Removing a Helmet
Thursday, January 18, 2007
Paul Auerbach, M.D.
I’ve mentioned many times the importance of wearing a helmet for safety. That’s especially important for skiers and snowboarders, who are involved in falls and collisions. You need to protect the precious cargo inside the bony box that comprises your skull.
As a Doctor Ski Patroller, I’m often called on to aid a downed skier. If the problem is not related to head and/or neck injury, and the victim is wide awake, then a helmet is straightforward to remove. However, if the victim has altered consciousness (up to and including unconscious) or may have suffered a neck injury, it is important to take extreme care in removing his or her helmet. Remember, a person can be alert and have suffered a severe neck injury without really appreciating the fact that the injury has occurred. This happens if the victim is distracted by pain elsewhere (e.g., a broken ankle or leg), is extremely cold, or even slightly under the influence of alcohol or recreational drugs.
To remove the helmet, follow these excellent recommendations offered by John Nichols, M.D. of the National Ski Patrol System, Inc.:
1) Helmet removal is a two-person maneuver.
2) Have one person (Rescuer 1) maintain in-line (straight) alignment of the victim’s head and neck while the second (Rescuer 2) prepares the helmet for removal (unbuckle the helmet, loosen straps, remove goggles and obstructing objects).
3) Rescuer 2 now moves to hold the victim’s neck and base of the skull from beneath the helmet. The best position for this is below Rescuer 1, who now moves to the head to be ready to remove the helmet.
4) Rescuer 1 now removes the helmet by lifting it straight off in line with the victim’s body, taking care to not flex (bend forward) or extend (bend backward) the head and neck.
The decision about whether or not to remove a helmet in the field is made according to medical necessity. If the helmet is not interfering with a rescue or transport, it may be left in place until medical care is reached. However, if it must be removed, for instance because an airway must be managed or a bleeding point identified, follow the instructions above. Remember to keep the head and neck in line and protected from movement after the helmet has been removed.
Tags: helmet, safety helmet, removing a helmet, wilderness medicine, outdoor medicine, healthline
photo by Paul Auerbach
2 Comments:
At Sat Feb 03, 08:13:00 AM 2007,
Anonymous said…
Dr. Auerbach, speaking of snow safety, do you know of any studies/research regarding wristguards in snowboarders (ie, do they really work or is the fracture just more proximal on the forearm?). Thanks.
At Mon Feb 05, 09:51:00 PM 2007,
Paul Auerbach, M.D. said…
Your question is a good one, but I don't know the answer. My intuition is that wristguards are likely beneficial, as they seem to be in skateboarders. The wrist is generally more sensitive to impact than the bones of the forearm, which are also more protected by surrounding muscle and other soft tissue further up proximally on the forearm. It comes down to how one falls and the vectors of force. I have not heard of the equivalent of boot top fractures in forearms protected by wrist splints, but perhaps this happens.
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