Emergency Situations and Injury Assessment

1. Emergency Situations and Injury Assessment Chapter 7

2. The Emergency Plan Have an Emergency Plan & Practice It! • Pre determined actions in the event of an emergency: • who will take charge, • who will control crowds, • who will call ambulance • Procedures need to be posted and a card in the kit with address of facility and directions to event. • The plan must be reviewed and discussed with participants, parents, officials, coaches and facility staff.

3. The Emergency Plan Considerations in Development • Parent Notification • Principles of Emergency Care • Primary Assessment ABC’s • The Unconscious Athlete • Review of Life-saving Techniques (CPR) • Equipment Considerations • Obstructed Airway

4. Emergency Action Plan (EAP) Charge Person • Most qualified person available with appropriate emergency first response training.

5. Charge Person • Should be familiar with emergency equipment for the particular activity • Should control the emergency until a medical authority arrives • Assesses the injury status of the athlete

6. Call Person • Must know location of working emergency telephone. • Must have emergency contact information available. • Must know directions to nearest hospital. • Must know address of event facility • Must know ambulance access routs

7. Information for Ambulance Dispatcher • State that it is a medical emergency. • State what the emergency is. • Is the athlete conscious? • Breathing normally? • Bleeding? • Give exact location of facility and access route.

8. Information for Ambulance Dispatcher • Give phone number of the phone used to place the call. Have someone stay by the phone • Ask for estimated time of arrival. • Report back to charge person. • Go to meet ambulance.

9. Control Person • Manages crowd to ensure adequate room for charge person to work. • Ensures clear route for ambulance onto playing surface. • Seeks medical personnel if requested by charge person.

10. On-Field Assessment • Tell athlete not to move • Determine level of consciousness • Stimulate • A. B. C.’s / primary survey • Reassure • Secondary survey • Monitor vital signs • Consider treatment • transportation

11. Secondary survey • Physical signs. • Fluid from ears, nose, mouth. • Bleeding • Deformity • Skin colour

12. Significance of Vital Signs • Pulse: children – 60-80 bpm, adults 80-100 bpm • Respiration:children breaths 20-25/m, adults 12 Blood Pressure: male systolic 115- 120 mm Hg, diastolic 75-80 mm Hg, females 8-10 mm Hg lower. • Temperature: 37 degrees C, 98.6 degrees F • Skin Color: Red, pale, ashen, white, blue

13. Significance of Vital Signs • Pupils: response to light, equal in size • Consciousness:alert and responds quickly, slow, unresponsive • Movement Ability: ability to move normally, weakness, paralysis • Nerve Responses: numbness, tingling, loss of sensation

14. Assessment Decisions to be Made • Seriousness of Injury: Life-threatening? • Type of First Aid Required? • Medical Referral Required? • Transportation Necessary?

15. Shock • Definition of Shock • Types of Shock • Signs and Symptoms • Management of Shock

16. Definition of Shock SHOCK is a generalized inadequacy of blood flow throughout the body to the extent of minimal to extreme tissue damage. The vascular system loses its capacity to hold the fluid potion of the blood due to dilation of blood vessels leading to disruption of osmotic fluid balance. Thus, plasma leaks into tissue spaces resulting in stagnation and slowing of blood flow causing decreased oxygen to tissues leading to eventual death.

17. Predisposing Factors of Shock • Extreme fatigue • Extreme exposure to heat or cold • Extreme dehydration • Illness

18. Types of Shock Hypovolemic = blood lost from trauma, internal or external bleeding, or lost plasma as in crush or burn injuries Respiratory = lungs unable to supply enough O2 to circulating blood, pneumothorax Neurogenic = general dilation of blood vessels thus the normal six litres of blood can no longer meet O2 demands Psychogenic = caused by fainting often from fear, sudden dilation of blood vessels causes decreased O2 to brain

19. Types of Shock Cardiogenic = failure of heart to pump enough blood to the body Septic = occurs from sever bacterial infection Anaphylactic = results from severe allergic reactions from food, insect bites, drugs, inhalants such as dust, pollens or other chemicals Metabolic = untreated diabetes, extreme loos of bodily fluids through diarrhea, vomiting or urination

20. Signs and Symptoms • Skin is moist, pale, cool, clammy. • Weak and rapid pulse. • Respiratory rate becomes increased and shallow. • Decreased blood pressure. • In severe cases - urinary retention and faecal incontinence. • Unconsciousness. • If conscious may display disinterest in surrounding, irritability, restlessness, excitement. • There may also be extreme thirst.

21. Management of Shock • Immediate Transportation to Medical facility • Face is pale lift the tail, Face is red lift the head. • Spinal leave in position found until on the board. • Head injury the head should be elevated - may be on board. • Fractures of lower extremity elevate after splinting.

22. Controlling Bleeding • Direct Pressure • Elevation • Pressure points • Hospitalization for observation of internal bleeding with injuries to head, abdomen and thorax.

23. Spinal Injury Evaluation Unconscious Athlete • Activate EAP • Assume spinal injury • Follow on-field assessment • Prepare to transport athlete

24. Spinal Injury Evaluation Conscious Athlete • Tell athlete not to move • Determine level of consciousness • A.B.C.’s • Take history from athlete/ secondary scan • Test sensation • Test movement – and grip, dorsi – flexion • Determine method of splinting and transportation

25. Spinal Injury Evaluation • Assume a head injury when c-spine is injured • Assume a c-spine injury when head injury occurs

26. TRANSPORTATION REVIEW • Emergency Immobilization Techniques • Moving the Athlete With Spinal Injury • What to do with spinal injuries • Use of spine board • Ambulatory Aided Transportation • Methods commonly employed • Fitting and using crutch or cane

27. Summary • Most important aspect of Emergency Care of the injured athlete is to have an Emergency Plan, and the second most important is to practice it. • Expect the unexpected and always be prepared for breathing emergencies. • Be prepared to provide emergency transportation.