On-Field Acute Care & Emergency Procedures

1. On-Field Acute Care & Emergency Procedures

2. Developing an EAP • Develop separate EAPs for each sport • Establish specific procedures and policies regarding removal of protective gear • Make sure phones are readily accessible (cell phone and landline) • ATC should specifically designate someone to make an emergency phone call • Make sure all keys to gates or padlocks are easily accessible • Hold annual meetings to inform all coaches, ADs, nurses, and maintenance personnel of EAP and their roles • Assign someone to accompany the injured athlete to the hospital • Carry contact info for all athletes, coaches, and other personnel at all times The Emergency Action Plan

3. The Emergency Procedure Flowchart Injury Unconscious Athlete Conscious Athlete Primary Survey Secondary Survey Responsiveness ABC’s Shock Profuse Bleeding Vital Signs History MusculoskeletalEval Call 911 Access Rescue Squad Treatment Condsiderations On-Field Injury Assessment Care for Athlete until Rescue Squad Arrives Transportation

4. The Primary Survey: • Determines the existence of potentially life-threatening situations (airway obstruction, no breathing, no circulation, severe bleeding, shock) On-Field Injury Assessment

5. The Primary Survey Unconscious Athlete • ATC should immediately note the athletes body position and determine level of consciousness and unresponsiveness • ABC’s • Injury to neck and spine should be considered • Helmets should never be removed until neck and spine injuries have been ruled out (face mask must be cut away and removed to allow CPR) • If supine and not breathing, assess ABC’s • If supine and breathing, nothing should be done until he/she gains consciousness • If prone and not breathing, he/she should be logrolled to supine and assess ABC’s • If prone and breathing, nothing should be done until consciousness regained. Then logrolled onto spine board • Life support should be monitored and maintained until EMT arrive • Once stabilized, the ATC should begin secondary survey On-Field Injury Assessment

6. Equipment Considerations • Removing the face mask should be the first step! • Helmet and shoulder pads should be left in place to avoid unnecessary movement of the cervical spine • The shoulder pad straps/strings must be cut to allow for chest compressions • If the helmet must be removed, the shoulder pads must be removed simultaneously Primary Survey - Overview of CPR

7. Opening the Airway: Head Tilt-Chin Lift Method • Lift under the chin with one hand while pushing down on the victim’s forehead with the other • The tongue is the most common cause of airway obstruction • The forward tilt raises the tongue away from the back of the throat, clearing the airway Primary Survey - Overview of CPR

8. Opening the Airway: Jaw Thrust Technique • For victims with suspected head or neck injuries • Grasp each side of the lower jaw at the angles, displacing the jaw forward as the head tilts back • Both elbows should rest on the same surface the victim is lying on Primary Survey - Overview of CPR

9. Establishing Breathing To determine if victim is breathing, maintain open airway, place ear over victim’s mouth – LOOK, LISTEN, and FEEL If not breathing, begin rescue breathing Place one hand on the victim’s forehead and pinch the nose shut. Administer two slow, full breaths and observe the chest rise and fall If the chest does not rise or fall, the airway is obstructed. Reposition the victim’s head and try again If the airway is still obstructed, give 15 chest compressions followed by a finger sweep Continue to repeat this sequence until ventilation occurs *If available, use a bag/valve mask. Barrier shields have been mandated by OSHA to minimize risk of transmitting bloodborne pathogens Primary Survey - Overview of CPR

10. Establishing Circulation To determine whether a pulse exists, locate the Adam’s apple with the index and middle fingers and then slide down into the groove just under the jaw (carotid artery) Feel for the xiphoid notch, where the ribs meet the sternum Place the heel of one hand just above that notch and the other hand on top Lock elbows with arms straight and shoulders positioned over the hands Apply enough force to depress the sternum 1 ½ to 2 inches and completely release to allow the heart to refill 80-100 compressions per minute; maintain a rate of 15compressions to 2 full breaths After one minute, recheck pulse. If no pulse, continue the 15:2 cycle, beginning with chest compressions Primary Survey - Overview of CPR

11. Obstructed Airway Management • Unconscious • 15 chest compressions, followed by a finger sweep with an attempt at ventilation (2 full breaths) • Conscious • Heimlich maneuver • Stand behind and to one side of the victim (place one foot between theirs) • Wrap both arms around the waist just above the belt line, and permit the athlete’s head, arms, and upper trunk to hang forward • Grasp one fist with the other and place thumb side just below the xiphoid process of the sternum • Sharply and forcefully thrust the fists into the abdomen, inward, and upward, several times until the obstruction is expelled or the athlete becomes unconscious Primary Survey - Overview of CPR

12. External Bleeding • Direct Pressure • Pressure Points • Elevation Primary Survey - Excess Bleeding

13. Internal Bleeding • Bleeding within a body cavity such as the skull, thorax, or abdomen is a life-or-death situation • Because the symptoms are obscure, internal hemorrhage is difficult to diagnose properly • All severe hemorrhaging will eventually result in shock and should therefore be treated on this premise Primary Survey - Excess Bleeding

14. Shock occurs when a diminished amount of blood is available to the circulatory system • Blood flow slows and not enough oxygen-carrying blood cells are available to the tissues • Widespread tissue death can lead to death of the individual unless treated Primary Survey - Shock

15. Types of Shock • Hypovolemic – stems from trauma in which there is blood loss • Respiratory – occurs when the lungs are unable to supply enough oxygen to the blood • Neurogenic – caused by general dilation of blood vessels within the cardiovascular system • Psychogenic – fainting; caused by a temporary dilation of blood vessels that reduces normal amount of blood in the brain • Cardiogenic – refers to inability of heart to pump enough blood to the body • Septic – occurs from a severe, usually bacterial, infection • Anaphylactic – is the result of a severe allergic reaction • Metabolic – happens when a severe illness goes untreated (diabetes); another cause is extreme loss of body fluid (through urination, vomiting, or diarrhea) Primary Survey - Shock

16. Signs & Symptoms • Low BP (systolic pressure below 90 mm Hg) • Weak and rapid pulse • Athlete may be drowsy and appear sluggish • Shallow and rapid breathing • Pale, cool, and clammy skin Primary Survey - Shock

17. Management • Maintain body temp as close to normal as possible • Elevate feet and legs 8-12 inches for most situations • Neck injury – immobilize as found • Head injury – head and shoulders should be elevated • Leg fracture – legs should be kept level and raised after splinting Primary Survey - Shock

18. The Secondary Survey: • Performed after life-threatening injuries have been ruled out • Gathers specific information about the injury from the athlete • Systematically assesses vital signs and symptoms • Allows for a more detailed evaluation of the injury • Vital signs and musculoskeletal assessment On-Field Injury Assessment

19. 1) Pulse • Normal RHR for adults60-100 BPM • Normal RHR for children80-100 BPM • Trained athletes typically have lower RHR than the general population Secondary Survey – Vital Signs

20. 2) Respiration • Normal breathing rate: 12-20 breaths/min for adults, 15-30 for children • Breathing alterations: • Frothy blood being coughed up – chest injury, i.e. a fractured rib that has affected a lung • ATC should LOOK, LISTEN, and FEEL Secondary Survey – Vital Signs

21. 3) Blood Pressure • Measured by a sphygmomanometer • Indicates the amount of pressure exerted against the arterial walls • Systolic BP – left ventricle contraction, pumping blood • Diastolic BP – residual pressure, between beats • Normal BP for 15-20 year old males should be <120 mm Hg (systolic) and <80 mm Hg (diastolic) • Normal BP for females is usually 8-10 mm Hg lower than in males for both systolic and diastolic Secondary Survey – Vital Signs

22. 4) Temperature • Normally 98.6º F (37º C) • Places of measurement: under tongue, in armpit, against tympanic membrane in the ear, or in case of unconsciousness, in the rectum • Core temp is most accurately measured in the rectum Secondary Survey – Vital Signs

23. 5) Skin Color • Individuals with light skin: • Flushed, red – heat stroke, sunburn, allergic reaction, high BP, elevated temp • Pale, ashen, or white – insufficient circulation, shock, fright, hemorrhage, heat exhaustion, insulin shock • Bluish – airway obstruction (usually in lips and fingernails) • Yellowish – liver disease or dysfunction • Individuals with dark skin: • Shock – skin around mouth and nose will be grayish, while tongue, inside of mouth, lips, and fingernails will be bluish • Shock as result of hemorrhage – tongue and inside of mouth become pale, grayish color Secondary Survey – Vital Signs

24. 6) Pupils PEARL • Pupils are • Equal • And • Responsive to • Light Secondary Survey – Vital Signs

25. 7) Level of Consciousness • The AVPU scale is widely used by EMTs for assessing the neurologic status of trauma patients • ALERT – patient is alert; awake; responsive to voice; and oriented to person, time, and place • VERBAL – patient responds to voice but is not fully oriented to person, time, or place • PAIN – patient does not respond to voice but does respond to painful stimulus such as a squeeze to the hand • UNRESPONSIVE – patients does not respond to painful stimulus Secondary Survey – Vital Signs

26. 8) Movement • Inability to move one side of the body – caused by head injury or stroke • Bilateral tingling and numbness/sensory or motor deficits of the upper extremity – cervical spine injury • Weakness or inability to move the lower extremities – injury below the neck • Limited use of limbs – pressure on the spinal cord Secondary Survey – Vital Signs

27. 9) Abnormal Nerve Response • Numbness or tingling – nerve or cold damage • Severe pain, loss of sensation, lack of pulse – blockage of a main artery • Lack of pain or awareness of serious injury – shock, hysteria, drug usage, or spinal cord injury Secondary Survey – Vital Signs

28. Assessment Decisions • Seriousness of injury • Type of first aid required • Whether injury warrants physical referral • Type of transportation needed Secondary Survey – Musculoskeletal Assessment

29. Immediate Treatment RICE • Rest • Ice • Compression • Elevation Secondary Survey – Musculoskeletal Assessment

30. Emergency Splinting • Any suspected fracture should be splinted • Rapid form vacuum immobilizer • Air splint • Half-ring splint • Splinting of a limb fracture – stabilize above and below the fracture site Secondary Survey – Musculoskeletal Assessment

31. Spine Board • Log Roll • 6-Person Lift • Manual Conveyance (2-Person Carry) • Ambulatory Aid (Human Crutch) • 1-Person • 2-Person Transporting the Injured Athlete

32. Fitting the Athlete • Crutch length determined by placing tip 6 inches from the outer margin of the shoe and 2 inches in front of the shoe • Underarm crutch brace is positioned 1 inch below the anterior fold of the axilla (armpit) • The hand brace is adjusted so that it is even with the athlete’s hand when the elbow is flexed at approx. 30º Proper Fit and Use of the Crutch