1. HELMET REMOVAL

2. 2 Types  Bicycle  Snowboard  Motorcycle  Ski racing

3. 3 Considerations  Helmet may prevent: Proper examination of the patient Proper application of cervical collar  Helmet may cause complications if patient: Is unconscious and may vomit Goes into respiratory arrest and requires AR or CPR  Look for deformities, abrasions or punctures on helmet

4. 4 Helmet Removal  Helmets must be removed when: the patient is unresponsive the patient’s airway is compromised the helmet’s design interferes with the application of a cervical spine stabilizing collar and/or spinal immobilization

5. 5 Procedure  Helmet removal must only be performed once a patient is supine  Two rescuers are required to perform the task of removing the helmet adequately  One rescuer works from the top of the patient’s head (rescuer A), the other works from the neck side (rescuer B)

6. 6 Procedure  Rescuer A stabilizes the helmet on both sides, while firmly stabilizing their elbows and forearms on the ground  Undo the chin strap first. If this is not possible, cut the strap.  Rescuer B reaches in and stabilizes the head.

7. Stabilizing the head – 2 methods a) hands over the clavicles, supporting the head on either side along the jaw line and behind the ears b) a fore and aft grip where one arm lies on the sternum with the hand supporting the head along the anterior jaw line and the other arm lying on the ground with the hand supporting the head under the occipital bones. 7

8. 8  Rescuer B provides support by placing their fingers at the base of the skull (occipital bone).  Rescuer B uses the tips of their thumbs to press against the corner of the jaw.  It may be helpful for Rescuer B to rest their forearms on the patient’s chest. This provides stability and makes the head easier to support.

9.  Rescuer A rotates the helmet forward to allow the neck pad of the helmet to clear the back of the head (occipital bone).  This is not a natural movement and Rescuer A must visualize the back of the helmet clearing the back of the head (occipital bone). 9

10. 10  A natural consequence of this motion is that the chin bar, on a full face helmet, may compress and/or pull on the nose.  Rescuer A slides the helmet rearward by wrapping their fingers under the base of the helmet and prying it open to allow the helmet to clear the ears.  This may require considerable effort.

11.  Rescuer B supports the entire weight of the patient's head.  Rescuer B must continue to do so until Rescuer A takes over.  Rescuer A supports the head without moving it, wrapping their hands from the back of the head to the ears.  Rescuer A properly aligns the head of the patient.  Rescuer B applies a cervical collar to the patient. 11