Sideline Injury Management on Different Field Surfaces and Conditions

1. Sideline Injury Management on Different Field Surfaces and Conditions Matthew Brewer, MS, ATC/R Certified Athletic Trainer Children’s Hospital ColoradoSports Medicine Program Orthopedics Institute

2. Presentation Outline • Discuss why sideline management of injuries is essential • Identify different sports that have different surfaces • Discuss how different surfaces can pose challenges for sideline management and injury evaluation • Discuss proper injury evaluation techniques on these surfaces and give strategies about when, where, and how to implement them • Identify and discuss different environmental/weather concerns that can further challenge injury management on sidelines

3. Why is Sideline Management Important? • To be able to give the most accurate and immediate care for all types of injuries sustained in sports • National Center for Sports Safety reports over 3.5 million children >14 years receive medical treatment for sports related injuries per year.

4. What Does This All Have To Do With Sideline Management? • Number of sport related injuries for each sport are as follows: • Gymnastics — 99,722 • Basketball — 680,307 • Baseball — 170,902 • Softball — 118,354 • Football — 413,620 • Soccer — 163,003 • Volleyball — 55,860 • Track & Field — 15,113 • Hockey — 63,945 • Number of sport related injuries for each sport are as follows: • Gymnastics — 99,722 • Basketball — 680,307 • Baseball — 170,902 • Softball — 118,354 • Football — 413,620 • Soccer — 163,003 • Volleyball — 55,860 • Track & Field — 15,113 • Hockey — 63,945

5. Different Surfaces

6. Immediate Care and Stabilization on High Friction Surfaces

7. Low Friction and Uncommon Surfaces • Following sports and surfaces pose a bigger challenge for injury evaluation and stabilization than previous.

8. Sideline Management of Water Related Injuries • Recreational swimming and diving third most common physical activity, and the most common in children. • An estimated 111,341 patients were treated in emergency departments in 17 year period, with injuries to head and neck being most common (38.2%) • Patients aged 10-14 years comprised largest group (36.3%) • Leading cause of injury was interference with diving board or platform (43.9%)

9. Pool Stabilization Video

10. Water Injury Management and Stabilization • If athlete is conscious and injured but cannot move with no head/neck injury suspected, roll onto back and use passive towing technique. • If athlete is unconscious and not breathing and no head/cervical injury suspected, get to pool deck and begin CPR ASAP-precautions for AED placement with water! • Once on land/deck, perform full evaluation. Prentice, W. 2003

11. Water Injury Management and Stabilization

12. Water Injury Management and Stabilization

13. Skiing and Snowboarding Injuries • Over 40 fatalities have been reported in over 10 years. • According to the National Orthopedics and Neurosurgery Center, more than 39,000 children and adolescents ages five to 14 were treated in hospital emergency rooms for snowboarding/skiing-related injuries.

14. Emergency Evaluation and Stabilization on Snow Video

15. Immediate Injury Assessment and Stabilization on snow • Different equipment concerns with these sports. • No need to take helmet off since full access can be gained to airway • High velocity impacts • Stabilize and evaluate on scene

16. Immediate Injury Assessment and Stabilization on Snow

17. Environmental Concerns Effecting Injury Evaluation and Sideline Management • Heat Illness • Move to cooler environment ASAP • Take appropriate steps to cool athlete (Ice towels, cold emersion, ect). • If athlete is injured and experiencing heat related illness-problems magnified • Barriers to evaporation • Give fluids and ice if possible to continue cooling athlete • Lying on ground can potentially burn skin • Try to shade athlete as much as possible and cool ground around them to prevent burns • Binkley et al. 2008.

18. Environmental Concerns Effecting Injury Evaluation and Sideline Management • Cold Weather • Large population of outdoor sports in Colorado • Military, football, baseball, soccer, lacrosse, track/field, skiing season all have the potential for cold injuries • Three categories-decreased core temperature (hypothermia), non-freezing injuries to extremities (chilblains), and freezing injury to extremities (frostbite) • Signs of mild hypothermia include vigorous shivering, increased blood pressure, core body temperature <98.6C, lethargy, apathy, and amnesia. Decreased vital signs, loss of consciousness, impaired motor and mental function, loss of speech, and core temperature >90.6C are signs of severe hypothermia, MEDICAL EMERGENCY! • Waxenberg. et al 2008.

19. Management of Cold Injuries • Re-warm athlete ASAP • Remove wet clothing while insulating them with dry clothing and blankets • Move to warmer and dry environment • Apply heat to areas of heat transfer including groin, armpits, and chest wall • Encourage shivering, while providing warm non-alcoholic fluids • Monitor closely and refer to EMS if necessary

20. Lightning and Severe Weather • 2nd most common storm related death in the U.S. • 1 out of 10 lightning strike victims die - cardiac arrest accounts for majority of fatal injures, while severe neurological impairment can cause permanent disability • The location, elevation, climate, and vast amount of people who enjoy outdoor activities (sports, hiking, biking, camping, etc) makes Colorado and the Rocky Mountains vulnerable to lightning injuries • The most active time for storm and lightning development occurs between 11a and 9p April-September-PRIME TIME for both sports and outdoor events

21. When is a Storm Too Close? • Lightning can strike up to 20 miles away from nearest cloud • If you see lightning, extreme caution needs to taken • 20 mile rule-begin preparations to postpone game/practice • 6 miles accepted distance to seek shelter immediately • Different ways to determine proximity of lightning • 30/30 rule, lightning detectors, text/instant messaging • NATA position statement on lightning promotes 30/30 rule Walsh. K 2000

22. Additional Things to Consider with Lightning • The JAT, 2000, reported that the most common sites for fatalities in Colorado associated with lightning included open fields (27%), near trees (16%), and close to water (13%) • All fatalities normally have 1 common link-being near tallest object in immediate area • EAP should have comprehensive lightning and evacuation plan with approved shelter • Sports such as track, golf, cross country, & large outdoor venues need to have additional time to evacuate given the large area and number of people present

23. Conclusions • Different surfaces and conditions pose different challenges for sideline management and stabilization of injuries • Many associated challenges can be decreased by having thorough and detailed EAP • This EAP must be practiced and rehearsed with everyone involved • Plan accordingly for adverse filed and weather conditions, and know what to do in each situation

24. Questions???

25. Work Cited Binkley, H., Beckett. J., Casa. D., Kleiner. D., & Plummer. P. National Athletic Trainer’s Association Position Statement: Exertional Heat Illness. NATA Position, Consensus, Official Support Statements. Dallas, TX. 2008 PP. 12-26. Cappaert. T., Stone. J., Castellani. J., Krause. B., Smith. D., & Stephens. B. National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries. Journal of Athletic Training, 43. 2008. PP. 640-658. Cooper. M., & Kulkarni. R. Lightning Injuries. Medscape References. http://emedicine.medscape.com/article/770642-overview Chang. D., & Bosco. J. Cervical Spine Injuries in the Athlete. Bulletin of the NYU Hospital for Joint Disease, 64. 2006. PP. 119-129. Day. C., Stolz. U., Mehan. T., Smith. G., & McKenzie. L. Diving Related Injuries in Children <20 Years Old Treated in Emergency Departments in the United States: 1990-2006. Pediatrics,122. 2008. PP. E388-E394. Prentice. W. Arnheim’s (2003) Principles of Athletic Training A Competency Based Approach. New York, New York: McGraw-Hill Higher Education. PP. 332-335. Walsh. K., Bennett. B., Cooper. M., Holle. R., Kithil. R., & Lopez. R. (200) . National Athletic Trainer’s Association Position Statement: Lightning Safety for Athletics and Recreation. Journal of Athletic Training, 35. 471-477.