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Emergency Action Plans

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									Emergency Action
Plans
Jennifer L. Doherty, MS, ATC/L
Florida International University
The Sports Medicine Team

  Sports Medicine Team must work
   together to properly execute an EAP
    ATCs, Team Physician, EMTs, ATSs,
     others?
  TIME and TEAMWORK is critical
  ATC is usually the first on the scene
Emergency Action Plan
(EAP)
  Primary concerns:
      Check the scene (is it safe?)
      Initial Survey
      Activate EAP/EMS
      Establish and maintain CV function
  Secondary concern:
    Establish level CNS function
    Treat/Prepare the victim to be transported
Developing an EAP
  Separate plans should be developed for each
   facility
    Outline personnel and role
    Identify necessary equipment
  Establish equipment and helmet removal
   policies and procedures
  Availability of phones and access to 911
  Coach should be familiar with community-
   based emergency health care delivery plan
    Be aware of communication, transportation,
     treatment policies
Developing an EAP
  Community-based care (continued)
    Individual calling medical personnel must relay the
     following: 1) type of emergency 2) suspected injury
     3) present condition 4) current assistance 5)
     location of phone being used and 6) location of
     emergency
  Keys to gates/locks must be easily accessible
  Key facility and school administrators must be
   aware of emergency action plans and be
   aware of specific roles
  Individual should be assigned to accompany
   athlete to hospital
Developing an EAP

  Is each member of the Sports Medicine
   Team aware of his/her role and
   responsibilities?
      Who is the sports medicine team leader?
      Who makes the call?
      Who meets the EMTs?
      Who rides with the athlete in the
       ambulance?
Developing an EAP

  Are the location of phones and
   emergency phone numbers known?
  Who has the keys to open
   gates/padlocks/buildings?
  What is the address of the field and the
   location of suitable entrances?
Developing an EAP

  What information should be given over the
   phone?
      Type of emergency situation
      Demographics of the athlete
      Type of suspected injury
      Present condition of the athlete
      Current assistance being given
      Location
      Directions
Executing an EAP
  Developing a site specific plan
  Delegating specific duties for each member of
   the sports medicine team
  Contacting other entities to offer input on an
   EAP (i.e. Local EMS, campus police)
  Reviewing an EAP as a team
    Identify potential weakness and create back-up
     plans
  PRACTICE MAKES PERFECT!
                                            INJURY

           Unconscious Athlete                           Conscious Athlete

Primary Survey                    Secondary Survey

                 Responsiveness
                                                      Vital Signs
                    Airway
                                                        History
                   Breathing
                                               Musculoskeletal Evaluation
                   Circulation


                                                                     Treatment Considerations


                                                                                                Transportation
Principles of Assessment

  Appropriate acute care cannot be
   provided without a systematic
   assessment occurring on the playing field
   first
  On-field assessment
    Determines nature of injury
    Provides information regarding direction of
     treatment
    Divided into primary and secondary survey
Primary survey


 Performed initially to establish presence
  of life-threatening condition
 Airway, breathing, circulation, shock
  and severe bleeding
 Used to correct life-threatening
  conditions
Secondary survey

  Life-threatening condition ruled out
  Gather specific information about injury
  Assess vital signs and perform more
   detailed evaluation of conditions that do
   not pose life-threatening consequences
The Unconscious Athlete
 Assume life-threatening condition
   Note body position and LOC
   Check and establish airway, breathing,
    circulation (ABC)
   Assume neck and spine injury
 Once stabilized, a secondary survey
  should be performed
Opening the Airway

  Head-tilt, chin lift
   method
  Push down on the
   forehead and lifting
   the jaw moves the
   tongue from the back
   of the throat
 Modified
  technique can
  be used when
  neck injury is
  suspected
 Modified jaw
  thrust
  maneuver
Establishing Breathing
 Look, listen, and feel
 Pinch nose, hold
  head back
 Take deep breath,
  create seal around
  lips, and perform 2
  slow breaths
    Each breath should
     last 1 second
   • If breath does not go in, re-tilt and ventilate
   • If airway is obstructed, perform 5 chest thrusts
   to a depth of 1.5 to 2 inches. If you see an object,
   sweep it out with your index finger.
Means of Artificial
Respiration
Establishing Circulation

 Locate
  carotid artery
  and palpate
  pulse while
  maintaining
  head-tilt
  position
 Locate the center
  of the breastbone
 Place one hand
  with the edge of
  the palm on the
  center of the
  breast bone
 Place other hand
  on top with fingers
  parallel and
  directed away from
  athletic trainer
 Keep elbows locked
  with shoulders directly
  above patient
 Compress chest 1.5 - 2”
    30 times per 2
      breaths
 For child (<8yr.) 30:2
  ratio should also be
  used
    Compress chest 1-1.5
     inches
 Look for movement and
  recheck for breathing
  every two minutes.
    If not present
     continue cycle
Obstructed Airway
Management
  Choking is a possibility in many activities
    Mouth pieces, broken dental work, tongue,
     gum, blood clots from head and facial
     trauma, and vomit can obstruct the airway
  Individual cannot breath, speak, or
   cough, may become cyanotic
  The standing abdominal thrust technique
   with back blows can be used to clear the
   airway
 Stand behind athlete
  with one fist against
  the body and other
  over top just above
  the navel
 Provide forceful
  thrusts to abdomen
  (up and in).
 Next perform 5 back
  blows just between
  the scapula with the
  patient in a bent over
  position
 Repeat these steps
  until the obstruction
  is clear
 If athlete becomes unconscious, open airway
  and attempt to ventilate
 If airway still obstructed, re-tilt and re-ventilate
 If no ventilation, perform 5 chest thrusts,
  finger sweep to clear obstruction, and two
  breaths.
    Be sure not to push object in further with sweep
 Repeat cycle until air goes in
 When athlete begins to breath on own, place
  in comfortable recovery position while lying
  on their side
 Index finger
  should be inserted
  in mouth along
  cheek
 Using hooking
  maneuver, pull
  across to free
  impediment
 Attempt to
  ventilate twice
  after each sweep
  until athlete is
  breathing
Automatic External
Defibrillator (AED)
  Device that evaluates heart rhythms of
   victims experiencing cardiac arrest
  Can deliver electrical charge to the heart
  Fully automated - minimal training
   required
  Electrodes are placed at the left apex
   and right base of chest - when turned on,
   machine indicates if and when
   defibrillation necessary
Conducting a Secondary
Survey
  Once athlete is     Recognizing vital signs
   deemed stable,         Heart rate and breathing
   secondary survey        rate
   can begin              Blood pressure
                          Temperature
                          Skin color
                          Pupils
                          Movement
                          Presence of pain
                          Level of consciousness
On-Field Injury
Inspection
 Determine injury severity and
  transportation from field
 Must use logical process to adequately
  evaluate extent of trauma
 Knowledge of mechanisms of injury and
  major signs and symptoms are critical
 Once the mechanism has been
  determined, specific information can be
  gathered concerning the affected area
   Brief history
   Visual observations
 Gently palpate to aid in determining
  nature of injury
   Determine extent of point tenderness,
    irritation and deformity
 Decisions can be made with regard to:
   Seriousness of injury
   Type of first aid and immobilization
   Whether condition require immediate
    referral to physician for further assessment
   Manner of transportation from injury site to
    sidelines, training room or hospital
 Individual performing initial
  assessments should document findings
  of exam and actions taken
Off-Field Assessment
 Performed by athletic trainer or physician
  once athlete has been removed from site
  of injury
 Divided into 4 segments
     History
     Observation
     Physical examination
     Special tests
Off-Field Assessment
 History
   Obtain information about injury
   Listen to athlete and how key questions
    are answered
 Visual Observation
   Inspection of injured and non-injured areas
   Look for gross deformity, swelling, skin
    discoloration
Off-Field Assessment

 Palpation
   Assess bony and soft tissue
   Systematic evaluation beginning with light
    pressure and progressing to deeper palpation
    – beginning away from injured area
 Special Test
   Designed for every body region for detecting
    specific pathologies
   Used to substantiate findings from other
    testing
Immediate Treatment
Following Acute Injury

  Primary goal is to          Control via PRICE
   limit swelling and              PROTECTION
   extent of                       REST
   hemorrhaging                    ICE
  If controlled initially,        COMPRESSION
   rehabilitation time will        ELEVATION
   be greatly reduced
 PROTECTION
   Prevents further injury
   Immobilization and appropriate forms of
    transportation will prevent further
    damage
 REST
   Allows healing to begin immediately
   Days of rest differ according to extent of
    injury
   Rest should occur 72 hours before
    rehab begins
 ICE (Cold Application)
   Initial treatment of acute injuries
      Used for strains, sprains, contusions, and
       inflammatory conditions
   Used to decrease pain
   Promotes vasoconstriction
   Lowers metabolism and tissue demand for
    oxygen
 Ice should be applied for 20 min.
   Repeat every 1 - 1 1/2 hrs.
   Applied during the first 72 hrs.
 COMPRESSION
  Decreases space allowed for swelling to
   accumulate
  Important adjunct to elevation and
   cryotherapy, and may be most important
   component
  A number of means of compression can be
   utilized (Ace wraps, foam cut to fit specific
   areas for focal compression)
  Compression should be maintained daily
   and throughout the night for at least 72
   hours
 ELEVATION
  Reduces internal bleeding due to forces of
   gravity
  Prevents pooling of blood and aids in
   drainage
  Greater elevation = more effective reduction
   in swelling
Emergency Action Plan

  Must be executed with techniques that
   will not result in additional injury
  No excuse for poor handling
  Planning is necessary and practice is
   essential
  Additional equipment may be required

								
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