Emergency Situations and Response Plans

You’re the A. T. C. You are the Athletic Trainer supervising the soccer game. Based on what you see: What do you think happened? What would you need to know? What would you do? What equipment might you use?

You are the Athletic Trainer employed by the Miami Heat You are the Athletic Trainer employed by the Miami Heat. Based on what you see: What would be different compared to previous situation?

Emergency Responsibilities Medical conditions that affect athletes: Asthma Diabetes Anaphalaxes Seizures Genetic conditions (cardio-respiratory) Illnesses Shock Infections / dermatological conditions

Emergency Responsibilities Injuries that occur to athletes: Airway obstructions Unconsciousness / paralysis Fractures Sprains & Strains Bleeding / Open Wounds Closed Wounds / Bruising Concussions

Emergency Plans Emergencies are inevitable Plans must take into account any possible scenario & must be shared and practiced by all personnel.

Emergency Procedures Observation & Assessment are 2 critical skills for a responder. Primary Survey – checks life threating conditions (Circulation/Airway/ Breathing or “Look, Listen & Feel”) Secondary Survey – head to toe assessment of patient’s condition

Assessment Procedures HOPS & SOAP are 2 recognized acronyms for injury assessment procedures. H – History O – Observation P – Palpation S – Special Tests S – Subjective O – Objective A – Assessment P – Plan

HOPS H – History – questions asked of the athlete to determine mechanism and history of the condition/injury O – Observation – of athlete bilaterally checking for deformity of any kind P – Palpation – using fingertips to locate an deformity / site of pain S- Special Tests – testing ROM, stability & strength of injured area

SOAP S – Subjective: detailed information about the injury and the athlete. Includes information about chief complaints, signs and symptoms. O – Objective: data from tests including inspection, palpation & special tests

SOAP A – Assessment: a detailed statement by the ATC of the type and severity of the injury including problems associated with the injury. P – Plan: description by the ATC of whether the athlete will be referred, treated or monitored. This includes rehab procedures and goals of the treatment.

Questions that should be asked During “H” of HOPS or “S” of SOAP What happened? When did it happen? How did it happen? Have you ever done this before? Where does it hurt most? How bad does it hurt? What kind of pain do you feel? What did you feel? Hear?

What you should look/check for during “O” of HOPS or SOAP Does it look normal? Anything sticking out? Any unusual depressions? Does it look like the other ankle? Any immediate swelling or discoloration? Palpation: (“P” of HOPS; still “O” of SOAP feel any deformity? feel any point tenderness?

What things you should assess during “S” of HOPS or “O” of SOAP Can you move it without increase of pain? Can they move it? Can they provide resistance? Can they do functional movements? http://www.youtube.com/watch?v=HJT2Et1Xug4

What are possible actions (based on your findings) you can take? Can they stay in the game? Can they walk off of the field? If so Do they need treatment? If so what? Ice? Rest? Re-taping or Padding? Do they need to be transported? Helped off? Carried? Carted? Do they need immobilization? Do they need to see a Dr. or ER visit?

SOAP Note SOAP Note: a written document of the findings of an injury assessment and recording an athlete’s progress through their rehabilitation.

SOAP Note You’re the ATC supervising the soccer game: List 3 things to do/ask during the S phase of SOAP List 3 things to do/ask during the O phase of SOAP

SOAP Note

Phases of Treatment The extent of the injury influences the rehab activities and goals chosen for treatment. Rehab programs should all follow a step by step progression starting with initial treatment through sport specific function.

IMPRESS I- initial injury (inflammatory) phase M – mobility restoration phase P – proprioception phase R – resistance training phase E – endurance training phase S –} S –} sport specific function phase

Initial/Inflammatory Injury Phase Control inflammation signs: warmth, redness, swelling, & pain Inflammation means that the tissue is returning to normal Treatment = PRICE Protect, Rest, Ice, Compression, Elevation

Mobility Restoration Phase Edema: thick swelling caused by excessive protein. 3 Phases of Range of Motion Restoration: Passive (PROM) Active-Assistance (AAROM) Active (AROM)

Passive ROM (PROM) The ATC moves an athlete’s body segment through ROM There is no active resistance or assistance by any muscles

Active Assistance ROM (AAROM) The ATC and the athlete move a body segment through ROM together

Active ROM (AROM) The athlete moves through the full ROM without assistance Now the athlete can start a strength program

Establish Flexibility Still part of the Mobility Restoration Phase Flexibility refers to the ability to move a joint through a full ROM without restriction

Proprioception Phase The body’s ability to get information to the brain in response to a stimulus arising within the body Also refers to the body’s ability to sense the position of it’s limbs at any moment Following an injury, receptors are damaged this makes a joint feel weird or not right Balance & Coordination will help with this phase

Resistance Training Phase Strengthen muscles, ligaments, and bones Free weights, resistance bands/tubes, machines, manual resistance

Endurance Phase Muscle Endurance: ability to perform movements over time Reps? Weight? Cardio Endurance: perform this as early as tolerated

Sport Specific Phase How to progress: Light Functional Heavy Functional Limited Practice Perform functional activities Slowly get back to practice Need to know requirements of the sport (movement patterns, degree of strength, speed & endurance needed) Mimic activities in the sport

Athlete can participate if: Full Range of Motion Normal Strength Normal Flexibility Normal Coordination Normal Cardio Endurance Consent of Team Doctor

Proper Progression of the Athlete Remember all athletes progress at a different pace What principle? Be as progressive as you can without doing any harm to the athlete

THERAPY ELEMENTS thermal mechanical electrical

Therapy Elements You must decide if a therapeutic modality is able to be used for each injury Indications: reasons that a modality can be used Contraindications: reasons to not use a certain modality

Thermal Elements Transfer heat into or out of the body Used to make tissues colder or warmer

Heating Modalities Heat should NOT be used on: Acute injuries Warm the body to help the healing process Should only be used after initial inflammatory phase is over Use on chronic Sprains/Strains Heat should NOT be used on: Acute injuries Areas of poor circulation Areas of impaired sensation.

Types of Heat Hydrocollator Pack Whirl Pool Moist heat pack 20 minutes 95-108 degrees

Cooling Modalities Cryotherapy: use of cold to elicit certain physiological responses Cool the injured area and constrict blood vessels Decrease inflammation Decreases cell metabolism Decreases pain Decreases muscle spasms

Types of Cooling Modalities Cryotherapy: Ice Packs/Cryocuff Chemical Ice Packs Make sure there is a barrier Ice Massage Not used on acute injuries Ice cups/shin splints

Ice Packs Must be in plastic bag Should not be applied: Open wounds, areas of numbness, someone overly sensitive to cold, cardiac or respiratory problems 20-30 mins at a time Wait 40-60 mins before reapplying Double the amount of time you iced

Produce a specific physiological effect with mechanical energy MECHANICAL ELEMENTS Produce a specific physiological effect with mechanical energy

Ultrasound Thermal modality because it produces a deep-heating effect Uses sound waves to pass through tissue Heat is produced by a process called conversion Has the ability to affect deeper than a hot pack

Ultrasound Types Continuous Pulsed Indirect Sound waves flowing 100% of the time Pulsed Can keep the ultrasound head in one place Must use a Coupling Medium (water, gel, lotion) Indirect Done on irregularly shaped areas under water

Traction Most commonly done to the vertebrae Deliberately attempting to separate the joints of the body if they have been compressed or gotten stiff over a period of time Also causes minimal stretching of ligaments and muscles Complications: pain, discomfort, muscle spasms, numbness, tingling

Massage Intentional and methodical kneading and stretching of the body’s soft tissues Used to increase circulation, decrease muscle spasms, relieve swelling

Types of Massage Effleurage: stroking the tissue with palm of your hand in a smooth, rhythmical manner. Petrissage: kneading of the tissue, in which the skin, muscle and fascia are squeezed between the hands. Vibration Massage: designed to cause tissue to tremble and shake usually done at joints to improve mobility. Percussion Massage (Tapotement): a series of light chopping motions Increases circulation & relaxation Friction: requires enough pressure to affect the deep tissues. Helps break up scar tissue and relieve muscle spasms.

Intermittent Compression Useful for reducing swelling & edema following injury Increases the pressure around the injury site and helps venous blood return from the injured extremity. Should not be used until a fracture is ruled out or used on compartment syndromes of the lower extremity. Treatment time: 20 min-1 hour treatment consists of alternating compression for 45 seconds with 15 seconds off.

ELECTRICAL ELEMENTS Tissues with high water content (muscles) conduct electricity very well

Types of Electrical Currents Direct Currents (DC): electricity moves in one direction as it passes through the tissue circuit. Alternating Current (AC): electricity moves back and forth between electrodes. Pulsed Current: interrupted Uninterrupted: continuous *All types of currents require electrical pads on the body

Electrical Stimulation High Voltage Pulsed Electrical Muscle Stim: causes a muscle contraction, helps prevent muscle weakness during recovery Low Intensity Stimulation: (Microcurrent) – thought to mimic the body’s own natural electrical flow & promote healing. Interferential Current: two electrical currents cross one another, creates a muscle contraction & reduces pain. Transcutaneous Electrical Nerve Stimulation (TENS): electrical current applied to the skin that is designed to stimulate the region.