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Combined Tool Approach is 100% Successful for Emergency Football Face Mask Removal

Copeland, Aaron J ATC*; Decoster, Laura C ATC*; Swartz, Erik E PhD, ATC; Gattie, Eric R ATC*; Gale, Stephanie D MEd, ATC*

Clinical Journal of Sport Medicine: November 2007 - Volume 17 - Issue 6 - p 452-457
doi: 10.1097/JSM.0b013e31815b187d
Original Research

Objective: To compare effectiveness of two techniques for removing football face masks: cutting loop straps [cutting tool: FMXtractor® (FMX)] or removing screws with a cordless screwdriver and using the FMXtractor as needed for failed removals [combined tool (CT)]. Null hypotheses: no differences in face mask removal success, removal time or difficulty between techniques or helmet characteristics.

Design: Retrospective, cross-sectional.

Setting: NOCSAE-certified helmet reconditioning plants.

Participants: 600 used high school helmets.

Interventions: Face mask removal attempted with two techniques.

Main Outcome Measurements: Success, removal time, rating of perceived exertion (RPE).

Results: Both techniques were effective [CT 100% (300/300); FMX 99.4% (298/300)]. Use of the backup FMXtractor® in CT trials was required in 19% of trials. There was significantly (P < 0.001) less call for the backup tool in helmets with silver screws (6%) than in helmets with other screws (31%). Mean removal time was 44.51 ± 18.79s (CT: 37.84 ± 15.37s, FMX: 51.21 ± 19.54s; P < 0.001). RPE was different between techniques (CT: 1.83 ± 1.20, FMX: 3.11 ± 1.27; P < 0.001). Removal from helmets with silver screws was faster (Silver = 33.38 ± 11.03, Others = 42.18 ± 17.64; P < 0.001) and easier (Silver = 1.42 ± 0.89, Other = 2.23 ± 1.33; P < 0.001).

Conclusions: CT was faster and easier than FMX. Most CT trials were completed with the screwdriver alone; helmets with silver screws had 94% screwdriver success. Clinically, these findings are important because this and other research shows that compared to removal with cutting tools, screwdriver removal decreases time, difficulty and helmet movement (reducing potential for iatrogenic injury). The combined-tool approach captures benefits of the screwdriver while offering a contingency for screw removal failure. Teams should use degradation-resistant screws.

Clinical Relevance: Sports medicine professionals must be prepared with appropriate tools and techniques to efficiently remove the face mask from an injured football player's helmet.

From the *New Hampshire Musculoskeletal Institute, Manchester, New Hampshire; and †University of New Hampshire, Durham, New Hampshire.

Submitted for publication December 14, 2006; accepted July 2, 2007.

This study was partially funded by a grant from NOCSAE (#05-04).

The authors state that they have no financial interest in the products mentioned within this article.

Reprints: Laura C. Decoster, ATC, NH Musculoskeletal Institute, 35 Kosciuszko Street, Manchester, NH (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.