ON THE FIELD ACUTE CARE & EMERGENCY PROCEDURES

1. ON THE FIELD ACUTE CARE & EMERGENCY PROCEDURES

2. IN THE EVENT OF AN EMERGENCY • Time is the most critical factor during an emergency • “Golden Hour” • Primary Concern: maintain cardiovascular function • Initial evaluation is key!! • Must be done rapidly and accurately

3. EMERGENCY ACTION PLAN (EAP) The following should be addressed when developing the EAP for all athletic settings: • Develop separate EAPs for each sport’s field, court, or gymnasium • Determine personnel who will be on the field during practices and games and understand each of their roles • Determine which emergency equipment should be available for each sport • Establish specific procedures and policies regarding the removal of protective equipment • Make sure phones are readily accessible

4. EMERGENCY ACTION PLAN CONT’D 4. All staff should be familiar with the community based emergency health care delivery plan, including existing communication and transportation policies • Campus police vs. 911 • Who will call 911 – make sure they know the correct information to give to the dispatcher 5. Make sure keys to gates or padlocks are easily accessible 6. Inform all coaches, athletic directors, school nurses, staff and maintenance personnel of the EAP • Annually reviewed, revised, and rehearsed

5. EMERGENCY ACTION PLAN CONT’D 7. Assign someone to accompany the injured athlete to the hospital 8. Carry contact information for all athletes, coaches, and other personnel at all times 9. Have a plan in case you as an athletic trainer are called to help a non-athlete

6. ATHLETIC TRAINER AND EMERGENCY MEDICAL TECHNICIAN (EMT) • Develop a relationship • Incorporate local EMT and fire departments in the development of EAP • Arrange practice sessions • If the rescue squad is called and responds, the EMTs should have the final say on how the patient is transported while the ATC assumes an assistive role

7. PARENTAL NOTIFICATION • If the injured athlete is a minor…. Who is a minor? • Consent must be signed by parent or guardian before or during an emergency • If parents can’t be contacted, the pre-determined wishes of the parent can be enacted • If no informed consent exists, the patient’s implied consent to save his or her life takes precedence • If the injured athlete is not a minor, inform the emergency contact ASAP

8. CPR & EMERGENCY ASSESSMENT • https://www.youtube.com/watch?v=Vmb1tqYqyII

9. IS THE ATHLETE CONSCIOUS? Primary survey Determines the existence of life-threatening situations. Takes precedence over all other aspects of the victim’s assessment Secondary survey Performed after life-threatening injuries have been ruled out Specific information about the injury – more detailed

10. PRIMARY SURVEY • Level of consciousness (LOC) • Airway • Breathing • Circulation • Severe bleeding • Shock

11. PRIMARY SURVEY Unconscious athlete: • Definition: state of insensibilityin which the athlete exhibits a lack of conscious awareness • Can be caused by a blowto the head, general shock, fainting due to inadequate blood flow to the brain, cardiac arrest – difficult to determine exact cause right away • Always must be considered to have life-threatening injury….CALL 911

12. PRIMARY SURVEYUNCONSCIOUS ATHLETE • Guidelines: • Note body position & determine LOC (level of consciousness) • Check ABC’s • ALWAYS assume C-spine injury • If the athlete is wearing a helmet, DO NOT REMOVEONLY TAKE OFF FACE MASK • Immediately establish ABCs if athlete is NOT breathing • Life support maintained until EMS arrives • Once athlete stabilizes – begin secondary survey

13. PRIMARY SURVEYUNCONSCIOUS ATHLETE • Establishing unresponsiveness • “Are you OK?” • Tap shoulder – DO NOT SHAKE • If no answer – EMS activated immediately • If breathing – place in recovery position • If not breathing – carefully & quickly place in supine position

14. PRIMARY SURVEYUNCONSCIOUS ATHLETE • Opening the airway • Head-tilt/chin lift method – NO C-SPINE INJURY • Lift under the chin with one hand – the other stabilizing the athlete’s forehead – DO NOT USE TOO MUCH FORCE • This raises the tongue away from the back of the throat • Modified jaw thrust – SUSPECTED C-SPINE INJURY • Grasp each side of the mandible and pull upward • Does not consistently open the airway – if this does not work use head-tilt

15. Practice Head Tilt/Chin Lift & Jaw Thrust

16. PRIMARY SURVEYUNCONSCIOUS ATHLETE Establishing circulation • Feel for a pulse at the carotid artery • No pulse….use AED ASAP • No pulse, No AED…begin compressions • Position yourself on the side of the athlete • Heel of the hand on the sternum (between nipples). Place other hand on top and interlace fingers • Keep elbows in a locked position – arms straight, shoulders over arms • Apply enough force to depress sternum 1.5-2 inches – continue at a rate of 100 compressions per minute – maintaining the thirty chest compressions to two breaths (30:2) • Continue this for 5 cycles (about two minutes) then recheck the pulse

17. Practice Chest Compressions • 30 Chest compressions, 2 rescue breaths (30:2) • 2 Green lights: perfect depth & speed • Red light: Not deep enough • Yellow light: Too fast

18. VIDEO – PRIMARY SURVEY/ADULT CPR https://www.youtube.com/watch?annotation_id=annotation_3404693227&feature=iv&src_vid=OaSovqEimyA&v=MWOGI2mXuG4 Pass out Sequence.

19. Practice Scenarios Scenario #1:You are walking home and you see a person collapsed on the ground down an alleyway. This alley is quiet and no one is around to hear you yell for help. • Scene is safe, person is unresponsive. CPR for 2 cycles before help arrives. Scenario #2: As an athletic trainer, you are covering basketball practice, when an athlete collapses suddenly collapses. Coaches and other players are present. There is an AED on site. • No pulse, No breathing. After a cycle of CPR, the AED arrives. Scenario #3: You are in the back yard working when you hear your neighbor screaming. You notice her 16 year old son lying on the patio and is blue. Mom is too distraught to help. No AED. • Scene is safe. No air gets into the lungs after rescue breaths. After 2 cycles, patient begins to breathe on its own and regains a pulse. Scenario #4: During a football game, an athlete gets knocked unconscious. • No pulse, No breathing. No tools for facemask. Coaches & the athletic director are present.

20. CHILD & INFANT CPR Child: • https://www.youtube.com/watch?annotation_id=annotation_2003680617&feature=iv&src_vid=d4N0--eFn9s&v=wtJwYwJP_cQ Infant/Baby: • https://www.youtube.com/watch?annotation_id=annotation_2764435155&feature=iv&src_vid=xyBueL3Sm_g&v=KKTCb29Xmoc

21. PRIMARY SURVEYUNCONSCIOUS ATHLETE • Establishing breathing • Maintain open airway • LOOK, LISTEN, FEEL 5-10 seconds • If not breathing: • Using the hand already on the athlete’s forehead, pinch the nose shut (keep head back), give two full breaths at the rate of one breath per second – observe the chest rise and fall • If airway is still obstructed –reposition the victim’s head and try rescue breaths again • Still obstructed – give thirty chest compressions • Look for object – if visible – remove • Continue to repeat this sequence until ventilation occurs

22. PRIMARY SURVEYUNCONSCIOUS ATHLETE • Using an Automated External Defibrillator (AED) • Evaluates the hearts rhythm of a victim of sudden cardiac arrest – capable of delivering an electrical charge to the heart • Extremely easy to use…..just follow the instructions! • Apply pads as directed by the machine • If the pulse does not resume after one shock, perform CPR for two minutes then deliver another shock

23. VIDEO - AED • https://www.youtube.com/watch?v=5FdB5mnJ55c

24. PRIMARY SURVEYOBSTRUCTED AIRWAY ATHLETE • Complete airway obstruction = unable to speak, cough or breath Conscious: • Call 911 • Lean victim forward – supporting the chest with one hand • Deliver 5 back blows between the scapulae • Stand behind, place both arms around the waist just above the belt line • Grasp one of your fists with the other – place below xiphoid process – thrust fist inward and upward 5 times – repeat until clear Unconscious: • Finger sweep

25. Choking • Adult • Child • Infant

26. PRIMARY SURVEYUNCONTROLLED HEMORRHAGING ATHLETE • Abnormal discharge of blood • External hemorrhage: • Direct pressure • Elevation • Pressure points (brachial artery & femoral artery) • Internal hemorrhage • Difficult to diagnosis on the field • Monitor blood pressure

27. PRIMARY SURVEYSHOCK • With any injury, shock is a possibility • Diminished amount of blood is available to the circulatory system – not enough blood to the brain • Signs and Symptoms: • Low blood pressure • Pulse is rapid and weak • Athlete may be drowsy and appear sluggish • Respiration is shallow and rapid • Skin is pale, cool, and clammy • Management: • Maintain body temperature • Elevate feet and legs 8-12 inches

29. SECONDARY SURVEY Vital Signs • LOC • Pulse • Respiration • Blood pressure • Temperature • Skin color • Pupils • Movement • Abnormal nerve response

30. SECONDARY SURVEY Level of consciousness • Normal: alert, aware of environment, and responds quickly to vocal stimulation • Can be assessed by a number of scales, most widely used is AVPU • Aalert: awake, responsive, oriented to person, place and time • Vverbal: signifies patient responds to voice but is not fully oriented to person, place and time • Ppain: does not respond to voice but responds to pain • Uunresponsive: doe not respond to painful stimulus

31. SECONDARY SURVEY Pulse • Direct extension of the functioning heart • Carotid artery or radial artery • Normal: 60-100 in adults • Well conditioned athletes may have a lower pulse • Alterations: • Rapid and weak: shock • Rapid and strong: heatstroke or fright • Strong but slow: skull fracture or stroke • No pulse: cardiac arrest or death

32. SECONDARY SURVEY Respiration • Breathing rate • Look, listen, feel • Normal: 12-20 breaths • Patterns: • Apnea: temporary cessation of breathing • Tachypnea: rapid breathing • Bradypnea: slow breathing • Dyspnea: difficulty breathing • Hyperventilation: labored breathing • Obstructed: blocked airway

33. SECONDARY SURVEY Blood pressure • Amount of pressure exerted against the arterial walls • Systolic: pressure caused by the heart pumping • Diastolic: residual pressure when the heart is between beats • Normal: 120/80

34. SECONDARY SURVEY Temperature • Normal: 98.6F or 36.8C • Gold standard for taking temperature • Under the tongue • Armpit • Tympanic membrane • Rectum

35. SECONDARY SURVEY Skin Color • Normal: pink • Flushed or red skin color: heatstroke, sunburn, allergic reaction, high blood pressure, elevated temperature • Pale, ashen or white: insufficient circulation, shock, fright, hemorrhage, heat exhaustion, insulin shock • Bluish: airway obstruction • Yellowish: liver disease or dysfunction • Dark-skinned individual: • Nail beds, inside of the lips, mouth and tongue

36. SECONDARY SURVEY Pupils • Sensitive to situations affecting the nervous system • Pupils • Equal • And • Reactive • Light

37. MUSCULOSKELETAL ASSESSMENT • After a quick on-field injury inspection and evaluation, the ATC should decide…. • Seriousness of the injury • Type of first aid and immobilization necessary • Immediate referral to a physician • Transportation – sidelines, ATR, or hospital

38. MUSCULOSKELETAL ASSESSMENT Emergency Splinting **Any suspected fractures should be splinted before the athlete is moved** • Cover any open wounds before applying the splint • Splint the injury in the position that it was found in • Make sure the splint immobilizes the injury • Above and below the joint • Continuously check the circulation & sensation of fingers and toes as well as

39. MUSCULOSKELETAL ASSESSMENT Moving and transporting the injured athlete **Use caution to prevent further injury** • Ambulatory aid • Crutches, walkers, canes • Manual conveyance • Chair carry, walking assistance

40. SPINE BOARDING • Cervical Spine Protection “Holding C-Spine” • Log Roll • Lift • Neck brace • Spine boarding

41. Spine Boarding How not to do it: https://www.youtube.com/watch?v=4ZMtWIkJLyQ How to do it: https://www.youtube.com/watch?v=IUY9Fz1FdrY