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Gymnastics Pit extraction. Care of the injured athlete. Ada County Paramedics. Steve Cole Cool Dude. Disclaimer. Although the information presented here is developed from practice , and published guidelines, it is in no way meant to replace or supercede local protocols.

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Gymnastics pit extraction l.jpg

Gymnastics Pit extraction

Care of the injured athlete


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Ada County Paramedics

Steve Cole

Cool Dude


Disclaimer l.jpg
Disclaimer

  • Although the information presented here is developed from practice , and published guidelines, it is in no way meant to replace or supercede local protocols.

  • It is intended for educational and conceptual use only.

  • Ada County Paramedics accepts no responsibility for the use/misuse of the information provided here.

  • When in doubt, consult with your local medical guidance.


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Objectives

  • Adapt and refine standard immobilization skills to the unstable gymnastics pit environment.

  • Gain knowledge on the Ladder approach and Mat approach to accessing the injured patient with spinal injury.

  • Lean the pro’s and cons of rapid entry and delayed entry techniques.


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Background

  • 33 % of fatal and catastrophic injuries that occur in college level “winter” athletics occurred with Gymnastics (in 1998).

  • The majority of these were related to spinal cord/cervical injury.

  • A unique factor in these injuries is that safety equipment, like many professional sports, while designed to protect the athlete, become a hindrance to care in the event the athlete is seriously injured.

  • As a result of this , new guidelines have been published on the care of injured gymnast, including spinal immobilization techniques.


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Background

  • The greatest hindrance in gymnastics to prompt emergency care is the gymnastics pit. These “pits” are either filled with foam chunks/squares or a large foam mat.

  • The greatest number of lawsuits against gymnastic centers currently from injuries sustained by visitors (parents) involved in horseplay.



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The Gymnastics Pit

  • A Typical pit will be 10 by 20 feet and approx. 6-8 feet deep. This produces a very safe “crash landing” area for the routine mishaps in gymnastics.

  •  This also creates a very unstable platform to access the patient on. Any movement by occupants entering the pit will often transfer to the patient. The debris in the pit will hinder any attempts at immobilization.

  • Thus special methods of accessing the patient have been developed.

  • Some rest on a trampoline style frame and suspension system. These are called “self fluffing”

  • Some are simply Pits filled with foam chunks


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Local Information

  • There are two known pits in Ada County

  • BSU- by the pavilion

  • Gem State Gymnastics at 5420 West State Street

    When discovering that there is a “Gymnastics Pit Extraction”, please notify other incoming units.


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SPECIAL NOTE:

All of these methods assume that the patient does not have any immediate airway, respiratory, or cardiac compromise.

In case of need of life saving interventions (like CPR) then rapid extrication by staff on hand while maintaining alignment as best as possible is recommended.



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The S.T.O.P. ProcedureTaught to trainers

  • S: Stop all activity around the section

  • T: Talk to the injured athlete

  • O: Observe the injured Athlete from outside the pit for breathing, movement, etc

  • P: prevent further injury. Proceed carefully into the pit based on perceived need

    Again: If an immediate threat to the ABC’s is perceived then “direct entry” is indicated.



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C- Spine Immobilization

  • The Jaw thrust is preferred for opening the airway in trauma.

  • The decision to provide more advanced care in the pit is made on a case by case basis

  • While most areas have back boards available, these will generally only be used before EMS arrival if a life threat exists.


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Moving in the pit

  • May be “over your head”

  • Will be deeper than it looks

  • Sudden movement stir up dust, may cause the athlete to move

  • We found that taking off boots helped


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Pit extraction Steps

  • S.T.O.P. (already discussed)

  • Pt. Access

  • Pit Entry

  • PT immobilization

  • PT removal


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Pt. Access

Three Methods

  • Direct entry

  • Ladder Access

  • Mat Access


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Pt. Access Direct Entry

  • Quickest

  • No Special Equipment

  • The most potential movement to the patient

    Should be done slow

    moving foam as you go



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Pt. Access- Ladder Access

  • Uses a standard FD roof ladder (16 feet ) to span the pit

  • The ladder is placed just above the patients head.

  • Provides a stable platform for assessment and securing c spine.

  • FD always has a ladder

  • What we found the easiest to do after trying all methods




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Pt. Access- MAT Access

  • Uses a standard 4” gymnastics mat to access the patient

  • The Mat distributes the weight of the person across the pit

  • Some movement may be transferred to the pt

  • Must spider crawl

  • Always available.




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Pt. Access- MAT Access

  • Though not illustrated in the photos, in larger pits, the same technique is used to move mats in to each side and provide access to the patient as well.

  • In the smaller pits, we discovered it to be a hindrance.


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Pit Entry/Pt Access- foam removal

  • Often the pt. is buried by the foam.

  • Foam is moved only when it covers the patient or interferes with the ABC’s

  • The foam beneath the patient provides the support for the patient

  • Removing foam beneath the patient will cause the pt. to sink lower in the pit.


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Pt. Immobilization

  • The pt. is often found in a pseudo seating position when supine

  • However pt may be prone, sideways, or even head lowest.

  • In our experience 4-5 people were required to safely immobilize and remove the pt. from the pit.

  • 1 on C-Spine, 2 on each side of the pt.


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Pt. Immobilization

  • The back board seemed to work best, as when the pt. was on the board the board distributed the pt.’s weight across the foam.

  • Other devices may be indicated (KED, Vacuum mattress)





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Pt removal

  • Once the patient is packaged, we found it easiest to remove the pt. by the means we made first entry.

  • The ladder was by far the easiest in our training.

  • The mat works well too.

  • Wading through the debris, lifting over our head was pretty hazardous.





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Summary

  • This practice session brought to light a whole set of issues not normally encountered

  • The most important lesson was to stop and carefully assess the situation, just like any other “rescue”

  • Utilization of proper resources is the issue



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