First aid question - full face helmet

[Lastchance 0]

I have a sticker on my motorcycle helmet that says "If you find this helmet with my head in it, don't touch it."

I may be getting old but I got to see all the cool bands.

[brettski74 0]

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I think these are viable options for a potential victim to communicate. Maybe there could be a way to make it more authoritative, something like a DNR filed at manifest? Like AggieDave said earlier, there are people that have survived accidents that later they might've wished they didn't.

I assume that when you say this you are someone with little or no training or experience as a first responder or as a provider of emergency care. While it is true that you want the helmet to be removed by a properly trained pair of individuals, if there really is a risk of c-spine injury, the patient will need to be immobilized on a backboard. You cannot properly immobilize a spine on a backboard when the patient is wearing a helmet for at least three reasons.

1. The helmet elevates the head which causes flexion of the cervical spine - ie. it cannot be placed in a straight and neutral position against the backboard while the helmet is in place.

2. The majority of helmets do not fit tight enough to ensure adequate immobilization of the head during transport. If the helmet is not removed and the cervical spine is compromised, we can only secure the helmet to the backboard, meanwhile, the head is free to jiggle around inside and maybe shear part of your spinal cord.

3. It is not possible to correctly fit a cervical collar to a patient while they are wearing a helmet.

Beyond that, leaving the helmet on can lead to complications in cases of vomiting and bleeding and may conceal signs of head injury.

Finally, as said before, first responders are usually not doctors. Where they have been trained to deal with a specific set of signs and symptoms in a particular way, they are not at liberty to improvise. If they've been trained that the safest way to move a possible c-spine injury patient requires removal of the helmet, and that's the only way they've been trained, then either the helmet is coming off, or they're not moving the patient, but what exactly should be the protocol for a patient who is lying immobile on the landing area, breathing and alert, but unable to move and refusing treatment because that would involve removing the helmet?

[headcase 0]

There is no correct answer except a good outcome.

If somebody has a helmet on but has no paralysis I would leave the helmet on if at all possible. On the other hand if they have paralysis and questionable airway they are likely going to die without immediate ventilatory assistance and they clearly already have a severe cervical spine injury so removing the helmet may improve the situation by allowing ventilation, cervical stabilization and traction.

But as mentioned previously airway always takes precedence in resuscitation as anoxia kills quickly and certainly---- except of course those rare anaerobes that survive by metabolizing alcohol in and of itself.

[brettski74 0]

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There is no correct answer except a good outcome.

I'm not trying to teach first aid or patient transport here. My point is that EMS personnel and other first-responders are trained to provide care in a certain way. They are trained to do so for reasons based on years of experience from countless individuals and incidents. They are much more aware of the relative risks of various courses of action and signs and symptoms than the accident victim probably is. They are legally required to provide care and transport in the manner in which they were trained. If they don't, they lose all protection that they would have otherwise had under good-samaritan laws. If their training says that a potential head/spinal injury patient must have spinal immobilization for transport, and this requires removal of the helmet and securing the patient to a backboard, that's what they're going to do, sticker or no sticker.

To put this another way, how do you think the motorcyclist would respond if told, "OK fine. We won't remove your helmet until you get a doctor to look at you, but that means we can't move you safely, since you have a potential spinal injury, so why don't you call your doctor and see if he can come out here to the accident site and have a look at you, and when he/she's done, we'll remove the helmet, put you on a backboard and take you to hospital."

If the EMS person or other first reponder has been trained in a safe way to move a spinal injury patient with the helmet still on, then they might do it that way, but that's a decision that's going to be based on their training, not on some sticker put there by someone with no real knowledge or experience in the area of patient care and transport.

Edit: Their/there/they're!!

[headcase 0]

Absolutely!!!

Process engineering and algorithmic procedures are/were developed with the idea of training. A first responder medical professional will in fact be required withing bounds to practice in a manner according to their training or risk loss of professional certification or worse--legal tort.

The original question was I believe directed at skydivers first on scene not professionally employed emergency medical professionals. I would stand-by my assertion.

[brettski74 0]

Ok - I think we're on the same page.

I was responding to the most recent question asked in this thread which asked for impressions regarding stickers that you can buy to put on your helmet warning people to not remove the helmet. While I'd consider this good advice to give to the average Joe Skydiver, one of the stickers was specifically directed at EMS personnel, which I think is silly for the reasons stated above.

[Jumpah 0]

Has there been any effort to develop a full face helmet that allows for the chin/face area to be removed quickly on a face-up victim without needing to move the head/spine? Perhaps a buckle/release/etc on the front or side that holds two halves of the front together, when removed the chin/cheek part of the helmet can be pulled from the helmet in two pieces

Similar to a cutaway system for the chin cup of an open face, but allowing the helmet to fall into pieces with the cranial portion remaining on and intact.

[aresye 0]

I checked with a buddy of mine in the service, an FMF Corpsman. I asked him about this very issue, and it seems to go along with what we were taught in rescue swimmer school.

If there is any problem with breathing, and the airway is blocked by a helmet, remove the helmet immediately, for you should have access to the airway in case they stop breathing. Of course, you should do it as carefully as possible, maintaining in-line stabilization of the head, and immediately placing the person in a cervical collar once the helmet is removed.

"Loss of ABCs is a life-threatening condition, and takes precidence over all other injuries." Life over limb.

Skydiving: You either learn from other's mistakes, or they'll learn from yours.

[billvon 2,400]

>Has there been any effort to develop a full face helmet that allows for
>the chin/face area to be removed quickly . . .

Yes, they make such a helmet. I forget the make, but it's not all that popular.

[kschilk 0]

It should really never be necessary to cut-off a helmet. Helmets should be slightly snug, as per fit....not tight. Protection value of the helmet is lost, if the fit is too tight. A slight upward pressure and rolling the helmet forward, should be all it takes to remove it....anything more, it's too tight and basically moot. Some potential problems can be avoided, by proper sizing.

"T'was ever thus."

[Lindsey 0]

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It should really never be necessary to cut-off a helmet. Helmets should be slightly snug, as per fit....not tight. Protection value of the helmet is lost, if the fit is too tight. A slight upward pressure and rolling the helmet forward, should be all it takes to remove it....anything more, it's too tight and basically moot. Some potential problems can be avoided, by proper sizing.

Slight upward pressure and rolling the helmet forward can be enough to make an a spinal cord injury worse. If the purpose of a helmet is to diminish the risk of serious lasting injury or death, the effect of removing the helmet from a person with a cervical spinal cord injury should, without doubt, be a primary consideration in its development.

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[headcase 0]

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It should really never be necessary to cut-off a helmet. Helmets should be slightly snug, as per fit....not tight. Protection value of the helmet is lost, if the fit is too tight. A slight upward pressure and rolling the helmet forward, should be all it takes to remove it....anything more, it's too tight and basically moot. Some potential problems can be avoided, by proper sizing.

Slight upward pressure and rolling the helmet forward can be enough to make an a spinal cord injury worse. If the purpose of a helmet is to diminish the risk of serious lasting injury or death, the effect of removing the helmet from a person with a cervical spinal cord injury should, without doubt, be a primary consideration in its development.

linz

True.

In watersports the "Bucketing Effect" was taken into consideration during the design of 3rd and 4th generation helmets. The potential for enhancing cervical spine injuries versus protection of the brain had reached a point whereby helmet use for certain levels of skill and types of high speed water activities had made the use of a helmet equally daunting for a cervical spine injury versus risking a naked skull and the potential for a head injury.

[billvon 2,400]

>the effect of removing the helmet from a person with a cervical spinal
>cord injury should, without doubt, be a primary consideration in its
>development.

There are aftermarket devices intended to allow easy removal of helmets, but they require EMT's to know how to operate it. (Called the "hats off" system.)

[Beerlight 0]

Saw this on USA today.....

American Heart Association updating info:

http://www.usatoday.com/news/health/2008-03-31-cpr-compression-only_N.htm?loc=interstitialskip

[brettski74 0]

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Yes, they make such a helmet. I forget the make, but it's not all that popular.

Do you perhaps mean the Bonehead Havok? I think there may be other brands with a similar system.

Even with this type of helmet, I'm not sure how easily or not they are to open and if there was a risk of cervical spine injury, I'd still be requiring a second person to immobilize the head before opening the helmet unless there was a higher priority issue to be dealt with such as airway or breathing problems.

[gravitysucks 0]

I had a lengthy reply written, but I lost it when I went for the spellcheck. So instead you get this hasty one.

1. Compression only CPR, i.e. just pushing on the chest, is adequate enough to provide circulation and if professional resuscitation is within just a few minutes away, will significantly improve the possiblity of a positive outcome. I don't think any person without a specific duty to act (typically limited to on-duty healthcare professionals) should feel bad about withholding mouth-to-mouth. It's a scary world we live in and I sure as hell don't want anybody else's blood and vomit in my own mouth.

2. Helmet removal is therefore best left to the professionals. Just remember to always act in a manner that preserves a neutral, in-line position of the victim's cervical spine. Also note that this starts with the removal of the rig, the elevation of a few inches worth of rig under the patient's back will also mis-align the neck. If you absolutely have to take off the helmet, make it at least a 2 or 3 person job and do it gently. Remember that 1 person only is in charge of keeping that neck in a neutral position and they do not let go of it until it is safely secured using a device specifically made to do so.

3. You can cut a penny with trauma shears. Just use somebody else's. On that note, if you use a hook kinfe to cut webbing, try to use the victim's or somebody else's. Those things ain't cheap!

Hope that helps. Yeah it WAS the short version!