Beltz EM*, Decoster LC*, Day MA*, Swartz EE†, Mihalik JP‡: †University of New Hampshire (Durham, NH), *New Hampshire Musculoskeletal Institute (Manchester, NH), ‡University of North Carolina (Chapel Hill, NC).

Context: Sports medicine professionals required to manage spine-injured athletes must gain quick airway access while avoiding iatrogenic sequelae. This is complicated in equipment-intensive sports (e.g., football) where protective equipment inhibits airway access. In many instances, helmet removal is required to adequately access the athlete’s airway. It has been suggested helmet air bladders be deflated to decrease the difficulty of helmet removal. However, no data exists to support this recommendation.

Objective: To determine the difficulty and total time of helmet removal (HR) across two different helmet styles and deflation status (inflated or deflated).

Design: Repeated measures cohort study.

Setting: Controlled laboratory.

Participants: Twenty-two certified athletic trainers (15 males, 7 females; age=33.9±10.5 yrs; experience=11.4±10.0 yrs; height=172±9.4 cm; mass=76.7±14.9 kg). All participants were free from upper extremity or central nervous system pathology for 6 months and provided informed consent.

Interventions: Independent variables consisted of helmet type (Riddell Revolution—REV—or VSR4) and bladder deflation status. After familiarization, participants conducted two successful trials in random order for each of four helmet removal conditions (REV-Inflated; REV-Deflated; VSR4-Inflated; VSR4-Deflated). Helmets were removed from a live model wearing a properly fitted helmet and shoulder pads. An investigator assisted in stabilizing the model’s head. When ready, participants cut chinstraps, removed cheek pads (VSR4 model only), deflated accessible bladders with an inflation needle (deflation trials only), removed the helmet, and then regained manual stabilization of the head. Total time was recorded with a digital stopwatch. The perceived level of difficulty for HR by the participant was recorded after each trial using a modified Borg CR-10 scale (RPE).

Main Outcome Measures: Dependent variables included total time and perceived difficulty. A 2x2 (helmet type x deflation status) within-subjects repeated measures ANOVA was employed for each dependent variable.

Results: We did not observe significant helmet type x deflation status interactions for time (F1,21=14.81; P=0.834) or RPE (F1,21=1.82; P=0.192). We observed a main effect for deflation status (F1,21=18.81; P<0.001), such that inflated helmets—regardless of type—required less removal time (81.5±5.2 sec) than deflated helmets (96.1±4.9 sec). We also observed main effects of helmet type for time (F1,21=131.51; P<0.001) and RPE (F1,21=13.89; P=0.001), such that Revolution helmets required less time and were easier (time=59.7±3.7 sec; RPE=3.2±0.2) to remove than VSR4 helmets (time=118.0±6.7 sec; RPE=4.2±0.3).,/p>

Conclusions: Helmet air bladder deflation prolonged the time required to remove the helmets in our study. Additionally, it is not possible to access every air bladder in a supine athlete. In combination, our results do not support deflating the helmet air bladders prior to helmet removal.