CrashHelmetRemoval
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Chapter objectives
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At the end of this chapter the reader will be able to:
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1. Identify the indications to remove a crash helmet
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2. Demonstrate the safe removal of a crash helmet
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Resources required for this assessment Skill matrix
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• Standardised patient or mannequin This assessment requires:
• Motorcycle helmet ce
• Infection control (CS 1.3)
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• Hand decontamination agent • Communication (CS 1.5)
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• Trauma (Chapter 5)
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Crash helmets are synonymous with motorcycle riding and cervical spine are similarly vulnerable in motorcycle
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and some motor sports, and the benefits of wearing them trauma wherever head trauma can occur. Spinal injury is
are almost intuitive. However, although helmets are worn relatively uncommon, and it is unclear whether wearing
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for the purposes of safety, they can inhibit the prompt and a helmet is beneficial or a contributing factor (Branfoot,
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effective assessment and management of those wearing 1994; Liu et al., 2008; Rice et al., 2016).
them. Paramedics must be competent in the removal of Crash helmets have been found to be an effective
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crash helmets so that treatment is not delayed or injury method of reducing cerebral injury and mortality
made more severe. This chapter discusses the safe removal (McIntosh et al., 2013; Rice et al., 2016; Singleton, 2017;
of motorcycle helmets. Sung et al., 2016). A 2008 Cochrane review found that
crash helmets are effective at reducing mortality and head
Anatomy and physiology injury by 42% and 69% respectively (Liu et al., 2008).
The scalp, skull and intracranial contents are better able to
Closed head injuries experienced by motorcycle riders tolerate collision forces when a crash helmet is worn, due
include coup and contra-coup, concussion, shearing of to the distribution of forces.
blood vessels, intracranial haemorrhage and meningeal Crash helmets typically enclose the head and face,
bleeding (Fernandes and de Sousa, 2013; Singleton, extending over the occiput to the point of the upper spine
529
Clinical Skills for Paramedic Practice ANZ Workbook
Clinical rationale
A crash helmet has four distinct components: a hard outer
shell, inner lining, comfort padding and chin strap. These
components work collectively but in different ways to
protect the head when it is involved in a collision. The
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outer shell and inner lining are directly related to dealing
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with the forces experienced by the head during a crash.
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The chin strap maintains the helmet in position and
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prevents its dislodgement. The padding is primarily for
Figure 5.5.1 Removing a helmet occiput first
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the rider’s comfort, but in newer models it can be removed
easily to aid helmet removal.
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The hard outer shell is designed to spread the impact • full-face helmets, which are designed to cover the
force over a larger surface area and prevent sharp objects entire head, face and neck
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penetrating the helmet. This spread across the helmet • modified full-face helmets with a flip-open or
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allows the inner liner to absorb these forces by crumpling, removable face/chin
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reducing the amount of force that actually reaches the • open-face helmets that have no face or chin coverage
skull and brain (Coelho et al., 2013; Fernandes and de • motocross helmets, which are like full-face helmets but
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Sousa, 2013; Fernandes et al., 2013). The energy involved are designed to be worn with goggles; they may have
in a motorcycle collision can be extreme due to the speeds
involved and the lack of safety features on a motorcycle ce
an attached visor.
Since the helmet is designed to fit reasonably tightly,
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compared to a modern car. it will take some manipulative effort to remove. The best
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Most conscious and ambulant patients remove their strategy is to release or cut the chin strap, flex the lower
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own crash helmet before the emergency services arrive. sides to loosen it if possible, then rotate the helmet off over
The patient who is still wearing their helmet may need the face. It will not likely pull straight off in an upwards
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assistance in its removal. Bystanders often elect against fashion as the chin piece may snare on the patient’s nose.
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removing the helmet (Branfoot, 1994) for fear of By the helmet rotating back upwards and over towards the
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exacerbating injury. front, this can be avoided. As the helmet is removed, the
Removing the helmet allows more effective second paramedic providing manual in-line stabilisation
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communication and patient assessment. Failure to do so will have to be prepared to support the head and prevent
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interferes with all airway procedures and the assessment the occiput from falling (Fig. 5.5.1).
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the cervical spine. This should be opposed by a second tools that should be used to determine a student’s ability
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paramedic providing manual in-line stabilisation to demonstrate the safe removal of a crash helmet.
(Branfoot, 1994). Once the helmet has been removed, a 1. Clinical Skill Work Instruction
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cervical collar can be applied if indicated. It is important 2. Formative Clinical Skill Assessment (F-CSAT)
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not to discard the helmet or leave it at the scene, as it 3. Performance Improvement Plan (PIP)
can provide insights into the impact for the Emergency 4. Summative Clinical Skill Assessment (S-CSAT)
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Department and may be deemed evidence by the police. (5. Direct Observation of Procedural Skills (DOPS) – see
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Associated Clinical Skills: Infection control; Communication; Consent; Trauma assessment; Cervical collar application
530
5.5 • Crash helmet removal
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Explain procedure to patient. Open helmet visor if possible to Gain consent and cooperation.
facilitate communication.
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Prepare Identify and unclip or, if necessary, cut away chin strap. Remove Removal of the helmet is inhibited
helmet for glasses if patient is wearing them. while the chin strap is in situ.
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removal Glasses may cause injury if not
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removed.
Manual Assistant places one hand under patient’s occiput for support. Support must be from below to
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in-line Their other hand supports the mandible above the neck to allow helmet removal.
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stabilisation provide spinal immobilisation.
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Remove chin Pull on release tabs if helmet has this feature for emergency Removing chin pads provides more
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pads removal. room and easier removal.
Remove
helmet ce
Grip base of helmet at the lateral edges and apply outward
pressure to open the helmet.
Pulling helmet opening apart helps
avoid catching the ears, tilting it
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Gently pull chin piece upwards slightly, towards the nose. avoids the nose and occiput.
Rotate the posterior helmet base from occiput over the head in Maintain direction of removal
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Once the rear has been part-way removed, rotate the front by unnecessary cervical spine
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tilting chin portion over the nose. Remove helmet fully. movement.
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Head support Provide occipital support with padding. Second paramedic Spinal immobilisation is maintained
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provides manual in-line spinal immobilisation (see Chapter 5.7), throughout the procedure.
replacing anterior/posterior support with lateral support.
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Replace Replace glasses if removed during procedure and patient Inability to see may be distressing.
glasses requires them.
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Retain helmet Retain helmet for review by Emergency Department staff and the The helmet provides information in
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Report Document/hand over whether a helmet was worn/removed and Accurate record kept and
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Associated Clinical Skills: Infection control; Communication; Consent; Trauma assessment; Cervical collar application
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Clinical Skills for Paramedic Practice ANZ Workbook
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Prepares Identifies and unclips or, if necessary, cuts away chin strap. Removes glasses 0 1 2 3 4
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helmet for if worn.
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removal
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Manual Assistant places one hand under patient’s occiput for support. Their other 0 1 2 3 4
in-line hand supports the mandible above the neck to provide spinal immobilisation.
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stabilisation
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Removes chin Pulls on release tabs if helmet has this feature for emergency removal. 0 1 2 3 4
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pads
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Removes Grips base of helmet at lateral edges and applies outward pressure to open 0 1 2 3 4
helmet helmet.
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Gently pulls chin piece upwards slightly towards the nose.
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Rotates posterior helmet base from occiput over the head, in line with the
spine.
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Once rear has been part-way removed, rotates the front by tilting chin portion
over the nose. Removes helmet fully.
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Head support Provides occipital support with padding. Second paramedic provides manual 0 1 2 3 4
in-line spinal immobilisation (see Chapter 5.7), replacing anterior/posterior
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Replaces Replaces glasses if removed during procedure and patient requires them. 0 1 2 3 4
glasses
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Retains Retains helmet for review by Emergency Department staff and police. 0 1 2 3 4
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helmet
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Comments:
*If Not Yet Competent (NYC) a PIP needs to be completed and a repeat of the F-CSAT
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5.5 • Crash helmet removal
Level of
Quality of assistance
Skill level Standard of procedure performance Outcome required
4 Safe Confident Achieved No supporting
Safe for Accurate Accurate intended outcome cues*required
unsupervised Behaviour is appropriate to Expedient
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practice context
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3 Safe Confident Achieved Requires occasional
Requires Accurate Accurate intended outcome supportive cues*
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supervision Behaviour is appropriate to Takes longer
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context than required
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2 Safe Lacks certainty Would not have Requires frequent verbal
Requires Accurate achieved outcome and occasional physical
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assistance Behaviour generally appropriate without support directives in addition to
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to context supportive cues*
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1 Safe only with guidance Unskilled Would not have Requires continuous
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Requires Not completely accurate Inefficient achieved outcome verbal and frequent
direction without support physical directive cues*
0 Unsafe Unskilled ce
Would not have Requires continuous
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Unsafe Unable to demonstrate behaviour achieved outcome verbal and continuous
Lack of insight into behaviour physical directive cues*
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appropriate to context
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Please document the agreed education plan and completion timelines for areas assessed as less than 4.
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Clinical Skills for Paramedic Practice ANZ Workbook
Associated Clinical Skills: Infection control; Communication; Consent; Trauma assessment; Cervical collar application
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• Completed Performance Improvement Plan (PIP): YES NO N/A
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Crash helmet removal
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Achieved
Activity Critical Action Without Direction
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Personal Dons PPE as required. NO YES
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protection
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Prepares patient Positions supine if circumstances allow. NO YES
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Second paramedic maintains spinal immobilisation. NO YES
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Explains procedure to patient. Opens helmet visor if possible to facilitate NO YES
communication. ce
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Prepares helmet Identifies and unclips or, if necessary, cuts away chin strap. Removes NO YES
for removal glasses if worn.
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Manual in-line Assistant places one hand under patient’s occiput for support. Their NO YES
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stabilisation other hand supports the mandible above the neck to provide spinal
immobilisation.
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Removes chin Pulls on release tabs if helmet has this feature for emergency removal. NO YES
pads
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Removes helmet Grips base of helmet at lateral edges and applies outward pressure to NO YES
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open helmet.
Gently pulls chin piece upwards slightly, towards the nose.
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Rotates posterior helmet base from occiput over the head, in line with the
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spine.
Once rear has been part-way removed, rotates the front by tilting chin
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Head support Provides occipital support with padding. Second paramedic provides NO YES
manual in-line spinal immobilisation (see Chapter 5.7), replacing anterior/
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Replaces Replaces glasses if removed during procedure and patient requires them. NO YES
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glasses
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Retains helmet Retains helmet for review by Emergency Department staff and police. NO YES
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5.5 • Crash helmet removal
Comments:
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*If Not Yet Competent (NYC) a PIP needs to be completed and a repeat of the F-CSAT
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Clinical findings the patient. The last is a traditional in-line stabilisation
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position superior to the patient’s head. Removal should
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occur at a pace that allows the support person to adjust
Basic options their position each time to enable their role.
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Opening the visor, if there is one, allows better
Minimise movement
communication, removal of the patient’s glasses if worn
and rudimentary facial/airway access. It may also help to ce
It is difficult to stop all head movement, even if resistance
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avoid rebreathing. is concerted. Gentle and small helmet removal movements
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PRACTICE TIP!
ground. This will change to providing support from below
the head/neck during helmet removal, likely sitting beside
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PRACTICE TIP!
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present, make use of them first. If possible, ask Helmet removal is better if performed by two
the rider for any tips or strategies for removing paramedics, with one supporting the head and
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the helmet. They are familiar with the device and resisting movement, and the other removing the
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Clinical Skills for Paramedic Practice ANZ Workbook
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3. What is the purpose of the outer shell and inner lining?
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To prevent penetration of objects and to distribute the force of the impact.
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4.
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How can the inner lining help the rescuer remove the helmet?
On newer helmets the inner lining can be removed, aiding removal of the helmet.
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5. What is the most common type of injury experienced by motorcycle riders?
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Closed head injuries.
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6. List the specific injuries common to the type given in question 5.
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Coup and contra-coup; shearing of blood vessels; bleeding between the meninges.
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What factor affecting the rider impacts most on a head injury?
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The force of deceleration.
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Supine.
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It is helpful to the Emergency Department and may be deemed evidence by the police.
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5.5 • Crash helmet removal
References
Branfoot, T., 1994. Motorcyclists, full face helmets and neck injuries: McIntosh, A.S., Curtis, K., Rankin, T., Cox, M., Pang, T.Y.,
can you take the helmet off safely, and if so, how? Journal of Accident McCrory, P. and Finch, C.F., 2013. Associations between helmet
and Emergency Medicine, (11), 117–120. use and brain injuries amongst injured pedal- and motor-cyclists:
Brühwiler, P.A., Stämpfli, R., Huber, R. and Camenzind, M., 2005. a case series analysis of trauma centre presentations. Journal of the
CO2 and O2 concentrations in integral motorcycle helmets. Applied Australasian College of Road Safety, 24(2), 11.
Ergonomics, 36(5), 625–633. Rice, T.M., Troszak, L., Ouellet, J.V., Erhardt, T., Smith, G.S. and
Coelho, R.M., de Sousa, R.A., Fernandes, F.A.O. and Teixeira-Dias, Tsai, B.W., 2016. Motorcycle helmet use and the risk of head,
F.M.V.H., 2013. New composite liners for energy absorption neck, and fatal injury: revisiting the Hurt Study. Accident Analysis &
purposes. Materials & Design, 43, 384–392. Prevention, 91, 200–207.
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Singleton, M.D., 2017. Differential protective effects of motorcycle
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Fernandes, F.A.O. and de Sousa, R.A., 2013. Motorcycle helmets – a
state of the art review. Accident Analysis & Prevention, 56, 1–21. helmets against head injury. Traffic Injury Prevention, 18(4), 387–392.
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Fernandes, F.A., de Sousa, R.J.A., Willinger, R. and Deck, C., 2013. Sung, K.M., Noble, J., Kim, S.C., Jeon, H.J., Kim, J.Y., Do, H.H.,
Park, S.O., Lee, K.R. and Baek, K.J., 2016. The preventive effect
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Finite element analysis of helmeted impacts and head injury evaluation
with a commercial road helmet. Paper presented at the International of head injury by helmet type in motorcycle crashes: a rural Korean
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Research Council on the Biomechanics of Injury (IRCOBI) single-center observational study. BioMed Research International, doi:
conference, 11–13 September, Gothenburg, Sweden. 10.1155/2016/1849134.
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Liu, B.C., Ivers, R., Norton, R., Boufous, S., Blows, S. and Lo, S.K.,
2008. Helmets for preventing injury in motorcycle riders. Online: The
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Cochrane Library.
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