a reminder for Foot ball season: pads and helmets

[Guest guest]

After having two different football players brought in to the ED for

evaluation of concussion, I've come to the conclusion that we need to re think

how

we are handling these young players if they are not being taken straight off

the field. This also came up in the ATLS class that I took last week, and many

of those docs, if they weren't from small towns, seemed to have never had to

remove a helmet and pads from a football player.

In both cases, the concussion was not noted until after the player got off

the field under their own power, and in both cases, the pads were left on when

the seated/standing take down was done to get them on the board...while the

void under the head was well and appropriately padded, the head was less than

optimally restrained. Getting the pads out from under the kid so that we

could do an appropriate evaluation and CT exam was not fun while trying to

maintain appropriate C spine precautions.

A modest suggestion: if you (as a field Medic/Basic) are doing a

standing/seated takedown on a football ball player with his helmet already

off...Please,

Please, PLEASE! stop and cut the jersey off, unlace the pads and remove them

PRIOR to doing the takedown! It is so much easier to do it then, and reduces

the amount of movement of the head and C spine en route...not to mention

removing the pads at that time will result in NOT having to cut them off in the

ED...saving the school system a fair chunk of money.

Similar rational applies to the player who still has his helmet on, but who

is still coherent enough that they are standing or seated...it's easy enough

to get the helmet (and then the pads) off while maintaining C spine

precautions prior to the take down (and to make it easier, the coach/trainer

should

have their nice little adjustment device that will often loosen the helmet

while still on the side lines)....and it's much easier to secure the patient to

the back board without 50 pounds of body armor on the kid.

You should indeed put the kid in full board with helmet and pads intact if

he is not conscious and cooperative (ie, unconscious on the field)...but you

should at least remove the face mask to provide adequate airway- remember that

the face masks are held on with simple plastic/nylon straps that can be cut

with a pair of diagonal cutters with ease.

I realize that many of you do work the sidelines at home town ball games and

are aware of these practices, but a reminder seemed to be in order after

seeing two cases in two different EDs and seeing the response at the ATLS

course.

ck

S. Krin, DO FAAFP