1. Handling Emergency Situations and Injury Assessment
Chapter 12

2. 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.**

3. 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

4. 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

5. 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

6. 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

7. 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

8. This checks for life-threatening injuries?
Primary
Secondary

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

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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

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

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

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

19. 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

20. 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

21. Vital Signs Level of consciousness Pulse Respiration
alert, responds to verbal directions
Pulse
adults normal; children
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

22. 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

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

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

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

26. 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

27. 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

28. 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 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

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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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