Drill of the Month Developed by Gloria Bizjak

1. Drill of the MonthDeveloped by Gloria Bizjak • Helmet Removal Drill of the Month Drill of the Month

2. Helmet Removal • Student Performance Objective: • Given information, resources, and opportunity for discussion and practice, EMTs will be able to: • List helmet types, features, and purpose • List the standards that cover helmets • Explain what types of helmets are removed or left in place after a trauma incident and why • Demonstrate assessment steps and emergency care • EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

3. Altered Mental Status: Assessing and Managing Seizure Patients • Overview • Helmets: Types, Features, Purpose • Helmet standards • Helmets: Remove or Leave in Place • Assessment and Care Procedures • Practice Drill of the Month

4. Helmets: Types, Features, Purpose • Types: Non-motor or sports helmets • Typically open in front • Some may have chin guards • Have easy access to ABCs Drill of the Month

5. Helmets: Types, Features, Purpose • Types: Non-motor sports helmets • Horseback riding, polo • Bicycle riding, mountain biking • Inline skating, skateboarding • Skiing, snowboarding • Hockey, football, lacrosse (high-impact contact sports) • Baseball Drill of the Month

6. Helmets: Types, Features, Purpose • Types: Motor sports helmets • Have different protection features than non-motor sports helmets • Include • Motorcycle riding • Motocross racing Drill of the Month

7. Helmets: Types, Features, Purpose • Features and Purpose • Outer shell: hard plastic (polystyrene)—protects head from impact of fall, crash, collision • Padding: a Styrofoam-type lining—cushions impact • Other lining: inflatable lining, cloth comfort lining—for better fit, snugness, comfort Drill of the Month

8. Helmets: Types, Features, Purpose • Features and Purpose • Face shield, chin guard: depending on sport and position played (football); preference (motorcycle)—offers further protection to facial areas, e.g., jaw, mouth, eyes • Chin strap: retention system—holds helmet in place Drill of the Month

9. Helmets: Types, Features, Purpose • Features and Purpose • Other safety features: Motocross racing requires Eject Removal System—inflatable bladder to remove helmet, requires tools, training; helmets must have chin bar • Label: Must show DOT, Snell, ANSI, ASTM, Eject system, or other standard label • Size and types: • Sized for children in some sports (bicycling) • Three types of motorcycle helmets • Full size; three-quarter size, half size Drill of the Month

10. Standards • All helmets must meet one or more of many rigid standards • Some standards are written specifically to a particular helmet and its use • All helmets meet standards for: • Impact and penetration • Retention • Surface contour • Lining • May have requirements for: • Peripheral vision (motorcycles specifically) • Labeling (e.g., DOT, Snell, Eject equipped, etc.) Drill of the Month

11. Standards • U.S. Consumer Product Safety Commission (CPSC)—benchmark for bicycle helmets • American Standard for Testing Materials (ASTM) • Snell Helmet testing standards • American National Standards Institute (ANSI) Drill of the Month

12. Standards • Central European Norm (CEN)—easiest standard to meet for skiing, snowboarding (better helmets meet Snell, ASTM) • National Operating Committee Standards (NOCS) for athletic equipment—industry accepted standard (football) • Safety Equipment Institute (football) Drill of the Month

13. Standards • Department of Transportation (DOT)—required for all motorcycle helmets • American Motorcyclist Association (AMA)—requires Eject Helmet Removal System (motocross racing) Drill of the Month

14. Helmets: Remove or Leave In Place? • Leave the helmet on IF : • The patient is conscious • It does not interfere with assessing or reassessing ABCs • There are no airway or breathing problems • The helmet fits snugly and does not move around on patient’s head Drill of the Month

15. Helmets: Remove or Leave In Place? • Leave the helmet on IF: • The patient is wearing shoulder pads • Removal will cause further injury • The patient’s head can remain in a neutral, in-line position during transport on a spine board Drill of the Month

16. Helmets: Remove or Leave In Place? • Remove the helmet • Generally IF: • It is easy to remove • It has a removable chin bar and/or face shield or just a chin strap • One other person is available to maintain head stabilization until immobilization is complete Drill of the Month

17. Helmets: Remove or Leave In Place? • Remove the helmet • Specifically IF: • You cannot assess ABCs • It interferes with providing oxygen • Removing face shield still interferes with providing oxygen • The patient is in respiratory or cardiac arrest • The helmet does not fit snugly and allows head movement inside helmet • You cannot immobilize patient on a spine board in a neutral, in-line position • If you remove helmet, remove shoulder pads Drill of the Month

18. Assessment and Care Procedures • Assessment: Perform General Patient Care (Maryland Protocols, pp 25-34, 124, 126, 128, 132) • Size up scene, gather information • Stabilize head with helmet on • Perform initial assessment • ABCs, oxygen as necessary Drill of the Month

19. Assessment and Care Procedures • Assessment: Perform General Patient Care (Maryland Protocols, pp 25-34, 124, 126, 128, 132) • Determine disability and whether to remove or leave on helmet • Check distal pulses and sensory motor function Drill of the Month

20. Assessment and Care Procedures • Assessment: Perform General Patient Care (Maryland Protocols, pp 25-34, 124, 126, 128, 132) • Provide cervical spine immobilization if: • Patient was or is unconscious • Patient is disoriented or shows change in mental status (person, place, time) • You suspect patient of substance abuse/use • Patient has midline cervical pain/tenderness Drill of the Month

21. Assessment and Care Procedures • Assessment: Perform General Patient Care (Maryland Protocols, pp 25-34, 124, 126, 128, 132) • Provide cervical spine immobilization if: • Patient shows decrease of or no function in a part of the body (focal neurological deficit) • Patient has other major painful trauma • Patient is less than 8 years of age Drill of the Month

22. Assessment and Care Procedures • Assessment: Perform General Patient Care (Maryland Protocols, pp 25-34, 124, 126, 128, 132) • Expose patient to assess injuries • Perform focused history and physical exam • Follow treatment protocols • Communicate with hospital or other response personnel • Determine priority and mode of transport and where (trauma center) Drill of the Month

23. Assessment and Care Procedures • Emergency care: Helmet removed (Brady Emergency Care 10th ed., pp 713-714, Brady First Responder 7th ed. pp 410-411) • First rescuer stabilizes helmet and head; second rescuer cuts chin strap • Second rescuer grasps and stabilizes mandible with one hand and occipital area with other hand • Second rescuer grasps lower edges of helmet, pulls sides away from ears, slowly slides helmet upward over patient’s head Drill of the Month

24. Assessment and Care Procedures • Emergency care: Helmet removed • First rescuer resumes head stabilization until immobilization is complete • Second rescuer measures and applies collar; with assistance moves patient to spine board; secures patient • If you remove helmet, remove shoulder pads OR • If you do not remove pads, place padding to maintain neutral, in-line spine position Drill of the Month

25. Assessment and Care Procedures • Emergency care: Helmet removed • Rescuers reassess patient • Retake vital signs • Recheck injury treatments • Recheck medical status • Rescuers transport/transfer/transition patient and information Drill of the Month

26. Assessment and Care Procedures • Emergency care: Helmet left in place • First rescuer stabilizes helmet and head • Second rescuer measures and applies collar; with assistance moves patient to spine board; secures patient • Rescuers reassess patient • Retake vital signs • Recheck injury treatments • Recheck medical status • Rescuers transport/transfer/transition patient and information Drill of the Month

27. Helmet Removal • Student Performance Objective: • Given information, resources, and opportunity for discussion and practice, EMTs will be able to: • List helmet types, features, and purpose • List the standards that cover helmets • Explain what types of helmets are removed or left in place after a trauma incident and why • Demonstrate assessment steps and emergency care • EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

28. Helmet Removal • Practice . . . • Review: • Helmets: Types, Features, Purpose • List several types of helmets • Name several features of helmets in general • State the purpose of helmets • Helmet Standards • List several of the well-known standards for helmets • Explain why you think standards were developed for the variety of activities for which helmets should be worn Drill of the Month

29. Helmet Removal • Review: • Helmets: Remove or Leave in Place • Explain when helmets should be left in place • Explain when helmets should be removed • Assessment and Care Procedures • Describe the steps of assessment • Describe the steps for care when the helmet is removed • Describe the steps for care when the helmet is left in place Drill of the Month