1. Helmet and Shoulder Pad Removal
Ryan Krzyzanowicz MSEd, ATC
Jeff Hinkle, ATC
Presentation to Princeton Community Hospital Physicians

2. Overview What is an Athletic Trainer? Concussion Grading Scales
Helmet and Shoulder Pad removal
Practice Removal
Handout
Pre-Hospital Care of the Spine-Injured Athlete

3. What is an Athletic Trainer
Prevention, diagnosis and intervention of acute and chronic medical conditions
Must have at least a bachelor’s degree
More than 70% of athletic trainers hold Master’s degree’s and Terminal Degree’s
Job settings
High school, College, Clinics, Emergency Rooms, Physician Offices, Industry

4. Concussion Many definitions
Complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces; alteration in mental status that may or may not involve loss of consciousness

5. Concussion Signs & Symptoms
Headache
Pressure in the head
Neck Pain
Balance Problems
Dizziness
Nausea or Vomiting
Visual Disturbances
Tinnitus
Feeling dazed or ‘dinged’
Drowsiness/Fatigue
Difficulty Sleeping
Difficulty Remembering
Difficulty Concentrating
Irritable
Sensitivity to Light/Noise

6. Grading Scales American Academy of Neurology Grade 1 Grade 2 Grade 3
No LOC
Transient Confusion
Symptoms Resolve in less than 15 minutes
Grade 2
No LOC, Transient Confusion
Symptoms last longer than 15 minutes
Grade 3
Any LOC

7. Cantu Grading Scale Grade 1 Grade 2 Grade 3
No LOC, Symptoms resolve in 15 minutes
Amnesia for less than 30 minutes
Grade 2
LOC for less than 5 minutes
Amnesia for more than 30 minutes but less than 24 hours
Grade 3
LOC for more than 5 minutes
Amnesia for more than 24 hours

8. Prague Group Graded AFTER symptoms resolve Simple Complex Good or bad?
Injury resolves over 7-10 days
Including all symptoms
Complex
Persistent symptoms, prolonged LOC >1 min or prolonged cognitive impairment
Good or bad?
What do you all think

9. Head Injury Management
Sidelines
Acute care given
If LOC occurs-stabilize spinal column; check ABC’s; remove facemask
Activate EMS
E.D. visit
If no LOC occurs-rule out neck injury; start SCAT card
Checks neurocognitive function
Reliable and Valid instrument
Give take home sheet
Refer to MD

11. Emergency Department Management
What is PCH policy?
Some research says a spinal cord injury needs to be in the E.D. within minutes
Some have used IV of cold Saline solution
Helps reduce swelling of spinal canal
Methylprednisolone
Assists with reducing inflammation of spinal canal
Imperative
Once a suspected spinal cord injury patient is in the E.D. they are the first priority
Due to risk of permanent paralysis

12. Helmet and Shoulder Pad Removal
Helmet and shoulder pads can remain on the patient while they have an X-Ray!
The helmet and shoulder pads must remain on the patient until spinal cord injury, fracture/dislocation have been ruled out!

14. Facemask Removal
Facemask is removed as soon as spinal cord injury is suspected
In case airway management is needed
Tools Used
Screwdriver- not effective
Pruning Shears- we use at Concord
Quick Release- Push a button and comes off

16. Helmet Removal Person 1 still provides in-line stabilization
Person 2 straddles or is next to the patient
Person 1 pulls helmet off while Person 2 places hands inside helmet to keep stabilization
After helmet is completely off
Person 1 resumes in-line stabilization

19. Shoulder Pad Removal Keeping in-line stabilization
Person 2 cuts all straps on the shoulder pads.
Straps will be over the sternum and possibly in the axilla area (not all shoulder pads are the same)
Person 2 retracts the pads; then slides one side of the shoulder pads out from the patient while Person 1 keeps in-line stabilization
The other side is then slid out from under the patient
I’ve had to ‘lift’ the patient before

23. Treatment
After removal of the helmet and shoulder pads the patient can now have an MRI/CT scan
The healthcare team treating the athlete should be the
Team Physician (Dr. Branson/Dr. Kassem at CU)
Athletic Trainer
Neurologist

24. Handout Pre-Hospital Care of the Spine Injured Athlete
This handout is meant to be supplemental material for review
It covers mostly on the field issues
But you can apply these to the hospital setting
More resources can be found at
National Athletic Trainers’ Association website