 David R. Diduch, MD |
David R. Diduch, MD, Professor of Orthopaedic Surgery, Fellowship Director, Sports Medicine, University of Virginia, presented a case study at the recent AAOS Conference in San Francisco. During on-field treatment of young athletes with suspected neck injuries, both helmet and shoulder pads should be kept on for initial stabilization and transport, and removed when the patient is in a controlled setting. The study clearly demonstrated that kids should follow the same guidelines as adults, and the helmet and shoulder pads should be left in place during transport to the ED where they can be removed as a unit by a team.
Facemasks should be removed during transport if there are any airway concerns. There should be no consideration to letting the EMT decide if the helmet fits or not, then selectively removing equipment in some cases. This would put the EMT at considerable liability. The kids are all fit for equipment by the league. The leagues do a good job of this. If the kid plays in the equipment all the time, it would be an unreasonable leap to assume that a responder can make an assessment on the field that the equipment doesn’t fit.
The hypothesis was that with the larger head to torso ratio in growing kids that the helmet should come off. It was disproven. Alignment maintained better to leave the helmet in place with the shoulder pads.
Other studies with live fluoro in adults have demonstrated that removal of the helmet does create movement of the spine no matter how hard you try to control for it. These recommendations go a long way towards simplifying things for the EMT community, as the all or none rule applies for all ages playing tackle football.
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