Helmet and Pads Off? Jason A. Powell, ATC

I, Jason Powell do not have any financial relationships with commercial interests to disclose.

 Discuss why the changes were made  Explain the recommendations being made  Explain the rationale behind equipment removal  Explain contraindications for removing equipment  Identify any challenges equipment removal may present

 Recommendations from the NATA membership and other organizations to revisit the 1998 guidelines by an inter- association task force to develop guidelines for the care of the spine injured athlete  The athlete-patient with a suspected SCI presents challenges for medical providers that are not common with the general population.  Implement a “Best Practices” approach for our patients now and in the future  Allow for greater flexibility in the wording due to all the variables associated with individual circumstances of a case.

 American Academy of Family Physicians  American Academy of Neurology  American Academy of Orthopaedic Surgeons – Committee on the Spine  American Academy of Pediatrics – Committee on Sports Medicine and Fitness  American College of Emergency Physicians  American College of Sports Medicine  American College of Surgeons – Committee on Trauma  American Medical Society for Sports Medicine  American Orthopaedic Society for Sports Medicine  Canadian Athletic Therapists’ Association  College Athletic Trainers’ Society  National Association of EMS Physicians  National Association of EMTs  National Association of Intercollegiate Athletics  National Association of State EMS Officials  National Athletic Trainers’ Association  National Collegiate Athletic Association National Federation of State High School Associations  North American Spine Society  Professional Football Athletic Trainers Society  United States Olympic Committee

Investigation and development of technique - Research Team Goal: Prevent neurological deterioration during transport and during initial stages of prehospital care and in the emergency department Research to support the efficacy of the removal of equipment in maintaining better cervical spine immobilization or spinal motion restriction(SMR) Cadaver research with sensors placed in the c-spine region to determine the amount of motion different techniques in spine injury care allow while determining the best spine board transfer techniques to use. Research in determining whether the long spine board is the best method to stabilize the spine injured athlete during transport Research on the best methods for removing the faceguard helmet and shoulder pads while limiting spine motion and maintaining immobilization.

 Athletic programs should have Emergency Action Plans(EAPs) developed in conjunction with local EMS  Preparation is essential and should include education and training.  Make sure you have EAPs in place for each venue  Have specifics on locations such as maps and even GPS coordinates  Include information on the closest level 1 trauma center

 Conducting a medical“Time Out” before athletic events.

 Make sure they understand who you are –AT, DR, PA, EMT etc.  Be professional and inform the other teams medical staff if EMS and your team physician will be available  Let the other medical staff know if you have an AED available and what other emergency equipment you may have available if needed

 Proper assessment and management of the spine injured athlete-patient and activation of the EAP in accordance with the level or severity of the injury

 Survey the scene  Note position- Prone or Supine  Check ABC’s(Airway, Breathing, Pulse/Circulation)  Look for obvious deformities or bleeding  If conscious check for sensation and pain  Initiate your EAP

 Protective athletic equipment should be removed prior to transport to an emergency facility for an athlete-patient with a suspected cervical spine instability

 Equipment removal to be performed by at least 3 rescuers trained and experienced with equipment removal at the earliest possible time. If fewer than 3 are present, the equipment should be removed as soon as enough trained individuals arrive on the scene

 Have the correct tools at your disposal – FM Extractors, electric/manual screwdriver, Trainers angels, garden shears, tongue depressors or reflex hammer, sharp scissors, etc.  Helmet Bladders should remain inflated when the helmet is removed  Check pad can be removed easily with a tongue depressor or the end of a reflex hammer  Cutting the Chin Strap with Scissors will help to prevent further motion

 Being familiar with wide varieties of equipment for various sports and even styles that vary within a sport and the techniques for removal of the equipment

 A rigid cervical stabilization device should be applied to the injured athlete-patient prior to transport

 The spine Injured athlete-patient should be transported using a rigid immobilization device  The sports medicine team must now recognize the concepts of spinal motion restriction(SMR )- implying true spinal immobilization cannot be obtained even once securely strapped to the spine board

 Techniques employed to move the spine injured athlete-patient from the field to the transportation vehicle should minimize spinal motion  8 person lift ( previously 6 plus lift) –Supine lying  Scoop stretchers  Log roll push or pull technique- Prone lying  Transportation Plan to be included in the EAP

 Equipment should be removed prior to placing on the spine board  The person stabilizing the head and neck controls the commands and timing of the lift as one unit to maintain the best level of immobilization/SMR  The lift should be no more than about 6 inches to get the long spine board in place under the athlete-patient

Recommended at least 4 people to perform

Must have at least 4 people to perform

 Transportation to a hospital that can deliver immediate, definitive care for these types of injuries  This should be determined and included in the EAP  Transported to the nearest hospital for stabilization and possible air medical evacuation to the nearest level one trauma center  Special care should be considered to minimize excessive delay to definitive care facilities  ED should train in the removal of equipment in the event an athlete arrives with equipment in place

 Spine injuries should be prioritized and require collaboration between the medical team, coaching staff and athletes  The medical team must have a strong working knowledge of the current research and recommendations as well as national and local regulations to ensure up-to-date care  Essential that future research continue to investigate the efficacy of devices used to provide SMR

In the Past we left equipment in place It is now recommended that, when appropriate, in an emergency situation with equipment-intensive sports (e.g., helmets and shoulder pads in football, hockey and lacrosse), the protective equipment be removed prior to transport to the hospital. The rationale for equipment removal on the field includes: Advances in equipment technology Equipment removal should be performed by those with the highest level of training – In most cases the athletic trainers have greater exposure to equipment removal training than other medical team members or hospital emergency staff. Chest and airway access is prioritized Expedited access to the athlete-patient for enhanced provider care

 The on field rescuers determine it is in the best interest of the athlete-patient to maintain the equipment in place based on the circumstances presented- Every situation is different  No trained individuals are present or not enough trained individuals are present to aide in the safe removal of the equipment while maintaining SMR  Equipment or tools for removal are not available  Suspected injury to other regions of the spine

 Have a EAP in place and make sure your staff understands it and can follow it  Know your stuff- Practice, Practice, Practice  Have the proper equipment on hand  Every situation and athlete-patient is different  Be prepared for the unexpected

 2009 NATA position statement on Acute Management of the Cervical Spine Injured Athlete (pdf) (2009)  National Spinal Cord Injury Statistical Center. Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham 2014  MaryBeth Horodyski, EdD, LAT, ATC, FNATA University of Florida, Gainesville, FL  Inter-Association Task Force : Appropriate Care of the Suspected Spine Injured Athlete