Updated: Feb 11
Properly managing the airway of a helmeted athlete can dramatically impact the athlete's chance of survival in an emergency situation. Typically, this conversation revolves around the sport of football, but other helmeted athletes must be considered in order to provide the highest level of care to all. In this edition of the Sports Emergency Care Digest, we briefly discuss airway management considerations with lacrosse equipment laden athletes.
Similar to football, lacrosse is a high-velocity collision sport where catastrophic injury may occur. In order for medical professionals, like athletic trainers, to best prepare for a potentially life-threatening event, one must practice proper equipment removal and trial and error any life saving techniques such as cardiopulmonary resuscitation (CPR). Equipment may pose a challenge when attempting to perform CPR with said equipment still in-tact, therefore forcing medical personnel to make clinical decisions on what equipment to remove and when it should be removed.
An estimated 11,000 new cases of spinal cord injuries occur each year in the United States (2). Participation in athletics is the fourth most common cause but when looking at patients under the age of 30 years old, sports participation is the second most common cause of spinal cord injury (2). In the event that a lacrosse player experiences a non-traumatic cardiac or respiratory arrest where the airway must be accessed, the decision for removing the helmet altogether may be easier for an athletic trainer to make, assuming one has ruled out spinal cord injury involvement. In the event that a lacrosse player experienced trauma and there is potential for a spinal injury along with a need to access the airway, equipment removal is more complicated.
According to the National Athletic Trainers’ Association Position Statement: Acute Management of the Cervical Spine– Injured Athlete, “rescuers should immediately attempt to expose the airway, removing any existing barriers (eg, protective face masks)” (2). In the event that available qualified personnel is limited when trying to remove all lacrosse equipment, the facemask may be removed in order to access the airway quickly and with fewer rescuers. According to the Journal of Athletic Training, “the jaw-thrust maneuver is recommended over the head-tilt technique, which produces unnecessary motion at the head and in the cervical spine” (2). In a study evaluating airway management of athletes wearing lacrosse equipment, it was found that a modified jaw thrust while using a pocket mask for ventilations with only the facemask removed was difficult and hindered providing successful breaths to the patient due to the chinstrap being in place (1). In the event that an athletic trainer does not have enough trained individuals to remove lacrosse equipment, it may be beneficial to consider having a King airway (KA) which in many states still falls under the scope of practice of an athletic trainer because supraglottic airways are used for basic life support (1). The use of nasopharyngeal and/or oropharyngeal airways is always an option but would run into the same complications when attempting a modified jaw thrust and sealing the mask in order to give adequate breaths.
Regardless of the ability to use an airway adjunct, it is vital to schedule routine equipment removal rehearsals with any individual that may be able to assist you in the event of an emergency, such as local EMS, coaches, equipment managers, etc. Always be sure to familiarize yourself with any equipment your lacrosse athletes may be using in order to be as prepared as possible for an emergency situation. Lastly, always have a venue-specific emergency action plan prepared and routinely rehearsed with vital personnel.
1. Bowman TG, Boergers RJ, Lininger MR. Airway Management in Athletes Wearing Lacrosse Equipment. J Athl Train. 2018;53(3):240-248. doi:10.4085/1062-6050-4-17
2. Swartz EE, Boden BP, Courson RW, et al. National athletic trainers' association position statement: acute management of the cervical spine-injured athlete. J Athl Train. 2009;44(3):306-331. doi:10.4085/1062-6050-44.3.306
Video: Lacrosse Equipment Removal
Video: NPA/OPA Placement
Image: Adult Basic Life Support Algorithm