EMERGENCY PLAN AND INITIAL INJURY EVALUATION

Emergency Plan

Proper planning is essential to ensure appropriate initial first aid management of an injury.

Anything done ahead of time to improve athletes’ health should be a priority.

Failure to have an emergency plan is grounds for negligence.

Emergency Plan Components

The emergency plan:

• Identifies personnel directly involved in carrying out the plan.

• Specifies necessary equipment.• Establishes a mechanism for communication.• Is derived from overall emergency planning policies.• Incorporates local emergency care facilities.

• Specifies documentation needed to support plan implementation and evaluation.

• Is reviewed and rehearsed at least annually, and the results of these efforts are documented.

• Is reviewed by the administration and legal counsel of the sponsoring organization or institution.

The Emergency Team

Members of the emergency team are personnel directly involved in interscholastic sports programming (high school level), including:

CoachesAdministratorsTeam physicianAthletic trainerLocal EMS staff

Functions of Emergency Team

MembersMembers of the emergency care

team are responsible for:

Immediate care of athlete.Emergency equipment retrieval.Activation of EMS, if necessary.Directing EMS to injury scene.

Emergency Plan

Plan should be comprehensive and include:

Procedures for both home and away events.

Steps for dealing with emergency situations affecting athletes, fans, and sideline participants.

Locations of phones (school personnel should have cell phones).

Emergency phone numbers. Directions to the site for EMS. Access points for EMS.

First Aid Training

All personnel should be trained in basic first aid, CPR, AED use.

Training should be conducted by nationally recognized organizations, e.g., the American Heart Association.

Personnel should upgrade training at least every 3 years.

Personnel should have periodic “mock” emergency drills to rehearse the plan.

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Injury-Evaluation Procedures

Coach’s responsibility is the immediate care of acute injury—this is critical.

Coaches will be seen as “first responders” and should focus on providing care to the extent of their training.

Coaches should avoid going beyond their level of training.

By law, coaches are most often held accountable for proper care when no physician or athletic trainer is present.

Injury-Evaluation Procedures

Coaching personnel should have BLS (basic life support) training that focuses on life-threatening situations.

Primary BLS skills are: Airway assessment and opening

techniques. Rescue breathing. CPR. AED protocol.

Coaches must distinguish minor from major injuries.

Initial Check

The initial check must include assessments of: Responsiveness Airway Breathing Severe Bleeding

Initial Check: Nervous System

Is the athlete responsive?

AVPU Scale• Alert and aware• Verbal stimulus response• Painful stimulus response• Unresponsive to any stimulus

If athlete fails to show any response, he or she is “unresponsive to any stimulus.”

If spinal or head injury is suspected, immobilize head and neck immediately.

Initial Check: Airway Assessment

Ask athlete a simple question.

A response indicates at that time the airway is open and circulation is adequate.

If athlete is unresponsive and has no apparent serious head or spinal injuries: Use head-tilt/chin lift method (do

not remove helmet or face mask).

Initial Check: Airway Assessment

If the person is not breathing and spinal or head injury is suspected:

o Use jaw-thrust technique and finger sweep (shown at left).

Breathing Assessment• Conscious athlete is

breathing but must be monitored.• Unconscious athlete can be

assessed quickly, ONCE airway is opened.• Look, listen, and feel for

air flow.

Initial Survey: Circulation Assessment

Responsive athlete who is breathing will have signs of circulation.

If athlete is unresponsive, breathing, coughing, and movement in response to rescue breaths are signs of circulation.

If there are no signs of circulation, begin CPR.

Initial Survey: Hemorrhage Assessment

Most external bleeding is obvious.Control with direct pressure, elevation,

pressure points, and/or pressure bandage.

-- Take precautions against bloodborne pathogens.

Internal hemorrhage is difficult to detect.An early sign of internal hemorrhage is hypovolemic (blood

& fluid loss causes the heart to improperly work) shock. Signs include:

Rapid weak pulse. Rapid shallow breathing. Moist clammy-feeling skin. Blue skin inside lips and under nail beds.

**Shock is a true medical emergency.

Physical Exam

Observation• Continually monitor for signs of breathing and

circulation.

• Note athlete’s body position and behavior.

• Note signs and symptoms relating to the injury.

• Perform D-O-T-S assessment – Deformities, Open Injuries, Tenderness, Swelling

Shock

Signs and symptoms include: • Profuse sweating

• Cool, clammy-feeling skin

• Dilated pupils

• Elevated pulse and respiration

• Irritable behavior

• Extreme thirst

• Nausea and/or vomiting

Treating Shock

Have athlete lie down (supine) with legs elevated about 8 to 12 inches.

Cover the athlete with a blanket (if environment is such that loss of body heat is possible).

Monitor vital signs. If spinal injury is suspected, do not move

the athlete.

Taking Medical History

Keep questions simple and brief— “yes” or “no” answers.

Use easy-to-understand terms; avoid questions leading to a preferred answer.

Coaches should maintain composure. Ask athlete what happened. Ask if there

were any strange sounds when injury occurred. If athlete is in pain, ask where it hurts.

Inquire about previous injuries to involved area.

Present history to medical personnel.

Palpation

Palpation: If practiced, is a useful skill to find

deformity, spasm, swelling, etc. A learned skill that requires physical

contact with the athlete. Should be performed carefully to avoid

aggravating existing injuries. Begin by palpating away from areas of

injury. Begin with the uninjured limb, if the

injury is to an extremity.

Removal from Field or Court

If athlete is conscious and has no injuries that preclude walking, he or she may leave field under own power but with assistance.

If lower-extremity injury is present, use passive transport system.

If athlete is unconscious or may have neck injury:

Stay with athlete Monitor vital signs Treat for shock Summon EMS

Unless athlete is likely to be injured further, do not move prior to EMS arrival.

Return to Play?

Athletes with neurologic injury should not be allowed to return until evaluated by trained medical personnel.

Athletes suffering from heat-related problems should be removed from participation and cleared for return only by a medical professional.

The Coach’s Limitations

Coaches must take special care NOT to overstep the bounds of their training and expertise when managing an injury.

Coaches should only provide first aid care and should avoid performing any procedure that is clearly the domain of allied health personnel.

Assessing Minor Injuries

S.O.A.P. NotesS – Subjective: Patient’s side of the story –

onset of the injury, pain level, type of pain, what causes the pain (movement), other symptoms

O – Objective: Vital signs, document observations (bruising, swelling, deformity, etc), lab results, measurements (height, weight, joint angles)

A – Assessment: Physician’s diagnosisP – Plan: prescribed medication, further

medical tests, referral to another physician

Common SOAP Notes Acronyms

Pt – Patient

w/o – without

f/u – follow up

ROM – range of motion

MOI – method of injury

BP – blood pressure

HR – heart rate

- Left

- Right

L

R

SOAP Note Practice

Acronym Practice Soap Note Example Write a Soap Note for this

accident

Scenario

A 17 year old girl comes to see you c/o pain in her lower legs. She has been in the school athletics team for 4 years and has recently started training for the london marathon. She says she has pain in her lower legs and points to the middle 1/3 of her tibias. It comes on if she runs any more than 4 or 5 miles and can last for days after the run

You note she is tender on the medial border of her tibias in the mid/upper 1/3

What advice would you give and what is your management plan?

Shin Splints

• Medial Tibial Stress Syndrome/Shin Splints

• Not Specific Diagnosis - Refers to pain along the course of the tibia

• Cause is thought to be related to overloading muscles of the lower limb and biomechanical irregularities

• Encompasses 3 main entities:

1. Medial Tibial Stress Syndrome

2. Chronic compartment syndrome

3. Tibial stress fracture

Case 1

A 23 year old footballer has had a twisting injury to the knee which has now locked and become swollen. He can weight-bare with pain. You see him a week after the injury.

What do you want to know? What treatments are available? Are the treatment different if he were

60?

Meniscus Injuries

Are there mechanical symptoms Fragility tear or not

Referral Options: Haemarthrosis

Arthroscopy without imaging

Imaging

Case 2

An 13 year old boy has persistent pain in his knee following a minor trauma two weeks ago. You can find no locking, effusion, instability. He can walk with minor discomfort. Would you:

A. Wait and see B. Refer to physio C. X-ray

Case 3

25 year old man with anterior knee pain. When you examine him he can straight leg raise, has no effusion or locking or crepitus but has point tenderness on the distal pole of the patella.

What is wrong? How do we treat this?