Emergent Access to the Airway and Chest in American Football Players

Abstract

Context: American football has the highest rate of fatalities and catastrophic injuries of any US sport. The equipment designed to protect athletes from these catastrophic events challenges the ability of medical personnel to obtain neutral spine alignment and immobilization during airway and chest access for emergency life-support delivery.Objective: To compare motion, time, and difficulty during removal of American football helmets, face masks, and shoulder pads.Design: Quasi-experimental, crossover study. Setting: Controlled laboratory. Patients or Other Participants: We recruited 40 athletic trainers (21 men, 19 women; age ¼ 33.7 6 11.2 years, height ¼ 173.1 6 9.2 cm, mass ¼ 80.7 6 17.1 kg, experience ¼ 10.6 6 10.4 years).Intervention(s): Paired participants conducted 16 trials in random order for each of 4 helmet, face-mask, and shoulder-pad combinations. An 8-camera, 3-dimensional motion-capture system was used to record head motion in live models wearing properly fitted helmets and shoulder pads.Main Outcome Measure(s): Time and perceived difficulty (modified Borg CR-10).Results: Helmet removal resulted in greater motion than face-mask removal, respectively, in the sagittal (14.888, 95% Conclusions: Protective equipment worn by American football players must eventually be removed for imaging and medical treatment. Our results fill a gap in the evidence to support current recommendations for prehospital emergent management in patients wearing protective football equipment. Helmet face masks and shoulder pads with quick-release designs allow for clinically acceptable removal times without inducing additional motion or difficulty.Key Words: cervical spine injury, sudden cardiac event, protective equipment Key PointsFace-mask removal induced less motion than helmet removal when accessing the airway. Helmet face masks and shoulder pads with quick-release designs allowed for clinically acceptable removal times without inducing additional motion or difficulty. The actual ability to effectively ventilate a patient with a helmet on and face mask removed was not studied and has not been established in the literature.

A Teaching Simulation is Effective in Improving Athletic Training Students' Football Helmet Facemask Removal Clinical Skills and Confidence

“…Studies 5,6 have found that football facemask removal created less cervical spine motion than helmet removal when accessing the airway. While recommendations for prehospital care of a fully equipped football player have recently changed, 22 it is still necessary for members of the medical team to be skilled in facemask removal to access the airway.…”

“…When performed proficiently, the facemask should be removed to allow airway access in a clinically acceptable time of 30 seconds or less. 5 While we know that these skills are taught in professional programs, students may not be practicing this skill regularly and may not be exposed to its use during clinical education. For example, some participants in this study indicated that they had never practiced acute care skills with a preceptor during clinical experiences, and well over half indicated that they had never assisted with a real-time acute care situation during clinical education experiences.…”

“…A widely accepted mechanism to access the airway in an equipment-laden sport athlete is by removing the facemask, which results in less cervical motion than helmet removal. 5,6 While students may learn and practice facemask removal techniques in the laboratory setting, acute care situations where they can provide real-time emergency care rarely occur during clinical education encounters. 7,8 Due to this limited exposure, students may lack the skill and confidence to properly remove a facemask.…”

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

“…Studies (N ¼ 4) compared the insertion of a pocket mask with face-mask removal or face-mask removal prior to helmet removal. [21][22][23][24] Helmet removal induces significantly more cervical spine motion than does face-mask removal alone. Motion is reduced but time is increased if the face mask is removed before the helmet, although this provides better access to the airway.…”

“…Through the systematic review, we found studies (N ¼ 7) comparing both pocket-mask insertion with face-mask removal (n ¼ 3) and face-mask removal with helmet removal (n ¼ 2) as well as equipment and rescuer characteristics. 22,23,[41][42][43][44][45] Only 4 criteria were specifically tested for their influence on face-mask removal: equipment design, lighting conditions, hand size of the rescuer, and grip strength of the rescuer. Specific helmet and face-mask designs affect the time for removal and the motion involved in all airway-access techniques, with no clearly superior What facilities are associated with the best outcomes for an athlete with a suspected CSI?…”