By Jim Upchurch
If you Web search the word ‘helmet,’ you will find its standard description as a type of head covering performing a variety of functions, from decoration to protection. You will also find that it is used as the name of a city in Virginia, a volcanic peak in British Columbia, a breed of fancy pigeons, and as an alternative metal post-hardcore band from New York City. If you persist in your search, you will eventually discover information concerning medical helmets that are under development or currently in use, as exemplified by the following scenarios.
Stroke helmet
This nifty device is under development at Duke University with the intent of providing an immediate look at blood flow in the brain during a stroke through the use of 3-D ultrasound probes embedded in the helmet. The images could potentially be transmitted from an ambulance or emergency department to a stroke center. If successful, the process would be faster than accessing a CT scanner in determining whether or not the blood-deprived region of the brain will benefit from a clot buster, thus shortening the three-hour window from the onset of a thrombotic stroke to fibrinolytic treatment.
Hypothermia helmet
Borrowing a little technology from the National Aeronautics and Space Administration, cooling helmets have been developed to provide mild localized hypothermia of the brain in response to stroke or head injury. In addition, they are also capable of inducing mild systemic hypothermia for the unconscious cardiac arrest patient with the return of spontaneous circulation. This beneficial therapy is accomplished by circulating some type of cooling fluid (such as aqueous glycerol) throughout the helmet, and as expected, the systemic temperature takes longer to decrease than brain temperature. There is also a hypothermia helmet on the market to prevent hair loss for chemotherapy patients.
Alzheimer helmet
Dementia is the loss of both memory and the necessary thought processes that allow us to function in our daily lives. It is a progressive condition, ultimately ending in death of the victim. Alzheimer’s disease is the most common form of dementia. Certain medications are available to help slow the progression of dementia, but there is no current treatment that can reverse the damage already done. An Alzheimer helmet is presently under development at the University of Sunderland in the United Kingdom, and recent animal research suggests that the low-level infrared light produced by the helmet can penetrate the skull and stimulate growth of brain cells. This, in turn, may reverse some of the memory loss traditionally associated with Alzheimer’s. Unfortunately, I could find no data from clinical studies that would support the ability of the helmet to reverse dementia in humans.
EMS helmet
As EMTs, we often work in dangerous environments that may expose us to infectious diseases, noxious chemicals, and hostile surroundings. One such hostile locale is the patient compartment of your own ambulance. Even without a patient who is trying to beat or bleed on you — or one that is vomiting, coughing or spitting in your general direction — you are at risk. Look around the box and consider any places your body may hit if the ambulance were to suddenly stop, roll over, or collide with another vehicle or object. Sure, you may try to wear a seat belt in the back, but how far do you sit from the nearest wall or cabinet? Just far enough to make sure your head picks up speed before impact? And, regrettably, that seat belt does not protect you from flying objects and the damage they may cause on contact. For us, head injury is an occupational hazard.
At least one EMS system that I know well requires its EMTs to wear protective head gear when in the patient care compartment of the ambulance. This mandatory helmet use has not interfered with patient care at any level. Major provider complaints of the helmet include ‘hat hair,’ painful ponytails, and sweaty sweat bands. It’s a nice try, but their arguments are ineffective and fail to overturn the helmet rule. In fact, they even concur that the chances of being injured or killed in an ambulance crash is higher than for crashes of other same-sized commercial vehicles. Further, ambulance collisions occur at a higher rate than vehicles in law enforcement or fire, and a helmet may reduce the chance of injury or death if an ambulance does crash.
Summary
Helmets are required personal protective equipment for participants in high-impact activities such as football, hockey, lacrosse, baseball, and even war, and their voluntary use is rapidly increasing in sports such as skiing, bull riding, rock climbing, and snowboarding. External helmets keep your skull and brain intact should your head meet a hard surface or a moving object, either of which may generate a force of impact invoking disability or death.
If your system does not have a helmet rule, this should not prevent you from making an individual decision to wear protective head gear while riding in the patient care compartment of an ambulance, particularly if you believe that prevention is a preferable alternative to the long- or short-term effects of an unnecessary head injury.
References
1. Sanddal ND, Alpert S, Hansen JD, Kupas DF. Contributing Factors and Issues Associated with Rural Ambulance Crashes: Literature Review and Annotated Bibliography. Prehospital Emergency Care. 2008; 12:257-267.
2. Levick NR, Garigan M. A Solution to Head Injury Protection for Emergency Medical Services Providers. Retrieved March 1, 2009 from www.objectivesafety.net/LevickIEA2006.pdf.
3. Ambulance Crash-Related Injuries Among Emergency Medical Services Workers - United States, 1991-2002. MMWR. 52(8):154-156, 2003.