Comparison of Football Facemask Retraction and Removal Times

Suspected spinal injury to a football player requires a delicate yet speedy response to minimize severity of injury. Standard on-field care of the suspected spine-injured football player includes leaving the helmet on and either retracting or removing the facemask to gain airway access. Recently published recommendations from the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete (IATF) give preference to removal, rather than retraction, of the facemask. However, little data exists to justify this procedural recommendation. Therefore, the purpose of this study was to compare the time required to successfully remove or retract a football facemask. Using four tools, Facemask Extractor (FME), Anvil Pruner (AP), Trainer’s Angel (TA), and PVC Pipecutter (PVC), two groups of certified athletic trainers retracted or removed the facemask from a supine model football player. The retraction group consisted of 11 subjects (age 29 ?9.5, years of certification 7.1 ?8.9), and the removal group consisted of 14 subjects (age 28.75 ?6.15, years of certification 5.94 ?5.61). Subjects were instructed in techniques for using each tool. Timing began when the tool was picked up and ended when the facemask was fully retracted or, in the case of removal, when the facemask was placed on the floor. Subjects knelt behind the model’s head, stabilizing the head with both knees. Mean retraction and removal times (in seconds) for each tool were compared using Student’s t-tests. Bonferroni-corrected p-values are reported. AP retraction time was 105.91 (+47.13), and removal time was 89.93 (+27.88) (p>.05). PVC retraction time was 256.55 (+95.19), and removal time was 140.43 (+70.47) (p=.008). TA retraction time was 184.18 (+79.73), and removal time was 88.50 (+50.35) (p=.000). FME retraction time was 176.82 (+120.51), and removal time was 67.86 (+52.48) (p=.052). A mixed two way repeated measures ANOVA was also calculated comparing the four tools (F=11.961, p= 0.000), the two techniques (F=30.65, p=0.000), and the interaction of tools by technique (F=3.48, p=0.020). Although there was some interaction, the main effect findings are valid because the interaction was ordinal and the main effects of tools and techniques are strong. Post hoc analysis revealed the following significant results: PVC required more time than any other tool (p<0.01), TA (p=0.048) and FME (p=0.055) times were both slower than AP time, and removal was quicker than retraction for all tools except the AP. Though it did not reach significance, removal was also faster than retraction with the AP. Considering time (independent of head/neck movement), this study supports the IATF’s 2001 recommendation that facemasks be removed rather than retracted. Also, unless an ATC has extensive practice using the PVC, its significantly longer times make it a questionable choice for this task.

2002 O’Sullivan PT, Decoster LC, Swartz EE: Comparison of Football Facemask Retraction and Removal Times (Abstract). J Athletic Training, Vol 37, Suppl