When responding to an incident involving a helmeted rider who requires spinal immobilization precautions, immobilization of the helmeted head to a backboard should be a measure of last resort. Ideally, the helmet should be removed prior to securing the patient on a backboard as most full-face helmets will prevent assessment of the head and neck, application of a cervical collar, and may increase the risk of airway compromise.
Bicycle Helmets[edit | edit source]
Bicycle helmets are by far the easiest to deal with as they are significantly less restricting than full face helmets. Begin by holding manual c-spine and introducing yourself, making sure to instruct the patient to avoid movement. Your hands may or may not be impeded by the helmet. Instruct a second rescuer to cut the helmet's straps and then remove the helmet from the patient's head. You must be ready to bear the weight of the patient's head as it will have been held slightly off the ground by the helmet. After the helmet has been removed, slowly lower the patient's head to the ground and continue maintaining manual c-spine until the patient has been fully immobilized.
Motorcycle Helmets (Full-face helmets)[edit | edit source]
Stabilization[edit | edit source]
Head stabilization of a helmeted patient begins similarly to head stabilization of a non-helmeted patient; place your hands on either side of the helmet to stabilize the patient's head and introduce yourself, making sure to instruct the patient to avoid movement. A helmet will restrict a patient's view and can be claustrophobic for some patients. Instruct a second rescuer to open the visor if it has not already been opened. This will allow for easier airflow and communication with the patient.
After external stabilization of the helmet has been completed, have the second rescuer undo or cut the chin strap. After the chin strap has been removed, have the second rescuer make a "V" with their thumb and forefinger on one hand with the other fingers resting alongside the forefinger. The second rescuer will place their hand on the patient's chest with the "V" facing the patient's head and slide the hand into place with the patient's chin resting in the "V". The rescuer's forearm may be placed on the patient's chest to increase stability. As the second rescuer is placing their first hand, their other hand should be placed on the posterior side of the patient's neck, just under the helmet's lower edge.
Removal[edit | edit source]
After the second rescuer is in place, the primary rescuer should move their hands so that they can grip the bottom of the helmet on either side of the patient's head. The primary rescuer will provide lateral pressure on both sides of the helmet (to pull the helmet's edges away from the patient's ears and decrease resistance) and tilt the helmet slightly back (to clear the patient's nose) while pulling the helmet off the patient's head. As the helmet moves up and off the patient's head, the second rescuer should move their hand that is posterior to the patient's neck until it is cradling the occiput of the patient's head, following the edge of the helmet as it moves. The end result of this maneuver will be the first rescuer holding the helmet that is no longer on the patient while the second rescuer is holding the patient's head in the same position it was in while helmeted (i.e. slightly raised off the ground).
The first rescuer may then resume manual c-spine and slowly lower the patient's head to the ground. The patient may then be fully immobilized following the correct procedure.
Securing a helmeted head to a backboard[edit | edit source]
If the patient's condition does not allow removal of the helmet, the helmet may be secured to the backboard with tape. Secure the head in the anatomical position (this may mean that you do not use the normal head immobilizer). This is not the preferred method of transport as it can significantly negatively impact patient care and assessment.
Transport[edit | edit source]
Helmets should always be transported to the hospital with the patient, and a thorough inspection and documentation of the damage to the helmet should be completed and communicated to the receiving doctor or nurse.
Self Assessment[edit | edit source]
- Review and practice with the helmet removal worksheet until comfortable with the workflow.
- Test your knowledge with this quiz.
References[edit | edit source]