title: Combined tool approach is 100% successful for emergency football face mask removal.
abstract: OBJECTIVE
  To compare effectiveness of two techniques for removing football face masks: cutting loop straps [cutting tool: FMXtractor (FMX)] or removing screws with a cordless screwdriver and using the FMXtractor as needed for failed removals [combined tool (CT)]. Null hypotheses: no differences in face mask removal success, removal time or difficulty between techniques or helmet characteristics.
  
  
  METHODS
  Retrospective, cross-sectional.
  
  
  METHODS
  NOCSAE-certified helmet reconditioning plants.
  
  
  METHODS
  600 used high school helmets.
  
  
  METHODS
  Face mask removal attempted with two techniques.
  
  
  METHODS
  Success, removal time, rating of perceived exertion (RPE).
  
  
  RESULTS
  Both techniques were effective [CT 100% (300/300); FMX 99.4% (298/300)]. Use of the backup FMXtractor in CT trials was required in 19% of trials. There was significantly (P<0.001) less call for the backup tool in helmets with silver screws (6%) than in helmets with other screws (31%). Mean removal time was 44.51+/-18.79s (CT: 37.84+/-15.37s, FMX: 51.21+/-19.54s; P<0.001). RPE was different between techniques (CT: 1.83+/-1.20, FMX: 3.11+/-1.27; P<0.001). Removal from helmets with silver screws was faster (Silver=33.38+/-11.03, Others=42.18+/-17.64; P<0.001) and easier (Silver=1.42+/-0.89, Other=2.23+/-1.33; P<0.001).
  
  
  CONCLUSIONS
  CT was faster and easier than FMX. Most CT trials were completed with the screwdriver alone; helmets with silver screws had 94% screwdriver success. Clinically, these findings are important because this and other research shows that compared to removal with cutting tools, screwdriver removal decreases time, difficulty and helmet movement (reducing potential for iatrogenic injury). The combined-tool approach captures benefits of the screwdriver while offering a contingency for screw removal failure. Teams should use degradation-resistant screws.
  
  
  CONCLUSIONS
  Sports medicine professionals must be prepared with appropriate tools and techniques to efficiently remove the face mask from an injured football player's helmet.
authors.affiliation: New Hampshire Musculoskeletal Institute, Manchester, New Hampshire, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Copeland
authors.forename: Laura C
authors.initials: LC
authors.lastname: Decoster
authors.forename: Erik E
authors.initials: EE
authors.lastname: Swartz
authors.forename: Eric R
authors.initials: ER
authors.lastname: Gattie
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Gale
mesh_terms: D001265:Athletic Injuries / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods*; D005538:Football; D006260:Head Protective Devices; D006801:Humans; D012189:Retrospective Studies; D012449:Safety; D013124:Spinal Injuries; D013647:Task Performance and Analysis