Medical Professionals Online

Study Confirms Best Way To Transport Youth With Football Neck Injuries

April 24, 2017

Paramedics at the University of Virginia Health System recently demonstrated a practice of care that researchers in the orthopaedic surgery department say should be implemented nationally. Responding to an on-field neck injury at a nearby high school, the UVA emergency team transported the young football player to the hospital without removing his helmet and shoulder pads.

"We don't see this kind of injury very often," says Tim Hodge, clinical manager of UVA's Pegasus Transport Services. "But when we do, we usually remove the player's face mask and leave on his other gear to prevent further injury and help stabilize him."

Hodge says that UVA emergency medical teams are trained to transport both young and adult football players suffering from neck injuries without removing their head and shoulder gear. "It's been our standard of care for five years or more," he adds.

"This standard of care should be practiced everywhere, but it isn't. In many places, EMTs have the option to remove children's helmets," says Dr. David Diduch, MD, professor of Orthopaedic Surgery and Team Physician at UVA.

Recent research by Dr. Diduch and his colleagues shows that removing gear may increase an injured child's risk of paralysis or neurological damage. "We observed alignment changes that were unacceptable," he notes.

According to Dr. Diduch, previous research established the national standard of care for fully grown players leave the helmet and shoulder pads on during transport to maintain spine alignment but no one had ever examined this relationship in children.

UVA researchers began their study assuming that differences in body proportions made it necessary to remove an injured youth's helmet on the field. "Growing boys have a larger head size relative to their torso, and our hypothesis was that removing the helmet would help to keep their necks from bending forward," explains Dr. Diduch. "This is the assumption widely held among EMTs." However, study results, which were presented at a national medical conference in March 2008, proved them wrong.

During the study, researchers took three different X-rays of 31 uninjured, volunteer boys between the ages of 8 and 14. All played in the local Pop Warner Football League, which loaned the equipment used in the study. The children had X-rays taken while lying down without equipment, while wearing both helmet and shoulder pads, and while wearing only shoulder pads.

The X-rays showed that when a player wore both his helmet and shoulder pads, his spinal alignment remained similar to when he did not wear equipment. Alignment changes occurred when the boys removed their helmets and wore only shoulder pads.

"Our findings make it clear that EMTs should leave in place a child's helmet and shoulder pads, unless the child has a breathing problem that can't be handled by facemask removal alone. Equipment should only be removed in the hospital emergency department by a team of specialists," Dr. Diduch explains.

He adds that it's important for everyone associated with youth football players, coaches, trainers, parents and fans to know that equipment should not be removed when neck injuries occur. "Everyone who may care for an injured player until EMTs arrive should know leaving a child's helmet and shoulder pads in place is the safest thing to do," he advises.

University of Virginia Health System
PO Box 800795
VA 22908-0795
United States