Updated: Mar 21, 2016
Author: James Cipolla, MD; Chief Editor: Jonathan P Miller, MD more...
https://emedicine.medscape.com/article/1413407-overview#a4
Background
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.
Indications
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
[ 8 ]
The following prehospital recommendations for helmet removal are based on the Inter-
Association 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 removal


If the facemask cannot be removed
If the helmet prevents adequate proper immobilization for transport
Contraindications
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 motion.
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 reasons:


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.
Equipment
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
Anesthesia
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 .
Positioning
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.
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).
 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.

by Emma Hammett | Apr 11, 2015 https://firstaidforlife.org.uk/remove-helmet/
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
https://1staidcprcourse.com/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 o o
Covers the whole face o Used in motorcycle, auto racing, motocross etc.
 Partial face coverage
Covers on the brain and the back of the head
Used in motorcycle, auto racing, etc.
 Light head protection o Covers only the top of the head o Used when riding bicycle, kayak, etc
 Football 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
Athlete:
 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 follows:
 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

 precautions: o For full facial coverage, remove the glasses first. To clear the nose to avoid impeding o removal, the helmet must be tilted backward and raised over it.
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: http://emedicine.medscape.com/article/1413407-overview http://www.facs.org/trauma/publications/helmet.pdf http://www.nata.org/statements/consensus/NATAPreHospital.pdf
Hi
I would like of the helmet removal instruction.
Thank you

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 guard.

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

1.
Comparison of the Ability to Predict Mortality between the Injury Severity Score 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 study.
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.
5.
Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury
Severity Score for mortality prediction in elderly trauma patients.
6.
New Injury Severity Score is a better predictor of mortality for blunt trauma patients than the Injury Severity Score.
7.
A comparison of the Injury Severity Score and the Trauma Mortality Prediction
Model.
8.
Model for predicting the injury severity score.
9.
The Applicability of Trauma and Injury Severity Score for a Blunt Trauma
Population in Korea and a Proposal of New Models Using Score Predictors.
10.
Comparison of the trauma and injury severity score and modified early warning 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.