Care of the injured athleteCare of the injured athlete

Gymnastics Pit extractionGymnastics Pit extraction

Ada County ParamedicsAda County Paramedics

Steve ColeSteve Cole

Cool DudeCool Dude

DisclaimerDisclaimer Although the information presented here is Although the information presented here is

developed from practice , and published developed from practice , and published guidelines, it is in no way meant to replace or guidelines, it is in no way meant to replace or supercede local protocols.supercede local protocols.

It is intended for educational and conceptual use It is intended for educational and conceptual use only.only.

Ada County Paramedics accepts no responsibility Ada County Paramedics accepts no responsibility for the use/misuse of the information provided for the use/misuse of the information provided here.here.

When in doubt, consult with your local medical When in doubt, consult with your local medical guidance.guidance.

ObjectivesObjectives Adapt and refine standard immobilization Adapt and refine standard immobilization

skills to the unstable gymnastics pit skills to the unstable gymnastics pit environment.environment.

Gain knowledge on the Ladder approach Gain knowledge on the Ladder approach and Mat approach to accessing the injured and Mat approach to accessing the injured patient with spinal injury.patient with spinal injury.

Lean the pro’s and cons of rapid entry and Lean the pro’s and cons of rapid entry and delayed entry techniques. delayed entry techniques.

BackgroundBackground 33 % of fatal and catastrophic injuries that occur in college 33 % of fatal and catastrophic injuries that occur in college

level “winter” athletics occurred with Gymnastics (in level “winter” athletics occurred with Gymnastics (in 1998). 1998).

The majority of these were related to spinal cord/cervical The majority of these were related to spinal cord/cervical injury. injury.

A unique factor in these injuries is that safety equipment, A unique factor in these injuries is that safety equipment, like many professional sports, while designed to protect like many professional sports, while designed to protect the athlete, become a hindrance to care in the event the the athlete, become a hindrance to care in the event the athlete is seriously injured. athlete is seriously injured.

As a result of this , new guidelines have been published on As a result of this , new guidelines have been published on the care of injured gymnast, including spinal the care of injured gymnast, including spinal immobilization techniques.immobilization techniques.

BackgroundBackground The greatest hindrance in gymnastics to The greatest hindrance in gymnastics to

prompt emergency care is the gymnastics prompt emergency care is the gymnastics pit. These “pits” are either filled with foam pit. These “pits” are either filled with foam chunks/squares or a large foam mat. chunks/squares or a large foam mat.

The greatest number of lawsuits against The greatest number of lawsuits against gymnastic centers currently from injuries gymnastic centers currently from injuries sustained by visitors (parents) involved in sustained by visitors (parents) involved in horseplay.horseplay.

Gymnastics PitGymnastics Pit

The Gymnastics PitThe Gymnastics Pit A Typical pit will be 10 by 20 feet and approx. 6-8 feet A Typical pit will be 10 by 20 feet and approx. 6-8 feet

deep. This produces a very safe “crash landing” area for deep. This produces a very safe “crash landing” area for the routine mishaps in gymnastics.the routine mishaps in gymnastics.

  This also creates a very unstable platform to access the This also creates a very unstable platform to access the patient on. Any movement by occupants entering the pit patient on. Any movement by occupants entering the pit will often transfer to the patient. The debris in the pit will will often transfer to the patient. The debris in the pit will hinder any attempts at immobilization. hinder any attempts at immobilization.

Thus special methods of accessing the patient have been Thus special methods of accessing the patient have been developed.developed.

Some rest on a trampoline style frame and suspension Some rest on a trampoline style frame and suspension system. These are called “self fluffing”system. These are called “self fluffing”

Some are simply Pits filled with foam chunksSome are simply Pits filled with foam chunks

Local InformationLocal Information There are two There are two knownknown pits pits

in Ada Countyin Ada County BSU- by the pavilionBSU- by the pavilion Gem State Gymnastics at Gem State Gymnastics at

5420 West State Street 5420 West State Street

When discovering that When discovering that there is a “Gymnastics there is a “Gymnastics Pit Extraction”, please Pit Extraction”, please notify other incoming notify other incoming units.units.

SPECIAL NOTE:SPECIAL NOTE: All of these methods assume that the patient All of these methods assume that the patient

does not have any immediate airway, does not have any immediate airway, respiratory, or cardiac compromise. respiratory, or cardiac compromise.

In case of need of life saving interventions In case of need of life saving interventions (like CPR) then rapid extrication by staff on (like CPR) then rapid extrication by staff on hand while maintaining alignment as best as hand while maintaining alignment as best as possible is recommended.possible is recommended.

Pre- EMS Actions:Pre- EMS Actions:

The S.T.O.P. ProcedureThe S.T.O.P. ProcedureTaught to trainersTaught to trainers

S: Stop all activity around the sectionS: Stop all activity around the section T: Talk to the injured athleteT: Talk to the injured athlete O: Observe the injured Athlete from O: Observe the injured Athlete from

outside the pitoutside the pit for breathing, movement, for breathing, movement, etcetc

P: prevent further injury. Proceed carefully P: prevent further injury. Proceed carefully into the pit based on perceived need into the pit based on perceived need

Again: If an immediate threat to the ABC’s is Again: If an immediate threat to the ABC’s is perceived then “direct entry” is indicated.perceived then “direct entry” is indicated.

S.T.O.P.S.T.O.P.

C- Spine ImmobilizationC- Spine Immobilization The Jaw thrust is preferred The Jaw thrust is preferred

for opening the airway in for opening the airway in trauma.trauma.

The decision to provide The decision to provide more advanced care in the more advanced care in the pit is made on a case by pit is made on a case by case basiscase basis

While most areas have back While most areas have back boards available, these will boards available, these will generally only be used generally only be used before EMS arrival if a life before EMS arrival if a life threat exists.threat exists.

Moving in the pitMoving in the pit May be “over your May be “over your

head”head” Will be deeper than it Will be deeper than it

lookslooks Sudden movement stir Sudden movement stir

up dust, may cause the up dust, may cause the athlete to moveathlete to move

We found that taking We found that taking off boots helpedoff boots helped

Pit extraction StepsPit extraction Steps S.T.O.P. (already discussed)S.T.O.P. (already discussed) Pt. AccessPt. Access Pit EntryPit Entry PT immobilizationPT immobilization PT removalPT removal

Pt. AccessPt. AccessThree MethodsThree Methods Direct entryDirect entry Ladder AccessLadder Access Mat AccessMat Access

Pt. Access Direct EntryPt. Access Direct Entry QuickestQuickest No Special EquipmentNo Special Equipment The most potential The most potential

movement to the movement to the patientpatient

Should be done slow Should be done slow

moving foam as you moving foam as you gogo

Pt. Access- Direct EntryPt. Access- Direct Entry

Pt. Access- Ladder AccessPt. Access- Ladder Access

Uses a standard FD roof ladder (16 feet ) to Uses a standard FD roof ladder (16 feet ) to span the pitspan the pit

The ladder is placed just above the patients The ladder is placed just above the patients head.head.

Provides a stable platform for assessment Provides a stable platform for assessment and securing c spine.and securing c spine.

FD always has a ladderFD always has a ladder What we found the easiest to do after trying What we found the easiest to do after trying

all methodsall methods

Pt. Access- Ladder AccessPt. Access- Ladder Access

Pt. Access- Ladder AccessPt. Access- Ladder Access

Pt. Access- MAT AccessPt. Access- MAT Access Uses a standard 4” gymnastics mat to Uses a standard 4” gymnastics mat to

access the patientaccess the patient The Mat distributes the weight of the person The Mat distributes the weight of the person

across the pitacross the pit Some movement may be transferred to the Some movement may be transferred to the

ptpt Must spider crawlMust spider crawl Always available.Always available.

Pt. Access- MAT AccessPt. Access- MAT Access

Pt. Access- MAT AccessPt. Access- MAT Access

Pt. Access- MAT AccessPt. Access- MAT Access Though not illustrated in the photos, in Though not illustrated in the photos, in

larger pits, the same technique is used to larger pits, the same technique is used to move mats in to each side and provide move mats in to each side and provide access to the patient as well.access to the patient as well.

In the smaller pits, we discovered it to be a In the smaller pits, we discovered it to be a hindrance.hindrance.

Pit Entry/Pt Access- foam Pit Entry/Pt Access- foam removalremoval

Often the pt. is buried by the foam.Often the pt. is buried by the foam. Foam is moved only when it covers the Foam is moved only when it covers the

patient or interferes with the ABC’spatient or interferes with the ABC’s The foam beneath the patient provides the The foam beneath the patient provides the

support for the patientsupport for the patient Removing foam beneath the patient will Removing foam beneath the patient will

cause the pt. to sink lower in the pit.cause the pt. to sink lower in the pit.

Pt. ImmobilizationPt. Immobilization The pt. is often found in a pseudo seating The pt. is often found in a pseudo seating

position when supineposition when supine However pt may be prone, sideways, or However pt may be prone, sideways, or

even head lowest.even head lowest. In our experience 4-5 people were required In our experience 4-5 people were required

to safely immobilize and remove the pt. to safely immobilize and remove the pt. from the pit.from the pit.

1 on C-Spine, 2 on each side of the pt.1 on C-Spine, 2 on each side of the pt.

Pt. ImmobilizationPt. Immobilization The back board seemed to work best, as The back board seemed to work best, as

when the pt. was on the board the board when the pt. was on the board the board distributed the pt.’s weight across the foam.distributed the pt.’s weight across the foam.

Other devices may be indicated (KED, Other devices may be indicated (KED, Vacuum mattress)Vacuum mattress)

Pt. ImmobilizationPt. Immobilization

Pt. ImmobilizationPt. Immobilization

Pt. ImmobilizationPt. Immobilization

Pt removalPt removal Once the patient is packaged, we found it Once the patient is packaged, we found it

easiest to remove the pt. by the means we easiest to remove the pt. by the means we made first entry.made first entry.

The ladder was by far the easiest in our The ladder was by far the easiest in our training.training.

The mat works well too.The mat works well too. Wading through the debris, lifting over our Wading through the debris, lifting over our

head was pretty hazardous.head was pretty hazardous.

Pt removal using a MatPt removal using a Mat

Pt removal using a ladderPt removal using a ladder

Pt removal using a ladderPt removal using a ladder

SummarySummary This practice session This practice session

brought to light a whole brought to light a whole set of issues not normally set of issues not normally encounteredencountered

The most important lesson The most important lesson was to stop and carefully was to stop and carefully assess the situation, just assess the situation, just like any other “rescue”like any other “rescue”

Utilization of proper Utilization of proper resources is the issueresources is the issue

Questions?Questions?