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DEALING WITH INJURIES

DEALING WITH INJURIES. A Guide for Rugby Referees. KEEPING THE GAME SAFE. M. Bruce Carter, MD December 4, 2007. Good Samaritans with Whistles. Duty of Care? Level of expertise/training Help may be refused Implied consent Don’t stop once you start No obligation to incur risk.

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DEALING WITH INJURIES

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  1. DEALING WITH INJURIES A Guide for Rugby Referees

  2. KEEPING THE GAME SAFE M. Bruce Carter, MD December 4, 2007

  3. Good Samaritans with Whistles • Duty of Care? • Level of expertise/training • Help may be refused • Implied consent • Don’t stop once you start • No obligation to incur risk

  4. Pre-existing Arrangements • Ask ahead of time • Assume anyone responding to an injury is qualified (until further notice) • Cell phones are everywhere

  5. Primum non nocere • Don’t make it worse • Don’t let someone else make it worse • This includes the injured person

  6. What is Serious? • Bleeding • Inordinate pain – blow the whistle • Unexplained sensations • Life or limb • Obvious deformity • Loss of consciousness

  7. Stabilize the Situation • Whistle • Full attention • Eliminate further danger • Minimize movement of affected part/person • ‘Neutral’ position • Comfort, hydration, shade/warmth

  8. Call For Help • Qualified folks on scene • If you think about it – activate the EMS

  9. If In Doubt – Don’t • Don’t move an injured person if it might make them worse • Don’t take any action for which you have no good reason

  10. The ABCs • Airway • Breathing • Circulation • Disability/Damage (neurological), Depth of Consciousness • Everything Else

  11. Head Injuries • This is how rugby players die • Bloody noses, black eyes, dangerous tackles, scrums and ‘normal’ tackles • Fortunately, this allows for preventive care

  12. Guidance from the IRB • “A player who is suffering definite concussion should not participate in any match or training session for a period of at least three weeks from the time of injury, and then only subject to being cleared by a proper neurological examination.”

  13. Concussion Defined • A period of altered consciousness in response to a head injury • What the IRB calls ‘definite concussion’ is what physicians call a Grade 3 concussion

  14. The Key Question - PEARL • HOW DID YOU GET TO THE GAME TODAY?

  15. Grades of Concussionwww.aan.com • Grade 1: ‘Bell rung’ – NO LOSS OF CONSCIOUSNESS – back to normal within 5 minutes • Grade 2: NO LOSS OF CONSCIOUSNESS – Not back to normal, feels ‘off’, after 5 minutes • Grade 3: ANY loss of consciousness

  16. Treatment for Grade 1 • Back to normal within 5 minutes • Rest and observation for 15 minutes • No further symptoms: okay to participate • Second Grade 1 = Grade 3

  17. Treatment for Grade 2 • Still not completely back to normal after 5 minutes • No further strenuous activity for 1 week, subject to professional examination and clearance

  18. Treatment for Grade 3 • This is what the IRB refers to as ‘definite concussion’ • “I think I was out for a second” – no further activity. IRB Guidance applies – 3 weeks’ rest, professional evaluation • Unconscious for more than one or two minutes – activate EMS • Seizure activity – activate EMS

  19. Preventive Treatment • Do not let concussed players continue to play • Inform coaches/teammates/friends/family of your concerns and recommendations • Rugby players look out for their mates better than they do for themselves

  20. SUMMARY • RUGBY IS ONLY A GAME • Safety is part of our charge • You care or you wouldn’t be there • You’re intelligent or you wouldn’t be there • The Law and the law are on your side • Ask for help and trust the helpers • “Preserve the fighting strength”

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