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Current Controversies-Removal of Protective Equipment

Although most prehospital personnel now accept the recommendations of the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete, some concern exists on the part of prehospital care providers regarding the inability to fully evaluate the helmeted head and neck before transport to the hospital.

Historically, cervical spine protocols were designed for motorcycle helmets; thus, they reflected the nature and energy of these injuries. Prehospital care protocols may still reflect these injuries. Given the higher energy and severity of motorcycle injuries to the head and neck, it may be reasonable to remove helmets in these cases for better evaluation of the patient.

Unlike motorcycle helmets, however, the combination of football helmets and shoulder pads helps to maintain a neutral alignment of the cervical spine. Furthermore, athletic injuries from collision sports are of much lower energy and have a lower incidence of severe head or neck injury.

In light of this, there is a consensus regarding the removal of protective gear during the initial on-field assessment of the spine-injured athlete. The current NCAA guidelines for football helmet management state that unless special circumstances exist, protective equipment (helmet and shoulder pads) should not be removed on the field.

This consensus may not be reflected at the level of local and community emergency medical services, however, which may lead to compromise of cervical spine care. Proper communication and cooperative education with local emergency medical services, hospitals, and on-field care providers should be undertaken to improve prehospital care.

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