title: On-field management of potential cervical spine injury in helmeted football players: leave the helmet on!
abstract: OBJECTIVE
  Improper handling of an unstable neck injury in the prehospital setting may result in potential iatrogenically induced neurologic injury. On-site management of the neck-injured, helmeted football player differs from that of other traumatic cervical spine injuries. Controversy still exists regarding helmet removal protocols for stabilizing the cervical spine of helmeted football players with a suspected neck injury. This article provides a critical review of the scientific evidence on cervical spine management in helmeted football players with a suspected cervical spine injury.
  
  
  METHODS
  A computerized literature search of databases (MEDLINE, Sportdiscus) and a manual search of journals from the sports medicine, emergency medicine, orthopedic, and athletic training literature identified articles related to the topic. Additional references were reviewed from the bibliographies of the retrieved articles.
  
  
  METHODS
  Conclusions are based on five quasi-experimental study designs evaluating motorcycle, football, and hockey helmet removal. In addition, an attempt was made to correlate articles relating to airway and cervical spine management in general trauma to the helmeted athlete.
  
  
  RESULTS
  Several studies support the recommendation not to remove the helmet or shoulder pads in the prehospital setting unless absolutely necessary. If necessary, both helmet and shoulder pads should be removed together as a unit. There are neither published studies in support of helmet removal nor any case reports of increased morbidity to athletes because of failure to remove the helmet in the prehospital setting.
  
  
  CONCLUSIONS
  Although studies support the notion that iatrogenic neurologic deterioration may occur with improper handling and attempted removal of the helmet in the prehospital setting, there is no literature to support increased morbidity associated with not removing helmet and shoulder pads. Stabilization of the cervical spine in an injured football player does not require routine prehospital removal of the helmet and shoulder pads before transport.
authors.affiliation: Sports Medicine Clinic, University of Delaware, Newark 19716-8101, USA.
authors.forename: K N
authors.initials: KN
authors.lastname: Waninger
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D005538:Football / Q000293:injuries*; D006260:Head Protective Devices; D006801:Humans; D013124:Spinal Injuries / Q000517:prevention & control