First aid question - full face helmet

[Casquito 0]

Strongly disagree with that one...
Not breathing is one of the ONLY indications to remove the helmet. A review of every protocol from Emergency Medicine, trauma, paramedic, down to bystander CPR will contradict you. Airway first. If they're not breathing then you must breathe for them. By your rationale, someone who just had a seizure is dead and you should just leave them there (they'll start breathing on their own actually, but you should support their breathing)?
Anyone who works in the medical field will tell you the same.

Ps, the trauma shears don't cut pennies, at least not the ones most EMT/Paramedics carry.

[goose491 0]

This thread got me thinking pretty hard. I'm going to go out and buy one of those CPR masks. You know, the ones you can get so that your mouth won't acutally touch the victims? I'm thinking of the out-cold-not-breathing-full-face-helmet-jumper now. I can picture perhaps working the mask into the helmet, getting a good seal and performing artificial respiration without having to remove the helmet.

Good question. It's good to discuss and raise some awarness on the issue Bill but I really think the question you're asking is only answerable on the spot.

Shallow breathing often accompanies the shock from a major trauma. It in itself is no threat to the patient. I mean, like you said, if they aren't breathing, then the bucket has got to go. But if they are, shallow or not, there will be no artificial respiration. So why does it have to come off?

So perhaps I haven't read correctly. Perhaps your scenario is that the helmet itself is actually choking the patient? I suppose that's the only reason I'd see myself wanting it off. But i'd only attempt to remove it in this case if A) I have a concious jumper that can confirm that the helmet is the reason he/she cannot breathe right or B) I can asses and know, beyond reasonable doubt, that the helmet is the culprit. Otherwise, I think I'll just leave it on and monitor the breathing.

My Karma ran over my Dogma!!!

[kelpdiver 2]

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This thread got me thinking pretty hard. I'm going to go out and buy one of those CPR masks. You know, the ones you can get so that your mouth won't acutally touch the victims? I'm thinking of the out-cold-not-breathing-full-face-helmet-jumper now. I can picture perhaps working the mask into the helmet, getting a good seal and performing artificial respiration without having to remove the helmet.

Pocket mask would be great to have on you, though might be a tad bulky for an item that may get used once or twice in your jumping life. Maybe good for the instructors or someone at the LZ to have. If you can work it into a full helmet, would be a much better choice, though you still need to have open airways.

[goose491 0]

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Pocket mask would be great to have on you, though might be a tad bulky for an item that may get used once or twice in your jumping life. Maybe good for the instructors or someone at the LZ to have. If you can work it into a full helmet, would be a much better choice, though you still need to have open airways.

True true. I'm also thinking it's not a bad idea to have in the car or something though. I mean my car will always be at the DZ when I am. And just for in case of an accident on the road... motorcyclists wear full-face.

My Karma ran over my Dogma!!!

[billvon 3,114]

>Pocket mask would be great to have on you, though might be a tad
> bulky for an item that may get used once or twice in your jumping life

At Otay we have two medical kits - the regular one and the trauma one. The trauma kit has things like rescue breathing masks, inflatable splints, IV fluids etc. For carrying around I have one of those foldable barriers; it folds up very small but can't be used with a full face.

[billvon 3,114]

>Perhaps your scenario is that the helmet itself is actually choking the patient?

It's any scenario where you believe they are not breathing. Unconscious people can't guard their airway, and if their face and nose is mashed against the lower guard of the helmet, it may have to come off (if you can't get an airway any other way.) In many cases you may be able to clear their airway by manipulating the helmet without removing it. As someone else mentioned, it's a last-ditch thing; the only time you want to take off their helmet is if they will die if you don't (due to suffocation.)

[dnewcomer 0]

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Try to pull it off and risk a different kind of cord damage? We didn't come up with a good answer, but it's a question worth considering before it happens. -bill von

B--

This is a "trick box" question. I didn't have time to read all the posts in reply, so I apologize if this information has already been offered.

If someone wearing a full-face helmet has questionably adequate airway after an accident, the answer is do not remove the helmet but watch closely and wait. If the person continues shallow breathing but is obviously moving air and skin/lip color remains good (pink), leave it up to the paramedics or other trained personnel when they arrive on the scene to remove the helmet.

If on the other hand the person's respiratory rate gets very high (>40/min.) or low (<6/min.) and skin/lip/nail bed color begins to turn blue, conditions are deteriorating. It would probably be safer to remove the helmet to establish a good airway. If you have no idea what to do to gain a good airway even with the helmet off, you'd probably be better off leaving things as they are.

Unfortunately there are numerous injuries (tension pneumothorax or cardiac tamponade, for example) other than a blocked airway that can cause someone to turn blue after a serious landing accident. Without special equipment (such as would be available to a paramedic), there is little that can be done in the field to "fix" those types of injuries. So it helps to be fairly sure the hypoxia is due to an airway problem.

Bottom line: if a person is going to die shortly after an accident due to suffocation from lack of an adequate airway, top priority would be to establish a good airway even at the risk of aggravating a C-spine fracture. You're just as dead with or without the C-spine fracture if you can't breath. You wouldn't want to say after the fact, "Well he may have suffocated to death, but at least we didn't make his C-spine fracture worse before he died." Duh! This is convoluted thinking.

Thanks to "Good Samaritan" laws in most states, you will never get sued for causing inadvertent injury if you try your best in an emergency situation to save someone given your level of knowledge.

D--
WEB SITE: www.newconthenet.com

[WeakMindedFool 0]

Your wrong on so many levels I won't even explain all of them to you. Tell me this...how many blunt force trauma codes survived in the U.S. last year? I can tell you how many survived in the last 10 years in this region. Guess? one. UCDMC did a large chart review of ALL trauma codes and found that over the preceding 8 years only one patient survived. Durring that time the only trauma codes that were called in the field were in cases of incineration, decapitation, vital organ seperation, and obvious greay matter in the presence of pulseless apnea...
And they do cut pennines.

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
Check out these Videos

[WeakMindedFool 0]

Sure...in a medical or drowning case, hell yeah. I'm thinking more along the lines of a skydiving incident.

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
Check out these Videos

[WeakMindedFool 0]

Hmmm, I have to be honest, I've never tried to cut one. I always take them off first thing, I always have trained help though. I've trained someone to do it while doing it but...damn you do have a delema. The only way to realistically do what you want to do is train people to do it. Unfortunately they will get very little practice unless you make it an issue to practice the skill.
Good luck

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
Check out these Videos

[Lindsey 0]

If I were the person with a possible c-spine injury, needing breathing assistance that was impeded by a full-faced helmet, I think I'd prefer a cricothyrotomy to possible spinal cord damage. Of course its six of one, half dozen of the other if nobody's around with adequate training/equipment.

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[dnewcomer 0]

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......I think I'd prefer a cricothyrotomy to possible spinal cord damage. Of course its six of one, half dozen of the other if nobody's around with adequate training/equipment.

linz

(Underlining by me for emphasis.)

Not sure what you mean by "adequate training?"

How many cricothyrotomies have you done? How many have you done on an unconscious person laying in a field wearing a full face helmet? I would not want this procedure to be done on me in this setting except by an experienced trauma surgeon. Too rmany possible complications at least as serious as a C-spine injury. No point in going into them here.

I believe most other trauma surgeons would agree with me on this. A cricothyr. can be a tricky procedure in a trauma patient even in an emergency room with plenty of lighting, assistance, and all the surgical equipment you need.

If you're an experienced trauma surgeon, I flatly disagree with you on this one --- I've had to do too many emergency cricos. Your opinion sounds like a case of "A little bit of knowledge........" No offense intended, so I hope none taken.

D--
WEB SITE: www.newconthenet.com

[Lindsey 0]

No offense taken. I DO have a little bit of knowledge. I did one cricothyrotomy last year as a junior medical student on a surgical rotation. The procedure itself was not particularly complicated (they let a junior medical student do it). Skin and a membrane.... Perhaps I don't appreciate the additional risks involved with an unconscious person wearing a full-faced helmet. It's hard for me to imagine it being a lot worse than the risks of cervical spine injury while removing that helmet. My expectation would be that in a pinch most MDs should be able to perform that procedure. Are you a trauma surgeon? The reason I ask is because of the territorial nature of the medical profession....

Peace~
linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[skymedic 0]

In my experience with full faced head injuries. easiest way to see if someone is breathing is stick your hand as far up into or down near the nose/mouth while still maintaining Cspine. you can feel heat and moisture. I work as a fire/medic when nascar comes to our local track and have taken care of a couple of knocked out drivers and this is a very easy way to check the abc's in one shot...well the a's and b's at least...

Marc
otherwise known as Mr.Fallinwoman....

[skymedic 0]

I have performed several surgical cricothyroidotomies in my career. one was on an obvious neck fx with a full faced helmet on a motorcyclist. and that was on the side of a road with the rider stuck inside the car that hit him. it is a relatively easy way to obtain an airway...in my opinion. But you open up other problems when doing that. especialy in the environment I work in. and you are right they are not complicated. sometimes less complicated than some intubations I've had to face in the field....especialy with traumatic injuries.

Marc
otherwise known as Mr.Fallinwoman....

[skymedic 0]

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Thanks to "Good Samaritan" laws in most states, you will never get sued for causing inadvertent injury if you try your best in an emergency situation to save someone given your level of knowledge.

You can still be sued....they just wont win....

Marc
otherwise known as Mr.Fallinwoman....

[PhillyKev 0]

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Thanks to "Good Samaritan" laws in most states, you will never get sued for causing inadvertent injury if you try your best in an emergency situation to save someone given your level of knowledge.

I thought you were only covered by them if you are red cross certified.

[CanuckInUSA 0]

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They're unconscious, lying on their backs. They're wearing a full face helmet. Their breathing seems very shallow, pulse is OK, no major bleeding. What do you do?

This is an old thread and I haven't read through it.

If they are still breathing and their pulse is okay and it's the type of fullface helmet which can not be opened without moving the victims head, then:

1) DO NOT TOUCH the helmet.
2) Call for an ambulance.
3) Get yourself or someone you trust to stablize the head.
4) Monitor the victim.
5) Wait for the ambulance.
6) Monitor the victim.
7) Get a neck brace on them.
8) Monitor the victim.
9) Get qualified people to put the victim on a backboard.
10) Continue to monitor the victim on the way to the hospital.

The key here is that the victim is still breathing (even if it is shallow breaths) and their pulse is okay. You risk doing them harm by trying to remove the helmet.

I am not the sharpest crayon in the box. But I'm not dull either. I was a volunteer ski patroller for 3 years and a pro patroller for another year at a major ski resort (Lake Louise in Alberta) and I have had to deal with some nasty shit. I was trained in the priorities of first aid and your victim as stated above is still doing fine. Now if they go into cardiac arrest and stop breathing, well all bets are off and the helmet comes off (as carefully as possible).

Also, guys like skymedic have the training to perform cricothyroidotomies, but how many of us know how to do this? I don't and I was a ski patroller ... mind you that was a good 14 years ago and things may have changed for patrollers since then.

Try not to worry about the things you have no control over

[dnewcomer 0]

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I thought you were only covered by them if you are red cross certified.

Not so. You are protected no matter what your knowledge. These laws were passed to discourage people from avoiding the chance to help accident victims for fear of being sued.

More about cricothyroidotomies (CTDY): we may be talking about different things. I was talkiing about a "surgical cricothyroidotomy" in my post, not the procedure where a narrow tube with a sharp trocar is used to pierce the cricothyroid membrane, then the trocar is removed leaving the plastic tube for an airway. That is a safer, easier procedure to gain access to the airway in an emergency --- especially in the field. Some people have actually used large bore needles (#14) to do this, but it would be very difficult to ventilate a person through a #14 needle. You can however administer Oxyg.

I don't think it is necessary to go into lengthy discourse here about airways in trauma victims, but a CTDY is not necessarily the "holy grail" of airway management in injured people wearing full face helmets. If you can't ventilate the pt. through the CTDY and there is no obstruction between the glottis and the upper trachea in the frist place, a CTDY would be little help.

These patients frequently have ventilatory problems from aspiration of blood or regurgitated stomach contents. Sucking out the mouth and upper airway is more likely to help them breathe than anything --- if something as simple as an ear syringe or bulb syringe is available to do the job. We added one to the first aid kit at our DZ a couple of years ago.....after we needed one. Even without the syringe, our seriously injured jumper with a marginal airway survived.

D--
WEB SITE: www.newconthenet.com

[PhillyKev 0]

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This is how the law reads verbatim. It is very straightforward as far as laws go, but there are some gray areas to it. The first questionable area is, 'unless the rescue attempt is unreasonable.' What this is referring to is when we provide care that is, by all accounts, unnecessary. Such as, removing an injured victim from a car that is not in imminent danger and the movement aggravates the injuries. Another example could be treating non-life-threatening injuries where the condition was worsened in the attempt, splinting a broken bone. Splinting requires moving the victim so we run the risk of causing an open fracture, etc.

The other area in question, 'the rescuer acts unreasonably in performing the attempted rescue.' First of all, a person is not obligated by law to do first aid in most states, not unless it's part of a job description obviously. Some states will consider it an act of negligence though, if we don't at least call for help. Beyond this, assisting is optional and voluntary, partly due to preserving the rescuer's own health in the process. Without protective equipment the rescuer could be exposed to infectious diseases by coming into contact with a victim's bodily fluids. In short, we are not obligated to render first aid in fear of cross-contamination yet, if we begin to help, we must continue to do so until one of three things happen: the victim recovers, another trained person replaces you or we are too physically exhausted to continue. Stopping for any other reason is interpreted legally as, 'acting unreasonably.' Then the good samaritan laws would offer us no protection if there were a tort suit.

http://pa.essortment.com/goodsamaritanl_redg.htm

That first example could easily be applied to the removal of a helmet when unnecessary.

Personally, I'm not helping anyone that I don't know. Too many screwed up people that will sue you. Not worth the risk.

[skymedic 0]

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More about cricothyroidotomies (CTDY): we may be talking about different things. I was talkiing about a "surgical cricothyroidotomy" in my post, not the procedure where a narrow tube with a sharp trocar is used to pierce the cricothyroid membrane, then the trocar is removed leaving the plastic tube for an airway. That is a safer, easier procedure to gain access to the airway in an emergency --- especially in the field.

umm....we do not use a trocar...I use a scalpel...then place the airway and secure. I have been using this procedure since 1993. we have a very advanced and progressive EMS system.

Marc
otherwise known as Mr.Fallinwoman....

[hexadecimal 0]

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Almost two years ago I saw a jumper hook in

Newbie question - What does "hook in" mean?

[denete 3]

Recently I saw a sticker on a motorcycle helmet:

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Do not remove my helmet.
Do not risk paralysis.

Online, I saw another:

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Warning:EMS Personnel
Do not remove helmet until I am examined by a doctor

Although this thread is fairly old, I think that most of the information is still valuable. However, I do want to ask if a sticker such as those above on a helmet can lead to problems potentially? In a real accident aid situation, would anybody even notice something like this?

By the way, there is a course presented in California on accident scene management which mentions training for those providing assistance to helmeted victims. http://www.accidentscene.net/

- David

SCR #14809

"our attitude is the thing most capable of keeping us safe"
(look, grab, look, grab, peel, punch, punch, arch)

[brettski74 0]

The first sticker may make some sense - I'm assuming that it's directed at untrained bystanders who may be first on the scene and do things they shouldn't.

The second sticker directed at EMS personnel is just plain dumb. EMS Personnel will do what they are trained to do. If they do not, they run the risk of losing protection of good samaritan laws and being liable in the event of any resulting complications.

As a former ski patroller, in all likelihood, I probably wouldn't notice a sticker like that until after the helmet was removed. If I did happen to notice it, however, it would not affect my decision to remove the helmet. As stated above, I am required to render first aid in the manner that I was trained. To do anything different exposes the patient to additional risk of injury and myself to risk of legal liability.

[Auryn 0]

I think these are viable options for a potential victim to communicate. Maybe there could be a way to make it more authoritative, something like a DNR filed at manifest? Like AggieDave said earlier, there are people that have survived accidents that later they might've wished they didn't.

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Recently I saw a sticker on a motorcycle helmet:

Quote

Do not remove my helmet.
Do not risk paralysis.

Online, I saw another:

Quote

Warning:EMS Personnel
Do not remove helmet until I am examined by a doctor

Although this thread is fairly old, I think that most of the information is still valuable. However, I do want to ask if a sticker such as those above on a helmet can lead to problems potentially? In a real accident aid situation, would anybody even notice something like this?

By the way, there is a course presented in California on accident scene management which mentions training for those providing assistance to helmeted victims. http://www.accidentscene.net/

- David