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Context: Facemask removal (FMR) is required to access the airway of a catastrophically injured football or ice hockey athlete. However, the best method of caring for the helmeted lacrosse athlete with suspected catastrophic injury remains unclear.Objective: To evaluate the effects of sex and grip strength on the speed and ease of use of various FMR methods across different lacrosse helmet types.Design: Cross-sectional study. Conclusions: Based on our results, FMR of lacrosse helmets should be attempted with a CSD. We recommend carrying a pruner as a backup cutting tool in case the CSD fails, practicing FMR regularly, and inspecting helmets for faulty hardware to reduce the chance of CSD failure.Key Words: emergency care, catastrophic injury, cervical spine Key PointsParticipants removed the facemasks of 5 different types of lacrosse helmets with a cordless screwdriver (CSD), which was fastest with helmets that do not require a cutting step, and reported this method was easier to use than the Face Mask Extractor 2, pruner, and Trainer's Angel. Grip strength and FMR times were strongly associated for the 3 techniques using cutting methods but not for the CSD. Facemask removal on lacrosse helmets should be attempted first with a CSD and second with a pruner if screw removal fails. Athletic trainers should practice regularly, be prepared to perform FMR on various types of helmets, and perform FMR using the tool with which they are most comfortable.

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Quantifying head impacts is a vital component to understanding and preventing head trauma in sport. Our objective was to establish the frequency and magnitude of head impact mechanisms in men's lacrosse athletes. Eleven male lacrosse athletes wore xPatch sensors during activity. Video footage of practices and games was analyzed to verify impacts and code them with impact mechanisms. The authors calculated incidence rates (IRs) per 1000 exposures with corresponding 95% confidence intervals (CIs) and used multivariate analysis of variances to compare the linear (g) and rotational (rad/s) accelerations between mechanisms. A total of 167 head impacts were successfully verified and coded with a mechanism using video footage during 542 total exposures. The highest IR was head to body (IR = 118.08; 95% CI, 89.15-147.01), and the lowest was head to ball (IR = 3.69; 95% CI, 0-8.80) (incidence rate ratio = 32.00; 95% CI, 67.83-130.73). Analysis indicated that impact mechanism failed to significantly alter the combined dependent variables (multivariate F = 1.79, P = .06, η = .06, 1-β = 0.83). While head to head, body to head, and stick to head mechanisms are penalty-inducing offenses in men's lacrosse, head to ground, head to ball, and combination impacts have similar head accelerations. If penalties and rules are created to protect players from traumatic head injury, the authors recommend stricter enforcement.

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