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Helmet removal. Helmet removal has to be done by two trained people. The biggest risk that we have to all motorcyclists, or anybody wearing a helmet, is the chin strap. If we don't remove the chin strap, it pulls the tongue into the back of the throat and occludes the airway. Most of them have a nice easy system where you lift the red tab and the chin strap will release quite easily. That will take the tongue off the back of the throat or at least assist with taking the tongue from the back of the throat. The next thing we do is lift the visor so as we can actually get access into the patient, they can see us and we can see what's going on. This particular casualty has a pair of glasses on. So at this point, gently remove the glasses out of the way because they are just going to be a problem as we take the helmet off. The next thing we do is we take a firm grip of the helmet low down, roughly where the straps are fixed to the helmet itself and bring the head into what we call neutral alignment, putting slight upward traction but bringing the head straight in line with the spine.

Next, we get a second pair of hands onto the patient and what we are going to do now is by keeping the head and neck still, we are going to remove the helmet vertical. So, when I rock the helmet back, the hands replace where the helmet has come from. So it is a rocking motion, front to back and the hands go in to match the position. Back to front, front to back. And working as a team, we replace the hand positions with the helmet or the helmet with the hand position until we come loose. As soon as we come loose, we need to tell each other because at the last the minute you will get a heavy head and if you're not ready for it, it tends to drop, will go towards the floor and we want it to stay in the position it comes off. So the helmet is removed, placed on the floor and then from my position, I take C-spine immobilisation and that allows Mike to release his grips.

At this point, you will notice if Mike puts his hand on the back of the patient's head, the head is still in the position it came away from the helmet. It has not been allowed to go to the floor and you will now note if I actually take it to the floor, how much distance the head and neck will travel. We want to avoid this at all costs because the idea of removing it carefully is to keep it in the position it came out of the helmet itself and not allow any movement, flexion, lifting or lowering. Some helmets will have a flip-up chin piece, that makes me moving the helmet far, far easier. We still take control of the helmet in the same position but then your number two, who's helping you, will remove the chin piece using the little button on the front of the helmet. Nice and carefully, give it a good pull, it'll go. Now, as you can see, removing the helmet is exactly the same process but this time far, far easier to do because there's no chin piece in the way. 

We still rock, we still tip and rock and tip until we come loose. Once the head is now free, the helmet comes off and we repeat the process

We have exactly the same position we did before but this time with a face piece that lifts forward on a helmet. These are becoming more and more common these days. This is an example of an expensive helmet that was involved in a motion cycle crush at 120 miles an hour. The patient survived with only minor injuries but you can see the damage that occurred to the helmet when they hit the road. The internals have all come loose and broken, the jaw piece is fractured, the visor has smashed away and the chin strap had to be cut away as we have just demonstrated with helmet removal. You can read the wreckage on the helmet to see actually what part of the helmet hit the road surface and what damage was done to the helmet. The helmet should always travel to the hospital with the patient because the consultants can then see the impact zone, and the area on the brain and the skull, that the impact actually first initially hit. Reading the wreckage on a car is exactly the same as reading the wreckage on a motorcycle helmet.