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Helmet Removal

Helmet Removal
Updated: Mar 21, 2016
Author: James Cipolla, MD; Chief Editor: Jonathan P Miller, MD more...
With each passing year, more individuals are playing contact sports and riding motorcycles.
Therefore, healthcare workers involved in emergency care should be proficient in the procedure
of helmet removal. [1, 2] Helmet removal, which requires minimal training, is a safe and quick
procedure that gives providers access to a patient's airway and allows them to stabilize the
patient's head and neck.
The indications for hospital helmet removal are as follows:
 Suspected cervical spine injury
 Suspected head injury
 Inability to securely immobilize the neck prior to transport to another healthcare facility
The following prehospital recommendations for helmet removal are based on the InterAssociation Task Force's Prehospital Care of the Spine-Injured Athlete: [9]
 If the helmet and chin strap fail to hold the head securely [10]
 If the helmet and chin strap design prevent adequate airway control, even after facemask
 If the facemask cannot be removed
 If the helmet prevents adequate proper immobilization for transport
The major contraindications to helmet removal are paresthesia or neck pain during the removal
procedure. Paresthesia suggests worsening stretch or pressure on nerve endings as they exit the
spinal column.
Healthcare providers with minimal knowledge of helmet removal should use caution if
attempting to remove a helmet.
Best Practices
A cordless screwdriver is the most efficient tool for removing the screws attaching the facemask
to the helmet because it can reduce the time needed for screw removal and help reduce spinal
If the airway is unstable, facemask removal is all that is necessary to intubate the patient; the
entire football helmet does not need to be removed for intubation. According to one study, face
mask removal for the potential spine-injured American football player is safer than helmet
removal for emergent airway access. [24] Face mask removal results in less motion in all three
planes (sagittal, frontal, transverse), requires less completion time, and is easier to perform.
Fullface motorcycle helmets should be removed in the prehospital setting for the following
They can increase forward flexion of the neck when the patient is placed on a backboard.
The airway cannot be observed with a full helmet in place.
Providers: At least 2 providers (3-4 is ideal) should be present.
Facemask removal: Studies have been performed to determine the ideal tool to remove the
facemask in prehospital and hospital settings. [11] The findings suggest that a cordless screwdriver
is the superior tool to remove the screws securing the facemask. [12] However, a manual
screwdriver can also be used.
Screwdrivers have been shown to minimize neck motion more than pipe cutters, anvil pruners,
facemask extractors, or Trainer’s Angels. These 4 tools do reduce the time needed to remove a
facemask; unfortunately, they also increase the amount of motion of the cervical spine.
Helmet removal: A pair of scissors is also necessary for helmet removal. [13] Scissors should be
used to cut clothing and the laces holding the shoulder pads together, if present. [14, 15] Exposure is
one of the basic tenets of trauma resuscitation.
Patient Preparation
No anesthesia is needed for helmet removal.
If airway instability occurs, rapid sequence intubation should be employed to secure the airway.
For more information, see Tracheal Intubation, Rapid Sequence Intubation and Tracheal
Intubation, Medications.
The patient should be placed supine on a long cervical immobilization board if he or she is not
already on one.
Minimization of cervical spine motion should be maintained prior to the initiation of helmet
removal. [16]
Monitoring & Follow-up
Helmet removal, when performed properly, does not carry inherent risks.
The major complication of helmet removal is worsening an extant cervical spine injury.
Helmet Removal Technique
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.
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).
The actual process of removing the helmet requires the first provider to pull the ear holes
away from patient’s head.
During this maneuver, the second provider prevents the neck from hyperextending and
the head from falling onto the bed. [20, 21]
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]
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.
How to Remove a Helmet
by Emma Hammett | Apr 11, 2015
Motorcycle helmets should only be removed if you need to gain access to the casualty’s face in
order to give rescue breaths or secure their airway. On some helmets there is a button underneath
the chin to release the chin bar and push up the front of the visor. If you do need to remove the
casualty’s helmet it is a job for two people. One person needs to stabilise the head and neck,
whilst the other very carefully removes the helmet and avoids twisting the head and neck.
How to remove a helmet
First Aid Management: Helmet Removal
It is essential to follow proper procedure for helmet removal in all cases of injuries and first aid
is required. The helmet is used to protect the head from any sort of injuries while playing contact
sports and riding motorcycles. While more people engage in activities that require the use of
helmet, there is also an increase in the number of injuries that would require helmet removal.
Emergency care workers, including first aiders, are advised to learn the safe and quick procedure
to remove the helmet. Helmet removal gives providers access to a patient’s airway and allows for
stabilization of the victim’s head and neck. However, improper removal of helmets may lead to
unintentional aggravation of cervical spine injuries.
Commonly Removed Helmet Types
Helmets comes in different shapes and sizes. The difference is based on which type of helmet is
most suitable for a particular type of activity. The following are the common types of helmet that
are removed:
Full face coverage
o Covers the whole face
o Used in motorcycle, auto racing, motocross etc.
Partial face coverage
o Covers on the brain and the back of the head
o Used in motorcycle, auto racing, etc.
Light head protection
o Covers only the top of the head
o Used when riding bicycle, kayak, etc
o Particular to the sport football
Prehospital Recommendations for Helmet Removal
It is generally recommended to have to helmet to removed in a hospital setting, especially if
there is a suspected head and/ or cervical spine injury, and the failure to securely immobilise the
neck before transporting to another healthcare facility. The following are the prehospital
recommendations for helmet removal as based on the Prehospital Care of the Spine-Injured
If the helmet and chin strap is incapable of holding the head securely
If the helmet and chin strap design prevent ample airway control, even after facemask removal
If the facemask cannot be removed
If the helmet prevents ample correct immobilisation for transport
First Aid Management: Helmet Removal
At all costs, do not attempt to remove the helmet individually. There should be at least two
trained individuals for proper helmet removal. This will ensure proper removal while holding the
head and keeping the head and neck rigid. The procedure for proper helmet removal is as
The first rescuer should maintain inline immobilisation by placing his/ her hand on each side of
the helmet, with the fingers on the victim’s lower jaw (mandible).
The second rescuer should cut or loosen the strap at the D-rings.
The second rescuer should place one hand on the lower jaw at the angle, with the thumb on one
side and the middle and index fingers on the other. Using the other hand, apply pressure from
the occipital region.
The rescuer at the top should then move the helmet, while keeping in mind particular
o For full facial coverage, remove the glasses first. To clear the nose to avoid impeding
removal, the helmet must be tilted backward and raised over it.
o For egg shaped helmets, expand laterally to clear the ears.
The second rescuer must maintain inline immobilisation from below to prevent unnecessary
neck motion throughout the whole removal process.
Once the helmet is removed, the rescuer at the top should place his/ her
First Aid Management
hands on either side of the victim’s head, with the palms over the ears.
Maintain inline immobilisation until a backboard is in place and replaced with a cervical
immobilization device.
Disclaimer: The information from this article does not provide medical advice and should not be
substituted for formal training. Seek medical attention when necessary. To learn more about
proper procedure for helmet removal and other essential techniques in first aid, enrol in First Aid
Courses and CPR Courses with workplace approved Training.
Online Sources:
I would like of the helmet removal instruction.
Thank you
Proper Helmet Removal in First Aid
Helmets are intended to protect the face, head, neck and spine and prevent possible injuries due
to motorcycle accidents and many sporting events. However, in case of an accident, you may
need to remove the helmet in order to administer first aid or initiate resuscitation efforts. When
removing the helmet, the head and neck should be held rigid to prevent further damage to
surrounding structures. Take note that improper removal of the helmet can lead to serious
complications. Proper removal of helmet is a special first aid skill that can be learned through
advanced first aid courses.
In helmet removal, your goal is to stabilize the head while manipulating the helmet out of the
head or cutting through the helmet. As much as possible, helmet removal should be done as a
two-rescuer procedure. One rescuer ensures stability of the head and neck while the other rescuer
performs the extrication or cuts the helmet.
If the helmet has a protection shield, the protection shield can be lifted to reveal the airway while
keeping it in place. If it has a face guard, the face guard can be cut while providing manual
stabilization. Before you cut through the helmet, you should make sure to avoid injuring the
victim by placing protective coverings (such as folded blankets, piece of cloth or towel) directly
over the face and neck. You can use a bolt cutter or any suitable device to remove or cut the face
Never attempt to remove the helmet if it results in increased pain, or if removal is impossible or
very difficult, unless pulmonary resuscitation is necessary or airway obstruction is apparent.
[ditty_news_ticker id="476"]
Helmet removal by one person – First Aid for motorcyclists
[media url=”http://www.youtube.com/watch?v=vPIDCs69Vsc” width=”600″ height=”400″]
In advanced first aid course, you will be taught how to collaborate with another first aider in
removing the helmet. Remember that helmet removal is a two-rescuer situation. After explaining
the procedure to the victim, the first aiders should follow this procedure:
1. Rescuer 1 is positioned at the top of the patient’s head and applies manual stabilization with
one hand on the lower jaw. Depending on the type of helmet, stabilization may be applied using
the fingers while the rest of the hand is on the side of the helmet.
2. Rescuer 2 cuts, removes or opens the chin strap, then puts one hand below the victim’s chin and
the other behind the lower head to prevent head tilt.
3. After the Rescuer 2 stabilizes the head and neck, Rescuer 1 can release manual stabilization and
slowly remove the helmet. Gently pull out the lower sides of the helmet to clear the ears. If the
victim wears eyeglasses, make sure to remove the glasses.
4. After the helmet is removed, Rescuer 1 reestablishes manual stabilization and opens up the
airway using jaw-thrust maneuver.
5. Rescuer 2 can release stabilization and then apply extrication collar, if available, or make-shift
stabilization collar (such as rolled towels on both sides of the head). Keep the victim’s body wellaligned and continuously monitor the victim while waiting for emergency services.
There may be variations with regards to the positioning and roles of the first aiders.
Read more: http://cprhcp.ca/proper-helmet-removal-in-first-aid/#ixzz5hRtMnJ6S
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and the New Injury Severity Score: A Meta-Analysis.
2. Comparison of the new Exponential Injury Severity Score with the Injury Severity
Score and the New Injury Severity Score in trauma patients: A cross-sectional
3. Major influence of interobserver reliability on polytrauma identification with the
Injury Severity Score (ISS): Time for a centralised coding in trauma registries?
4. The Value of Injury Severity Score and Abbreviated Injury Scale in the
Management of Traumatic Injuries of Parenchymal Abdominal Organs.
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7. A comparison of the Injury Severity Score and the Trauma Mortality Prediction
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score with rapid lactate level (the ViEWS-L score) in blunt trauma patients.
11. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury
Severity Score for mortality prediction in elderly trauma patients.
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