Chapter 12: On-the-Field Acute Care and Emergency Procedures

Overview

Most sports injuries do not result in life-or-death emergency situations, but when such situations do arise, prompt care is essential. Time becomes the critical factor, and assistance to the injured athlete must be based on knowledge of what to do and how to do it. There is no room for uncertainty, indecision, or error. The individual preparing to become an athletic trainer must have a thorough knowledge of modern technique of emergency care. A positive approach, reflecting an attitude of confidence, optimism, and reassurance, will reduce the injured athlete's anxiety.

The prime concern of emergency aid is to maintain cardiovascular function and, indirectly, central nervous system function, because failure of any or all of these systems leads to death. The initial evaluation of the injured athlete and assessment of vital signs are the keys to emergency aid. In some instances these first steps not only will be lifesaving but also may determine the degree and extent of residual disability.

Learning Objectives

After completing this chapter, the student will be able to:

  • Establish a plan for handling emergency situations at your institution.
  • Explain the importance of knowing cardiopulmonary resuscitation and how to manage an obstructed airway.
  • Describe the types of hemorrhage and their management.
  • Assess the types of shock and their management.
  • Describe the emergency management of musculoskeletal injuries.
  • Describe techniques for moving and transporting the injured athlete.

Visit connect.mcgraw-hill.com for further exercises:

  • Clinical application scenarios covering handling emergency situations, shock and emergency management of musculoskeletal injuries
  • Click and drag questions covering emergency action plans, emergency managements and cardiopulmonary resuscitation
  • Multiple choice questions covering emergency management of musculoskeletal injuries, transporting an injured patient, emergency action plans and management of hemorrhage
  • Selection questions covering musculoskeletal injuries and vital signs

Key Terminology

Primary survey - Assesses life-threatening injuries

Secondary survey - Performed after life threatening injuries have been ruled out

Systolic blood pressure - The pressure caused by the heart pumping

Diastolic blood pressure - The residual pressure when the heart is between beats

mm Hg - Millimeters of mercury

Other Terms

Shock - Inadequate tissue perfusion with oxygenated blood.

Extended Lecture Outline

  • Introduction:
  • An emergency is defined as an unexpected serious occurrence that may cause injuries that require immediate medical attention
  • Time becomes a critical factor in an emergency, there is no room for indecision or error
  • A mistake in the initial management of an injury can prolong the length of time required for rehabilitation, and can potentially create a life-threatening situation for the athlete
  • The Emergency Action Plan (See Focus Box 12-1 “sample emergency action plan”, and Appendix I for NATA Position Statement)
  • All sports programs must have a pre-arranged emergency action plan (EAP)
  • Issues to be addressed in the EAP
  • Each sport should have a separate EAP
  • Determine personnel who will be on the field during practices and competitions
  • Decide what emergency equipment will be available for each sport
  • Establish specific procedures and policies regarding removal of protective equipment
  • Availability of phones for emergencies
  • Availability of community-based emergency health care delivery systems – how to contact in case of emergency
  • Keys to gates or padlocks
  • Inform all involved (coaches, administrators, etc) of EAP
  • Assign personnel to accompany injured athlete to the hospital if need arises
  • Carry contact information for athlete’s to all competitions and practices
  • Establish plan for treating emergencies of spectators, parents, referees.
  • Cooperation between Emergency Care Providers
  • Hold practice sessions involving EMT’s and athletic trainers at least once a year
  • Parent Notification
  • If athlete is a minor, need to obtain consent/informed consent from parents or guardian prior to treating athlete during an emergency (See Focus Box 12-2 “consent form for medical treatment of a minor”)
  • If no informed consent exists, implied consent on the part of the athlete to save the athlete’s life takes precedence
  • Principles of On-the-Field Injury Assessment
  • Primary Survey
  • Done immediately – determines the existence of a life-threatening injury or illness
  • Secondary Survey
  • Gathers information about the injury from the athlete – assesses vital signs and symptoms and provides for more detailed evaluation
  • The Primary Survey
  • Treatment of Life-Threatening Injuries
  • Includes situations including those that require CPR (obstruction of airway, no breathing, no circulation, profuse bleeding and shock)
  • Dealing with the Unconscious Patient
  • Unconsciousness – a state of insensibility in which the athlete exhibits a lack of conscious awareness
  • Unconscious athlete is always considered to have a life-threatening injury, and/or neck and spine injury
  • Guidelines:
  • Note body position and determine level of consciousness and unresponsiveness
  • Establish ABC’s
  • Remove facemask to allow for CPR - do not remove helmet
  • If supine and breathing – monitor, if not breathing establish ABC’s
  • If prone and not breathing – logroll and establish ABC’s, if prone and breathing – monitor
  • Life support should be monitored and maintained until emergency medical personnel arrive
  • Once athlete is stabilized start the secondary survey
  • Overview of Emergency Cardiopulmonary Resuscitation
  • Check-call-care (check the scene, call 911 and initiate care)
  • Equipment Considerations
  • Establishing Unresponsiveness
  • Opening the Airway
  • Establishing Breathing
  • Administering supplemental oxygen
  • Establishing Circulation
  • Using an Automatic External Defibrillator
  • Obstructed Airway Management
  • Conscious victim
  • Unconscious victim
  • Control of Hemorrhage
  • External Bleeding: (Bleeding from open skin wounds such as abrasions, incisions, lacerations, punctures, or avulsions)
  • Direct Pressure
  • Elevation
  • Pressure Points
  • Internal Hemorrhage: (Invisible to the eye unless manifested through some body opening or identified through other diagnostic testing)
  • Shock
  • Occurs when a diminished amount of blood is available to the circulatory system;
  • The extremes of fatigue, exposure to heat or cold, dehydration, or illness predispose an athlete to shock
  • Types of Shock
  • Hypovolemic: Stems from trauma in which there is blood loss
  • Respiratory: Lungs unable to supply enough oxygen to the circulating blood
  • Neurogenic: General dilation of blood vessels within the cardiovascular system
  • Psychogenic: Fainting or syncope – temporary dilation of blood vessels reduces blood to brain
  • Cardiogenic: Inability of heart to pump enough blood to the body
  • Septic: From bacterial infection
  • Anaphylactic: From severe allergic reaction
  • Metabolic: Occurs when severe illness goes untreated (diabetes), or extreme loss of body fluids (vomiting, diarrhea or urination)
  • Symptoms and Signs
  • Management
  • The Secondary Survey
  • Recognizing Vital Signs
  • Level of Consciousness
  • AVPU Scale
  • ACDU Scale
  • Glasgow Coma Scale
  • Pulse
  • Respiration
  • Blood Pressure
  • Temperature
  • Skin Color
  • Flushed or Red = heatstroke, high blood pressure, elevated temperature
  • Pale or Ashen = insufficient circulation, shock, fright, hemorrhage, heat exhaustion, or insulin shock
  • Bluish = airway obstruction or respiratory insufficiency
  • Yellowish = liver dysfunction (jaundice)
  • Pupils
  • Movement
  • Abnormal Nerve Response
  • Musculoskeletal Assessment
  • History
  • Observation
  • Palpation
  • Assessment Decisions
  • Seriousness of the injury
  • Type of first-aid and immobilization necessary
  • Whether injury warrants immediate referral to a physician for further assessment
  • Manner of transportation from the injury site to the sidelines, athletic training room or hospital
  • Immediate Treatment
  • Rest (restricted activity)
  • Ice (cold application)
  • Compression
  • Elevation
  • Emergency Splinting
  • Any suspected fracture should always be splinted before moving the athlete
  • Types of Splints
  • Rapid form vacuum immobilizer
  • Air splint
  • Sam Splint
  • Half-ring splint
  • Splinting Lower-limb fractures
  • Fractures of ankle or leg require immobilization of foot and knee
  • Fractures involving the knee, thigh, or hip needs splinting of all lower-limb joints and one side of trunk
  • Splinting Upper-limb fractures
  • Fractures of shoulder immobilize with sling and swathe bandage
  • Upper-arm and elbow fractures – splint and immobilize with arm in straight position
  • Lower arm and wrist fractures – splint in position of forearm flexion and support with sling
  • Hand and finger dislocations and fractures – splinted with tongue depressor or aluminum splint
  • Splinting the Spine and Pelvis
  • Use spine board, or total body rapid form vacuum immobilizer
  • Moving and Transporting the Injured Patient
  • Placing the Patient on a Spine Board
  • Ambulatory Aid (Figure 12-27)
  • Support or assistance given to an injured individual who is able to walk
  • Manual Conveyance (Figure 12-28)
  • Used to move a mildly injured individual a greater distance than can be walked with ease – most often done by two individuals
  • Stretcher Carrying
  • Need minimum of 4 individuals to transport safely – 2 on each side
  • A limb injury must be splinted prior to transportation
  • Pool Extraction
  • Emergency Emotional Care
  • Principles as set forth by the American Psychiatric Association
  • Accept everyone’s right to personal feelings, Do not tell the injured person how he or she should feel, show empathy not pity
  • Accept the injured person’s limitations as real
  • Accept your own limitations as a provider of first aid
  • Proper Fit and Use of the Crutch or Cane
  • Fitting the Patient
  • Crutch length determined by placing tip 6 inches from the outer margin of the shoe and 2 inches in front of the shoe
  • Top of crutch should be 1 inch below anterior axillary fold
  • Hand brace is even with the patient’s hand when elbow is flexed 30°
  • Cane fitted so top is even with superior aspect of the greater trochanter
  • Walking with the Crutch or Cane
  • Non-weight bearing (NWB)
  • Touch-down weight bearing (TDWB)
  • Partial weight bearing (PWB)
  • Four-point gait
  • Tripod gait