After a crash, leave the helmet on: when and how to remove it safely

Why the helmet stays on

A rider thrown off a bike can have a neck injury that doesn't show. St John Ambulance warns that moving someone with a spinal injury can cause permanent loss of feeling or movement, and the Global Road Safety Partnership's first response manual, hosted by the IFRC, names paralysis. The UK Highway Code's first aid annex puts it plainly: don't remove a motorcyclist's helmet unless it is essential.

So if he's breathing and his airway is clear, the helmet stays on until the ambulance arrives. On a high pass that can be a long wait. Wait anyway, and keep his head still.

If he's awake, tell him not to move. The European Resuscitation Council's 2021 first aid guidelines say to encourage an alert casualty to hold his own neck still, and advise first aiders against routine neck collars. Ask about his neck and his hands: St John Ambulance lists tingling as a warning sign of spinal injury. Tell the call taker on 112.

The two reasons it comes off

• It's in the way of his breathing, and you can't keep his airway open with it on.
• He isn't breathing and needs CPR.

The Global Road Safety Partnership manual sets a similar bar: remove it only if there are signs of breathing or circulation trouble, such as an unconscious rider or cardiac arrest, and emergency services can't be reached for advice. St John Ambulance Victoria adds a point for open-face and flip-up helmets: undo or cut the chin strap and leave the helmet on.

How to remove a motorcycle helmet: two people

St John Ambulance WA and the Summa Health EMS protocol teach the two-person method the reel shows. Calling out when you're ready is my addition. St John Ambulance Victoria says don't try it alone.

1. 01Rescuer one kneels behind the rider's head and holds the helmet steady with both hands, fingers on his jaw.
2. 02Rescuer two undoes the chin strap, or cuts it if it won't open.
3. 03Rescuer two takes the neck from below: one hand on the angle of the jaw, the other behind the skull.
4. 04Both say when they're ready. Only then does the helmet move.
5. 05Rescuer one slides the helmet off slowly, spreading the sides outward to clear the ears and tilting the helmet, not the head, back to clear the nose on a full-face helmet.
6. 06Once it's off, rescuer one takes the head back and holds it still, in line with the body, until help arrives.

Two places where the reel and the written guidance use different words. In the reel I said rock it off a little up and down. The protocols describe spreading it sideways and tilting it back. Either way, the movement is small and slow. I also said palms over the ears for the final hold. The European Resuscitation Council's head hold says not to cover the ears, so the rider can still hear you. Both keep the head still.

If the rider says his neck hurts or his hands tingle, you stop. That's my rule. The written protocols above don't cover it.

If he's unconscious but breathing

The Highway Code says to put an unconscious casualty who is breathing into the recovery position until help arrives. With a possible neck injury, St John Ambulance turns him with one helper keeping the head in line with the body while another rolls him. The European Resuscitation Council notes the recovery position may not suit every injured casualty, so keep checking his breathing whatever position he's in. None of these sources says whether the helmet should come off before the roll.