title: Emergent Access to the Airway and Chest in American Football Players.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Quasi-experimental, crossover study.
  
  
  METHODS
  Controlled laboratory.
  
  
  METHODS
  We recruited 40 athletic trainers (21 men, 19 women; age = 33.7 ± 11.2 years, height = 173.1 ± 9.2 cm, mass = 80.7 ± 17.1 kg, experience = 10.6 ± 10.4 years).
  
  
  METHODS
  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.
  
  
  METHODS
  Time and perceived difficulty (modified Borg CR-10).
  
  
  RESULTS
  Helmet removal resulted in greater motion than face-mask removal, respectively, in the sagittal (14.88°, 95% confidence interval [CI] = 13.72°, 16.04° versus 7.04°, 95% CI = 6.20°, 7.88°; F(1,19) = 187.27, P < .001), frontal (7.00°, 95% CI = 6.47°, 7.53° versus 4.73°, 95% CI = 4.20°, 5.27°; F1,19 = 65.34, P < .001), and transverse (7.00°, 95% CI = 6.49°, 7.50° versus 4.49°, 95% CI = 4.07°, 4.90°; F(1,19) = 68.36, P < .001) planes. Face-mask removal from Riddell 360 helmets took longer (31.22 seconds, 95% CI = 27.52, 34.91 seconds) than from Schutt ION 4D helmets (20.45 seconds, 95% CI = 18.77, 22.12 seconds) or complete ION 4D helmet removal (26.40 seconds, 95% CI = 23.46, 29.35 seconds). Athletic trainers required less time to remove the Riddell Power with RipKord (21.96 seconds, 95% CI = 20.61°, 23.31° seconds) than traditional shoulder pads (29.22 seconds, 95% CI = 27.27, 31.17 seconds; t(19) = 9.80, P < .001).
  
  
  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.
authors.affiliation: Department of Kinesiology, University of New Hampshire, Durham;
authors.forename: Erik E
authors.initials: EE
authors.lastname: Swartz
authors.affiliation: Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill;
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.affiliation: New Hampshire Musculoskeletal Institute, Manchester.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Decoster
authors.affiliation: New Hampshire Musculoskeletal Institute, Manchester.
authors.forename: Sossan
authors.initials: S
authors.lastname: Al-Darraji
authors.affiliation: New Hampshire Musculoskeletal Institute, Manchester.
authors.forename: Justin
authors.initials: J
authors.lastname: Bric
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D056352:Athletes; D018592:Cross-Over Studies; D020878:Device Removal; D004638:Emergency Treatment / Q000379:methods*; D004869:Equipment Safety; D005260:Female; D005538:Football / Q000293:injuries*; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D009038:Motion; D011481:Protective Clothing; D013997:Time Factors; D014481:United States
keywords: cervical spine injury; protective equipment; sudden cardiac event