Wow! Quick healing to you both!

 

I'm no MD but many moons ago I was a certified wilderness first responder, and my thinking is "why on earth would you take the helmet OFF before getting to the ER?" If the EMTs in the ambalam did it, I guess that's OK, but if I came up on a guy who'd been so knocked in a car wreck that he needed to go to the hospital, I would be too worried about aggravating head and neck injuries to take off his helmet or to let him do it himself. Slap a c-collar on that boy and let the docs at the hospital move things around how and when they like. Pretty much everyone in that situation would be above my paygrade and I'd totally defer to their better judgment, but I've seen lots of examples of people being injured and everyone wants to run up and move them around like you get a prize for cutting a C4. Unless the helmet is preventing a good airway, why would you take it off?

 

My feeling is that they needed to get the helmet off (chin strapped and goes behind her head and neck) to get the c-collar on and get her on the longboard.
Ironically my wife is an ER physician and I'm an anesthesiologist. I don't think there is anything wrong with how they did things.

 

How many people have an Eject Removal system in their helmet?

Dave - I hope Irene is ok!

 

OK thanks. I'll definitely let the pros decide when to remove helmets, personally.

 

She's fine Matt. Sound asleep while I fritter away my life on the internet and watch the Red Sox.

 

There's so little evidence about on scene immobilization that it's really laughable. It has become more ritual than science to slap collars and backboards on people. There are many thoughtful papers on the matter - if anyone is interested you can PM me.

Glad everyone is ok on this one. With a patient that is talking, and modern imaging available, inspecting a helmet is really just for interest. With an unconscious patient in a rural hospital without CT it may help the doc a wee bit to risk stratify re. mechanism/energy.

 

Matt, when Stand21 did my new helmet in April, I had them add an Eject system. Cheap at any price. OBTW, does anyone know if PCA carries Eject inflators in the race kits/setups that are used at every race?

 

Matt, I completely agree. Especially about the spinal immobilization.

Except I would add:
An unconscious patient needs a head CT ASAP, regardless of the condition of the helmet. If you are unfortunate enough to end up in a TINY E.R. without a CT scanner, they need to quickly get you to an E.R. with a scanner... again, regardless of the condition of the helmet. I would be very disappointed and surprised to learn that injured drivers from Mid Ohio would be transported to an E.R. without CT capability.

 

Wow, glad she will be ok.
And the Sox are now up 1-0.

 

I know of only 1 of my friend wearing it. My next FIA Helmet will have one.

It is not very well known among drivers, AFAIK.

c.

 

I don't understand. Is there a downside to this when head and neck trauma are indicated?

 

As an ER doc that, as Jack above, trained at a Level 1 trauma center we never seemed to deem any relevant information from a helmet other than quenching our curiosity and maybe suggesting severity of head trauma. But, as stated above, there are usually no surprises when you see the helmet, then the patient. They usually look the way you would expect them to look. If there was loss of consciousness or the patient has other ongoing neurologic symptoms then CT scan regardless of condition of the helmet. I personally have a very low threashold for CT scanning someone in a high energy/speed accident regardless of helmet or not. The risk of missed severe intracranial injury carries a high morbidity and mortality.

Blood type on a helmet or suit is foolish. No way I would ever transfuse someone based on their patch, sticker or even tatoo! O- blood that should be readily available at any significant medical center, esp one that you would be transfered to following high speed MVC, is given in emergencies and does not require a blood type and crossmatch.

Drug allergies are a whole different story. I seriously recommend wearing a tag, patch, sticker, etc with drug allergies, as these are taken very seriously and will truly benefit your caretakers and subsequently you.

As for taking helmets off and immobilization, there is old theoretical data about immobilization and the ritual that it has become. There is really no 'downside', but I agree it is more ritualistic and frankly CYA as opposed to a well validated practice. One of the reasons is that there is no new data or recommendations and that no EMS crew or Medical Director is going to attempt a new study in which patients are not immobilized and see if they have bad outcomes. Think about the potential for litigation: "You didn't follow the hallowed procedure of spinal immobilization and now the patient is a quadripeligic...". EMS and ER staff are trained to safely remove helmets without causing collateral damage or manipulation/worsening of an unstable spinal fracture. There are always curcumstances that require that the helmet(especially full faced) to be removed emergently such as airway compromise or need to manipulate or further manage the airway. Conversely, it is perfectly ok to leave the helmet on in a 'stable' patient and let EMS or the ER staff safely remove the helmet. It is not terribly difficult to immobilize the cervical spine with a helmet on, even without the use of a cervical collar. Again, a procedure that EMS is well-versed at performing.

Just my .02

 

Ian Stiell's group in Ottawa is currently doing a pilot study re. EMS applying the Canadian C-Spine clearance rules (similar to NEXUS) in the field and avoiding board & collar per assessment. Multi-center validation study will be next. Can't wait since I have an ongoing argument with our EMS service about immobilizing everyone who farts. It is CYA behaviour at its finest and not good for the patient.

 

I got a new driving suit this year.

I had them embroider my name and blood type on the front. Not because I thought any doctor would use it. Instead is was a psychological reminder to myself and others that what we do can have serious consequences.