1. Emergency Situations and Injury Assessment
Chapter 7

2. Overview
Most sports injuries do not result in life-or-death emergency situations, but when such situations do arise, prompt care is essential.
Time becomes a critical factor, there is no room for uncertainty, indecision, or error.
In situations in which an athletic trainer is not available, the responsibility falls on the coach.

3. The Emergency Action Plan
The prime concern of emergency aid is to maintain cardiovascular function and, indirectly, central nervous system function, because failure of any of these systems may lead to death.
The key to emergency aid in the sports setting is the initial evaluation of the injured athlete.

4. The following issues must be addressed when developing the Emergency Action Plan:
Separate emergency action plans should be developed for each sport’s fields, court, gymnasium.
A. Determine the personnel who will be on the field during practices and competitions. Each person should understand exactly their role and responsibility.
B. Decide what emergency equipment should be available.

5. The following issues must be addressed when developing the Emergency Action Plan:
2. specific procedures and policies should be established regarding the removal of protective equipment, particularly the helmet and shoulder pads.
3. Phone access should be readily accessible.

6. The following issues must be addressed when developing the Emergency Action Plan:
4. The coach should be familiar with transportation policies, and emergency care facility admission and treatment policies and also designate someone to make emergency phone calls providing:
the type of emergency situation
type of suspected injury
present condition of the athlete
current assistance being given
exact location of emergency

7. The following issues must be addressed when developing the Emergency Action Plan:
5. Keys to gates or padlocks must be easily accessible.
6. An emergency action plan meeting should be established to discuss all information with athletic directors, school nurses, athletic trainers, and maintenance personnel.
7 someone should be assigned to accompany the injured athlete to the hospital.

8. Cooperation Between Emergency Care Providers
If an athletic trainer or physician is not available, the coach should not hesitate to dial 911 to let the rescue squad handle the emergency situation.
The emergency medical technicians should have the final say on how the athlete is transported, the coach and the athletic trainer should assume their assistive role.

9. Parent Notification
According to HIPAA regulations discussed in chapter 2
if the injured athlete is a minor, it is essential that consent to treat the athlete is obtained from the parent
Actual consent may be given in writing either before or during an emergency.

10. Principles of Assessment
Primary Survey: assessing for potentially life-threatening problems including (ABC) Airway, Breathing, Circulation, and also severe bleeding or shock.
Secondary Survey: assessing injuries sustained by the athlete.

11. The Unconscious Athlete
A coach acting alone without an athletic trainer should always dial 911, an unconscious athlete must always be considered to have life-threatening injury.
The coach should note body position and determine level of consciousness and responsiveness.
Airway, breathing, and circulation should routinely be established.
Injury to the neck or spine can be a possiblity for an unconscious athlete.

12. The Unconscious Athlete
If the athlete is wearing a helmet, it should never be removed until neck and spine injury have be ruled out. Facemask must be removed if CPR is needed.
If the athlete is supine and not breathing, establish ABC immediately.
If the athlete is supine and breathing, do nothing until consciousness returns.

13. The Unconscious Athlete
If the athlete is prone and not breathing, logroll them carefully to supine position and establish ABC immediately.
If the athlete is prone and breathing, do nothing until consciousness returns.
Monitor and maintain life support for the unconscious athlete until emergency medical personnel arrive.

14. Primary Survey
Life-threatening injuries take precedence over all other injuries sustained by the athlete.
Situations that are considered to be life-threatening include those that require CPR for obstruction of the airway, no breathing, no circulation, and also profuse bleeding and shock.
Whenever there is a life-threatening situation, the coach should always dial 911.

15. Overview of Emergency CPR
All coaches should be currently certified in CPR so that if an athletic trainer is not available, the coach can perform the techniques correctly.
It is essential that a careful evaluation of the injured athlete be made to determine whether CPR should be conducted.

16. Overview of Emergency CPR
In order to perform CPR you must be certified through American Red Cross, the American Heart Association, or the National Safety Council.
Good Samaritan Laws were enacted to protect individuals who willing provide emergency care.

17. Overview of Emergency CPR
An individual must gain consent in order to perform first aid on a victim.
In the case of an unconscious victim who requires CPR, consent is implied.

18. Emergency Action Steps
Check – the scene to find out what happened and to identify other individuals who might help and then check the victim for consciousness
Call – 911 to access EMS
Care – Initiate the proper care needed

19. Establish Unresponsiveness
Gently tap the victim on the shoulder and ask “Are you okay?”
If the athlete is breathing, the can be placed on their side in the recovery position.
If the athlete is not breathing,
gently logroll them onto their
back and begin CPR.

20. Equipment Considerations
Protective equipment worn may complicate life-saving first aid procedures.
Removing a face mask should be the first step.
The decision to remove the helmet and shoulder pads before initiating CPR should be based on the potential of injury to the cervical spine.
A coach should never remove a helmet from an athlete with a suspected cervical spine injury!

21. Opening the Airway
Open the airway by using the head tilt-chin lift method.

22. Establish Breathing
To determine if the victim is breathing, maintain open airway, place ear over the victims mouth, observe the chest.
Look – Listen – Feel

23. Establish Circulation
To determine if there is a pulse, feel for the carotid pulse for 5-10 seconds, while maintaining an open airway.
If there is no pulse,
begin chest compressions
on the sternum.

24. CPR
Hands Only CPR
Every coach and athletic trainer should be certified in CPR and should take a refresher course at least once a year.
All assistants should be certified as well.

25. Obstructed Airway Management
Choking is a possibility in may sports activities; mouth guards, broken dental work, chewing gum and other item present hazards.
Unconscious victims can have their airway obstructed when their tongue falls back into their throat.
The conscious victim may require standing abdominal thrusts.

26. Obstructed Airway Management

27. Obstructed Airway Management
In the case of an unconscious victim, chest compressions should be performed for about 10 seconds followed by a finger sweep of the mouth if an object is visible.
Continue this process until the athlete return to normal breathing or more qualified help arrives.

28. Using an Automated External Defibrillator
An AED is a device that evaluates the heart rhythm of a victim.
The device is capable of delivering an electrical charge to the heart and does not require the expertise of a medical professional.
An AED device is easy to use and should be readily available at all sporting events.

29. Controlling Bleeding
An abnormal external or internal discharge of blood is called a Hemorrhage.
The caregiver must always be concerned with exposure to blood borne pathogens and other diseases when coming into contact with someone’s blood or other body fluids.
Disposable non-latex gloves should be used routinely when in contact with blood and other body fluids.

30. Controlling Bleeding External bleeding can usually be managed by using…
Direct Pressure – pressure is applied directly over a wound with a sterile gauze pad.
Elevation – in combination with pressure, reduces hydrostatic blood pressure and facilitates drainage.
Pressure points – when the other methods fail to slow the bleeding, there are 11 pressure points that have been identified to control external bleeding.

31. Internal Hemorrhage Internal bleeding can be difficult to diagnose.
Athletes with internal injuries require hospitalization under complete and constant observation by a medical staff to determine the nature and extent of the injuries.

32. Shock With any injury shock is a possibility.
Shock occurs when a diminished amount of blood is available to the circulatory system.
Signs or shock:
Blood pressure is low, Pulse is rapid and very weak, athlete appears drowsy and sluggish, Respiration is shallow and extremely rapid
Pale, cool, clammy skin.

33. Managing Shock
Maintain body temperature as close to normal as possible.
For most situations, elevate feet and legs 8-12 inches.
For a neck injury, immobilize body as found.
For a head injury, head and shoulder should be elevated.
For a leg fracture, leg should be kept level and raised after splinting.

34. Managing Shock
Shock can be produced by the psychological reaction of the injury.
Fear or sudden realization can lead to irrational thoughts.
Athlete should be instructed to lie down and avoid viewing the injury.
Spectators should be kept away.
Reassurance is vital to keeping an athlete out of shock.

35. Secondary Survey
If the athlete has no life-threatening injuries, the coach should conduct a secondary assessment to survey the existing injury.
It is important that a coach is able to recognize when an athlete is showing signs that appear to be abnormal.

36. Recognizing Vital Signs
Heart Rate
Breathing Rate
Blood Pressure
Body Temperature
Skin Color
Pupils of the Eye
Movement / Presence of Pain
Level of Consciousness

37. On-Field Injury Inspection
The seriousness of the injury
Type of first aid necessary.
How the injured athlete should be transported from the playing field.
Does the injury warrant immediate referral to a physician for further assessment?
Document in written form the finding of the on-the-field assessment.

38. Off-Field Assessment
A more thorough off-field evaluation is performed by the trainer of physician once the athlete has been removed from the playing surface to a more comfortable and safe place.
The evaluation scheme is divided into 4 broad categories: History, Observations, Physical Examination, and Special Tests.

39. History
Obtaining as much information as possible about the injury is of major importance.
If there is prior history the examiner can develop strategies for further examination and possible immediate follow-up management.

40. Observation
What is seen in combination of what the athlete explains they experienced is taken into great consideration of what the injury could possibly be.
It is important to not jump to conclusions during an observation.

41. Palpation There are 2 types of Palpation or Physical Examination
Boney Tissue
Soft Tissue
A physical examination must be performed systematically
very light pressure > deeper pressure
Away from site > toward site of injury

42. Special Test
Special tests have been designed for almost every body region as means for detecting specific injuries.
These test are discusses in the later chapters of the book.

43. Immediate Treatment Following Acute Injury
Musculoskeletal injuries are extremely common, Every initial first-aid effort should be directed toward one goal, reduce swelling.
If swelling can be controlled initially, the amount of time required for rehabilitation will be reduced.
Initial management for musculoskeletal injuries is the PRICE or RICE protocol.

44. PRICE / RICE
Protection – from further injury through immobilization, splinting, or bracing.
Rest – is extremely important for 72 hours after an injury . Severity of injury may call for more time .
Ice – Initial treatment of injury should use cold to stop swelling. 20 mins on/off for the first 72 hours.
Compression – Immediate compression is perhaps more important than ice in controlling swelling.
Elevation – Elevation reduces internal bleeding. 72hrs

45. Emergency Splinting
If a coach suspects that an athlete has a fracture, dial 911 and access EMS immediately.
Any suspected fracture should be splinted before the athlete is moved.
2 major concepts of splinting:
1. Splint from one joint above the fracture to one joint below the fracture.
2. Splint the injury in the position it was found.

46. Emergency Splinting
Rapid Form Vacuum Immobilizers - Formed to any joint or shape needed and then the air is sucked out of it to become rigid.
Air Splints – inflated around the injury, provides support and moderate pressure

47. Splinting Limb Fractures
Fractures of the ankle or leg require immobilization of all the lower-limb joints.
Fractures of the shoulder complex are immobilized with a sling.
Upper-arm and elbow fractures must be splinted in the position they were found.
Lower-arm, wrist, and forearm fractures should be splinted in elbow flexion and supported by a sling.

48. Splinting of the Spine and Pelvis
Injuries involving a possible spine or pelvic fracture are best splinted and moved using a spine board.

49. Moving and Transporting the Injured Athlete
Great caution must be taken when transporting an injured athlete to prevent further injury.
If spinal injuries are suspected, the coach should immediately dial 911 and wait until EMS arrive before attempting to move the athlete.
Placing the athlete on a spine board or stretcher should be done by qualified professionals.

50. Moving and Transporting the Injured Athlete
Ambulatory Aid
Supported on both sides
slow walking/short distance

51. Moving and Transporting the Injured Athlete
Manual Conveyance
Moving greater distances than
needed for Ambulatory Aid

52. Crutches The crutch must be properly fitted to the athlete.
The crutch tips are placed 6 inches from the outer margin of the shoe and 2 inches in front of the shoe.
The underarm crutch brace is positioned 1 inch below the anterior fold of the axilla (armpit).
The hand brace is placed even with the athlete's hand, with the elbow flexed approximately 30 degrees.