1. Chapter 7 Emergency Plan and Initial Injury Evaluation

2. Emergency Plan A written document that outlines the personnel and equipment necessary for response to emergencies. Proper planning is essential to ensure appropriate initial first aid management of an injury. Anything done ahead of time to improve athletes’ health should be a priority. Failure to have an emergency plan is grounds for negligence.

3. Emergency Plan Components The emergency plan: Identifies personnel directly involved in carrying out the plan. Specifies necessary equipment. Establishes a mechanism for communication. Is derived from overall emergency planning policies. Andersen et al., 2002

4. Emergency Plan Components The emergency plan: Incorporates local emergency care facilities. Specifies documentation needed to support plan implementation and evaluation. Is reviewed and rehearsed at least annually, and the results of these efforts are documented. Is reviewed by the administration and legal counsel of the sponsoring organization or institution. Andersen et al., 2002

5. The Emergency Team Members of the emergency team are personnel directly involved in interscholastic sports programming (high school level), including: Coaches. Administrators. Team physician. Athletic trainer. Local EMS staff.

7. Functions of Emergency Team Members Members of the emergency care team are responsible for: Immediate care of athlete. Emergency equipment retrieval. Activation of EMS, if necessary. Directing EMS to injury scene.

8. Emergency Plan Plan should be comprehensive and include: Procedures for both home and away events. Steps for dealing with emergency situations affecting athletes, fans, and sideline participants. Emergency evaluation/care role of each individual Locations of phones (school personnel should have cell phones). Emergency phone numbers.

9. Emergency Plan Plan should be comprehensive and include: Emergency supplies location & procedure for use EMS access points to site Directions to the site for EMS Who will guide emergency vehicles to site? Location of gates/passageways to site. Which one is to be used? Who has the keys?

10. First Aid Training All personnel should be trained in basic first aid, CPR, & AED use. Training should be conducted by nationally recognized organizations ( e.g., the American Heart Association). Personnel should renew training at least every 3 years. Personnel should have periodic “mock” drills to rehearse the plan. © Phototdisc

11. Injury-Evaluation Procedures Coach’s responsibility is the immediate care of acute injury—this is critical. Coach must be familiar with the preexisting emergency plan and be able to function effectively as a primary player – “first responder” Coaches should focus on providing care to the extent of their training and should avoid going beyond their level of training. Coaches must distinguish minor from major injuries. By law, coaches are most often held accountable for proper care when no physician or athletic trainer is present.

12. Injury-Evaluation Procedures Coaching personnel should have Basic Lifesaving Skills (BLS) training that focuses on life- threatening situations. Primary BLS skills are: Airway assessment and opening techniques. Rescue breathing. CPR. AED protocol.

14. Initial Check The initial check must include assessments of: Responsiveness Airway Breathing Severe Bleeding

15. Initial Check: Nervous System Is the athlete responsive? AVPU Scale. Athlete is… Alert and aware Responds to verbal stimulus Responds to painful stimulus Unresponsive to any stimulus If spinal or head injury is suspected, immobilize head and neck immediately.

16. Initial Check: Airway Assessment Ask athlete a simple question. A response indicates that at that time the airway is open and circulation is adequate. If athlete is unresponsive and has no apparent serious head or spinal injuries: –Use head-tilt/chin lift method (do not remove helmet or face mask).

17. Initial Check: Airway Assessment If the person is not breathing and spinal or head injury is suspected. Use jaw-thrust technique to open airway. Use finger sweep if object is lodged in mouth.

18. Initial Assessment: Breathing Breathing Assessment Conscious athlete is breathing but must be monitored. Unconscious athlete can be assessed quickly, ONCE airway is opened. Look, listen, and feel for air flow.

19. Initial Survey: Circulation Assessment The two major concerns: Presence or absence of the signs of circulation (breathing, coughing, movement, pulse, and normal skin color) Presence or absence of loss of blood (hemorrhage), either internally or externally Responsive athlete who is breathing has signs of circulation. Unresponsive athlete needs to be quickly assessed for signs of circulation. If there are no signs of circulation, begin CPR.

20. Initial Survey: Hemorrhage Assessment External hemorrhage is usually obvious. Control with direct pressure, elevation, pressure points, and/or pressure bandage. Take precautions against bloodborne pathogens wear personal protective gear. Internal hemorrhage is difficult to detect but may be evident with bruising or the progression of shock. Artery—blood spurts Vein—blood constant flow

22. Initial Survey: Hemorrhage Assessment An early sign of internal hemorrhage is hypovolemic shock. Signs include: Rapid weak pulse. Rapid shallow breathing. Moist clammy-feeling skin. Blue skin inside lips and under nail beds. Shock is a true medical emergency. Safe to donate/loss—1 pint Shock = 2-3 pints Life Threatening = >3 pints

23. Shock Other signs and symptoms of shock include: Profuse sweating. Cool, clammy-feeling skin. Dilated pupils. Elevated pulse and respiration. Irritable behavior. Extreme thirst. Nausea and/or vomiting.

24. Treating Shock If spinal injury is suspected, do not move the athlete. Stabilize in position found. Have athlete lie down (supine). Elevate legs about 8 to 12 inches if no head injury. “If the face is pale, raise the tail”. Elevate head if potential for cranial bleeding. “If the face is red, raise the head.” Cover the athlete with a blanket (if environment is such that loss of body heat is possible). Monitor vital signs.

25. Physical Exam To be effective, the physical exam must be conducted in a preplanned, sequential fashion. History Observation Palpation Sign involves objective findings such as bleeding, swelling, discoloration, and deformity. Symptoms are subjective in nature such as nausea, pain, and point tenderness.

26. Physical Exam Taking Medical History Keep questions simple and brief— “yes” or “no” Use easy-to-understand terms; avoid questions leading to a preferred answer. Ask athlete what happened. Ask if there were any strange sounds when injury occurred. If athlete is in pain, ask where it hurts. Inquire about previous injuries to involved area. Present history to any medical personnel.

27. Physical Exam Observation Continually monitor for signs of breathing and circulation. Note athlete’s body position and behavior. Note swelling, hemorrhaging, bruising, or deformity. Do bilateral comparison. Note signs and symptoms relating to the injury.

28. Physical Exam Palpation A learned skill that requires physical contact with the athlete. If practiced, is a useful skill to find deformity, spasm, swelling, etc. Should be performed carefully to avoid aggravating existing injuries. Begin with the uninjured limb, if the injury is to an extremity. Begin by palpating away from areas of injury.

29. Removal from Field or Court If athlete is conscious and has no injuries that preclude walking, he or she may leave field under own power but with assistance. If lower-extremity injury is present, use passive transport system – carry, stretcher, sports chair. If athlete is unconscious or may have neck injury: Do not move prior to EMS arrival unless athlete is likely to be injured further. Stay with athlete, Monitor vital signs, Treat for shock, Summon EMS.

30. Return to Play In the absence of a trained medical professional such as a physician or BOC-certified athletic trainer, the coach must answer the question, “Should this athlete be allowed to return to play?” Remove from play and arrange for evaluation by medical professional. –Athletes with neurologic injury. –Athletes with suspected concussion. –Athletes suffering from heat-related problems.

31. Return to Play Musculoskeletal system injuries such as joint sprains, muscle strains, and contusions. If the injury results in any degree of functional loss, the athlete should not be allowed to return to participation. Functional loss in the extremities Have athlete to perform simple drills such as hopping, running, cutting, or performing sport related techniques (blocking, throwing, catching etc…)

32. The Coach’s Limitations Coaches must take special care NOT to overstep the bounds of their training and expertise when managing an injury. Coaches should only provide first aid care and should avoid performing any procedure that is clearly the domain of allied health personnel.