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J Athl Train. 1993 Winter; 28(4): 294, 296, 298, 300, 302, 304-305.
PMCID: PMC1317732

A Discussion of the Issue of Football Helmet Removal in Suspected Cervical Spine Injuries

Ross D. Segan
Ross D. Segan is Senior at Salisbury State University, Department of Athletic Training, Salisbury, MD 21801. He currentlyhas a 9-month assistant athletic trainer internship with the Philadelphia Eagles Football Team in Philadelphia.
Christine Cassidy
Christine Cassidy is Senior at Salisbury State University. She is currently spending her senior year practicum experience as the Head Athletic Trainer at Delmar High School, Delmar, Md. In addition to her athletic training internship, she is student teaching in Wicomico County, Md.


In some areas, it is a commonly accepted emergency medical technician protocol to remove a helmet during the initial management of suspected cervical spine injures. After a comprehensive survey of relevant literature, four primary reasons why Emergency Medical Services professionals would desire to remove a helmet emerge. Sources suggest that the presence of a helmet might: 1) interfere with immobilization of the athlete; 2) interfere with the ability to visualize injuries; 3) cause hyperflexion of the cervical spine; and 4) prevent proper airway management during a cardiorespiratory emergency. Many available protocols are designed for the removal of closed chamber motorcycle helmets that do not have removable face masks. There are a great number of differing viewpoints regarding this issue. The varying viewpoints are results of the failure of many emergency medical technician management protocols to address the unique situation presented by a football helmet. We: 1) demonstrate that football helmet removal is potentially dangerous and unnecessary, 2) suggest that cardiorespiratory emergencies can be effectively managed without removing the helmet, and 3) provide sports medicine professional with information that may be used to establish a joint Emergency Medical Services/Sports Medicine emergency action plan.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Clover J. Removing football face masks. J Athl Train. 1992;27(3):198–198. [PMC free article] [PubMed]
  • Knight KL. Removing football helmet face masks. J Athl Train. 1992;27(3):197–197. [PMC free article] [PubMed]
  • Ortolani A. Letters to the editor. J Athl Train. 1992;27(4):295–295. [PMC free article] [PubMed]
  • Ray R. Letters to the editor. J Athl Train. 1992;27(4):294–294. [PMC free article] [PubMed]
  • Stephenson MD. Helmets and face masks. J Athl Train. 1992;27(4):294–294. [PMC free article] [PubMed]
  • Torg JS, Vegso JJ, Sennett B, Das M. The National Football Head and Neck Injury Registry. 14-year report on cervical quadriplegia, 1971 through 1984. JAMA. 1985 Dec 27;254(24):3439–3443. [PubMed]
  • Vegso JJ, Lehman RC. Field evaluation and management of head and neck injuries. Clin Sports Med. 1987 Jan;6(1):1–15. [PubMed]
  • Watkins RG. Neck injuries in football players. Clin Sports Med. 1986 Apr;5(2):215–246. [PubMed]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association