Handling Emergency Situations and Injury Assessment Chapter 12

You must be ready for anything. It could be life or death. Time is critical in emergencies. All sports medicine staff, coaches, and anyone else supervising a sport should be CPR/first aid certified **A lot of information is this chapter is for informational purposes only. Call 911 and get help from appropriate medical personnel.**

Emergency Action Plan (EAP) Outlines procedures and guidelines for emergencies Provides specific information on emergencies All personnel must be familiar with the EAP Legally required Sports Med team must communicate and work with Emergency Medical Services (EMS) Contact EMS in advance Discuss procedures and practice

Parent Notification Parent must give consent if the athlete is under 18 Each athlete should have a “Permission to Treat” form Implied Consent If the athlete is under 18 and a parent can’t be reached and there is no signed consent form, then the athlete will be treated under implied consent in efforts to save his or her life

On-the-Field Injury Assessment Why does there need to be a systematic way to evaluate an athlete? Primary survey Assessment of 5 life-threatening problems Airway, breathing, circulation, severe bleeding, shock Secondary survey Takes a closer look at a specific non-life threatening injury On-the-field and off-the-field components Vital signs HOPS: History, Observation, Palpation, Special tests

On-the-Field Injury Assessment Unconscious Athlete Primary Survey Call 911 Provide care Conscious Athlete Secondary Survey Treatment options Transport Primary Survey Non-Life threatening injuries Life threatening injuries

Primary Survey Call 911 for all life-threatening injuries Blocked airway No breathing No circulation Severe bleeding Shock Unconscious athlete Call 911 for all unconscious athletes Check ABCs (airway, breathing, circulation) Monitor until help arrives

This checks for life-threatening injuries? Primary Secondary

Which is not life-threatening? Airway obstruction Severe bleeding No breathing Being unconscious

Equipment Considerations Protective equipment can make CPR more difficult Ways to remove a facemask Electric screwdriver 3 specific cutters: Anvil pruner, Trainer’s Angel, FM Extractor Helmet and shoulder pads should not be removed if there is a suspected cervical neck injury – only remove the facemask Shoulder pads can be opened on the front for CPR or AED use, but do not have to be removed

Controlling Bleeding – Primary Survey Hemorrage – abnormal external or internal discharge of blood Venous blood- (from veins) constant flow, dark red Arterial blood- (from arteries) spurts, bright red Universal precautions decreasing your risk to bloodborne pathogens or diseases when coming in contact with another person’s blood. wearing gloves, not touching blood, washing hands

Controlling External Bleeding Direct pressure Pressure on wound with gauze Do not remove if blood comes through – add more gauze Elevation Elevate above heart if possible – slows bleeding Continue pressure Pressure points apply pressure to an artery to decrease blood flow to an area Brachial artery (upper arm) Femoral artery (top of thigh)

Internal Bleeding or Hemorrhage Usually impossible to see Bleeding in a body cavity can be life-threatening Skull Thorax (chest) Abdomen All severe hemorrhaging will result in shock Treat for shock even if no signs are present Internal bleeding requires hospitalization Primary Survey

Signs of Shock Severe injuries increase the chance of shock Moist, pale, cool, clammy skin Pulse is weak and rapid Respiratory rate (breathing) increases and is shallow Decreased blood pressure Disinterest in surroundings Irritability Restlessness Excitement Extreme thirst Primary Survey- Life threatening

Shock Treatment Maintain body temperature (cover with blanket) Elevate feet and legs 8-12 inches for most situations Do not elevate if it causes pain Shock can be made worse or initially produced by the athlete’s mental reaction to the injury have athlete lie down Don’t let them look at injury Reassure the athlete Don’t give any food or water incase surgery is needed

What is the correct order to stop bleeding? Elevate, direct pressure, pressure pt Direct pressure, elevate, pressure pt Pressure pt, elevate, direct pressure

Severe loss of blood will lead to Fainting Heart attack Shock Stroke

If a head/neck injury is suspected the helmet should be removed. True False

Secondary Injury Assessment After the primary survey Done to get more information about the injury On-the-field assessment Seriousness of injury First aid and immobilization How to transport athlete off the field Off-the-field assessment HOPS Vital signs 9 different vitals

Secondary Injury Assessment 9 Vital signs – checked both on and off the field Level of consciousness Pulse/heart rate Respiration/breathing rate Blood pressure Temperature Skin color Pupils (PEARL) Movement Sensory changes

Vital Signs Level of consciousness Pulse Respiration alert, responds to verbal directions Pulse adults 60-80 normal; children 80-100 Respiration adults approx. 12/min. normal (count for 30 seconds x 2) Children approx. 20/min Blood pressure (BP) normal 120/80 Systolic – top number; diastolic – bottom number Temperature normal 98.6 degrees

Vital Signs Skin color Pupils Movement Sensory changes red – heat illness, fever, high BP; pale or ashen – shock, hemorrhage, insulin shock; blue – lack of oxygen Pupils PEARL – Pupils Equal And Reactive to Light Movement compare sides – nerve damage, stroke Sensory changes numbness, tingling… nerve damage

What is the average respiration rate for adults? 12/min 20/min 60/min 80/min

What is the normal BP for adults? 100/80 120/80 120/60 100/60

What color skin might indicate shock, severe bleeding, or insulin shock? Normal skin color Blue Pale/ashen Red

HOPS History Observation Palpation Special Tests Talk to athlete – ask questions What, when, how, History What do you see? Swelling, bruising, deformity… Observation Touching bony & soft tissue Start away from injury and work toward Palpation Used to determine more information Checks flexibility, ligaments, strength… Special Tests

Immediate Care of Acute Musculoskeletal Injuries Injuries to muscles and bones Very common in sports Use PRICE Immediate and primary goal: To reduce the amount of swelling swelling = rehab time

Protection Rest Ice Compression Elevation Splint or stabilize if necessary Transport athlete with appropriate method Protection Must rest for healing process to begin Rest for 48-72 hours before beginning activity Rest Decreases pain and swelling (vasoconstriction) 20 minutes of ice; 1 hour without – repeat Ice Decreases swelling – reduces space for swelling Elastic wrap, horseshoe – 72 hours Compression Reduces swelling and gravity helps drain fluids Elevate as high as possible Elevation

The primary goal of all immediate care? Reduce pain Reduce bruising Reduce swelling Return to play

Emergency Splinting Call 911 for obvious fractures Splint the fracture before moving the athlete 2 principles of good splinting Splint from the joint above to the joint below the injury Splint the injury in the position it is found

Rapid Form or Vacuum Splints Types of Splints Rapid Form or Vacuum Splints Styrofoam pieces inside Can be molded to fit any joint Pump removes air and it becomes rigid Air Splints Clear plastic, sleeve Inflate splint by blowing Pushes on injury and could change the shape of body part Other Materials SAM splint Knee immobilizer Towels Sling & swathe Tongue depressor Aluminum splints

Splinting Considerations Ankle/lower leg fractures – splint foot to above knee Knee/thigh/hip fractures – splint lower leg and one side of the trunk Shoulder injuries – sling and swathe Upper arm/elbow – splint in position found Forearm – splint hand to above elbow with arm flexed Hip/spine injuries – use a backboard

Moving the Injured Athlete Must be very careful when moving an athlete to prevent further injury Need correct equipment and people Suspected Spinal Cord Injuries Call 911 and do not attempt to move the athlete until EMS arrives The only exception is if the athlete needs to be placed on his/her back to perform CPR Use a spine board, keep head and neck aligned with body

Moving Injured Athletes Stretcher Carrying Best, safest way to transport if no spinal cord injury Must splint injuries before going on stretcher Minimum of 4 people to carry Ambulatory Aid – assisted walk Support or assistance for someone that can walk 1 assistant on each side of the athlete Athlete places the arms around their shoulders

Moving Injured Athletes Manual Conveyance 2 person seated carry Athlete puts arms around assistants’ shoulders First responders hold each others wrists under athlete’s legs

Crutch Fitting Must be fitted, so extra stress is not placed on body Crutch tip – 6” from outside of shoe and 2” in front of shoe Top of crutch – about 1” below axilla or armpit Hand brace is positioned so elbow has 30 degree bend Only using 1 crutch or a cane