Removal of Motorcycle Helmets in the First Aid Setting
G’day everyone and welcome to another blog. The topic for this blog has come about as a result of one of the more common questions that we as first aid trainers get asked: What do you do if a motorcyclist has a helmet on and you need to render first aid after they have crashed? With the help of some family members recruited as models, this should now make things a little bit clearer for you, and if you are a trainer, could be used as an additional reference tool.
First up, let’s have a look at the types of helmets you will encounter.
FULL FACE HELMET
Covers the whole head with a fixed chin bar and offers the best level of protection.
FLIP FACE or MODULAR HELMET
Full face helmet that can be worn with the chin bar locked into place or lifted open. This helmet provides the best protection with chin bar locked down.
Covers only the top of the head, providing minimal overall protection.
OFF ROAD HELMET
Same design as a full-face helmet with an elongated chin bar. Generally worn with goggles and are more lightweight in construction.
OPEN FACE or ¾ HELMET
Covers head, cheeks, and back of the head. Leaves the face and chin open with no protection.
Management of Motorcycle Crash Victims
As with all road traffic crashes that you attend as a first aider, you must always consider your safety. So in line with your first aid training, DANGER is the first thing we want to consider when approaching the casualty. Hazards to consider include, but are not limited to:
- Bodily fluids
- Weather conditions
- Other people/bystanders
- Leaking fuel/oil
- Hot surfaces
- Broken glass, broken plastic, bent metal all produce sharp edges
- Any ignition sources
Next up you want to stabilise any movement of the casualty. To do this, we perform a maneuver known as MILS, or Manual In-Line Stabilisation. This is keeping anatomical alignment of the spine by holding on to the head. From this point, we can perform the remainder of our checks in line with DRSABCD.
Manual In-Line Stabilisation (MILS) is demonstrated in the image below.
If a patient is responsive and talking to you, it’s fair to say that they have a clear and open airway. If this is the case, simply maintain MILS and continue with secondary survey and any first aid treatment that may be required.
In an unresponsive patient, airways and breathing must take priority. With most helmets, this must necessitate the removal of the helmet. With half helmets, ¾ helmets and open modular helmets, airways and breathing can be determined to a certain degree, however with full face helmets it is almost impossible to determine accurately. Therefore, for an unconscious patient where you are unable to determine a clear and open airway with breathing, or if you can determine that the patient has a compromised airway and CPR is required, then the helmet must come off.
To remove the helmet from your casualty, you want to minimise any additional movement of the cervical spine (e.g. neck). Using two people, this is achieved by undertaking the following steps:
Maintain MILS. First aider #1 to hold on to the head of the patient, hands either side of the helmet.
First aider #2 to use trauma shears to cut chin strap. Alternatively, undo the chin strap.
First aider #2 to take over MILS of the patient. To do this, slide one hand under the head to the occiput (rounded back of the skull). Other hand is to support the jaw, being mindful of not squashing down on the throat.
First aider #1 to grasp the helmet at the bottom either side of the head. They are to then pull outwards (laterally), before easing the helmet up and off the head.
Be cautious of the nose, you may need to tilt the helmet backwards (towards the ground) to get the chin bar past the nose. REMEMBER TO TILT THE HELMET, NOT THE HEAD.
Once helmet removed, first aider #1 to take over MILS by placing hands either side of the head.
NOTE – IT IS IMPORTANT TO REMEMBER THAT, IF A HELMET HAS BEEN REMOVED, IT IS TO REMAIN WITH THE PATIENT THROUGH TO HOSPITAL.
This lets the treating medical staff inspect the helmet to determine any impact or damage that may have occurred to the casualties’ head.
If the patient is in the prone position (i.e. lying on their front), perform a log roll as best you can to move the patient on to their back, then perform the above steps.
It also pays to be on the lookout for some helmets that contain additional safety technology.
This photo illustrates the Emergency Quick Release System. The red tags, when pulled, remove the cheek pads of the helmet, making the removal process of the helmet removal significantly easier.
This photo shows the Eject Helmet Removal System. This is a pre-installed deflated airbag located inside the helmet on top of the head. A tube is routed to the back of the helmet. A small hand bulb can then be attached to this tube, inflating the helmet and thus pushing the helmet off the head.
Another helmet system commercially available is the VOZZ Helmet. The technology surrounding this helmet is best demonstrated by viewing the video at this link https://www.youtube.com/watch?v=mpED2rK7Ftk
And that is pretty much all there is to it. Don’t fall into the trap of listening to bystanders shouting at you to leave the patient where they are and not to remove their helmet. Follow your first aid training knowing that airway and breathing have precedence and therefore helmets must be removed to perform any techniques required. However, if they are talking to you, then yes, leave the helmet on.
If you’re a bit behind in your recertification for first aid or CPR, as always, we encourage you to book in to attend training. Paradise First Aid offers courses at three locations on the Gold Coast, Mermaid Beach, Helensvale and our new training venue at Biggera Waters, just outside of Harbour Town. If you have the numbers and want us to come to you, that can be arranged as well. Just give our friendly staff in the office a call to book your course in, either with us or at your site, on 07 5572 5299 or view dates here. Stay safe on the roads folks.
Queensland Ambulance Service Clinical Practice Manual (CPP, Trauma/Helmet Removal)
Curtis, K. & Ramsden, C. (2014). Emergency and Trauma Care for Nurses and Paramedics
Special thanks to my wife Lauren for assisting me with first aid on my father-in-law Gerald in the photos demonstrating helmet removal. Mother-in-law Jane was the photographer.