Football player Head/Neck Trauma

[WWFDCorrie]

Hello all,
hope all is well.
Recently I had to transport a Football player (American football) Due to a injury to the neck / head. I was able to get the helmet off, Jersey / SHoulder pads off. But that's was it. I was told at the ER that the Lower pads where also to come off. To treat them as a MVA Trauma Patient. I know I have to resort to what my protocols say and I found nothing in them about it, I've asked my Ambulance Captain and he didn't know either. I witnessed the incident as we were on Standby for the game and it was purely a Head / Neck trauma.

Any insights?

 

[jwk]

I thought the routine for these types of injuries was to leave everything on, especially the helmet. Football helmets are on very snugly around the head and don't come off easily. The face-cage can be taken off with a screwdriver, the other stuff can come off with scissors if needed for some reason.

 

[abckidsmom]

Properly removing pads from an injured football play takes the coordinated movments of 6-8 people who know what they are doing. If the airway is self maintained and the pads fit well, leave them on.

If you take off any of them, take them all off.

 

[NYMedic828]

Hello all,
hope all is well.
Recently I had to transport a Football player (American football) Due to a injury to the neck / head. I was able to get the helmet off, Jersey / SHoulder pads off. But that's was it. I was told at the ER that the Lower pads where also to come off. To treat them as a MVA Trauma Patient. I know I have to resort to what my protocols say and I found nothing in them about it, I've asked my Ambulance Captain and he didn't know either. I witnessed the incident as we were on Standby for the game and it was purely a Head / Neck trauma.

Any insights?

Protocols are guidelines in place to be supplemented by your own clinical judgement.




When you bring in a trauma patient, they get stripped down bare to be fully assessed by the receiving physician. Having shoulder pads on is just another article of clothing in the way.

BUT at the same time football helmets, like motorcycle helmets are designed to provide some degree of cervical stabilization. When they are combined with the added bulk of the shoulder pads they do an even better job of it. So either take it all off, or leave it all on until someone else can remove it.


http://www.sportsmd.com/Articles/id/35.aspx



Personally, I take it off because how can I do a proper assessment of the complaint/injury sight if it has a helmet and shoulder pads blocking my way?


Your captain doesn't know? He has no business being in charge if something that simple is out of his grasp...

 

[WWFDCorrie]

Protocols are guidelines in place to be supplemented by your own clinical judgement.




When you bring in a trauma patient, they get stripped down bare to be fully assessed by the receiving physician. Having shoulder pads on is just another article of clothing in the way.

BUT at the same time football helmets, like motorcycle helmets are designed to provide some degree of cervical stabilization. When they are combined with the added bulk of the shoulder pads they do an even better job of it. So either take it all off, or leave it all on until someone else can remove it.





Personally, I take it off because how can I do a proper assessment of the complaint/injury sight if it has a helmet and shoulder pads blocking my way?


Your captain doesn't know? He has no business being in charge if something that simple is out of his grasp...

I understand and thank you for your input. I may of misworded the question a bit, However I was asking about the lower pads, the pants, girdle, etc. Below the injury site. The Helmet and shoulder pads where off and he was placed with a C-Collar / back-board with spider straps before transporting.

 

[NYMedic828]

I understand and thank you for your input. I may of misworded the question a bit, However I was asking about the lower pads, the pants, girdle, etc. Below the injury site. The Helmet and shoulder pads where off and he was placed with a C-Collar / back-board with spider straps before transporting.

There is no benefit to leaving them on if you need to assess the area.

If the situation warrants stripping the patient down due to a complaint in that region then I would but otherwise I would rather keep them comfortable and unexposed unless necessary. Let the hospital worry about it. I don't intend to check his rectal sphincter tone...

 

[mycrofft]

We can gas back and forth, but it devolves to "follow your protocols". If you are doing standby without protocols, or are the ambo who will be primarily treating football injuries in your area, without protocols designed for this, then someone needs to fix that.

I wonder if there are model protocols written by the NFL, or sports medicine specialists, or a team doctor asociation or something?
http://nflps.org/

Me? Rule of thumb: find what happened or likely happened, weigh benefit to potential harm of a treatment mode in the time before you get to the hospital, then act conservatively. (Or, in a nutshell, "Can't hoit; might help?" plus "Do no harm"). As a fallback, for BLS short trips, immobilize and board the player as is for suspected ortho injujries and let the hospital sort it out, as long as airway is OK and pain is not severe. I'd rather the hospital be talking out of their armpit about how I didn't strip the player for them, than about how I (might have) screwed up that neck, or aggravated that ankle by monkeying around.

 

[Handsome Robb]

I had one of these not too long ago. Shoulder pads and helmet removed prior to our arrival and got called to the table for it.

Per ITLS face mask comes off and helmet + pads stay on. Unless there's an immediate life threat.

With that said, people and situations don't all fit in neat little boxes, and everything is a case by case basis.

 

[mycrofft]

FIFA.COM (non-American football, aka "soccer") has a pretty good take on thier website, even if it is first-aid based. Acronym SALTAP. Has stuff we tend to blow past but is worth remembering, especially if working a first-aid standby and NOT as ALS or BLS-slash-whatever.
However, they don't wear armor outside the atheletic supporter (and then for males only).

Their SCAT2 assessment for cases of suspected closed head injury:
http://www.thinkfirst.ca/documents/Pocket_SCAT2.pdf

 

[leoemt]

Hello all,
hope all is well.
Recently I had to transport a Football player (American football) Due to a injury to the neck / head. I was able to get the helmet off, Jersey / SHoulder pads off. But that's was it. I was told at the ER that the Lower pads where also to come off. To treat them as a MVA Trauma Patient. I know I have to resort to what my protocols say and I found nothing in them about it, I've asked my Ambulance Captain and he didn't know either. I witnessed the incident as we were on Standby for the game and it was purely a Head / Neck trauma.

Any insights?

Why did you remove helmet and pads? Even in EMT school (if you go by the book) they teach you not to remove the helmet or pads unless patient is critical. The helmet and pads will work to maintain netural alignment.

Sports medicine also teaches this. Even in the pros they do this and we do it on our standby's.

NFL Player with suspected spinal injury...notice secured to backboard with helmet and pads intact: http://usatoday30.usatoday.com/news/opinion/editorials/2011-02-04-editorial04_ST_N.htm


If you take it off you take it ALL off. The hip pads can prevent the player from remaining inline or stable. The hospitals in my area expect all players to be transported with their helmet and pads intact. They will remove them in the ER. The trainer has a special tool to remove the facemask if you need to monitor the airway.

 

[Tigger]

The vast majority of the time there is no reason to remove helmet and pads from football or hockey players, just the facemask will suffice. If you remove the helmet, you will not be able to maintain a neutral spinal alignment since the pads sit the player's torso up. Good luck removing shoulder pads without excessive manipulation of the spine without a lot of hands available. If you must remove the helmet, towels are your friend to prop the head.

Also be wary of using a c-collar with shoulder pads, if the distal front end of the collar is sitting on top of the pads, the c-collar should not be used as it is levering the the neck into extension. Blocks and tape (and where I work a vacuum splint) provide plenty of stability.

The face mask should also be removed after rolling the patient if possible, it keeps the helmet more secure until it can be taped down. Definitely get the mask off before you transport, wouldn't want things to go south and not have the tools available to get it off.

 

[hops19]

I was going through some posts today and come upon this one. I thought I'd share my thoughts as a certified athletic trainer...

In the case of the c-spine injured football player on the field, it is standard procedure to keep helmet and shoulder pads intact provided they provide necessary stabilization. If an athlete is suspected of having a neck injury, any unnecessary movements shall be avoided. I am trained in removal of both helmet and shoulder pads at the same time, but ultimately the only reason I'm going to do so is if CPR and AED use is indicated. Otherwise, they both will remain intact.

You can shoot x-ray through all of the football equipment. So if you suspect a neck injury, there is little reason to remove the equipment until it has been ruled out at the hospital.

Once I (or a team physician) makes the decision that EMS transport is necessary, my next move after notifying EMS (whether onsite or via cell phone) would be to remove the facemask. I carry shears in my belt pack to cut through the plastic clips and we also carry screwdrivers if needed. Additionally, the newer Riddell helmets have a special "quick-release" clip that is supposed to pop out with a simple push. The ear pieces and chin strap remain in place as well as the entirety of the shoulder pads.

The preferred method of placing onto a backboard is now via a 6-man lift. Research has shown less neck movement occurs with this compared to rolling onto the board. I would hazard a guess that most will continue to use the rolling method due to familiarity and available personnel.

Riddell also has a new shoulder pad system that makes it much easier to remove the shoulder pads in case of emergency, but many of us will not see it in the near future due to cost.

If you choose to remove the shoulder pads, the helmet must come off and vice versa. This will require additional personnel and I would advise training as a group to do this. This requires 4-6 people and it needs to happen all at once.

I encourage you to make contact with the football teams you may get called to and possibly practice with them. Not only for c-spine injuries, but all emergency situations that may arise. It is important the sports medicine team and EMS be on the same page.

 

[mycrofft]

Thanks! We have another certified trainer in the members, he hasn't weighed in.

Looking back myself, how frequently are there severe injuries experienced under pads AND neck injury is suspected?

 

[Veneficus]

I was told at the ER that the Lower pads where also to come off. To treat them as a MVA Trauma Patient.

I am not sure I understand this phrase.

You had to tell the ED how to treat a patient?

It doesn't make sense in my head.

 

[Tigger]

I was going through some posts today and come upon this one. I thought I'd share my thoughts as a certified athletic trainer...

In the case of the c-spine injured football player on the field, it is standard procedure to keep helmet and shoulder pads intact provided they provide necessary stabilization. If an athlete is suspected of having a neck injury, any unnecessary movements shall be avoided. I am trained in removal of both helmet and shoulder pads at the same time, but ultimately the only reason I'm going to do so is if CPR and AED use is indicated. Otherwise, they both will remain intact.

You can shoot x-ray through all of the football equipment. So if you suspect a neck injury, there is little reason to remove the equipment until it has been ruled out at the hospital.

Once I (or a team physician) makes the decision that EMS transport is necessary, my next move after notifying EMS (whether onsite or via cell phone) would be to remove the facemask. I carry shears in my belt pack to cut through the plastic clips and we also carry screwdrivers if needed. Additionally, the newer Riddell helmets have a special "quick-release" clip that is supposed to pop out with a simple push. The ear pieces and chin strap remain in place as well as the entirety of the shoulder pads.

The preferred method of placing onto a backboard is now via a 6-man lift. Research has shown less neck movement occurs with this compared to rolling onto the board. I would hazard a guess that most will continue to use the rolling method due to familiarity and available personnel.

Riddell also has a new shoulder pad system that makes it much easier to remove the shoulder pads in case of emergency, but many of us will not see it in the near future due to cost.

If you choose to remove the shoulder pads, the helmet must come off and vice versa. This will require additional personnel and I would advise training as a group to do this. This requires 4-6 people and it needs to happen all at once.

I encourage you to make contact with the football teams you may get called to and possibly practice with them. Not only for c-spine injuries, but all emergency situations that may arise. It is important the sports medicine team and EMS be on the same page.

We have tried this a my sports medicine job, and it does not lend itself particularly well to an ice hockey setting. For us, less lifting means less chance of slipping and falling.

I also read a recent NATA position summary on spinal injuries and they advocated for using a scoop stretcher when faced with a supine athlete. I agree, but many EMS agencies do not recognize the scoop as an immobilizer (stupid), so we are stuck with the LBB.

 

[DesertMedic66]

I am not sure I understand this phrase.

You had to tell the ED how to treat a patient?

It doesn't make sense in my head.

The ED told him to treat it like a MVC patient.

 

[DesertMedic66]

We have tried this a my sports medicine job, and it does not lend itself particularly well to an ice hockey setting. For us, less lifting means less chance of slipping and falling.

I also read a recent NATA position summary on spinal injuries and they advocated for using a scoop stretcher when faced with a supine athlete. I agree, but many EMS agencies do not recognize the scoop as an immobilizer (stupid), so we are stuck with the LBB.

My EMS agency does recognize a scoop as an immobilizer but yet no ambulances or Fire Departments carry them (same with vacuum mattresses).

 

[Tigger]

I am not sure I understand this phrase.

You had to tell the ED how to treat a patient?

It doesn't make sense in my head.

I don't think that's what the poster meant. That said we will send someone (ATC ideally) to the ED along with the patient to assist with equipment removal. This is per the ED request, and common sense.

 

[Handsome Robb]

My EMS agency does recognize a scoop as an immobilizer but yet no ambulances or Fire Departments carry them (same with vacuum mattresses).

That's a bummer. I love scoop stretchers. Money for getting grandma with the cracked hip or femur off the ground. Less movement plus some fent and maybe versed makes life easier for,everyone.

We can use them as immobilizers if we can justify why. We are supposed to be getting at least one scoop/lsb combo board for each ambulance here pretty soon. That'll be nice.

 

[hops19]

I have no experience with a scoop stretcher. I've seen one before, but never actually used it. We had one in ATR in college, but took backboard out for practice and games. And that's what I would expect to use today in my job. Hockey presents another interesting challenge with the ice and all...

Biggest thing is to PRACTICE. And I think many of us are guilty of not doing so enough. I was lucky last year when I had an incident that our head coach and I were able to just execute without any prior practice. But it was definitely an interesting experience for me because I had never done it in real life before and trying to explain to him what to do was difficult. I am a visual teacher so I so wanted to show him what to do, but could not use my hands because they were holding c-spine stabilization.

EMS is a crucial member of the sports medicine team and any athletic trainer or physician who does not understand that does not truly understand sports medicine. We must all work together!