Combined Tool Approach is 100% Successful for Emergency Football Face Mask Removal

Context: Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment. Objective: To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment. Design: Crossover study. Setting: University sports medicine clinic. Patients or Other Participants: A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players. Intervention(s): Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained. Main Outcome Measure(s): The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale. Results: All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players. Conclusions: Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited.

Section: Limitationsmentioning

confidence: 99%

The Assessment of Airway Maneuvers and Interventions in University Canadian Football, Ice Hockey, and Soccer Players

Delaney

Al-Kashmiri

Baylis

et al. 2011

“…Whereas it took more than 10 seconds longer on average to remove the Riddell 360 helmet, the times for face-mask removal using quick-release technology in this helmet were improved dramatically over times reported for removal with a cordless screwdriver 9,11 or when cutting a loop strap is required. 14 Helmet manufacturers should consider incorporating full quick-release face-mask designs into any helmets that do not possess the technology and should design all future helmets with this feature. Finally, researchers should continue to examine the effects of helmet designs on viable emergency airway support, as some investigators have explored inserting a pocket mask beneath the face mask 9,15 and using airway adjuncts in a simulation-manikin research model.…”

Section: Discussionmentioning

confidence: 99%

Emergent Access to the Airway and Chest in American Football Players

Swartz

Mihalik

Decoster³

et al. 2015

Context: American football has the highest rate of fatalities and catastrophic injuries of any US sport. The equipment designed to protect athletes from these catastrophic events challenges the ability of medical personnel to obtain neutral spine alignment and immobilization during airway and chest access for emergency life-support delivery.Objective: To compare motion, time, and difficulty during removal of American football helmets, face masks, and shoulder pads.Design: Quasi-experimental, crossover study. Setting: Controlled laboratory. Patients or Other Participants: We recruited 40 athletic trainers (21 men, 19 women; age ¼ 33.7 6 11.2 years, height ¼ 173.1 6 9.2 cm, mass ¼ 80.7 6 17.1 kg, experience ¼ 10.6 6 10.4 years).Intervention(s): Paired participants conducted 16 trials in random order for each of 4 helmet, face-mask, and shoulder-pad combinations. An 8-camera, 3-dimensional motion-capture system was used to record head motion in live models wearing properly fitted helmets and shoulder pads.Main Outcome Measure(s): Time and perceived difficulty (modified Borg CR-10).Results: Helmet removal resulted in greater motion than face-mask removal, respectively, in the sagittal (14.888, 95% Conclusions: Protective equipment worn by American football players must eventually be removed for imaging and medical treatment. Our results fill a gap in the evidence to support current recommendations for prehospital emergent management in patients wearing protective football equipment. Helmet face masks and shoulder pads with quick-release designs allow for clinically acceptable removal times without inducing additional motion or difficulty.Key Words: cervical spine injury, sudden cardiac event, protective equipment Key PointsFace-mask removal induced less motion than helmet removal when accessing the airway. Helmet face masks and shoulder pads with quick-release designs allowed for clinically acceptable removal times without inducing additional motion or difficulty. The actual ability to effectively ventilate a patient with a helmet on and face mask removed was not studied and has not been established in the literature.

“…To this end, many investigators have examined questions related to equipment removal and cervical spine motion, [1][2][3] airway access techniques, 4,5 and techniques and efficiency of face-mask removal. [6][7][8][9][10][11][12][13] Evidence has suggested that airway access can be obtained in the football-helmeted athletes without the removal of the face mask, ultimately reducing motion of the cervical spine often associated with face-mask removal. 4,5,14 However, the National Athletic Trainers' Association 15 and the InterAssociation Task Force for the Appropriate Care of the Spine-Injured Athlete 16 advocate full removal of the football face mask under all circumstances.…”

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confidence: 99%

“…However, the efficiency of facemask removal and the extent to which cervical spinal motion is generated by using these tools have been questioned considerably. 8,9,11,13,14 Gale et al 12 and Copeland et al 6 suggested a combined-tool approach, indicating that using a cordless screwdriver and the FM Extractor when screws fail is fast, easy, and reliable. More recently, Toler et al 14 reported that access was quicker and helmet motion was less when using the Revolution IQ (Riddell Sports, Inc, Elyria, OH) helmets equipped with the Quick Release (QR) Face Guard Attachment System (Riddell Sports, Inc) than when using helmets that require removing clips with a cordless screwdriver.…”

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confidence: 99%

“…Traditionally, helmets undergo reconditioning at the conclusion of a season. Whereas some researchers have examined the facemask removal rates of helmets set to undergo reconditioning, 6,19 only Gale et al 12 have examined face-mask removal during the season, noting excellent face-mask removal rates using a combined-tool approach. However, no investigators have addressed the function of the QR clip during or at the conclusion of a football season.…”

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confidence: 99%

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Successful Removal of Football Helmet Face-Mask Clips After 1 Season of Use

Scibek

Gatti

McKenzie

2012

Context: Whereas many researchers have assessed the ability to remove loop straps in traditional face-mask attachment systems after at least 1 season of use, research in which the effectiveness of the Riddell Quick Release (QR) Face Guard Attachment System clip after 1 season has been assessed is limited.Objective: To examine the success rate of removing the QR clips after 1 season of use at the Football Championship Subdivision level. We hypothesized that 1 season of use would negatively affect the removal rate of the QR clip but repeated clip-removal trials would improve the removal rate.Design: Retrospective, quasi-experimental design. Setting: Controlled laboratory study.Patients or Other Participants: Sixty-three football helmets from a National Collegiate Athletic Association Division I university located in western Pennsylvania used during the 2008 season were tested.Intervention(s): Three certified athletic trainers (2 men, 1 woman; age ¼ 31.3 6 3.06 years, time certified ¼ 9.42 6 2.65 years) attempted to remove the QR clips from each helmet with the tool provided by the manufacturer. Helmets then were reassembled to allow each athletic trainer to attempt clip removal.Main Outcome Measure(s): The dependent variables were total left clips removed (TCR-L), total right clips removed (TCR-R), and total clips removed (TCR). Success rate of clip removal (SRCR) also was assessed.Results: Percentages for TCR-L, TCR-R, and TCR were 100% (189 of 189), 96.30% (182 of 189), and 98.15% (371 of 378), respectively. A paired-samples t test revealed a difference between TCR-R and TCR-L (t 188 ¼À2.689, P ¼ .008, l d ¼ 0.037, 95% confidence interval [CI] ¼À0.064, À0.010). The percentage for SRCR was 96.30% (n ¼ 182), whereas SRCR percentages for trials 1, 2, and 3 were 95.24% (n ¼ 60), 98.41% (n ¼ 62), and 95.24% (n ¼ 60), respectively, and did not represent a difference (F 2,186 ¼ 0.588, P ¼ .56, 95% CI ¼ 0.94, 0.99).Conclusions: Our results indicated favorable and consistent success rates for QR clip removal after 1 season of use. Whereas the QR clip is an advancement in face-mask technology, continued examination of this system is required to ensure the highest level of function, allowing for effective management of the helmeted athlete.Key Words: quick release attachment system, protective equipment, equipment removal, emergency management Key PointsAfter 1 season of collegiate football use, the Riddell Quick Release Face Guard Attachment System side clips demonstrated favorable results, with 98% of all clips being removed successfully within a clinically acceptable time frame. Both side clips could be removed in approximately 96% of cases, allowing for face-mask retraction. The removal rate did not increase over time. Regular equipment maintenance, refurbishment, and reconditioning must be emphasized at all levels of football. Athletic trainers must practice and familiarize themselves with the improvements and challenges that new equipment developments might present during potentially life-threatening situations.