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					               Fullerton College

             Physical Education 235
               First Aid & Safety Education
                        Spring 2007
                          2.0 Units
                     Pete Snyder, Ph.D.
                 First Aid & CPR
• In class 7:00-10:00pm Fridays, first session April 15 second
  session April 29, third and final session May 13
• M-Tu-W on-line
• Room 1207, Fullerton College Campus,
  321 E. Chapman Avenue, Fullerton
• You should take the weekly quiz on-line prior to Tuesday or
  Friday meeting! (passing = 80%, practice)
• Class meetings will be skill work, prep. for & taking exams.
• Book: National Safety Council First Aid & CPR can be
  purchased @ FC Bookstore.
• Dr. Snyder - 714.992.7128,

      (Please note: This is a five(5) week class; students are expected to keep up with
       the material by doing the reading and taking the on-line quizzes. The in-class
       tests are cumulative. We will likely NOT go back to earlier material or skills.)

                   First Aid Written Midterm……………40 pts.
                   CPR Practical Final………………….20 pts.
                   CPR Written Final……………………40 pts.
                   First Aid Written Final………………..60 pts.
                   First Aid Practical Final…………….….p/np.
                  Chat room participation………………10 pts.
                  TOTAL…………………………………200 pts.
                         Note: the above are to be done in class!
                     [In order to receive certifications, a student must achieve 80% or
                       better on exams & pay a $5.00 fee per card (First Aid, CPR)]
                          Weekly Topics
Week One: Introduction; lifestyle inventory - leading causes
 of death and disability; emergency medical system;
 priorities for first aid - checking the victim; age of victim;
 definitions, legal considerations for rescuers. (In Class =
 single person C.P.R.)
Week Two: Vital signs - D.O.T.S.; Rescue breathing; airway
 obstruction -Abdominal thrusts (Heimlich); cardiac
 emergencies - A.B.C.; sudden illness; cardiac arrest v.
 stroke;moving the victim; when to stop. (In Class = Adult &
 infant C.P.R.-Practical exam)
• note: you can visit to supplement reading.

     P.E. 235 Weekly Topics (con’t.)
Week Three: Bleeding, Wounds (A.P.A.I.L.) & shock;
 Infection; Soft tissue & musculoskeletal injuries
 (R.I.C.E.); Burns - degrees of, chemical, heat,
 electrical.(In class = dressings, bandages)
Written Examination on C.P.R. material, First Aid
 Written Midterm to follow: in-class, Friday.
 Bring a Scantron sheet (1/2 p.) and #2 pencil!
Week Four: Injuries to head, neck, back - paralysis; Eye
 injuries; Abdominal and Chest injuries; embedded
 objects. (In class = bandaging, splinting, movement &
 transportation of victim)
• note: you can visit to supplement reading.
       P.E. 235 Weekly Topics (con’t.)
Week Five: Poisoning, Bites & Stings; Hypothermia
 (Exposure) and Hyperthermia (Heat complications);
 Diabetic coma & insulin shock; Substance abuse.
 (In class = Practical Test on First Aid Skills)
Written Final Exam will be only on 1st Aid material -
 cumulative, also on last Friday of Class.
 Bring a Scantron sheet (1/2 p.) and #2 pencil!
Upcoming are slides corresponding to the 5 weeks -many
 of the photos you can double click for animation.
• note: you can visit to supplement reading.
             Emergency Response
               Priorities: A, B, C
                Prompt Rescue
                 Survey Scene
               Call for Help (911)
          Primary, Secondary Surveys
   Good Samaritan Laws & Legal responsibilities
                 Reasons to Respond
• Altruistic intentions - good Samaritan.
• Life or death emergency.
• Permanent disability.
• Large medical bills, financial considerations.
• Loss of job, effect on personal life.
• Bystander non-intervention, need for personal
  initiative; assess situation & its severity, elicit help.
• Prevention of infectious diseases.

“Good Samaritan”-What the Law Says

Consent of the Victim:
 1. Implied - victim unresponsive.
 2. Expressed - get permission from victim.
 3. If the victim refuses your help, you must not force
      first aid on him(her).
 4. Administration of hypodermic needle - only under
      directions of victim.
                 Legalities (con’t.)
• Negligence - (you are potentially liable if):
  1. Standard of care not met - follow practices as
     according to published recommendations.
  2. Causing further damage to victim; making injury
     or illness worse as a result of your actions.
  3. Abandonment - once you begin first aid
     procedures, you must continue until higher
     authority takes over.
Note: If you are hailed, you have a responsibility to respond.
  You are covered in CA. by Good Samaritan laws provided you
  use standard first aid practices.
                 Prudent Life Living
• Leading Causes of death in the U.S.
  1. Heart attack (cardiovascular disease)
  2. Stroke (cerebralvascular disease)
  3. Cancer
  4. Accidents - highest percentage among children.
• Risk factors for Heart disease (cumulative):
  Heredity, smoking, high blood pressure, gender, lack of
  exercise, blood cholesterol levels, overweight
• “A,B,C” = Airway, Breathing, Circulation priority order.
                                         TEST #1
        1. The leading cause of death and disability in children & young adults is:
              a. injuries
              b. Cancer
              c. Heart disease
              d. Homicide
        2. Each year, one person in _____ suffers a nonfatal injury serious enough to need medical
              a. Three
              b. Four
              c. Six
              d. Eight
        3. First Aid is intended to:
              a. Take the place of medical treatment.
              b. Provide care until the prognosis is known.
              c. Only take care of injuries for which medical care is not needed.
              D. Provide temporary assistance until competent medical care, if needed, is obtained.
        4. Consent to give first aid must be obtained from every victim who is:
              a. Conscious
              b. Mentally competent
              c. An adult
              d. All of the above.
        5. If the victim is unconscious, permission to give first aid is known as:
              a. Actual consent.
              b. Expressed consent.
              c. Implied consent.
11/11/2011 d. Legal consent.
                                 TEST #1 (con’t.)
6. A first aider must stay with the victim until another equally or better trained person takes over. Failure to do
     so would be considered:
     a. Negligence.
     b. Abandonment.
     c. Breach of duty.
     d. Assault or battery.
7. Deviating from accepted standards of care that result in further injury to the victim is known as:
     a. Abandonment.
     b. Negligence.
     c. Carelessness.
     d. Assault or battery.
8. Which of the following statements concerning Good Samaritan laws is true?
     A. They guarantee legal protection for the first aider.
     B. They make litigation against the first aider impossible.
     C. They protect the first aider no matter what type of care was given.
     D. They protect first aiders acting in good faith.
9. Why are laypersons less likely to offer help when an emergency occurs in a public place?
     A. Ignorance
     B. Confusion about what is an emergency.
     C. Characteristics of the emergency.
     D. All of the above.
10. The EMS should definitely be called in which instance?
     A. Severe bleeding
     B. Breathing Difficulty.
     C. Choking
     D. All of the above.
                Airway Emergencies
Rescue Breathing
• Open Airway - chin lift, head tilt. “A”
• Check for breathing - look, listen, feel.
• Seal the mouth with lips, pinch the nose.
• Ventilate fully twice until chest expands.
• Airway obstruction - clear using abdominal thrusts
  (Heimlich).Unconscious victim: five thrusts, check
  breathing. “B”
• Adult breathing - one ventilation every 5 seconds.
• Infant breathing - one ventilation every 3 seconds.
        Airway Mgt.- Conscious Victim
• Talk to victim - can s(he) speak or breathe?
• Look for bluishness (cyanosis)
• Locate abdomen, navel & make a fist.
• Inward & upward thrusts - keep head out of way.
• If victim becomes unconscious, lower (him)her to
• Encourage victim to cough.
    out any trapped particles.

C.P.R.- External Cardiac Compressions
             • Circulation = check pulse (carotid:
               adult; brachial: infant) “C”
             • Locate bottom 1/2 of sternum- up
               from xyphoid process.
             • Use the heel of your hand.
             • Keep arms straight,depress sternum
               1.5-2.0”- adult.
             • Thirty compressions, two
               ventilations (rate=100 per min).
             • Infant: two fingers, above mid-nipple
               line, .5-1” deep.(rate>100/min.)
             Sudden Illness
             • Stroke - cerebralvascular disease.
             • Signs, symptoms: slurred speech,
               loss of feeling in extremities, loss
               of memory, inability to move or
               perform certain mental functions.
             • Assist person to seated (semi-
               reclining position); elevate head.
             • Call medical personnel.

         When to Stop C.P.R., chances
• As a 1st Aider, for a complete cardiac arrest, the victim
  will have < 10% recovery chance after C.P.R. This
  probability increases dramatically when advanced
  emergency equipment & personnel partake.
• Once you begin C.P.R., you must not stop unless:
  1. You are too exhausted to continue.
  2. A higher authority takes over.
  3. The victim is pronounced dead
       (only a physician can do this).
                                  TEST #2
1. Continue performing back blows and chest thrusts on a conscious choking infant until:
      A. The infant starts breathing on his or her own.
      B. trained help arrives and relieves you.
      C. You are completely exhausted.
      D. All of the above.
2. When giving chest compressions to an infant, place two fingers:
      A. One finger’s width above the nipple line.
      B. one finger’s width below the nipple line.
      C. On the center of the abdomen just above the navel.
      D. None of the above.
3. After giving abdominal thrusts to an unconscious adult choking victim, the rescuer should:
      a. Activate EMS.
      b. Performa finger sweep.
      c. Check the mouth for foreign objects
      d. Give two rescue breaths.
4. It should take ____ to _____ seconds to feel for the pulse.
      a. 1 to 2
      b. 3 to 5
      c. 5 to 10
      d. 20 to 30.
5. Rescue breathing for an adult with a pulse should be performed:
      a. 8 to 10 times a minute.
      B. 10 to 12 times a minute.
      C. 14 to 15 times a minute.
11/11/2011 times a minute.
      D. 20
                                 Test #2 (con’t.)
 6. If the victim has a pulse but is not breathing, the rescuer should:
       A. Activate the EMS.
       B. Start CPR immediately.
       C. Start rescue breathing immediately.
       D. Give two slow breaths.
 7. How would you turn an unconscious victim over?
       A. As a unit, keeping the body from twisting.
       B. One part at a time - first the head, then shoulders, then legs.
       C. One part at a time - first the legs, then shoulders, then head.
       D. Grab one arm and pull slowly yet firmly.
 8. In adult one-rescuer CPR, give chest compressions at the rate of:
       A. 40 to 50 compressions per minute
       B. 50 to 80 compressions per minute.
       C. 80 to 100 compressions per minute.
       D. at least 100 compressions per minute.
 9. Give chest compressions:
       A. Smoothly
       B. With a jerk.
       C. With a rocking motion.
       D. With a bounce.
 10. Stomach (gastric) distention describes:
       a. Stomach bloated from air.
       B. Stomach bloated from food and liquids.
       C. Stomach bloated from swallowing water.
       D. Vomiting by the victim.
      Bleeding & Hemorrhagic Shock
• Identify location and type of wound: “A.P.A.I.L.”
• Direct pressure on wound,unless compound fracture.
• Elevate affected part, if No bone break.
• Depress pressure point if unable to stop bleeding.
  Pressure points: radial, brachial, femoral, popliteal.
• Tourniquet??
• Treat for infection by applying
  dry sterile dressing - do not re-
  open wound.
             Shock position -   1 st Aid

             • Life threatening emergency.
             • Identify type of shock - hemorrhagic,
               hypovolemic, traumatic, anaphylactic.
             • Signs, symptoms - pale skin, rapid
               pulse, shallow breathing, nausea.
             • Treatment - cover body to maintain
               heat, elevate feet, reassure victim;
               give fluids if conscious and non-
               internal injury.
             • Seek medical assistance.
             Electrical Shock

         Bone, Joint, & Tissue Injuries
• Bone breaks: Type of fracture
  1. Open, closed as according
    to skin continuity.
  2. Look for D.O.T.S.
  3. Ask victim about sounds when injury occurred.
• Joint(s) affected - swelling, pain, discoloration.
• Musculature, connective tissue - Sprain = joint; Strain =
  muscle; contusion (bruise) = muscle.
• R.I.C.E.; DO NOT relocate nor re-insert exposed bone.
                                      Test #3
1. Shock refers to the failure of what system?
     A. digestive
     b. circulatory
     c. nervous
     d. respiratory
2. Without oxygen, the brain will usually be irreparably damaged in _____ to ______ minutes.
     A. 2 to 4
     b. 10 to 15
     c. 15 to 30
     d. 45 to 90
3. When a person experiences shock, their skin is usually:
     a. hot
     b. dry
     c. moist
     d. red
4. A shock victim with head injuries or stroke should be placed:
     a. on their back with the head slightly raised.
     B. on their back with the legs raised.
     C. sitting up straight.
     D. on their side.
5. What type of shock results from a bacterial infection?
     A. hypovolemic
     b. cardiogenic
     c. neurogenic
     d. septic
                            Test # 3 (con’t.)
 6. Anaphylactic shock:
      a. is a massive allergic reaction.
      B. is a mild allergic reaction.
      C. is not life-threatening.
      D. is the least serious form of shock.
 7. The purpose of a bandage is:
      a. to hold a dressing in place.
      B. to prevent contamination.
      C. to absorb blood.
      D. all of the above.
 8. What injury results when a joint comes apart and stays apart?
      A. compound fracture.
      B. dislocation
      c. sprain
      d. strain
 9. Fractures, dislocations, and sprains are all initially treated with:
      a. a hot water bag.
      B. an ice pack.
      C. a saltwater soak
      d. a compression bandage.
 10. The mnemonic DOTS can help you remember:
      a. how to examine an area
      b. how to keep your sense of humor.
      C. how to put the victim at ease.
      D. the signs of injury.

             1st Aid: Bone & Joint Injuries

       Bone, Joint, and Tissue Injuries

             Amputated body part

             Specific Injuries
• Head wounds - scalp, eye, ear, nose, mouth,
• Neck or spinal injuries - cerebral spinal fluid.
• Abdominal wounds - sucking chest, impaled
  objects, protruding organs.
• Bites and stings - animal, wildlife, insects;
  allergies to.

• Method of entry to body:
  swallow, inhale, absorption
• Type of poison? Identify
   (acid,base,petroleum distillate)
• Vomit or Not?
  Use of emetic: syrum of ipecac.
• Dilute substance with milk or water, activated
• C.O. poisoning - gaseous substances: must be
  looked @ by physician.
             1st Aid for Bites

             1 st Aid   for Snake bites

             1 st   Aid for Spider bites

             1 st   Aid for Insect Stings

                                       Test #4
1.    If bitten by an animal, the person should:
      a. try to capture the animal
      b. kill the animal
      c. call the police or animal control officers
      d. none of the above.
2. Anaphylaxis typically comes on within ______ of exposure to the offending substance.
      a. seconds
      b. minutes
      c. hour
      d. days
3. Which drug can reverse the life-threatening process of anaphylaxis?
      a. nitroglycerin
      b. epinephrine
      c. antihistamine
      d. ibuprofen
4. What type of wound involves damage beneath the skin’s surface but no actual break in the skin?
      a. open
      b. closed
      c. external
      d. internal
5. What injury results when a joint is torn or stretched?
      a. compound fracture
      b. dislocation
      c. sprain
      d. strain
                             Test#4 (con’t.)
6. A _____ results when bones are displaced from their normal joint alignment.
    a. strain
    b. sprain
    c. dislocation
    d. fracture
7. Muscle contusions result from:
    a. A blow to the muscle.
    b. Overuse of one specific muscle group.
    c. Stretching the muscle beyond its normal range.
    d. Cutting the muscle with a sharp object.
8. Under what circumstances should you suspect a spine injury?
    a. all unconscious victims.
    b. all head-injury victims.
    c. all victims of severe accidents.
    d. all of the above.
9. Which type of brain injury is a bruising of brain tissue?
    a. concussion
    b. contusion
    c. hematoma
    d. none of the above.
10. Critical information needed in cases of swallowed poisoning includes:
    a. age and size of victim
    b. what was swallowed.
    c. when it was swallowed.
    d. all of the above.
                Diabetic Coma, Insulin Shock
• Diabetic Coma: due to not enough insulin -
  symptoms: flushed dry, warm skin…fruity odor
  breath, severe thirst. 1st Aid: if in doubt, give sugar -
  rescuer should not administer insulin.
• Insulin Shock: Too much insulin - not enough sugar;
  symptoms: pale, clammy skin, appearance of
  intoxication; irritable, disoriented. 1st Aid: give sugar
  (fruit drink).
• Hypoglycemic: naturally too low blood sugar; treat as
  insulin shock.
    Diabetic Emergencies - imbalance:

         Heat Emergencies, Complications
• Cramps- Involuntary muscle spasm - stretch,
  replace fluids with electrolyte drinks,
  add potassium via bananas; extra sodium in diet.
• Exhaustion - profuse sweating,
  nausea, dizziness, clammy/pale skin -
  get to a cool place, replenish liquids.
• Stroke - Hot, red skin, unresponsive,
  move person to a half-sitting position in shade, spray
  with H2O, apply ice packs to head, neck, armpits.
• Thermal versus chemical.
• Rule of Nines - if more than ___%,
   total body reaction to burn.
• Depth of Burn: (p.157)
  1st degree = sunburn, reddish color
  2nd degree = blisters
  3rd degree = blisters + charred look.
First Aid: flush with H2O if 1st or 2nd; Dry sterile
  dressing; treat for shock; seek medical help.
                   Cold Emergencies
• Hypothermia - exposure to cold climate.
• Symptoms - bluishness, irrationality, slurred speech.
• Stages of: 1st = shivering.
  2nd = uncontrollable shivering.
  3rd = unconscious.
• Prevention - layered clothing, keep skin insulated,
  cover extremities especially head. Ways of losing
  heat: convection, conduction, evaporation, respiration.
• Treatment - gradual re-warming, cover skin with warm
  material, warm liquids if conscious, treat for shock.
                                         Test #5
1. All acids, alkalis, and organic compound burns are best treated by:
   a. Neutralizing the chemicals.
   b. applying a solvent to the burn
   c. Washing the area with large quantities of water.
   d. wrapping the area to keep out oxygen.
2. Which of the following statements concerning electrical shock is correct?
   A. Even a mild electrical shock can cause serious internal injury.
   B. The 110 volts found in ordinary household current can be deadly.
   C. Electricity produces the most damage inside the body.
   D. All of the above.
3. Most electrical burns are ___burns.
   A. first-degree
   b. second degree
   c. third degree
   d. none of the above.
4. According to the Rule of Nines, what percentage of an adult’s body surface is involved if both legs are
   A. 9
   b. 18
   c. 27
   d. 36
5. What condition occurs when the body has too much sugar in the blood?
   A. hypoglycemia
   b. hyperglycemia
   c. insulin reaction
   d. insulin shock.
                           Test #5 (con’t.)
6. Too much insulin, too little or delayed food, exercise, alcohol, or a combination of these factors can
     lead to _____:
   a. hypoglycemia
   b. hyperglycemia
   c. diabetic coma
   d. none of the above.
7. The tightening of blood vessels in skin that is exposed to cold is called:
   a. vasoconstriction
   b. veneousconstriction
   c. vasodilation
   d. vesselconstriction
8. Up to 50% of the body’s total heat production can be lost by radiation through the:
   a. head
   b. armpit area
   c. stomach area
   d. groin area
9. Heat loss can be stopped in the hypothermic victim by:
   a. covering the victim’s head
   b. adding insulation beneath and around the victim.
   C. replacing wet clothing with dry clothing.
   D. all of the above.
10. Which heat illness is live-threatening?
   A. heatstroke B. heat exhaustion C. heat cramps D. heat cramps
                         First Aid Newsletters
April 2001
Welcome to Jones & Bartlett's Emergency Care Electronic Newsletter.

Hammond, LA -- A Wal-Mart Super Center customer said that he was bitten by a 6-inch rattlesnake while handling some
   plants. Animal control officers identified the snake as a Pygmy rattler and said that it was venomous. The victim said
   that he shook off the snake -- whose bite did not penetrate his skin -- and stomped it to death.

Lansing, MI -- An 11-year-old girl drown and her 13-year-old cousin nearly died trying to save her during a pool party. The
    older girl dived into the water and lost consciousness while trying to save her cousin. At the hospital, she asked about
    her cousin’s condition. Family members returned to the hotel pool where they found the 11-year-old at the bottom of
    the pool. No adults were supervising the pool party.

Jefferson, WI -- A 7-year-old girl died in a roller skating accident. An autopsy showed that the victim died of a skull
     fracture. The girl fell while skating and was crushed by a man who was skating backwards and did not see her on the

Cheyenne, WY -- Firefighters say a woman saved her husband and two children from near-lethal levels of carbon
    monoxide when she came home from work and found then unconscious. The three family members were rushed to a
    hospital where they were treated and released. A faulty water heater in their mobile home was the suspected cause
    of the carbon monoxide leak.

Rochester, MN -- A 2-year-old boy who nearly died after wandering outside in subzero temperatures has been discharged
     from the hospital. Physicians call his recovery remarkable. When the boy was found by his father, his body
     temperature was in the low 60s.
Identifying Stroke
Reliable identification of stroke victims in the field by prehospital personnel could expedite treatment for stroke. The Los
     Angeles Prehospital Stroke Screen (LAPSS) is a one-page tool designed to allow prehospital personnel to rapidly
     identify acute stroke victims in the field. The LAPSS demonstrated that the positive predictive value was 97% when
                                 First Aid Readings
Lay Persons Using AEDs
When utilized within the first few minutes of the collapse, defibrillation is the one factor scientifically proven to improve
     victim outcome from cardiac arrest. Beginning in 1997, researchers trained and equipped casino security officers
     from 32 locations around the United States in AED use. A standardized 6-hour training program was used. Data
     on all cases of ventricular fibrillation from March 1997 through October 1999 was collected for the study. A total of
     90 victims had a witnessed collapse and a documented rhythm of ventricular fibrillation. The survival rate was 74%
     in the group that received their first shock within three minutes of collapse. The survival rate dropped to 49% for
     the group that received shocks more than three minutes after collapse.
This study supports the need for widespread applications of AEDs by bystanders.
Source: New England Journal of Medicine 343(Oct26):1206-1209, 2000.

Toddler Drowning in Residential Swimming Pools

In Australia, more than half of the pediatric drowning fatalities occurred in unfenced pools and spas. Children gained
     access to fenced pools through faulty or inadequate gates or through gates that were propped open. Not one child
     gained unaided access to a pool fitted with a fully functional gate and fence that met the Australian standard. This
     finding highlights the need for pool owners to install approved fences and gates and to maintain existing fences
     and gates.

National Institutes of Health at Natn’l. Highway Traffic Safety Admin.
Healthcare Information Search Site at AED information at
5. FIRST AID DIGEST Concussions , Alton Thygerson, Ed.D.

What do Chris Miller, Merril Hoge, Al Toon, Harry Carson, Steve Young, Troy Aikman, and Stan Humphries all have in
   common? While playing in the National Football League, all seven men sustained multiple concussions. Several
      the men listed had to retire due to their head injuries.
                                First Aid Readings
What is a Concussion?
A concussion is a violent jar or shock that injuries the central nervous system. A concussion may or may not cause loss
    of consciousness.

How Prevalent are Concussions?
The Centers for Disease Control and Prevention (CDC) estimates that 300,000 sports-related concussions occur per
    year (100,000 occur in football alone). An estimated 900 sports-related traumatic brain injury deaths occur per
    year. The risk of concussion in football is four to six times higher in players who have sustained a previous

What Happens to the Brain?
The brain is a jello-like substance that is vulnerable to outside trauma. The skull helps protect the brain against trauma,
    but does not absorb impact forces. During a concussion, the brain rotates and twists inside the skull, causing
    damage to brain tissue.

Signs of a Concussion
According to the American Academy of Neurology (AAN), symptoms of a concussion can appear early (minutes to
    hours) or late (days to weeks) . The early symptoms of concussion include:

* Impaired attention -- vacant stare, delayed responses, inability to focus * Slurred or incoherent speech
* Disorientation                                                * Emotional reactions that are out of proportion
* Memory deficits                                               * Any loss of consciousness
The late signs of concussion include:

* Persistent headache                 * Dizziness/vertigo                    * Poor attention and concentration
* Memory dysfunction                  * Nausea or vomiting                   * Fatigue easily
* Irritability                        * Intolerance of bright lights                      * Intolerance of loud noises
* Anxiety and/or depression                        * Sleep disturbances
                          First Aid Readings
Post-Concussion Syndrome
Lingering symptoms and continuing cognitive problems following a concussion may occur for weeks or months after the
     injury. Chris Miller said that after two concussions involving helmet-to-helmet hits, he felt, "…kind of out of sorts
     [for] two months afterward. I felt like I was punch drunk. I couldn't formulate thoughts or conversation."
Second-Impact Syndrome
The second-impact syndrome occurs when the head suffers another trauma while still healing from a previous
     concussion. The second-impact is more likely to cause brain swelling and other widespread damage. It can be
     fatal – there is a 50 percent death rate in the most severe cases of second-impact syndrome.
How is a Concussion Assessed?
The American Academy of Neurology classifies concussions into three grades:
* Grade 1: transient confusion, no loss of consciousness, and mental status abnormalities resolve in less than 15
* Grade 2: transient confusion, no loss of consciousness, and mental status abnormalities last more than 15 minutes.
* Grade 3: any loss of consciousness, either brief (seconds) or prolonged (minutes).

The AAN has issued recommendations on when a player can return to the field after a concussion. The
     recommendations are based on the grade of the concussion. If the player suffers another concussion of the same
     severity, then it is considered a “multiple” for the purposes of these recommendations. The player must show no
     symptoms of a concussion for the entire time period -- both while resting and while exercising.
* Grade 1 -- 15 minutes * Multiple grade 1 -- 1 week
* Grade 2 -- 1 week         * Multiple grade 2 -- 2 weeks
* Grade 3 (brief loss of consciousness) -- 1 week * Grade 3 (with prolonged loss of consciousness) --2 weeks
* Multiple grade 3 -- 1 month or longer, based on a doctor’s ruling
The benefits of helmet use in sports is obvious. Rule changes should be implemented to keep the head safer by
     making penalties tougher for those players who use head-butting as a tactic on the field. All players and coaches
     need to understand that fatalities can occur due to second-impact syndrome. Players, coaches, and parents need
        work together to make all sports safer.

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