Approach Considerations
The first provider should position himself at the head of the bed and immobilize the cervical spine by placing both hands on the ear holes of the helmets and placing the fingers on the patient’s mandibles bilaterally. [17]
The second provider should then cut the chin strap.
Once the chin strap has been cut, the second provider should take over the job of inline stabilization by placing one hand on the patient’s occiput and another hand on the patient’s chin. [18]
The first provider should then use a screwdriver (manual or cordless) to remove the screws securing the facemask to the helmet. This allows the facemask to be lifted up and out of the way, which opens access to the airway.
If the patient is wearing shoulder pads, a third provider should cut the laces on the anterior portion of the shoulder pads while the first provider is removing the facemask screws. These laces are located superficial to the sternum. [19]
Once the first provider has finished removing all 4 screws, the first and third providers should simultaneously remove the helmet and shoulder pads (if present).
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The actual process of removing the helmet requires the first provider to pull the ear holes away from patient’s head.
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If shoulder pads are being removed, a third provider should place his hands underneath the patient's shoulders, since the shoulders can drop suddenly, causing extreme flexion of the neck. One recent cadaveric study concluded that this elevated torso technique can minimize cervical spine motion during shoulder pad removal. [22] Another cadaveric study noted that motion was produced during all 3 studied techniques (full body levitation, upper torso tilt, and log roll) and that a single technique could not be deemed better except on a case-by-case basis. [23]
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If a fourth provider is available, he may help stabilize the head during the helmet removal process to help prevent overextension of the head onto the bed.
Once the helmet and shoulder pads are removed, the first provider should place a cushion under the patient’s head.
Once the cushion is placed, the first provider should resume maintaining inline stabilization. The second provider, meanwhile, places a rigid cervical collar on the patient.
Once the rigid collar has been applied, the patient can be rolled and the backboard can be removed. Helmet removal is shown in the image below.
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Helmet removal.
