Studied by 66 people
Inertia
Fundamental property of matter that describes the resistance to any changes in velocity (speed and direction); a function of mass
Mass
A physical and fundamental property of matter
Creates gravitational interactions, responds to energy, has inertia
Motion
Matter changing position over time; recorded as how far an object goes in a given amount of time
w/o reference to direction is speed motion = distance = r/t
Velocity
Unit of speed in a given direction Can be represented as a vector
Energy (potential and kinetic)
Potential: the ability to do something (stored energy) Kinetic: energy of moving objects
Starting PE + KE = Ending PE + KE
Acceleration
Changes in speed or direction over time; change in velocity
Requires a force acting on a mass to change how that mass is moving
Force
Unit of mass times acceleration (F=ma)
“Force of impact” is acceleration of mass over a time or distance
The faster this delivery of energy, the greater the resulting energy
D-stop
Distance to stop
Pressure
Force over an area (P=force/area) The more concentrated the force → the higher the pressure → the greater damage Given in lbs/in2 or newtons/m2
Power
The unit of force acting over a distance per unit of time
given in watts
Rotation
The act of moving around a point in an elliptical path (circles are special ellipses) There are special forces acting on a rotating mass
Momentum
Inertia in moment (resistance to a change in velocity) A function of mass and velocity (“On the move” and “hard to stop”)
Law of Conservation of Energy
Energy cannot be created or destroyed, it can only change form; balance between kinetic & potential energy
Law of Inertia
Mass that is moving (or rest) will stay moving (or rest) unless it has a net force acted upon it
Law of Action and Reaction
Every action has an equal and opposite reaction. If a player runs into a stationary player, the runner and the blocker both exert a force on one another
Energy always has a point of ________ and a point of ________. Why?
Energy always has a point of entry and a point of exit
Why? – energy cannot be destroyed, the energy of an impact must be transferred to another part of a system
Point of Entry / Impact
Area (not a single point) on the body that interacts with the other person, surface or equipment, all the energy transfers occur here (energy entry point)
Keep in mind: any padding or armor, the area of entry, physiology under the point of entry, angle of the forces at the point of entry
Point of Exit
Final point of dissipation of the energy as it leaves the body (usually the feet), when the entire body is taken as a complete system
Keep in mind
Surface of exit
Area of exit
Physiology interacting with the point of exit
Angle of the forces at the point of entry
Dissipation
Energy changing form and leaving the system
How is energy dissipated?
Heat – friction between different components, breakdown of biological structures
Maco Biochemical – movement of tissues and organs within the body and the body itself along with the disruption of macro processes (think heartbeat and breathing)
Micro biochemical
Define structural capacity and some elements
Each organ, tissue, cell, process, and micro component has a capacity of how much energy it can take before it breaks
Compression
Tension
Torsion
Heat
Cold
Conduction
Cavitation
Boundary Integrity
How much impact to the brain can generate concussion systems?
35-45kw OR a single 5kw impact over one second
What is power (in terms of energy)?
Measuring the dose of energy that a body, or organ, receives (ex; dose of advil means a certain amount of energy over 5 hours)
What happens to an organ if it surpasses its boundary integrity / structural capacity?
It will break down
Cavitation
A permanent or temporary separation of tissue, organ, or potential cavity
If any energy is put any system, there is possibility of cavitation
Temporary cavitation vs Permanent cavitation
Temporary: short lived cavity produced by stretching of the tissues
Permanent: area left behind after the temporary cavitation
What are some factors of cavitation?
Elasticity Density Shape of impactors Angle of impact Cellular integrity Solid of hollow organs
Kinematic stress is...
Below grade 1 stressE
Elastic stress includes...
Torsional, compressive, tensile, bending stresses Overcomes one structural capacity Grade 1
Partial failure
Plastic deformation Substantial tear (bruising) Grades 1 and 2
Complete failure
Complete destruction Grade 3+ Can be repaired with surgery
Strain vs Sprain
Strain (t) = tendons and muscles Sprain (p) = ligaments
What drives impacts (x2)?
impacts are driven by the masses and velocities involved
What are things that factor into damage?
Combined amount of energy Area of impact Time over which the impact dissipates D-stop: the distance over which the impact dissipates (distance from point of impact to point of rest)
What can lessen impact?
Level of impact can decrease if (1) the sum of forces are decreased and (2) the area/distance over time which it dissipates over is reduced
Describe vector arrows
Vector (arrow) is the magnitude of the force Direction of vector is the angle of the force Magnitude: the number/amount, how big/small a force is
Vertical components of impact
Ev = mgh (in Joules, J) F = Ev/Dstop (in Newtons, N)
where... Ev = energy in the vertical direction (N) m = mass of the object (kg) g = gravitational acceleration (9.81 m/s) h = height of the falling object (m) F = force Dstop = the distance over which the object should come to a stop (m
Horizontal components of impact
Eh = 0.5mv2 (in Joules, J) Fh = Eh/Dstop (in Newtons. N)
where... Eh = energy in the horizontal direction (N) m = mass of the object (kg) v = velocity of the object (m/s) at the start of the impact F = force Dstop = the distance over which the object should come to a stop (m)
What parts of the body are considered springs? By what means?
Springs, Bones, Ligaments, and Tendons are SPRINGS; they are able and usually deform under activity
Elasticity
the ability of an element to return to its original shape after deformation (can compress, twist, sway)
Why do bones break?
Bones break when there is too much force and it cannot deform enough
Has an elastic, plastic, and ultimate failure point
Cross sectional area, mineralization, osteocyte (bone turnover cells) distribution
Describe a bone's cross sectional area
Ligaments and tendons are stronger than bones if the pressure is linear = strings, slow stretched
Bigger, more dense cross section → more energy needs to go through it for a bone to break
Smaller cross section → less energy needed to go through for a bone to break
Describe bone mineralization
Amount of calcium is needed for mineralization until age 5 and after 65 (determines bone capacity)
Describe osteocyte (bone turnover cells) distribution
Osteocytes protect the bones If the distribution is uneven, wherever there are less osteocytes is a weaker section of the bone
In most people the osteocyte distribution in bones in normal
At what level of a trauma center should athletes be evaluated at?
Unless location really demands it, ALL ATHLETES SHOULD BE EVALUATED AT A LEVEL III OR HIGHER TRAUMA CENTER
Level V center
Rural, remote clinic style facilities NOT A TRAUMA CENTER IN OUR AREA
Provides extremely limited evaluation, resuscitation, and operative interventions to stabilize a patient
Minimum requirements MD/DO, RN, ER Tech, X-Ray
Complex cases (anything greater than stuffy nose) a should be sent to higher level immediately
Not open 24 hours a day (they have a closing time; 9am-5pm) ex; resorts, rural areas
Level IV center
Found in areas where there would be substantial delay to receive care at a level III
Capabilities:
Provides limited evaluation, resuscitation and operative interventions to stabilize a patient
Minimum requirements MD/DO, RN, ER Tech, X-Ray, basic lab, and operating suite (operating room that does not get used); varies widely
Complex cases should be sent to a higher level immediately
Not a hospital, they are a rural clinic Emergency room is open 24 hours a day, 7 days a week
Level III center
Real hospital * Found in standard hospitals that service a community, may be several in any geographic area supported by a Level I or Level II 2 Psych beds
Capabilities:
Provides evaluation, resuscitation, and operative interventions to stabilize a patient
Most specialities available at most times, some on call. - Every specialty is on call for 45 minutes.
Complex cases should be sent to Level 1 or Level 2
Level II center
Sub-regional comprehensive care centers Found in large hospitals that will take patients from other hospitals (Level III hospitals send their patients to Level II hospitals)
Capabilities:
May be missing some level 1 facilities but typically include service from prevention through rehabilitation
All specialities available at all times
Able to manage complex cases however, some very complex cases might need to be sent to Level 1
Leader in trauma care for a given geographic area
Research and education are not a core component but fellowship is common
Psychiatric wing
Level I center
Found in large university hospitals that are actively involved in research and teaching Have students in every single department (whether you’re a med, nursing, paramedic student etc)
Capabilities:
Everything is available here 24 hours a day
Medical education is a core component
Full service from prevention through rehabilitation
All specialities available at all times
Able to manage complex cases
Leader in trauma care for a given geographic area
Medical education a core mission
Two main factors that differentiate a Level I center from a Level II center are…
Education and Diagnostics
diagnostics: you are presented with a patient and no one can determine what’s wrong with them, so you are the one trying to figure out what is wrong with the patient (must be the best of the best in your speciality)
Blunt force trauma
When the skin is not broken, but has potential for devastating injury
Blunt force trauma is governed by ________ and ____________
Blunt force trauma is governed by SHEAR and COMPRESSION
Describe shear and compression
Shear = difference in velocity between two impactors (acceleration and deceleration)
Compression = force directly applied to the organ; includes time, energy, and area
Types of blunt force trauma
Human vs human (fist to the face, tripping over yourself) Human vs equipment (baseball bat) Human vs surface (falling into ground) Blast Motor vehicle impact (MVI)
What are TIPs?
TIP = Trauma Impact Pathways
Describe what typical down/under TIPs vs typical up/over TIPs (and what down/under vs up/over mean)
Typical down and under TIPs: Lower extremity Fx Pelvic Fx Femur dislocation Bladder, kidney, intestinal damage Lower spine Fx
Typical up and over TIPs: Skull Fx Upper spine Fx damage Brain injuries Thorax injuries
Whiplash
The brain slamming into the front and back of the skull Coup → contrecoup
Axial loading injury What causes axial loading injuries?
Force directed through the top of the head and through the spine (may result in a Fx/dislocation of one or more of the cervical vertebrae)
Causes: vertical falls (feet or head first)
Height of fall (energy of impact)
Surface impacted
Angle of impact
Distance to stop (Dstop)
Crumpling of the body
Primary blast injuries
Direct injuries from the shockwave Travels at the speed of sound
Type of injuries: rupture of membrane, tearing of the hollow organs, shearing shredding of the solid organs, and concussive effects on the brain upto and including diffuse axonal injuries
Secondary blast damage
Impact of fragments: little small fragments and missiles carried/kicked up by the blast wave (ie; twigs, rocks, object close to the bomb)
sizes and shape will be random
Types of injuries: penetrating or lacerating trauma, amputations (from shards traveling at high speeds, power and forces)
Tertiary blast damage
Big wave propels body into objects or large objects strike body Large objects that are sent into the air and strike the patient → causes severe blunt force trauma; CRUSHING injuries
Also, a body might be sent in the air or into motion and strikes a wall, ground, or other object
Quaternary blast damage
Environmental contamination from the device
Encompasses trauma that is not caused by the object but by fires, chemical reactions on the body surface, or the contamination of words
Radiation trauma from a pulse wave is NOT considered quaternary blast damage, but primary
Quinary blast damage
Bodily absorption of device additives (toxic effects of products of the chemicals used in the explosion)
Penetration vs Puncture
Penetration: any trauma where an object enters the body
Puncture: any trauma where an object enters the body and does not exit; either no exit wound or object remains in body and communicated with outside
All punctures are penetrations and not all penetrations are punctures
What impact does angle and depth have on an injury?
Angle and Depth have a huge impact on the damage of a blow
Perpendicular penetration is devastating and can compromise the lungs and the heart
No angle over 30° could miss the lungs entirely
If the penetrator has been removed it is not able to be 100% sure of the angle and depth of the penetration
GSW stands for...
Gun shot wound
Temporary vs permanent cavitation via GSW
Permanent cavitation is formed by the path of the bullet
Temporary cavitation is formed by the tissue blown outwards from a pressure wave, causing compression injuries or tearing surrounding the wound
What factors determine cavitation in a a GSW? describe
Mass Ballistics (path/trajectory of bullet) Deformation of bullet (will it deform upon impact?) Spin Tumble (can create a bigger cavitation) Fragmentation
What can ramp up damage in a GSW?
“More effective” to ramp up velocity > mass (ex: small bullet with a higher velocity is more dangerous than a large bullet with a lower velocity)
What is needed if you want to train in a specific sport?
Knowledge of TIPs with an understanding of the physics involved in the pathway
Knowledge of the flow of the games and practices (what is likely to happen)
Knowledge of the physiology of the elements of the TIP
Combat levels - how are they determined?
How often do you get touched in your sport?
determined by the level of person to person contact (not the overall energy of the plays, not player vs equipment, surface, or ball)
Combat / Full Contact Band (CFC)
Player to player interactions are an integral of practice and play (ie; football, sideline and performance cheer/stunt, dance)
Incidental Contact Band (IC)
Player to player contacts may be common but are considered a foul or not a regular part of each play (ie; basketball, soccer, volleyball, baseball, softball, cross country)
Noncontact Band (NC)
Player to player contact is not possible or part of play (ie; golf, tennis, track and field, swim)
How are risk ratings determined?
LIKELIHOOD, SEVERITY, COMPLEXITY
energy levels, fall height, complexity of rehab, complicated training and intense rehab needs
High risk sport
High force / full speed impacts are likely Falls over two meters are likely Catastrophic injured to multiple systems Complicated training and intense rehabilitation needs
Medium risk sport
High force / full speed impacts are possible but rare/unlikely Falls are limited to under 1 meter or standing Catastrophic injuries are possible but unlikely Rehabilitation needs are usually straightforward
Low risk sport
High force / full speed impacts are very rare or impossible Falls are limited to standing or running Catastrophic injuries are extremely rare Most injured athletes need only straightforward rehab needs
When developing risk envelope analysis, trainers must…
Understand the RULES of the sport Understand the PLAYS (sometimes better than the players!) Understanding the PRACTICE (practice culture)
Steps to developing risk envelope analysis
Determine the contact band Determine the risk band Determine the coaching evaluation Understand the rules, plays, practice Determine the operational requirements Combine the four determinations
Pathway
A common route of energy / movement in each impact
You have to understand the energies, forces, and how those are generated or what they are affected by
Risk rating per pathway fraction
Likelihood (numerator) vs Severity (denominator)
Likelihood 10-8 often; expected each season 7-5 rare; expected each career 5-2 unlikely; expected across each team career 1-0 rare; expected few times across all of the sport
Severity 10-9 career ending 8-6 season ending 5-4 at least 3 week rehab 3-2 at least 1 week rehab 1-0 at least one day rehab
Tort Law
Disagreements between individual citizens Based on negligence, must have caused actual harm (property or personal damage) Also includes contract and business law
Criminal Law
Infractions of a citizen against society (the public good) “The people versus John Doe” Based on criminal statutes Harm to society Mens Rea
Mens rea
Having the metal state with intent to do harm
What are the 3 types of law? Describe
Statutory law – anything passed by legislature
Administrative law – law created by governmental agencies that carry out laws passed by legislature
Common law – courts; derived from judicial decisions instead of from statutes
Stare Decisis
(Let the Decision Stand) When a court faces a legal argument, if a previous court has ruled on the same or a closely related issue, then the court will make their decision in alignment with the previous court's decision.
Who has Stare Decisis?
State superior court – common law for county State supreme court – common law for state Federal district court – common law for federal district Federal circuit court – common law for states in circuit Federal supreme court – common law for the U.S. (all)
Defendant vs Plaintiff
Plaintiff = person making the claim and has the burden of proof
Defendant = person defending against the claim and may refute the statements
Negligence
A situation in which a person acts in a careless (or "negligent") manner, resulting in someone else getting hurt or property being damaged
What are the 3 types of Negligence? describe
NONfeasance
Failure to do something that was required by a duty to act
“Didn’t know you had a duty”
No mens rea
MISfeasance
Attempting to adequately do one’s duty and making an error (no ill will)
“Honest mistake” – No mens rea
Should have understood the correct way to carry out the order
MALfeasance
Understanding the correct way to carry out the duty and purposefully doing the wrong thing to harm the defendant
Must prove Mens Rea (difficult to prove)
Usually criminal as well as Tort
What are the requirements of Negligence?
Duty to act
Must have a legal obligation to act in a certain way
Abandonment
"Protect the public"
Removal of attractive hazards since “you can’t entice people to crime”
Breach of duty
Omission
Screwing up, didn't know what suposed to do
Cause in fact
"Without this..."
Cause of harm done to plaintiff
Sine qua (essential)
Proximate cause
“Causa proxima”
Closest cause that was foreseeable to the harm
Monetizable harm
Must have $$ value
The cost of making the plaintiff whole
"Judgment proof” (ex; kids, but may be transferred to parents)
If not able to be monetized, then not able to be ordered to repay
Cost of a person
Person’s wages x [the number years until they reach 65 y/o aka retirement age] since 65+ y/o do not have value to society
Creation of a duty to act
Once you understand you have a duty, you must act in accordance to it; you should be worried about what you hear and see (AKA burden of knowledge)
When must you act when burden of knowledge is piqued?
Duty to act is IMMEDIATE
Preservation of evidence
Everything is discoverable (even after you "delete")
