title: Football Equipment Removal Improves Chest Compression and Ventilation Efficacy.
abstract: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy.
  
  
  
  Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions.
  
  
  
  The fully equipped athlete resulted in the lowest mean compression depth (F5,154 = 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F5,154 = 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F5,150 = 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F5,153 = 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F5,150 = 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F3,28 = 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F3,28 = 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled.
  
  
  
  Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.forename: Robert C
authors.initials: RC
authors.lastname: Lynall
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fraser
authors.forename: Laura C
authors.initials: LC
authors.lastname: Decoster
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: De Maio
authors.forename: Amar P
authors.initials: AP
authors.lastname: Patel
authors.forename: Erik E
authors.initials: EE
authors.lastname: Swartz
mesh_terms: D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002574:Cervical Vertebrae / Q000293:injuries; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005538:Football; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D016544:Patient Simulation; D011312:Pressure; D012121:Respiration, Artificial / Q000379:methods*; D013124:Spinal Injuries / Q000628:therapy*
keywords: cardiopulmonary resuscitation; facemask; football helmet; simulation; spine injury; sudden death