Sideline Injury Management on Different Field Surfaces and Conditions Matthew Brewer, MS, ATC/R Certified Athletic Trainer Children’s Hospital Colorado Sports Medicine Program Orthopedics Institute

Presentation Outline 2 Discuss why sideline management of injuries is essential Identify different sports that have different surfaces Discuss how different surfaces can pose challenges for sideline management and injury evaluation Discuss proper injury evaluation techniques on these surfaces and give strategies about when, where, and how to implement them Identify and discuss different environmental/weather concerns that can further challenge injury management on sidelines

To be able to give the most accurate and immediate care for all types of injuries sustained in sports National Center for Sports Safety reports over 3.5 million children >14 years receive medical treatment for sports related injuries per year. 3 Why is Sideline Management Important?

Number of sport related injuries for each sport are as follows: Gymnastics — 99,722 Basketball — 680,307 Baseball — 170,902 Softball — 118,354 Football — 413,620 Soccer — 163,003 Volleyball — 55,860 Track & Field — 15,113 Hockey — 63,945 4 What Does This All Have To Do With Sideline Management? Number of sport related injuries for each sport are as follows: Gymnastics — 99,722 Basketball — 680,307 Baseball — 170,902 Softball — 118,354 Football — 413,620 Soccer — 163,003 Volleyball — 55,860 Track & Field — 15,113 Hockey — 63,945

Different Surfaces 5

Immediate Care and Stabilization on High Friction Surfaces 6

Low Friction and Uncommon Surfaces Following sports and surfaces pose a bigger challenge for injury evaluation and stabilization than previous. 7

Sideline Management of Water Related Injuries Recreational swimming and diving third most common physical activity, and the most common in children. An estimated 111,341 patients were treated in emergency departments in 17 year period, with injuries to head and neck being most common (38.2%) Patients aged years comprised largest group (36.3%) Leading cause of injury was interference with diving board or platform (43.9%) 8

Pool Stabilization Video 9

Water Injury Management and Stabilization If athlete is conscious and injured but cannot move with no head/neck injury suspected, roll onto back and use passive towing technique. If athlete is unconscious and not breathing and no head/cervical injury suspected, get to pool deck and begin CPR ASAP-precautions for AED placement with water! Once on land/deck, perform full evaluation. Prentice, W

Water Injury Management and Stabilization 11

Water Injury Management and Stabilization 12

Skiing and Snowboarding Injuries Over 40 fatalities have been reported in over 10 years. According to the National Orthopedics and Neurosurgery Center, more than 39,000 children and adolescents ages five to 14 were treated in hospital emergency rooms for snowboarding/skiing-related injuries. 13

Emergency Evaluation and Stabilization on Snow Video 14

Immediate Injury Assessment and Stabilization on snow Different equipment concerns with these sports. No need to take helmet off since full access can be gained to airway High velocity impacts Stabilize and evaluate on scene 15

Immediate Injury Assessment and Stabilization on Snow 16

Environmental Concerns Effecting Injury Evaluation and Sideline Management Heat Illness Move to cooler environment ASAP Take appropriate steps to cool athlete (Ice towels, cold emersion, ect). If athlete is injured and experiencing heat related illness-problems magnified Barriers to evaporation Give fluids and ice if possible to continue cooling athlete Lying on ground can potentially burn skin Try to shade athlete as much as possible and cool ground around them to prevent burns Binkley et al

Environmental Concerns Effecting Injury Evaluation and Sideline Management Cold Weather Large population of outdoor sports in Colorado Military, football, baseball, soccer, lacrosse, track/field, skiing season all have the potential for cold injuries Three categories-decreased core temperature (hypothermia), non-freezing injuries to extremities (chilblains), and freezing injury to extremities (frostbite) Signs of mild hypothermia include vigorous shivering, increased blood pressure, core body temperature 90.6C are signs of severe hypothermia, MEDICAL EMERGENCY! Waxenberg. et al

Management of Cold Injuries Re-warm athlete ASAP Remove wet clothing while insulating them with dry clothing and blankets Move to warmer and dry environment Apply heat to areas of heat transfer including groin, armpits, and chest wall Encourage shivering, while providing warm non- alcoholic fluids Monitor closely and refer to EMS if necessary 19

Lightning and Severe Weather 2 nd most common storm related death in the U.S. 1 out of 10 lightning strike victims die - cardiac arrest accounts for majority of fatal injures, while severe neurological impairment can cause permanent disability The location, elevation, climate, and vast amount of people who enjoy outdoor activities (sports, hiking, biking, camping, etc) makes Colorado and the Rocky Mountains vulnerable to lightning injuries The most active time for storm and lightning development occurs between 11a and 9p April-September-PRIME TIME for both sports and outdoor events 20

When is a Storm Too Close? Lightning can strike up to 20 miles away from nearest cloud If you see lightning, extreme caution needs to taken 20 mile rule-begin preparations to postpone game/practice 6 miles accepted distance to seek shelter immediately Different ways to determine proximity of lightning 30/30 rule, lightning detectors, text/instant messaging NATA position statement on lightning promotes 30/30 rule 21 Walsh. K 2000

Additional Things to Consider with Lightning The JAT, 2000, reported that the most common sites for fatalities in Colorado associated with lightning included open fields (27%), near trees (16%), and close to water (13%) All fatalities normally have 1 common link-being near tallest object in immediate area EAP should have comprehensive lightning and evacuation plan with approved shelter Sports such as track, golf, cross country, & large outdoor venues need to have additional time to evacuate given the large area and number of people present 22

Conclusions Different surfaces and conditions pose different challenges for sideline management and stabilization of injuries Many associated challenges can be decreased by having thorough and detailed EAP This EAP must be practiced and rehearsed with everyone involved Plan accordingly for adverse filed and weather conditions, and know what to do in each situation 23

Questions??? 24

Work Cited Binkley, H., Beckett. J., Casa. D., Kleiner. D., & Plummer. P. National Athletic Trainer’s Association Position Statement: Exertional Heat Illness. NATA Position, Consensus, Official Support Statements. Dallas, TX PP Cappaert. T., Stone. J., Castellani. J., Krause. B., Smith. D., & Stephens. B. National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries. Journal of Athletic Training, PP Cooper. M., & Kulkarni. R. Lightning Injuries. Medscape References. Chang. D., & Bosco. J. Cervical Spine Injuries in the Athlete. Bulletin of the NYU Hospital for Joint Disease, PP Day. C., Stolz. U., Mehan. T., Smith. G., & McKenzie. L. Diving Related Injuries in Children <20 Years Old Treated in Emergency Departments in the United States: Pediatrics, PP. E388-E394. Prentice. W. Arnheim’s (2003) Principles of Athletic Training A Competency Based Approach. New York, New York: McGraw-Hill Higher Education. PP Walsh. K., Bennett. B., Cooper. M., Holle. R., Kithil. R., & Lopez. R. (200). National Athletic Trainer’s Association Position Statement: Lightning Safety for Athletics and Recreation. Journal of Athletic Training,