1. On-Field Acute Care & Emergency Procedures

2. The Emergency Action Plan
Developing an EAP
Develop separate EAPs for each sport
Establish specific procedures and policies regarding removal of protective gear
Make sure phones are readily accessible (cell phone and landline)
ATC should specifically designate someone to make an emergency phone call
Make sure all keys to gates or padlocks are easily accessible
Hold annual meetings to inform all coaches, ADs, nurses, and maintenance personnel of EAP and their roles
Assign someone to accompany the injured athlete to the hospital
Carry contact info for all athletes, coaches, and other personnel at all times
The Emergency Action Plan

3. On-Field Injury Assessment
The Emergency Procedure Flowchart
Injury
Unconscious Athlete
Conscious Athlete
Primary Survey
Secondary Survey
Responsiveness
ABC’s
Shock
Profuse Bleeding
Vital Signs
History
Musculoskeletal Eval
Call 911
Access Rescue Squad
Treatment Condsiderations
Care for Athlete until Rescue Squad Arrives
Transportation
On-Field Injury Assessment

4. On-Field Injury Assessment
The Primary Survey:
Determines the existence of potentially life-threatening situations (airway obstruction, no breathing, no circulation, severe bleeding, shock)
On-Field Injury Assessment

5. On-Field Injury Assessment
The Primary Survey Unconscious Athlete
ATC should immediately note the athletes body position and determine level of consciousness and unresponsiveness
ABC’s
Injury to neck and spine should be considered
Helmets should never be removed until neck and spine injuries have been ruled out (face mask must be cut away and removed to allow CPR)
If supine and not breathing, assess ABC’s
If supine and breathing, nothing should be done until he/she gains consciousness
If prone and not breathing, he/she should be logrolled to supine and assess ABC’s
If prone and breathing, nothing should be done until consciousness regained. Then logrolled onto spine board
Life support should be monitored and maintained until EMT arrive
Once stabilized, the ATC should begin secondary survey
On-Field Injury Assessment

6. Primary Survey - Overview of CPR
Equipment Considerations
Removing the face mask should be the first step!
Helmet and shoulder pads should be left in place to avoid unnecessary movement of the cervical spine
The shoulder pad straps/strings must be cut to allow for chest compressions
If the helmet must be removed, the shoulder pads must be removed simultaneously
Primary Survey - Overview of CPR

7. Primary Survey - Overview of CPR
Opening the Airway: Head Tilt-Chin Lift Method
Lift under the chin with one hand while pushing down on the victim’s forehead with the other
The tongue is the most common cause of airway obstruction
The forward tilt raises the tongue away from the back of the throat, clearing the airway
Primary Survey - Overview of CPR

8. Primary Survey - Overview of CPR
Opening the Airway: Jaw Thrust Technique
For victims with suspected head or neck injuries
Grasp each side of the lower jaw at the angles, displacing the jaw forward as the head tilts back
Both elbows should rest on the same surface the victim is lying on
Primary Survey - Overview of CPR

9. Primary Survey - Overview of CPR
Establishing Breathing
To determine if victim is breathing, maintain open airway, place ear over victim’s mouth – LOOK, LISTEN, and FEEL
If not breathing, begin rescue breathing
Place one hand on the victim’s forehead and pinch the nose shut. Administer two slow, full breaths and observe the chest rise and fall
If the chest does not rise or fall, the airway is obstructed. Reposition the victim’s head and try again
If the airway is still obstructed, give 15 chest compressions followed by a finger sweep
Continue to repeat this sequence until ventilation occurs
*If available, use a bag/valve mask. Barrier shields have been mandated by OSHA to minimize risk of transmitting bloodborne pathogens
Primary Survey - Overview of CPR

10. Primary Survey - Overview of CPR
Establishing Circulation
To determine whether a pulse exists, locate the Adam’s apple with the index and middle fingers and then slide down into the groove just under the jaw (carotid artery)
Feel for the xiphoid notch, where the ribs meet the sternum
Place the heel of one hand just above that notch and the other hand on top
Lock elbows with arms straight and shoulders positioned over the hands
Apply enough force to depress the sternum 1 ½ to 2 inches and completely release to allow the heart to refill
compressions per minute; maintain a rate of 15 compressions to 2 full breaths
After one minute, recheck pulse. If no pulse, continue the 15:2 cycle, beginning with chest compressions
Primary Survey - Overview of CPR

11. Primary Survey - Overview of CPR
Obstructed Airway Management
Unconscious
15 chest compressions, followed by a finger sweep with an attempt at ventilation (2 full breaths)
Conscious
Heimlich maneuver
Stand behind and to one side of the victim (place one foot between theirs)
Wrap both arms around the waist just above the belt line, and permit the athlete’s head, arms, and upper trunk to hang forward
Grasp one fist with the other and place thumb side just below the xiphoid process of the sternum
Sharply and forcefully thrust the fists into the abdomen, inward, and upward, several times until the obstruction is expelled or the athlete becomes unconscious
Primary Survey - Overview of CPR

12. Primary Survey - Excess Bleeding
External Bleeding
Direct Pressure
Pressure Points
Elevation
Primary Survey - Excess Bleeding

13. Primary Survey - Excess Bleeding
Internal Bleeding
Bleeding within a body cavity such as the skull, thorax, or abdomen is a life-or-death situation
Because the symptoms are obscure, internal hemorrhage is difficult to diagnose properly
All severe hemorrhaging will eventually result in shock and should therefore be treated on this premise
Primary Survey - Excess Bleeding

14. Shock occurs when a diminished amount of blood is available to the circulatory system
Blood flow slows and not enough oxygen-carrying blood cells are available to the tissues
Widespread tissue death can lead to death of the individual unless treated
Primary Survey - Shock

15. Primary Survey - Shock Types of Shock
Hypovolemic – stems from trauma in which there is blood loss
Respiratory – occurs when the lungs are unable to supply enough oxygen to the blood
Neurogenic – caused by general dilation of blood vessels within the cardiovascular system
Psychogenic – fainting; caused by a temporary dilation of blood vessels that reduces normal amount of blood in the brain
Cardiogenic – refers to inability of heart to pump enough blood to the body
Septic – occurs from a severe, usually bacterial, infection
Anaphylactic – is the result of a severe allergic reaction
Metabolic – happens when a severe illness goes untreated (diabetes); another cause is extreme loss of body fluid (through urination, vomiting, or diarrhea)
Primary Survey - Shock

16. Primary Survey - Shock Signs & Symptoms
Low BP (systolic pressure below 90 mm Hg)
Weak and rapid pulse
Athlete may be drowsy and appear sluggish
Shallow and rapid breathing
Pale, cool, and clammy skin
Primary Survey - Shock

17. Primary Survey - Shock Management
Maintain body temp as close to normal as possible
Elevate feet and legs 8-12 inches for most situations
Neck injury – immobilize as found
Head injury – head and shoulders should be elevated
Leg fracture – legs should be kept level and raised after splinting
Primary Survey - Shock

18. On-Field Injury Assessment
The Secondary Survey:
Performed after life-threatening injuries have been ruled out
Gathers specific information about the injury from the athlete
Systematically assesses vital signs and symptoms
Allows for a more detailed evaluation of the injury
Vital signs and musculoskeletal assessment
On-Field Injury Assessment

19. Secondary Survey – Vital Signs
1) Pulse
Normal RHR for adults BPM
Normal RHR for children BPM
Trained athletes typically have lower RHR than the general population
Secondary Survey – Vital Signs

20. Secondary Survey – Vital Signs
2) Respiration
Normal breathing rate: breaths/min for adults, for children
Breathing alterations:
Frothy blood being coughed up – chest injury, i.e. a fractured rib that has affected a lung
ATC should LOOK, LISTEN, and FEEL
Secondary Survey – Vital Signs

21. Secondary Survey – Vital Signs
3) Blood Pressure
Measured by a sphygmomanometer
Indicates the amount of pressure exerted against the arterial walls
Systolic BP – left ventricle contraction, pumping blood
Diastolic BP – residual pressure, between beats
Normal BP for year old males should be <120 mm Hg (systolic) and <80 mm Hg (diastolic)
Normal BP for females is usually 8-10 mm Hg lower than in males for both systolic and diastolic
Secondary Survey – Vital Signs

22. Secondary Survey – Vital Signs
4) Temperature
Normally 98.6º F (37º C)
Places of measurement: under tongue, in armpit, against tympanic membrane in the ear, or in case of unconsciousness, in the rectum
Core temp is most accurately measured in the rectum
Secondary Survey – Vital Signs

23. Secondary Survey – Vital Signs
5) Skin Color
Individuals with light skin:
Flushed, red – heat stroke, sunburn, allergic reaction, high BP, elevated temp
Pale, ashen, or white – insufficient circulation, shock, fright, hemorrhage, heat exhaustion, insulin shock
Bluish – airway obstruction (usually in lips and fingernails)
Yellowish – liver disease or dysfunction
Individuals with dark skin:
Shock – skin around mouth and nose will be grayish, while tongue, inside of mouth, lips, and fingernails will be bluish
Shock as result of hemorrhage – tongue and inside of mouth become pale, grayish color
Secondary Survey – Vital Signs

24. Secondary Survey – Vital Signs
6) Pupils PEARL
Pupils are
Equal
And
Responsive to
Light
Secondary Survey – Vital Signs

25. Secondary Survey – Vital Signs
7) Level of Consciousness
The AVPU scale is widely used by EMTs for assessing the neurologic status of trauma patients
ALERT – patient is alert; awake; responsive to voice; and oriented to person, time, and place
VERBAL – patient responds to voice but is not fully oriented to person, time, or place
PAIN – patient does not respond to voice but does respond to painful stimulus such as a squeeze to the hand
UNRESPONSIVE – patients does not respond to painful stimulus
Secondary Survey – Vital Signs

26. Secondary Survey – Vital Signs
8) Movement
Inability to move one side of the body – caused by head injury or stroke
Bilateral tingling and numbness/sensory or motor deficits of the upper extremity – cervical spine injury
Weakness or inability to move the lower extremities – injury below the neck
Limited use of limbs – pressure on the spinal cord
Secondary Survey – Vital Signs

27. Secondary Survey – Vital Signs
9) Abnormal Nerve Response
Numbness or tingling – nerve or cold damage
Severe pain, loss of sensation, lack of pulse – blockage of a main artery
Lack of pain or awareness of serious injury – shock, hysteria, drug usage, or spinal cord injury
Secondary Survey – Vital Signs

28. Secondary Survey – Musculoskeletal Assessment
Assessment Decisions
Seriousness of injury
Type of first aid required
Whether injury warrants physical referral
Type of transportation needed
Secondary Survey – Musculoskeletal Assessment

29. Secondary Survey – Musculoskeletal Assessment
Immediate Treatment RICE
Rest
Ice
Compression
Elevation
Secondary Survey – Musculoskeletal Assessment

30. Secondary Survey – Musculoskeletal Assessment
Emergency Splinting
Any suspected fracture should be splinted
Rapid form vacuum immobilizer
Air splint
Half-ring splint
Splinting of a limb fracture – stabilize above and below the fracture site
Secondary Survey – Musculoskeletal Assessment

31. Transporting the Injured Athlete
Spine Board
Log Roll
6-Person Lift
Manual Conveyance (2-Person Carry)
Ambulatory Aid (Human Crutch)
1-Person
2-Person
Transporting the Injured Athlete

32. Proper Fit and Use of the Crutch
Fitting the Athlete
Crutch length determined by placing tip 6 inches from the outer margin of the shoe and 2 inches in front of the shoe
Underarm crutch brace is positioned 1 inch below the anterior fold of the axilla (armpit)
The hand brace is adjusted so that it is even with the athlete’s hand when the elbow is flexed at approx. 30º
Proper Fit and Use of the Crutch