Mandatory First Aid Training

1. Mandatory First Aid Training Qualified Safety Plan 2013Canyon View Little LeagueTucson, Arizona“Taking Safety to the Teams” 2/25-26/2013

2. District First Aid Training

3. First Aid Outline • BONE, BRUISE AND CUT INJURIES • Cuts and scrapes • Sprains and Strains • Fractures (broken bones) • EYE INJURIES • Black eye • Eye Injury or Foreign Body • FAINTING, UNCONSCIOUSNESS, CONCUSSION AND HEAT INJURIES • Head trauma • Concussion • Heat Injuries • TOOTH LOSS • NOSEBLEEDS • CENTRAL FIRST AID KIT • INJURY REPORTING REQUIREMENTS • OVERUSE INJURIES, LITTLE LEAGUE ELBOW, PITCH COUNTS • OPEN WOUND PROCEDURES • LIGHTNING PROCEDURES

4. General Recommendations • Always inform parents of an injury if they are not present when it occurs. • What To Report to the Safety Officer – An incident that causes any player, manager, coach, umpire or volunteer to receive medical treatment and/or first aid must be reported to the Safety Officer. This includes even passive treatments such as the evaluation and diagnosis of the extent of the injury or periods of rest. • The injured player MUST give you a doctor’s release to return to play!!! • Scott Goorman, 237-2819

5. For minor injuries: • RICE • Rest the injured limb. • Ice the area. Using a cold pack, a slush bath or a compression sleeve filled with cold water all limit swelling after an injury. Try to apply ice as soon as possible after the injury. If you use ice, be careful not to use it for too long (20 minutes at a time is ok) as this could cause tissue damage. YOU HAVE TWO INSTANT ICE IN YOUR FIRST AID KIT THE SNACK BAR HAS ICE and REPLACEMENT INSTANT ICE. • Compress the area with an elastic wrap or bandage. Parents may want to do this if they feel comfortable with this and know how to do so. Do not make the compress so tight it cuts off circulation. • Elevate the injured limb whenever possible to help prevent or limit swelling. • Instruct parents that if the injury is not better 24 hours or if they have ANY doubts or concerns it should be evaluated professionally.

6. Cuts and Scrapes • Clean the wound. Rinse out the wound with clear water. If debris remains embedded in the wound after cleaning, see your doctor. Thorough wound cleaning reduces the risk of infection. • Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. Hold the pressure continuously for up to 20 to 30 minutes. Don't keep checking to see if the bleeding has stopped because this may damage the fresh clot that's forming and cause bleeding to resume. If the blood spurts or continues to flow after continuous pressure, seek medical assistance. • Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin to help keep the surface moist • Cover the wound. Exposure to air speeds healing, but bandages can help keep the wound clean and keep harmful bacteria out. • Don’t put latex containing items on a latex allergic person. • Get stitches for deep wounds.A wound that cuts deeply through the skin or is gaping or jagged-edged and has fat or muscle protruding requires stitches. A strip or two of surgical tape may hold a minor cut together, but if you can't easily close the mouth of the wound, see your doctor. Proper closure minimizes scarring and infection. • Get a tetanus shot within 48 hours of the injury

7. Sprains and Strains • These are common injuries. Most are minor and will respond well to rest and ice. If a player is not able to comfortably move the injured area within a few moments of an injury, they should be removed from the game. (i.e., if they aren’t able to “walk it off.)” • If a player is not able to voluntarily move an injured area, you should not attempt to move it for them. • If immediate swelling occurs or if a limb is obviously deformed, immobilize the site if you know how to do so safely. Splints are in the first aid kit. Have them get medical attention immediately. Call 911 or have the player’s parent do so. • If the player heard a popping sound when their joint was injured or they can't use the joint. This may mean the ligament was completely torn apart. They should have emergency evaluation. On the way to the doctor, apply a cold pack.

8. Fractures (broken bones) • A fracture is a broken bone. It requires emergency medical attention. • Dial 911 or call emergency medical assistance if: • There is heavy bleeding. • Even gentle pressure or movement causes pain. • The limb or joint appears deformed. • The bone has pierced the skin. • The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.

9. Splints supplied in First Aid Kit

10. DON’T • DO NOT move the person unless the broken bone is stable. • DO NOT move a person with an injured hip, pelvis, or upper leg. • DO NOT move a person who has a possible spine injury. • DO NOT attempt to straighten a bone or change its position unless blood circulation appears hampered. • DO NOT test a bone's ability to move.

11. Eye Injury or Foreign Body • Black eye • A black eye is caused by bleeding beneath the skin around the eye. Sometimes a black eye indicates a more extensive injury, even a skull fracture, particularly if the area around both eyes is bruised. Most black-eye injuries aren't serious but, bleeding within the eye, called a hyphema, is serious and can reduce vision and damage the cornea. In some cases, glaucoma also can result. • Take these steps to take care of a black eye: • Using gentle pressure, apply ice or a cold pack to the area around the eye for 10 to 15 minutes. Take care not to press on the eye itself. Apply cold as soon as possible after the injury to reduce swelling. • THESE MUST BE EVALUATED EMERGENTLY: • Blood in the white and colored parts of the eye. • Bony step off in the bones around the eye. • Raccoon Eyes • Vision is blurry or in any way abnormal

12. Foreign Body in the Eye • Use water to rinse the eye. • Run lukewarm tap water over the eye or splash the eye with clean water. Rinsing the eye may wash out the offending foreign body. There is irrigation solution in the Snack Bar’s first aid kit to use to rinse out the eye. • Blink several times. • This movement may remove small particles of dust or sand. • Pull the upper eyelid over the lower eyelid. • The lashes of the lower eyelid can brush the foreign body from the undersurface of the upper eyelid. • Don't rub your eye after an injury. This action can worsen a corneal abrasion.

13. If a severe head injury occurs: • CALL 911 • Until medical help arrives, keep the person who sustained the injury lying down and quiet, with the head and shoulders slightly elevated if possible. • DON’T MOVE AN UNCONSCIOUS PERSON unless you follow precautions for NECK AND SPINE INJURY!! • If the person stops breathing, do mouth-to-mouth rescue breathing if you know how! To ventilate the person's lungs to supply oxygen to the blood in the lungs. At this point, there is no need to do chest compression if the person's heart is still beating.

14. Unconsciousness and Head Injury, continued Dial 911 or call for emergency medical assistance if any of the following signs are apparent: • Severe head or facial bleeding • Change in level of consciousness, even if temporary • Black-and-blue discoloration below the eyes or behind the ears (Raccoon Eyes) after injury • Cessation of breathing • Confusion • Loss of balance • Weakness or an inability to use an arm or leg

15. Concussions • A concussion is a brain injury. • All concussions are serious. • Concussions can occur without loss of consciousness. • Concussions can occur in any sport. • Recognition and proper management of concussions when they first occur can help prevent further injury or even death.

16. Recognizing a Concussion Watch for 2 things: • A forceful blow to the head or body that results in rapid movement of the head. • Any change in the player’s behavior, thinking, or physical functioning.

17. Signs of a Concussion • Appears dazed • Is confused about position • Forgets plays • Is unsure of game, score, or opponent • Moves clumsily • Answers questions slowly • Loses consciousness

18. Suspect a Concussion? • If you suspect that a player has had a concussion, keep them out of the game or practice. • The player should be kept from play or practice until given permission to return by a health care professional with experience in evaluating for concussion.

19. Annual Concussion Form • Canyon View Little League • Mild Traumatic Brain Injury (MTBI) / Concussion • Annual Statement and Acknowledgement Form • I, _________________________ (athlete), acknowledge that I have to be an active participant in my own health and have the direct responsibility for reporting all of my injuries and illnesses to the organizations staff (e.g., coaches, team physicians, and athletic training staff). I further recognize that my physical condition is dependent upon providing an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries and/or disabilities experienced before, during or after athletic activities. • By signing below, I acknowledge: • My organization has provided me with specific educational materials including the CDC Concussion fact sheet (http://www.cdc.gov/concussion/HeadsUp/youth.html) on what a concussion is and has given me an opportunity to ask questions. FACT sheets are different for Parents, Coaches, Players. • I ACKNOWLEDGE THAT I HAVE READ THE FACT SHEET on the CDC website for Parents and Players.

20. Heat Related Illnesses • Heat emergencies fall into three categories of increasing severity: heat cramps, heat exhaustion, and heatstroke • Heat illnesses are easily preventable by taking precautions in hot weather. • Bring extra water to practice for kids who forget. • Children have a higher risk of developing heat illness. Even a top athlete in superb condition can succumb to heat illness if he or she ignores the warning signs. • If the problem isn't addressed, heat cramps (caused by loss of salt from heavy sweating) can lead to heat exhaustion (caused by dehydration), which can progress to heatstroke. Heatstroke, the most serious of the three, can cause shock, brain damage, organ failure, and even death.

21. Causes • Causes common causes of heat emergencies: • High temperatures or humidity • Dehydration • Prolonged or excessive exercise • Medications Corey Stringer. Formerly of the MN Vikings

22. Symptoms The early symptoms of heat illness include: • Profuse sweating • Fatigue • Thirst • Muscle cramps • Kids sometimes just act tired or lazy! Watch for this when it starts to get hot. • Keep them drinking!

23. Headache Dizziness and light-headedness Weakness Nausea and vomiting Cool, moist skin Dark urine Heat Exhaustion

24. Heatstroke • The main sign of heatstroke is a markedly elevated body temperature • Rapid heartbeat • Rapid and shallow breathing • Elevated or lowered blood pressure • Cessation of sweating • Irritability, confusion or unconsciousness • Fainting Corey Bechler was more than halfway through conditioning drills Sunday when witnesses said he began looking winded and pale. Trainers took him to the training room, administered fluids and summoned an ambulance. "As he lay there," Hargrove said, "he got worse."

25. Fainting • Help restore blood flow. If the person is breathing, restore blood flow to the brain by raising the person's legs above the level of the head. Loosen belts, collars or other constrictive clothing. The person should revive quickly. If the person doesn't regain consciousness in 1 to 2 minutes, dial 911 or call for emergency medical assistance. • Watch the airway carefully. People who lose consciousness may vomit. • Check for breathing. Position your ear over the person's mouth to listen for breathing sounds. If breathing has stopped, the problem is more serious than a fainting spell. Initiate cardiopulmonary resuscitation (CPR) if you know it – or ask for help from the stands. Get emergency medical care. Call 911.

26. Heat Injury Treatment IF alert, give the person beverages to sip (such as Gatorade), or make a salted drink by adding a teaspoon of salt per quart of water. Give a half cup every 15 minutes. Cool water will do if salt beverages are not available. For muscle cramps, give beverages as above and massage affected muscles gently, but firmly, until they relax. • If the person shows signs of shock (bluish lips and fingernails and decreased alertness ), starts having seizures, or loses consciousness, call 911 and administer first aid accordingly Auerbach PS. Wilderness Medicine. 4th Ed. St. Louis, MO: Mosby; 2001:240-316. DeLee JC, Drez, Jr., D, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 2nd Ed. Philadelphia, PA: Saunders; 2003:763.

27. Emergency Dental Assistance for Avulsed or Severely Chipped Tooth • First, if the child has a regular dentist, have the parent try to call them • If no assistance send them to the Emergency Room

28. Tooth loss • Save any tooth for possible re-implantation. • Handle the tooth by the top only, not the roots. • Don't rub it or scrape it to remove dirt. • Gently rinse your tooth in a bowl of tap water. Don't hold it under running water. • Try to replace your tooth in the socket. Then bite down gently on moistened gauze or a moistened tea bag to help keep it in place. • If you can't replace your tooth in the socket, immediately place it in Tooth Saver Container and take to dentist.Tooth Saver is located in the Central First Aid Kit in the Snack Bar. Milk is sometimes suggested to use to store the tooth. • This is an emergency and should have emergency evaluation • If you participate in contact sports, preventing tooth loss is often possible by wearing a mouth guard, fitted by your dentist. • Source: MedlinePlus

29. Nosebleed • Sit upright. By remaining upright, you reduce blood pressure in the veins of your nose. This discourages further bleeding. • Pinch your nose. Use your thumb and index finger and breathe through your mouth. Continue the pinch for 5 or 10 minutes. This maneuver sends pressure to the bleeding point on the nasal septum and often stops the flow of blood. • To prevent re-bleeding after bleeding has stopped, don't pick or blow your nose and don't bend down until several hours after the bleeding episode. Keep your head higher than the level of your heart. • If re-bleeding occurs, sniff in forcefully to clear your nose of blood clots. Pinch your nose again in the technique described above and call your doctor. • Seek medical care immediately if: • The bleeding lasts for more than 15 to 30 minutes • You feel weak or faint, which can result from the blood loss • The bleeding is rapid or if the amount of blood loss is great • Bleeding begins by trickling down the back of your throat

30. The First Aid Kit is located in the snack bar. Every Manager is issued a smaller, portable kit for practices The smaller kit MUST be taken with you to all practices and games along with your player information folder!!! CVLL First Aid Kit Contents and incident report form Temporary Splints

31. CONTENTS OF THE FIRST AID KIT • Malleable Splints for arms and legs • Ace Wraps • Tooth saver for broken or dislodged teeth • Athletic Tape • 4x4, 6x8 and assorted gauze pads • Bandage Scissors, tweezers • Incident tracking forms • Please inform the safety officer if any of these materials are used so they can be replaced. • If you don’t know how to use these materials, please don’t use them. • Ice and additional First Aid kit supplies are available in the snack bar.

32. ComidoCordis Everyone who is around youth baseball should be aware if this life threatening condition Comotiocordis, literally concussion of the heart, can cause sudden cardiac death of a young person following a blunt impact to the chest. Impact with items like a baseball, softball, or hockey puck or a collision between players, such as in lacrosse, or karate young (95% male, 78% female under age 18; (62% organized, 38% daily routine and recreational activities). While most people believe a high-energy impact is required to cause comotiocordis, that is not necessarily so. Some victims had structurally normal hearts with no heart disease, the strikes occurred over the heart at a precise moment, resulting in ventricular fibrillation, cardiac arrest or cardiac sudden death. A strike at the vulnerable time of the heart cycle, between beats, can trigger an abnormal rhythm. Any blow to the chest, regardless of its intensity, velocity or force is capable of producing cardiac arrest. Unfortunately, comotiocordis can be 84% fatal. Early recognition of the arrest, CPR, and early defibrillation seem to offer the best chance of survival. The 16% of patients who survive a comotiocordis event have three things in common: 1. Early recognition of the arrest 2. Treatment with CPR and early defibrillation 3. Survival rates rapidly drop to zero when interventions are delayed.

33. Lightning • THE FIRST SIGNS OF LIGHTNING OR THUNDER IS THE TIME TO GO TO A BUILDING OR A VEHICLE: • STOPthe game/practice and leave the ball field. • WALK, don’t run, to your vehicle/bus and take shelter there with the windows rolled up or to a substantial building. • IF YOU CAN HEAR IT (THUNDER) CLEAR IT (SUSPEND ACTIVITIES) • AVOID the metal ramadas, the rain and sun shelters and the dugout areas. AVOID going underneath trees. Trees “attract” lightning. • AVOIDwater, open fields and high ground. • AVOIDmetal fences, gates, dugouts, ramadas, tall light poles and power poles, metal or wood bleachers. • DO NOT hold or pick up a metal bat. • WAITfor a decision on whether or not to continue the game or practice. Activities should be suspending for 30 minutes after the last observed lightning or thunder. • If caught outside during close-in lightning, immediately remove metal objects (including baseball cap), place your feet together, duck your head, and crouch down low in baseball catcher’s stance with hands on knees, avoid proximity to other people (minimum of 15 feet).

34. Obtaining 911 • Mehl Park address is: 4001 E. River Rd – Tucson, AZ 85718

35. Final Suggestions • Always tell parents what happened. • Always tell the parents they should get professional medical attention for injuries –don’t pretend to know more than you do. • Report injuries and events • If you don’t know what to do, ask for help. • Don’t do things you are not fully trained to do!