Football Face-Mask Removal With a Cordless Screwdriver on Helmets Used for at Least One Season of Play

Abstract

Management of injuries in helmeted football players with potential respiratory compromise requires speedy face-mask (FM) removal, because permanent brain damage can occur rapidly in anoxic individuals. Minimizing head movement during FM removal is also paramount because excessive movement may increase the severity of spinal injuries.^1–5 The importance of these considerations is reflected in the recommendations of the Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete (IATF).⁶ Specifically, the IATF recommends leaving a football player's helmet in place and removing the FM “as quickly as possible and with as little movement of the head and neck as possible.”⁶ The IATF further recommends that “all loop straps of the face mask be cut and that the face mask be removed from the helmet, rather than being retracted”⁶ (which requires removal of only the 2 side loop straps and the use of the top loop straps as a hinge to swing the FM up). In response to those recommendations, released in 2001, researchers have begun to focus on full FM removal. This research has shown this task to be relatively difficult⁷ and sometimes unacceptably time intensive.^7,8

Cutting implements for FM access include tools manufactured expressly for this purpose, such as the FM Extractor (Sports Medicine Concepts, Inc, Rochester, NY) and the Trainer's Angel (Trainer's Angel, Riverside, CA), and other commercially available tools, such as anvil pruners and polyvinyl chloride pipe cutters. Two groups^7,8 have investigated the use of cutting tools for full FM removal. Other researchers have studied cutting tools for FM retraction.^9–12 This work has provided insight regarding both tool and task performance, with mean times for FM removal or retraction of more than 1 minute and sometimes significantly longer. According to the literature, the mean time required to remove an FM using the FM Extractor ranges from 63.08 to 203.33 seconds.⁷ Mean times associated with FM removal using the anvil pruner (96.2 ± 41.6 seconds),⁸ polyvinyl chloride pipe cutter (155.9 ± 63.8 seconds),⁸ and Trainer's Angel (94.1 ± 19.4 to 159.7 ± 21.1 seconds)⁷ have also been reported in the literature.

Another possible tool for FM removal is a manual or power screwdriver. The IATF concluded that “the effectiveness of a screwdriver has been deemed limited and unreliable.”⁶ Indeed, anecdotal and historical reports have suggested that the screwdriver is unreliable based on the chance of encountering rusted or damaged hardware.^6,11–14 However, if the actual risk of encountering damaged hardware was shown to be minimal, the screwdriver would meet the IATF's recommendation that “The best tool … for face-mask removal should be efficient with regard to both time and movement.”⁶ Recently, investigation of the screwdriver for FM removal resulted in faster removal times and less movement than with a cutting tool.⁷ In that investigation, which used new (unworn) football equipment, the average time to remove an FM with the screwdriver ranged from 42.1 ± 6.8 to 55.83 ± 48.8 seconds, depending on FM and loop strap brand.⁷ This time was significantly shorter than that for both of the cutting tools (FM Extractor and Trainer's Angel) used in the study. The superiority of the screwdriver over cutting tools in minimizing head movement, force, or torque created during the FM removal process has also been reported.^7,8,11,12 Thus, the findings from studies of new equipment suggest that the use of the screwdriver for FM removal may actually successfully address 2 critical issues in the potentially spine-injured football player: speed of airway access and minimizing head and neck movement.

An important concern about this body of research to date is that although 2 groups have considered FM removal from new equipment, no researchers have investigated equipment that has been worn for football participation. A full season of play may have a significant effect on football equipment and its associated hardware. Countless impacts, weather, playing surfaces, sweat, and other unforeseen or unknown variables might make the FM removal process more difficult on equipment that has been used. Our purpose was to determine what percentage of FMs could be unscrewed from helmets after use for a full high school football season.

METHODS

We used a cross-sectional research design with helmets from 3 high schools that had been used for at least 1 season of New Hampshire Division I football. During the season, the 3 schools used a total of 222 helmets (Table 1). All helmets used during the season were included in this study. No effort was made to determine each individual helmet's actual exposure time. In all cases, the FM was attached to the helmet with loop straps in the 4 traditional locations. The 4 locations were labeled left ear, left top, right top, and right ear (Figure 1). Schools 1 and 2 each had 13 weeks of practice and 9 games. School 3 had 15 weeks of practice and 11 games. Schools 1 and 3 practiced on grass, whereas school 2 practiced on a turf field (mean games, 9.7 ± 1.2; mean practice weeks, 13.7 ± 1.2). Each high school played games on both grass and turf fields. Schools 2 and 3 used the same reconditioning plant before the 2003 season, and school 1 helmets were reconditioned at a different plant. School 2 instructed its players to perform weekly inspections of the chinstraps and tightness of their FMs, but otherwise no regular maintenance was performed during the season. At all schools, maintenance was performed on an as-needed basis, for example, replacement of broken or missing hardware (screws, t-nuts, loop straps). No reconditioning or maintenance was performed after the last game of each team's season and before our experiment. Between the end of the season and our experimental sessions (4 to 6 weeks), helmets were stored in dry, climate-controlled rooms.

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Figure 1

Face-mask clip positions

A, Right ear. B, Right top. C, Left top. D, Left ear

Table 1

Helmet Brands per School

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After the end of the season, 3 investigators (all certified athletic trainers) performed FM removal in 3 separate sessions at the convenience of each school's staff. During the FM removal trials, the helmet was secured to a board, with the back of the helmet resting on a concave surface to prevent movement (Figure 2). Screws were removed with an appropriately sized Phillips head bit inserted into a cordless screwdriver (3.6-V pivot driver, Black & Decker, Towson, MD) with factory settings of 40 inch-pounds of torque and 180 rpm. Before each session, we charged a number of batteries, and the battery in the screwdriver was changed after approximately 25 trials. Each trial was timed with a digital stopwatch, and success or failure was recorded. Other data recorded included 2003 reconditioning sticker information, brand and model of helmet, removal time, success or failure at each of the 4 screw locations, and cause of failure. To reduce the effects of fatigue, the investigators rotated after approximately 12 trials. Each investigator had significant experience with FM removal techniques.

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Figure 2

In preparation for face-mask removal attempts, we secured each helmet to a board with a hook-and-loop strap

After observation and recording of information about the helmet and condition of the screws, the investigator stood behind the top of the helmet (to the left in this photograph) and used a cordless screwdriver to attempt to unscrew all 4 screws

For each trial, timing started when the investigator picked up the screwdriver and stopped when the investigator said “finished,” indicating the last screw was successfully removed. A successful trial was defined as the removal of all 4 screws. Failure was defined as the inability to remove 1 or more of the screws. Three failure categories were created for statistical purposes: (1) t-nut spinning, (2) stripped screw head, and (3) other. If the operation of the screwdriver caused the screw head to turn but this did not loosen the screw because the t-nut was spinning, this failure was categorized as t-nut spinning. When the use of the screwdriver did not cause the screw or the t-nut to turn, this resulted in stripping of the screw head and was categorized as such.

Finally, we telephoned the 2 reconditioning plants that had prepared helmets for these schools before the 2003 season. The purpose of the calls was to determine whether stainless steel or carbon steel hardware (screws, t-nuts) had been used during the reconditioning process. School 1 helmets were reconditioned using carbon steel hardware, and school 2 and 3 helmets were outfitted with stainless steel hardware. No analysis of the metal content of the hardware was undertaken.

Frequencies of successful removal were derived from the descriptive data to provide success rates by school and screw location. We computed a χ² analysis to test for the significant difference in failure rates per screw location. A 1-way analysis of variance was performed to test for significance among the schools in time to removal and the number of failures per helmet. Tamhane post hoc tests, chosen to account for unequal variances, were calculated to identify significant differences between the dependent variables at α < .05. All statistical analyses were performed using SPSS software for Windows (version 11.0; SPSS Inc, Chicago, IL).

RESULTS

Observation of the screws during removal trials revealed the presence of gold-colored screws in all but 1 of the school 1 helmets and silver-colored screws in all but 6 of the helmets at the other schools. At school 1, the 1 odd helmet had silver screws, and at schools 2 and 3, the nonsilver screws were black. We noted the standard manufacturer's loop straps, as opposed to after-market upgrades, for all the helmets.

The FM removal (all 4 screws removed from a single helmet) success rate was 82.4% (183/222). The FMs were successfully removed from 24 (52.2%) of 46 of the helmets at school 1, 84 (91.3%) of 92 at school 2, and 75 (89.3%) of 84 at school 3. The difference in the number of screw failures per helmet among schools was significant (F_2,219 = 24.608, P < .001). School 1 demonstrated significantly more (0.76 ± 0.92) screw failures per helmet than school 2 (0.10 ± 0.30, P < .001) and school 3 (0.12 ± 0.51, P < .001).

Overall, we attempted to remove 885 screws from 222 helmets. (Each school had 1 helmet with 1 screw missing.) A total of 832 (94%) of the 885 screws were successfully unscrewed. A total of 53 screws could not be removed, sometimes including several screws on 1 helmet. Of these, 35 failures were in school 1 helmets, 8 in school 3 helmets, and 10 in school 2 helmets. However, 4 of the 10 failures in school 2 helmets (all on the same helmet) involved black screws, not silver. Because the screws did not match the color of screws in most of the school 2 helmets, they may have had different metal content than the reported stainless steel used by the reconditioning plant. The most common reason for failure was a spinning t-nut, accounting for 38 (71.7%) of 53 of all the removal failures. Seven (13.2%) of the 53 failures involved screws that were rusted into the t-nut. Another 13.2% of the failures involved previously damaged screw heads that were observed to be stripped before our first removal attempt. In 1 (1.9%) of the 53 failures, an unknown substance was embedded into the screw head, preventing access by the screwdriver.

Removal of the screw at the left and right ear positions was significantly less successful (198 [90%] of 220 and 201 [90.5%] of 222, respectively; P < .001) than removal of the left and right top screws (217 [97.7%] of 222 and 216 [97.7%] of 221, respectively). At school 1, success in removing the left and right ear screws was much less than the overall average (31 [67.4%] of 46 and 30 [65.2%] of 46, respectively).

Times from successful trials were also analyzed. The mean ± SD time for successful removal of the FM was 26.9 ± 5.83 seconds (range, 17–52 seconds) (Table 2). The time for FM removal at school 1 was significantly longer than at the other schools (F_2,180 = 18.827, P < .001).

Table 2

Face-mask Removal Time per School

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DISCUSSION

The objective of this small cross-sectional study was to determine the percentage of FMs that could be successfully unscrewed from helmets after they had been used for a high school football season. It was assumed that the condition of the helmets at the end of the season would represent the maximal effects of use and environment on the hardware. For schools 2 and 3, approximately 90% of FMs were successfully removed using the cordless screwdriver. However, success varied among schools, with the success rate at school 1 being significantly lower (52.2%). One possible reason for the difference is the use of carbon steel rather than stainless steel hardware in those helmets. Carbon steel is more vulnerable to degradation by rust and corrosion than stainless steel. Another possibility is related to the fact that most of the helmets used by school 1 were Schutt Air helmets (Litchfield, IL), whereas the other schools used primarily Riddell VSR helmets (Elyria, OH). Screw removal might be affected by the different approaches these helmet companies take to stabilize the t-nut inside the helmet. For example, Riddell incorporates a molded t-nut wall into the shell of the VSR helmets; this can stop t-nut spinning as long as the t-nut is properly seated. The Schutt Air helmet uses a washer that the Riddell hardware does not include but has no other means of preventing t-nut spinning (Figure 3). This may have been a factor independently or in association with the carbon steel hardware issue. The design of the current study does not allow further analysis of that question.

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Figure 3

Left, Riddell VSR helmets have t-nut restraints molded into the plastic helmet shell

With a properly seated t-nut, these t-nut “walls” can resist spinning. Right, Schutt Air helmets include a metal washer

Several other potential reasons exist for the differences in success rate found among schools in this study. Although these possibilities have not been studied, intuitively it seems that differences could be related to playing surface or weather exposure. School 2 practiced and played primarily on an artificial turf field, whereas schools 1 and 3 played primarily on grass. Playing on artificial turf might reduce exposure to the mud or dirt present in a natural surface, which might affect screws and t-nuts. The high removal success rate at school 2 might support that possibility; however, success rates at school 3 were similar, despite their playing primarily on grass fields. Because the schools were within the same city and practice and game times were largely similar, weather was probably not a differentiating factor in this study, although we theorize that an extremely wet or salty environment could negatively affect screw function. Finally, differences in FM or loop strap design may have been a factor, because these components have been shown to be related to FM removal efficiency.⁷

Considering our results on the basis of successful removal of individual screws rather than removal of the entire FM, 832 (94%) of 885 screws were successfully unscrewed. This rate appears to be comparable with that reported by Knox and Kleiner,¹² who noted an 8% incidence of screw spinning, and Jenkins et al,¹¹ who reported a 7% incidence. Other groups^9,15,16 have also reported spinning screws during FM removal or retraction attempts, but did not specify the incidence. The significant difference in failure rate by screw position we found may be related to the protection provided the top screws by virtue of their position beneath thick padding, where they may not be comparably exposed to weather or sweat. In our study, the most common reason for failure was a spinning t-nut, which can be related to helmet design, malpositioning of the t-nut in the helmet, or the melding of the screw to the t-nut secondary to rust or corrosion processes. Although the possibility that the screwdriver may fail to remove a screw in an emergency is certainly of concern, failure of cutting tools has also been reported. Swartz et al⁷ found that 8.5% of 295 attempts to remove an FM within 4 minutes with cutting tools (FM Extractor and Trainer's Angel) failed.

We are unaware of previous investigations of the effectiveness of the screwdriver in FM removal with helmets that have been worn for football participation. However, other authors have reported on time and efficiency of FM removal tools on new equipment. Although studies of FM removal (rather than retraction) are limited, when compared with cutting tools, the screwdriver has produced faster removal times in a previous study.⁷ With an overall mean of 26.9 seconds, our times were faster than reported in that study (42–56 seconds), despite the fact that they also used a cordless screwdriver. Possible reasons for the faster times we recorded include the current investigators' considerable experience and the fact that the experimental conditions, with the helmet mounted to a board, did not mimic real life, whereas the previous authors used a model dressed in football equipment. One way in which this might have affected the results is that shoulder pads can impede access to helmet loop straps.

The use of the screwdriver for FM removal is supported by findings of faster removal times and higher FM removal success rates when compared with cutting tools.⁷ The choice of the screwdriver is further supported by decreased head and neck movement associated with its use.⁷ However, as indicated by our different results among schools, factors that can make the screwdriver less effective clearly exist. Also, factors can reduce the effectiveness of various cutting tools (eg, the Trainer's Angel cannot cut the Riddell Revolution helmet's side loop straps). Consequently, tool choice must be ultimately based on individual situations, and appropriate backup tools must be present regardless of primary tool choice.

Our experimental setup, with the helmet mounted to a board, represents a potential limitation of this study. Another possible limitation is the fact that there was no geographic or environmental variety to the source of the helmets we studied. This factor could be important because, for example, helmets and hardware from coastal regions of the country might be affected by salty air. Finally, all helmets in this project had the traditional 4–loop strap configuration. We are not able to predict results with other configurations except to say that logically it seems that the presence of more screws would require more time for screw removal.

CONCLUSIONS AND RECOMMENDATIONS

This study of helmets worn for a full season in 3 New England high schools showed that 94% of loop strap screws could be unscrewed using a cordless screwdriver. At 2 of the 3 schools, removal of all 4 screws was successful in roughly 90% of helmets, whereas success at the other school was only 52.2%. The use of non–stainless steel hardware or differences in helmet brands used may have been factors in this difference.

Based on these findings and previous research that demonstrated quicker access time and reduced head movement associated with the use of the screwdriver instead of cutting tools for FM removal, we believe the screwdriver is an acceptable tool for FM removal. However, an appropriate cutting tool must be immediately available should the screwdriver fail. The screwdriver appears to be significantly more effective when stainless steel hardware is used to hold the FM to the helmet and in helmets featuring molded t-nut walls. Certified athletic trainers must be familiar with their team's equipment, choose tools that will work for their situation, and practice the skill of FM removal regularly. The choice of backup tool must also reflect the specifics of the equipment that will be encountered in an emergency. Future researchers should consider helmet hardware from different climates and geographic regions of the country.

Acknowledgments

REFERENCES