Handling Emergency Situations and Injury Assessment

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 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. Primary Survey Controlling Bleeding – • 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 • Signs 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 • alert, responds to verbal directions • Pulse • adults 60-80 normal; children 80-100 • 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 • 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

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

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. Types of 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