Chapter 7

1. Chapter 7 Emergency Plan and Initial Injury Evaluation

2. Emergency Plan • A written document that outlines the personnel and equipment necessary for response to emergencies. • 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.

3. 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.

4. Emergency Plan Components The emergency plan (cont.): • 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. Andersen et al., 2002

5. The Emergency Team Members of the emergency team are personnel directly involved in interscholastic sports programming, including: • Coaches, administrators, team physicians, athletic trainers, school nurses, local EMS staff and others that might be involved. Members 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.

6. Best Practices for Emergency Planning • No activity should occur until all staff are familiar with the EAP. • Post the specific EAP at each venue. • Establish an efficient communication system with on-site and off-site emergency teams. • Post location of all emergency equipment and assign retrieval and readiness checks to team members.

7. Best Practices for Emergency Planning • Place (AEDs) and other CPR equipment to allow for immediate retrieval. • Train members of emergency team in proper use and maintenance of all equipment including battery replacement and documentation of maintenance records. • Determine the role of each emergency team member in regard to evaluation and care of the injured party.

8. Emergency Care 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 renew training as required by certifying body. • Personnel should have annual periodic “mock” drills to rehearse the plan.

9. Injury-Evaluation Procedures Coach’s responsibility is the immediate care of acute injury—this is critical. • Coach must be familiar with the preexisting emergency plan and be able to function effectively as a primary player – “first responder” • Coaches should focus on providing care to the extent of their training and should avoid going beyond their level of training. • Coaches must distinguish minor from major injuries. • By law, coaches are most often held accountable for proper care when no physician or athletic trainer is present.

10. Injury-Evaluation Procedures • Coaching personnel should have Basic Lifesaving Skills (BLS) training that focuses on life-threatening situations. • Head and neck injuries – assume if unconscious and do not move • Exertional heat stroke – Cool immediately and call EMS • Exertional sickling – Knowledge of athletes with sickle cell trait and recognize indications of sickling (low back pain, weakness, difficulty recovering, shortness of breath) • Sudden cardiac arrest - Airway assessment and opening techniques, rescue breathing, CPR, and AED protocol.

11. The Evaluation Process • The emergency treatment protocol must be generic enough to be effective regardless of the type of injury. • First evaluate all vital life functions following up with a step-by-step examination. • Initial check (Primary survey) • Physical exam (Secondary Survey)

12. Initial Check • The initial check must include assessments of: • Responsiveness • Airway • Breathing • Severe Bleeding • The coach should make every effort to perform the assessment without moving the athlete or allowing others to move the athlete. • If the athlete needs no life-saving measures, then the secondary survey that includes a physical exam can be conducted.

13. Determining Responsiveness • Is the athlete responsive? • AVPU Scale. Athlete is… • Alert and aware • Responds to verbal stimulus • Responds to painfulstimulus • Unresponsive to any stimulus • If spinal or head injury is suspected, immobilize head and neck immediately.

14. Respiratory System • First priority when rendering first aid • This portion of the initial check should require no more than 5–10 seconds and can begin en route to the injured athlete if he or she is within visual proximity. Breathing Assessment • Conscious athlete is breathing but must be monitored for difficulty or abnormal sounds. • Unconscious athlete may not be breathing but circulation must be prioritized, starting compressions if necessary. • Look for the chest to rise and fall and feel the chest for movement.

15. Airway Assessment Ask athlete a simple question. • A response indicates that 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 facemask). • If the person is not breathing and spinal or head injury is suspected. • Use jaw-thrust technique to open airway. • Use finger sweep if object is lodged in mouth.

16. Circulation Assessment • The two major concerns: • Presence or absence of the signs of circulation (breathing, coughing, movement, pulse, and normal skin color) • Presence or absence of loss of blood (hemorrhage), either internally or externally • Responsive athlete who is breathing has signs of circulation. • Unresponsive athlete needs to be quickly assessed for signs of circulation after opening airway and checking for breathing. • If there are no signs of circulation, begin CPR.

17. Hemorrhage Assessment • External hemorrhage is usually obvious. • Control with direct pressure, elevation, pressure points, pressure bandage and/or possibly a tourniquet. • Take precautions against bloodborne pathogens wear personal protective gear. • Internal hemorrhage is difficult to detect but an early sign is hypovolemic shock. Signs of this true medical emergency include: rapid weak pulse, rapid shallow breathing, moist clammy-feeling skin and blue skin inside lips and under nail beds.

18. Physical Exam • To be effective, the physical exam must be conducted in a preplanned, sequential fashion. • History • Observation • Palpation • Sign involves objective findings such as bleeding, swelling, discoloration, and deformity. • Symptoms are subjective in nature such as nausea, pain, and point tenderness.

19. Physical Exam Medical History • Keep questions simple and brief— “yes” or “no” • Use easy-to-understand terms; avoid questions leading to a preferred answer. • Identify self and indicate that he/she is there to render first aid care. • Ask athlete what happened and 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 any medical personnel.

20. Physical Exam Observation • Continually monitor for signs of breathing and circulation. • Note athlete’s body position and behavior. • Note swelling, hemorrhaging, bruising, or deformity. • Do bilateral comparison. • Note signs and symptoms relating to the injury.

21. Physical Exam Palpation • A learned skill that requires physical contact with the athlete. • If practiced, is a useful skill to find deformity, spasm, swelling, crepitus, etc. • Should be performed carefully to avoid aggravating existing injuries. • Begin with the uninjured limb, if the injury is to an extremity. • Start palpations away from areas of injury.

22. Shock • Acute life-threatening condition involving the failure to maintain adequate circulation to vital organs. • Caused by a number of conditions: cardiogenic (heart failure), neurogenic (dilated blood vessels), and simple psychogenic (fainting) conditions. • Other signs and symptoms of may include: • Profuse sweating, cool, clammy-feeling skin, dilated pupils, elevated pulse and respiration. • Irritable behavior, extreme thirst, nausea and/or vomiting.

23. Treating Shock • If spinal injury is suspected, do not move the athlete. Stabilize in position found. • Have athlete lie down (supine). • Elevate legs about 8 to 12 inches if no head injury. • Calm and reassure the athlete. • Cover the athlete with a blanket (if environment is such that loss of body heat is possible). • Monitor vital signs.

24. 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 – carry, stretcher, sports chair. • If athlete is unconscious or may have neck injury: • Do not move prior to EMS arrival unless athlete is likely to be injured further. • Stay with athlete; Monitor vital signs; Treat for shock; Summon EMS.

25. Return to Play • In the absence of a trained medical professional such as a physician or BOC-certified athletic trainer, the coach must answer the question, “Should this athlete be allowed to return to play?” • Coaches may face an ethical dilemma. • Remove from play and arrange for evaluation by medical professional. • Athletes with neurologic injury • Athletes with suspected concussion • Athletes suffering from heat-related problems

26. Return to Play • Musculoskeletal system injuries such as joint sprains, muscle strains, and contusions. • If the injury results in any degree of functional loss, the athlete should not be allowed to return to participation. • Functional loss in the extremities • Have athlete to perform simple drills such as hopping, running, cutting, or performing sport related techniques (blocking, throwing, catching etc…) • Failure to execute a functional test removes athlete from participation.

27. 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.