MFLL Coaches First Aid Clinic April 9, 2014 Jody Kuhlenbeck , MFLL Safety Officer/Paramedic/FF Leigh Beyer, MFLL Safety

1. MFLL Coaches First Aid ClinicApril 9, 2014Jody Kuhlenbeck, MFLL Safety Officer/Paramedic/FFLeigh Beyer, MFLL Safety Officer/Physical Therapist

2. “Safety SafetySafety, It’s All About Safety!”

3. Prevention is the Key! • Take first aid kit with player medical cards to every practice/game. Know which players have medical conditions. • Check your fields before every practice/game for debris, rocks, sharp objects, holes etc • Inspect all equipment before every use. Turn damaged equipment into the Equipment Mgr • All bats must be inspected and labeled prior to use

4. Player Safety • Properly fitting batting helmets with chin straps are required by all batters, base runners, player base coaches and anyone handling a bat. • All catchers must wear full catching gear. Coaches are not to warm up pitchers! • All male players are required to wear an athletic supporter • Mouth guards are highly recommended!! Baseball is #1 sport for mouth/dental injuries! • Remove all jewelry

5. Player Safety • Control “horse play”, no climbing on fences etc • Teach safe practices- calling fly balls, NO sliding head first unless returning to a base, designated area for swinging a bat, NO warm up swings while in the batter’s box, “Heads up and PAY ATTENTION!” • Perform proper warm up and stretching before play. See stretching power point on website. • Know and follow the Thunder & Lightning Policy

6. “Man Down on the Field” • Perform basic first aid treatment as appropriate and within your comfort zone/skills • For more serious injuries or deciding to call for an ambulance, it is best to have the parent be apart of the decision. • If the parent is unavailable, the coach should make a decision in the best interest of the player • It is ALWAYS ok to call 911 and let the EMT’s assess the situation when you are not sure of the severity of injury.

7. Emergency Phone Numbers • Direct EMS Dispatch Line for cell phone use: 262-532-1700 • Emergency Dentist: player’s family dentist or CMH dentist on call: 262-251-1000 • Jody Kuhlenbeck, Safety Officer: 262-227-6571 • Leigh Beyer, Safety Officer: 262-617-1649 • Mark McLean, President: 414-975-8451 • Jason Marquardt, VP BB: 262-470-9315 • Gail Onasch, VP SB: 262-894-9176

8. MFLL Injury Reporting Policy

9. MFLL Injury Reporting Policy • Record all injuries on the Little League Baseball & Softball Accident Notification Form • Forms can be found in team first aid kits and concession stands • The player’s parent and league official/coach will complete the form AT THE TIME OF THE INJURY • Forward the accident form to the Safety Officer within 48 hours of the incident. Use the mailbox at the complex.

10. MFLL Injury Reporting Policy cont. • Notify a Safety Officer the same day of the incident: Jody Kuhlenbeck, cell: 262-227-6571 OR Leigh Beyer, cell: 262-617-1649 • The Safety Officer will complete an injury follow up with the player’s parents and coaches • If a concussion is suspected, a signed MD release is required prior to the player returning to practice/ game play. NO EXCEPTIONS! • In all other cases, a signed MD release is only needed if an injury was serious enough to seek medical evaluation/treatment.

11. Blood/Body Fluids

12. Blood/Bodily Fluids • #1 Goal is to prevent spread of infectious microorganisms (HIV, hepatitis B/C, MRSA etc) • Pathogens are found in blood, vomit, urine/stool, saliva, & other bodily fluids • Pathogens are spread when you come into contact with another person’s blood/body fluids, or contaminated sharps/needles • Pathogens enter through broken skin, mucous membranes of eyes, mouth, nose

13. How to Protect Yourself • Treat ALL blood/bodily fluids as if they are contaminated • Wear gloves, eyewear, mask, gown, CPR mouth barrier etc (“PPE”) • Always check PPE for tears, defects before use. If PPE becomes torn, defective or dirty, remove and replace. Do not reuse PPE! • Properly dispose of used PPE and all contaminated materials in a red biohazard bag/receptacle. • Wash hands (or use hand sanitizer if soap/water are not available) immediately after removing PPE

14. MFLL Blood/Bodily Fluid Policy • Prior to participation, all open and possible contagious wounds should be covered with a dressing that will not allow for transmission • Always wear gloves, PPE when tending to player wounds or cleaning up bodily fluids • Clean and disinfect all items covered in blood or bodily fluids-player, equipment etc with antiseptic wipes • Clothing/uniforms with blood must be changed or cleaned w/ “Blood Buster” solution in spill kit caddy in concession stand

15. MFLL Blood/Bodily Fluid Policy • For large spills- use spill kit from Concession stand. Sprinkle powder over fluid. Use scraper to scoop up & put in biohazard bag. • Place ONLY contaminated items in red biohazard bags located in first aid kit, or at concession stand • Put biohazard bag in biohazard container in concession stand. If closed, contact Jody for disposal • Wash hands after removal of PPE

16. Exposure Incident Guidelines • Wash the area exposed immediately with soap and water • See Medical provider immediately - personal MD, urgent care MD etc for evaluation, treatment • Notify the MFLL Safety Officer same day of incident • Complete the Little League Baseball & Softball Accident Notification Form and forward to the Safety Officer within 48 hours of incident

17. Concussions

18. Concussions • Type of traumatic brain injury (at the cellular level) caused by a blow to the head or body that moves or twists the brain inside the skull. • Injury examples- direct hit in head w/ ball or bat, collide with another player/the ground/or fence • Concussions cause problems with brain function vs brain structure • T or F? Loss of consciousness is required to have a concussion. Answer: FALSE! • Concussions affects people in 4 areas of function: physical, thinking, emotions, sleep

19. Concussions Concerns Unique to Adolescents • They are more vulnerable to concussions • They get concussions more often • Their concussions take longer to heal than adults • Players can be reluctant to admit their symptoms for fear of being removed from play • Many times the player does not realize the full extent of his symptoms or think to tell you all of the things he is feeling

20. Concussions- When to Call 911 • Loss of consciousness (? serious head injury?) • Decreasing level of alertness • Unusually drowsy, difficult to arouse • Severe or worsening headache • Seizure • Unequal pupil size • Slurred speech • Persisting vomiting • Difficulty breathing

21. Concussion Signs & Symptoms • Headache • Vision changes, ringing in ears • Nausea/vomitting • Dizziness, unsteadiness • Numbness and tingling • Change in mental alertness, drowsiness • Decreased awareness- person, place, time • Feeling “foggy”, groggy, confused, forgetful

22. Concussion Signs & Symptoms • Dazed or stunned appearance • Clumsy, decreased reaction time • Answers questions more slowly than usual • Player asks repetitive questions • Has memory, concentration concerns • Changes in sleep patterns (too much/little) • May feel irritable, sad, nervous, depressed • **Symptoms can be delayed and can occur 1-2 days after the hit/jolt**

23. Concussions- The Need to Heal • Research has shown it may take up to 2 weeks to heal, and in some cases even longer. • Player needs to “rest” his/her brain following a concussion- NO physical activity, video games, computer use, texting, reading, watching TV, social activities etc until they are symptom free and cleared by MD

24. Avoid Returning to Activity too Quickly • Can worsen symptoms and prolong recovery • Increases the risk for repeat concussion. • This may increase the chance of long term problems (ie decreased brain function, potentially chronic traumatic encephalopathy) or • Second Impact Syndrome (rapid brain swelling and death)

25. You suspect a concussion, now what? • Immediately remove the player from practice/ game play • Assess for emergent signs- need to call 911? • Notify the parents of the injury and have them come get their child. Do not allow the player to drive himself home. • Complete the Accident Notification Form w/ the parent and notify a Safety Officer the same day • Issue the Parent Concussion Letter w/ concussion fact sheet found in the first aid kit • Write the details of the injury and circle all signs and symptoms the player is reporting on the letter

26. Concussion First Aid response cont • Advise the parent to take their player for medical evaluation that day.The player should not be left alone. **Very Important to monitor for a worsening in condition**. • Advise they take the Parent Letter with them to the appt. This letter also states the MFLL requirements for return to play. • Remind them that a signed MD release will be required before the player may return practice

27. MFLL Stepwise Return to Play • Player must be symptom free for a minimum of 48 hours and off any pain medication • Player must be in school full time without modifications • Player must have a signed MD release allowing him to return • Player will go through a stepwise return to full play (either on own under MD guidance or with MFLL) • Neuropsych Testing and SCAT 3 Assessment by MD is highly recommended!

28. MFLL Stepwise Return to Play • Program allows for one step per 24 hours • Player’s symptoms are monitored before, during and after each step. Safety will keep a log. • If the player experiences any symptoms, the player will be pulled from activity & must return to his medical provider for re-evaluation • It is a 5 step process to return to full competition/ game day • These steps will be coordinated by the Safety Officer, coach and parents

29. HeatIllness

30. Heat Illness • Occurs when the body becomes dehydrated and cannot cool the body by evaporation of sweat • Players who are overweight, in poor physical condition or not acclimated to the heat are at more risk • Important to know which players have a history of heat intolerance!! Watch them closely.

31. Heat Concerns Unique to Adolescents • Kids do not adapt to extremes of temperature as effectively as adults • Kids have a higher surface area-to-body mass ratio than adults, allowing a greater amount of heat to transfer from the environment to the body. • During physical activity, children produce more metabolic heat than adults. • Sweating capacity is considerably lower in children than adults

32. Types of Heat Illness

33. Heat Illness Prevention

34. Heat Illness Prevention • Drink before, during, and after!! 20 oz prior, 16 oz for every # lost due to sweating following activity. Avoid high sugar drinks, caffeine • Wear light colored clothing & little as possible • Remove hats and equipment whenever possible to let heat leave top of head • What’s the color of your pee??

35. Heat Index Practice Recommendations • Green Flag: Index is b/n 80-89. Watch players closely, give frequent water breaks. 75% regular activity/25% light activity, rest. • Yellow Flag: Index is b/n 90-94. Water breaks every 20-25 min, use iced towels. Practice in shaded area, 50% regular activity/50% light activity, rest. Limit equipment • Orange Flag: Index is b/n 95-99. Mandatory water breaks every 15-20 min, limit-no equipment, practice in shade or indoors, iced towels. 25% regular activity, 75% light activity, rest. Limit activity to <90 min

36. Heat Index Practice Recommendations • Red Flag: Index is b/n 100-104. Mandatory water breaks every 15 min. Practice in shade/indoors, before 10 AM or after 5 PM, Remove equipment. 25% regular activity/75% light activity, rest. Limit activity to <90 min. Awe, heck just have fun and go to a water park instead!! • Black Flag: Index is above 104. Cancel Practice and games.

37. Lumps, Bumps and Bruises

38. Head/Neck/Back Injuries • Always assume the possibility of a spine injury with an unconscious player • If player is unconscious, DO NOT move him. Call 911. Check for a pulse, & breathing. If no pulse: * Have a trained person begin CPR * Get the AED from the concession stand • If player is conscious but reports severe pain in her spine, numbness/tingling, or weakness in arms and legs etc, DO NOT move her. Hold player still, call 911. • Also always consider possibility of concussion with a neck injury

39. Eye Injuries • Always consider possibility of a concussion • Any vision changes, flashes of light, “curtain over field of vision”?? ER VISIT! • Uneven pupils or blood in the pupil?  ER visit! • Foreign body: flush with water, do not attempt to remove object to avoid further injury • Corneal abrasions: irrigate, patch with gauze and send to MD • Black eye: check for visual changes, apply ice

40. Dental Injuries • Wear Gloves when assisting player • If tooth is loose: stabilize tooth,  Dentist! • If tooth is knocked out: Do not touch root of tooth, brush/scrub tooth or sterilize tooth. Gently rinse w/ water if needed. If able, reimplant tooth and stabilize. If not, place tooth in milk (prefer), saline soaked gauze, under tongue or in water  Dentist! • If tooth breaks: stabilize remaining part of tooth, control bleeding, save all fragments of tooth (see above)  Dentist!

41. Cuts/Wounds/Bleeding • Always wear gloves when tending to a wound • Use gauze/towel & apply direct pressure to wound • Flush wound with water • Apply antibiotic ointment and bandaid/dressing • Properly discard contaminated gauze/dressing and wash/sanitize your hands after removing gloves! • If unable to stop bleeding w/ holding direct pressure, call 911. Do not apply a tourniquet. • Bloody Noses: gloves, pinch nostrils and hold for 15 min with head tilted forward. Apply ice to back of neck. If unable to stop bleeding, see MD.

42. Bumps & Bruises/Fractures • Assess for any obvious deformity • If fracture/dislocation is suspected: Do not move the area. Splint/support the area with a stiff object. Do not let player drink/eat- may need surgery • If area below the injury turns blue/cold, no pulse- Medical emergency! call 911 • Elevate area if possible and apply ice • Contact parents

43. Bee Stings • Assess for trouble breathing, swollen throat, rash/hives, • Call 911 if allergic reaction/anaphylaxis shock • Use epi pen if child has one • Remove stinger • Wash area with soap and water, apply antibiotic ointment • Apply ice for 15 min to reduce redness and swelling