes - what do you do when their breathing seems labored or shallow, or you can't tell? Leave it on, and risk asphyxiation? Use a saw and risk cord damage? Try to pull it off and risk a different kind of cord damage?

When I took an EMT1-A course 15 years ago there was a debate about motorcycle helmets; same concerns. It's been a long time but I think the concensus was airway takes precedence over all other concerns; if the patient's breathing headed downhill then removing the helmet became a priority. Traction on the C-spine and remove it carefully is what I remember even though the risk of cord damage is high.
Is there a good answer? Seems like a case of choosing between the lesser of two evils to me.
pull and flare,
lisa
---
Mondays suck

[AndyMan 7]

Remember your ABC's Airway, Breathing, Circulation. The black and white is easy - if either of these are in jeopardy, well - spinal damage is not part of the ABC's.
You didn't say if the labored breathing was stable or not. Is it consistent or deteriorating? Seems to me people will survive just fine with labored breathing, it just means you need to monitor it all the more closely until the pros arrive.
_Am
ICQ: 5578907
MSN Messenger: andrewdmetcalfe at hotmail dot com
Yahoo IM: ametcalf_1999

[Kelly 0]

billvon,.
give me a couple of minutes.. theres a chapter on it in my EMT book. complete with pics and all.. Ill scan them, send them to you, and you can decide if they should be posted here on dropzone.com
kel
http://kel197.tripod.com/skydivefriendsTRIPOD/

[freefalle 0]

before my present job, I worked for a major trauma center and for a county ambulance company so I do have some idea of what I speak. If you have a patient with a full face helmet and you can remove the FACE SHIELD without moving the patient, do so. As a general rule, DO NOT remove the patients helmet. it MAY cause further spinal cord damage. If the patient is having difficulty breathing and is not conscious or has an apparent head injury, chances are the difficulty breathing is as a result of a closed head injury. removing the helmet will not do anything to improve the situation and as previously stated may cause further spinal injury. I do NOT recommend attempting to cut any portion of the helmet away, in MOST cases medical professionals will be arriving shortly let them deal with the helmet.
THAT BEING SAID,,, there is an exception. If you have a patient, who is not breathing and you are willing to attempt rescue breathing (mouth to mouth) and CPR if necessary CAREFULLY remove the helmet. The accepted thought is this. If the patient is not breathing they are going to die, therefore the risk of spinal injury is outweighed by the impending loss of life. Im not really sure about other DZ's but Ive often wished DZ's would ad whats called an AMBU bag to their first aid kit. (an ambu bag is a face mask with a collapsable hard plastic bad attached you squeeze the bag and it forces air into the face mask and into the patients lungs via the mouth and nose) if youve ever watched ER and such youve seen them used. AN AMBU bag deletes the need to preform mouth to mouth rescue breathing on a patient and is safer for all involved.
Just one last thought. If you are on the DZs when someone has an accident the MOST important thing to do, DONT PANIC. quickly call 911 and stay on the line till the dispatcher tells you its okay to hang up. MANY people get pissed at the 911 operators because they ask ALOT of questions. THEY ASK THEM FOR A REASON. The information you provide is relayed to responding crews and trauma centers.
I hope this post helps answer any questions you may have if I can be of any help please let me know.

[weid14 0]

during a safety day a few years ago we had a trauma nurse and EMT give a talk on just this scenerio -- basically there is a two person method for removing helmets (developed for motorcycles) that they showed us, and we got to practice -- hurts your ears if you're the practice dummy after a while

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[Albatross 0]

As an EMT I have seen this come up. I always go with the notion that if they are breathing without trouble that it should stay until enough trained people can get there with a c-spine collar to remove the helmet safely. However, if airways are at all comprimised it is better to take the risk and keep them breathing than hesitate.
God bless us and God Bless America
Albatross

[skymedic 0]

IF the pt is in imminent respitory arrest then Yes get the thing off....Key here is you need TWO people.. like some others have said....and since the danger is so high of further injuring the pt then it helps to have two TRAINED people...one to stablize the C-Spine and the other to pull the helmet off...you dont need to rock it back and forth it will come off straight off...as long as someone is holding C-spine is the key...and that person can NOT let go for any reason once they apply stability.(hate to use the word traction cause it really isn't true).....
marc
BSBD

[AggieDave 6]

Let me give you a first hand experience. Almost two years ago I saw a jumper hook in, he was wearing a full face. The people adminstering first aid had to take the helmet off simply because of blood. If they hadn't, he probably would have drowned in his own blood. He was FUBAR either way you look at it, and luckily, taking the helmet off didn't further his injuries (that we know of), but he would have more the likely died with it on (although at this point, he might have wanted to, he's got a rough life ahead of him...).
"Give me one ping and one ping only..."

[Kelly 0]

Billvon,
check your private messages. I've got a whole file ready to be shared (if you think it should be), complete with step by step instructions and pictures.
kel
http://kel197.tripod.com/skydivefriendsTRIPOD/

[councilman24 36]

I'm licensed as a medical first responder (MFR) in MI. I agree with most of the above. I wouldn't suggest untrained people, who aren't current, to try to remove a helmet while trying to maintain c spine. But, if they're not breathing a little knowledge may be better than none.
One option for the borderline labored breathing. An AMBU bag or many pocket masks may be able to be used with the helmet on. Most skydiving helments fit closer and have larger face shields than motorcycle helmets. There may be room to fit a pocket mask or AMBU bag mask through the opening and onto the face without removing the helmet. A helmet where the chin piece holds the helmet on probably not. A helmet like an Oxygyn, maybe. I think I'll be checking out my equipment with various helmets. This would not work with a simple key chain, shield type mask. It would take a formed mask with oxygen attachment to stick up high enough. May also require an oral or nasal airway to maintain open airway. Not usually available or realistic for untrained persons. I also carry them with my personal kit. Other option is if oxygen is available at least flood the face area so that what they are getting is doing the most good. Again in MI you have to be licensed to admin oxygen.
One other thought. Many skydiving helmets fit tighter and are fastened different from motorcyle or football helmets. May want to offer information to EMS on how helmet is fastened if not with a traditional chin strap.

[skymedic 0]

You are not licensed in MI...you are certified....the paramedics are licensed in your state.....
marc
BSBD

[councilman24 36]

Well, the card in my wallet says "Medical First Responder License". And, the MI web site calls it a license when I look up what I have, the same as my paramedic friends. So, I guess you can call it what you want. I'll call it what the state does.
MFR license # 3204001622

[Shotgun 1]

I was doing a search on "first aid" and came across this old thread, and I have a question about this...

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First, most full face helmets have faceplates that open/come off pretty easily,

I have never worn a full-face helmet, but I have changed the lenses on them a few times, and I have helped others to lift the lens while they were wearing the helmet... In my experience, most of the shields are pretty stiff and require a certain amount of force to move them, enough that I would imagine trying to remove a lens from an injured person would cause significant movement of their neck... maybe not as much as removing the whole helmet, but possibly enough to cause further spinal damage.

So I am curious to hear thoughts on this from jumpers who regularly use full-face helmets or who have ever had to remove just the shield from an injured person. What would be the best way to remove the shield? Lifting it as it was designed (which might require a bit of force), or removing it with an allen wrench? (I suppose it is not very likely that an allen wrench would be immediately available.)

[amy 0]

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What would be the best way to remove the shield? Lifting it as it was designed (which might require a bit of force), or removing it with an allen wrench? (I suppose it is not very likely that an allen wrench would be immediately available.)

Most dropzones have a first aid bag that includes a set of heavy trauma shears, which would cut through an Oxygn-style visor pretty easily. The only exception I can think of (at least, among the helmets that I see commonly used) is the Z1, which is easy to get open without cutting it or moving the head.

I suppose the other exception is the Bonehead Havoc. I haven't played with one, but looks like it opens easily. . . the release mechanism is on the back of the helmet, however, which would present its own challenges.

I don't think the visors on most full-face helmets pose much issue with first aid; it's the chin protection that could be problem, because it would make it tough to get to someone's mouth (and in some cases, their nose as well).

Amy

[EDYDO 0]

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I suppose the other exception is the Bonehead Havoc. I haven't played with one, but looks like it opens easily. . . the release mechanism is on the back of the helmet, however, which would present its own challenges.

The release for the Havoc face shield is on the front just above the eyes.

Ed

[billvon 2,396]

> What would be the best way to remove the shield?

Personally I would have someone stabilize their helmet and then remove it by using leverage (i.e. put my fingers or a tool in the gap and then "lever" it open rather than by just pulling.) Establishing and maintaining an airway is pretty important in serious injuries so I'd want a way to do this quickly.

[Shotgun 1]

I wonder if this is a serious enough issue that folks should be considering it before making the decision to use a full-face??? Or does the protection it provides outweigh the probability of a situation where the full-face helmet becomes a hazard?

[tb62871 0]

This should propvide the leverage. I would think.http://dropzone.com/cgi-bin/forum/gforum.cgi?post=627845;#627845

--TB
Welcome my friends to the show that never ends.

[Reginald 0]

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I wonder if this is a serious enough issue that folks should be considering it before making the decision to use a full-face??? Or does the protection it provides outweigh the probability of a situation where the full-face helmet becomes a hazard?

People that jump without a full face are crazy if they are doing RW, IMHO. I see far too many black and blue people bleeding from eye's noses, etc. that are wearing open face helmets. Some are so bad I wonder how they managed to even pull. Most of these injuries would have been highly mitigated with a full face. I consider freefall collisions a very real high probability event with potentially catastrophic consequences. In my view this far outweighs the very remote possibility of there being a problem with a full face in the event of a catastrophic injury on landing.

"We've been looking for the enemy for some time now. We've finally found him. We're surrounded. That simplifies things." CP

[billvon 2,396]

>I see far too many black and blue people bleeding from eye's noses,
>etc. that are wearing open face helmets.

Although that is more a problem with the person's skill at RW than what sort of helmet they wear. Getting kicked hard in the face is not acceptable no matter what sort of helmet you wear; a full-face does not have much padding, nor does it do anything to protect your neck. Indeed, it may aggravate injuries to your neck because it sticks out farther than your chin (and thus increases leverage on your spine.)

>I consider freefall collisions a very real high probability event . . . .

If you're about to do a skydive with a high probablility of freefall collisions - stay in the plane! That will do far more to protect you than any helmet.

[Reginald 0]

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>I see far too many black and blue people bleeding from eye's noses,
>etc. that are wearing open face helmets.

Although that is more a problem with the person's skill at RW than what sort of helmet they wear. Getting kicked hard in the face is not acceptable no matter what sort of helmet you wear; a full-face does not have much padding, nor does it do anything to protect your neck. Indeed, it may aggravate injuries to your neck because it sticks out farther than your chin (and thus increases leverage on your spine.)

>I consider freefall collisions a very real high probability event . . . .

If you're about to do a skydive with a high probablility of freefall collisions - stay in the plane! That will do far more to protect you than any helmet.

Sorry my friend it's the experienced 4 way teams that I see the most collisions on. It's the block moves at high speed on your way to a 20 point round that are the killers. Fortunately, the really experienced teams all religiously wear full-face helmets, even still I’ve seen some pretty beat up people. With open face helmets they would have been minced meet.

"We've been looking for the enemy for some time now. We've finally found him. We're surrounded. That simplifies things." CP

[wmw999 2,121]

I'll admit I've never been part of a serious (or any other kind of) 4-way team. But the vast majority of my jumps are RW, including a certain amount of combat RW and AFF instruction.

I do know that I've had one facial injury (a very minor black eye), and have broken one helmet on an airplane door, and bumped good and hard with others. Most of them probably would not have killed me (although breaking the helmet on a DC3 doorway might have made it hard to open) or even caused particularly noticeable brain injury, but this way I don't have to know. My personal experience.

I'll stick to the best helmet for actual head injury protection I know of right now, the Pro-tec. Might get a Freezr eventually -- the padding on the one I saw looked pretty good.

Wendy W.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)