EMS is responding to a call at a local high school football game. One of the high school football players is not responsive to verbal stimuli after a helmet-to-helmet collision with another football player. His RR is 12 breaths per minute, BP 100/65 mm Hg, and a strong pulse is palpated at 60 beats per minute. There is a small crack at the top of the helmet, but it is otherwise intact and strapped tightly to the patient’s head. EMS wants to remove the helmet to assess for head trauma, but they call you for permission. What is the most appropriate prehospital management of this patient?

a. Do not attempt to remove the helmet. Maintain cervical spine precautions and transfer the patient on a backboard to the hospital.

b. While maintaining cervical spine precautions, carefully remove the helmet and assess for head injury.

c. Check the patient’s pupils if there is asymmetry, remove the helmet with cervical spine precautions, and assess for head injury.

d. Wait at the scene for a physician to arrive with an electric saw for removal of the helmet and further on-scene assessment.

e. Do not remove the helmet but assess the cervical spine for step-off or any signs of obvious injury before transfer.