Chapter 8: Handling Emergency Situations and Injury Assessment Vocabulary Flashcards

Foundations of Emergency Management in Sports

• Definition of Emergency: An emergency is defined as an "unforeseen combination of circumstances and the resulting state that calls for immediate action."

• Time Sensitivity: Prompt care is vital; in life-or-death emergencies, time is critical to preserve tissue function and survival.

• Personnel Certification Requirements: All fitness professionals, athletic coaches, and individuals involved in exercise and sport science must be formally certified in:

  • Cardiopulmonary Resuscitation (CPR)

  • Automated External Defibrillator (AED) operation

  • First Aid

• Legal Limits and Scope of Practice: The extent of emergency care services provided by non-physician personnel is governed and restricted by individual state laws and statutes. All actions must remain within legal professional boundaries.

Emergency Action Plan (EAP) Development and Implementation

• Primary Objectives of Emergency Care:

  • Preserve cardiovascular function.

  • Maintain Central Nervous System (CNS) function.

  • Prevent cardiovascular or respiratory failure, which rapidly leads to death.

  • Provide immediate initial evaluation of the injured athlete to prevent treatment delay, reduce mortality, and minimize long-term disability.

• EAP Structural Requirements: Every athletic program must maintain a pre-arranged, written Emergency Action Plan developed in direct coordination with local Emergency Medical Services (EMS).

• Location-Specific Plans: Distinct EAPs must be developed for every individual sport facility, venue, or court (e.g., gymnasium, stadium, practice field).

• Key EAP Elements:

  • Identification of initial responders and their explicit duties.

  • Cataloging available emergency equipment and exact storage locations.

  • Established policies for removing protective gear (helmets, shoulder pads).

  • Communication protocols with readily accessible phones:

  • Landlines must be accessible if cellular reception fails.

  • Clear directives on contacting 911 vs. campus security vs. local police.

  • Integration with community-based emergency healthcare plans, including transportation protocols.

  • Key accessibility: Assigned staff members must possess keys to locked gates, doors, and facility access routes.

  • Annual Plan Review: Mandatory annual pre-season meetings for all medical staff, coaches, and maintenance personnel to review roles and protocols.

  • Emergency Escort: A designated individual must be assigned to accompany an injured athlete to the hospital.

  • Documentation and Consent: Emergency contact information for every athlete and signed parental treatment consent forms for minors must be carried at all times.

Emergency Care Provider Roles and Legal Considerations

• Inter-professional Cooperation: Emergency providers (Athletic Trainers, Emergency Medical Technicians, Physicians) must maintain professional communication and seamless cooperation.

• Chain of Command without On-site Medical Staff: If a Certified Athletic Trainer (ATC) or physician is unavailable, the local rescue squad handles the emergency.

• Transportation Authority: Emergency Medical Technicians (EMTs) hold final authority regarding decisions on patient transport methods and procedures.

• Annual EAP Rehearsal: To prevent role confusion during critical events, all potential care providers must practice emergency procedures together at least once annually.

• Parental Consent and Legal Regulations:

  • Under the Health Insurance Portability and Accountability Act (HIPAA) and state minor consent laws, written parental/guardian consent to treat a minor athlete must be secured prior to the athletic season.

Primary Survey and Life-Threatening Emergencies

• Definition and Priority: The Primary Survey assesses life-threatening conditions and takes precedence over all other physical injuries.

• Target Conditions Assessed: Airway obstruction, absent breathing, absence of circulation, profuse hemorrhage, and medical shock.

• Action Protocol: Any life-threatening emergency mandates an immediate 911 call for EMS activation.

• Management of the Unconscious Athlete:

  • Unconsciousness is defined as a state of insensibility characterized by a lack of conscious awareness.

  • Unconsciousness is always treated as a life-threatening injury.

  • EMS (911) must be contacted immediately for any unconscious athlete, regardless of perceived cause.

Primary Survey Flowchart Sequence:

1. Injury occurs $\rightarrow$ Initiate Primary Survey.

2. Determine Level of Consciousness:

   • Unconscious Patient:

     • Stabilize cervical spine immediately.

     • Evaluate Responsiveness, Circulation, Airway, Breathing, Profuse Bleeding, and Shock.

     • Call 911 and access rescue squad.

     • Administer ongoing care until rescue squad arrives.

     • Transition to Secondary Survey once vital functions stabilize or consciousness returns.

   • Conscious Patient:

     • Proceed directly to Secondary Survey.

     • Assess Vital Signs, History, and Musculoskeletal System.

     • Formulate Treatment Considerations.

     • Decide on final transportation method from field, court, or gymnasium.

Protective Equipment Management

• Complications in CPR: Equipment such as football helmets, facemasks, and shoulder pads can impede airway access and chest compressions.

• Cervical Spine Protection: Decisions to remove equipment are based primarily on cervical spine injury risk.

• Current Removal Protocol:

  • Historical guidelines advised leaving helmets intact for suspected cervical spine trauma.

  • Modern guidelines dictate that protective equipment should be removed prior to EMS transport by at least three trained, experienced rescuers.

  • Removal ensures proper cervical spine stabilization and unrestricted airway access.

Hemorrhage Control and Shock Management

• Hemorrhage: An abnormal discharge of blood, occurring externally or internally.

• Classifications of Hemorrhage:

  • Venous Bleeding: Dark red blood flowing in a steady, continuous stream.

  • Capillary Bleeding: Tissue exudation with a reddish hue.

  • Arterial Bleeding: Bright red blood spurting dynamically under pressure.

• Control Procedures:

  • External Bleeding: Controlled using direct pressure, elevation above heart level, and digital pressure points.

  • Internal Bleeding: Invisible externally; requires immediate monitoring, cessation of exertion, shock prevention, and emergency referral.

  • Universal Precautions: Personal protective equipment (gloves, masks) must be used to minimize exposure to bloodborne pathogens.

Pathophysiology and Signs of Shock

• Pathophysiology: Severe reduction in blood volume/pressure leads to diminished oxygenation of vital organs, increased vascular resistance ("sticky blood"), tissue hypoxia, necrosis, and organ death.

• Predisposing Risk Factors: Severe external/internal bleeding, bony fractures, severe internal organ injury, extreme heat or cold exposure, dehydration, fatigue, or acute illness.

• Clinical Presentation / Vital Signs of Shock:

  • Skin: Moist, pale, cool, clammy.

  • Pulse: Weak and rapid.

  • Respiration: Increased rate, shallow depth.

  • Blood Pressure: Decreased ($\text{hypotension}$).

  • Severe Progression: Fecal incontinence and urinary retention.

  • Consciousness: May occur in conscious or unconscious states.

• Shock Management Steps:

  1. Call 911 immediately.

  2. Maintain core body temperature (cover with blankets; avoid overheating).

  3. Elevate feet and legs $8\text{--}12\,\text{inches}$ (if lower limb injury does not contraindicate elevation).

Secondary Survey and Assessment Protocols (HOPS)

• Indication: Initiated only after primary survey rules out life-threatening conditions.

• Objectives: Gather detailed injury data, systematically monitor vital signs, perform thorough physical examination, and detect hidden pathology (e.g., concussion).

Baseline Vital Signs Norms

• Pulse Rate: $60\text{--}80\,\text{BPM}$ for children; $80\text{--}100\,\text{BPM}$ for adults.

• Respiration Rate: $12\,\text{breaths per minute}$ for adults; $20\text{--}25\,\text{breaths per minute}$ for children.

• Blood Pressure: Normal baseline standard is $120/80\,\text{mmHg}$.

• Body Temperature: Normal standard is $98.6^\circ\text{F}$ ($37^\circ\text{C}$); core body temperature provides the highest diagnostic accuracy.

• Skin Color: Inspected for cyanosis, pallor, or flushing.

• Pupil Reactivity: Checked via PERL (Pupils Equal, Reactive to Light).

• Neurological / Motor Function: Voluntary movement, pain perception, altered sensation (numbness/tingling), and Level of Consciousness (LOC/Alertness).

On-Field Inspection

• Evaluates injury severity and determines if the athlete can be safely moved.

• Components: Brief subjective history, visual observation, and basic palpation.

• Decisions derived: Injury severity, necessary first aid/splinting, need for medical referral, transport method, and injury documentation.

Off-Field Assessment (HOPS Structure)

Performed by Certified Athletic Trainers (ATC), Physical Therapists (PT), or Medical Doctors (MD):

• H - History:

  • Question athlete regarding Mechanism of Injury (MOI), prior injuries, location of pain, and structural sensations (e.g., pop, snap).

• O - Observation:

  • Visual alignment check, scanning for edema, ecchymosis, asymmetry, or postural alterations.

• P - Palpation:

  • Systematic physical palpation of anatomical landmarks (bony structures and soft tissues).

  • Pressure progression: Light touch to deep pressure.

  • Direction: Progressing from uninjured areas away from the site toward the focal injury site.

• S - Special Tests:

  • Region-specific manual tests evaluating joint ligamentous stability, tendon/muscle integrity, impingement, tissue tightness, muscle imbalances, and anatomical alignment.

Acute Injury Management (PRICE)

• Goal: Limit tissue hemorrhage, edema, and secondary hypoxic injury.

• P - Protection: Shield damaged tissues from further mechanical strain (splints, braces, pads).

• R - Rest: Cease activity to allow cellular healing.

• I - Ice: Apply cryotherapy to promote vasoconstriction and analgesia.

• C - Compression: Apply pressure wraps to reduce interstitial fluid accumulation.

• E - Elevation: Position injured structure above heart level to assist lymphatic drainage.

Emergency Splinting and Immobilization Techniques

• Mandatory Requirement: Any suspected bone fracture must be immobilized with a splint prior to moving the patient.

• Complications of Unimmobilized Fractures: Sharp bone fragments can cause tissue damage, vascular hemorrhage, open skin perforation, increased shock, and long-term disability.

• Fundamental Rules of Splinting:

  1. Splint the joint above and the joint below the fracture site.

  2. Splint the limb in the exact position it is found; do not attempt to reduce angulated deformities forcefully.

Standard Splint Categories

• Rapid Form Vacuum Immobilizers:

  • Pliable cloth sleeve filled with Styrofoam beads.

  • Wrapped around the deformed limb using Velcro straps.

  • Hand pump extracts internal air, locking beads into a rigid matrix molded to the precise limb shape.

  • Highly effective for severe, angulated limb deformities.

• Air Splints (Pneumatic Splints):

  • Clear double-walled inflatable plastic jacket placed over the limb.

  • Provides uniform circumference support, pressure, and clear visual/radiographic (X-ray) transparency.

  • Requires formal technical training.

  • Contraindication: Must not be used if inflation alters or accentuates the fracture deformity.

• Commercial and Rigid Splints:

  • Includes SAM splints, rigid padded board splints, and traction splints for long-bone fractures.

Regional Splinting Protocol Guidelines

• Lower Extremity (LE):

  • Ankle/Lower Leg Fractures: Require complete immobilization of the foot, ankle joint, and knee joint.

  • Knee, Thigh, or Hip Fractures: Require full length immobilizers spanning the entire lower extremity.

• Upper Extremity (UE):

  • Shoulder Fractures: Immobilized using a sling and swathe, binding the arm securely against the thorax.

  • Upper Arm (Humerus) / Wrist Fractures: Splinted in position found.

  • Forearm / Lower Arm Fractures: Splinted in forearm flexion and supported with an elevating shoulder sling.

  • Hand / Finger Injuries: Immobilized individually with specialized splints.

Cervical Spine and Pelvis Immobilization

• Suspected spinal cord or pelvic trauma mandates immediate EMS 911 activation.

• The patient must not be moved prior to EMS arrival unless:

  1. The athlete is non-breathing, requiring a coordinated log-roll onto the back for CPR delivery.

  2. Environmental conditions present immediate life-threatening physical danger.

Patient Transport and Transfer Procedures

• Ambulatory Support:

  • Used to assist light weight-bearing athletes off the venue.

  • Must rule out serious underlying fracture or spinal trauma beforehand.

  • Progression: Supine position $\rightarrow$ Seated position $\rightarrow$ Standing position.

  • Requires two assistants of equal height positioned on either side.

  • Patient's arms drape over the assistants' shoulders; assistants encircle the patient's waist/back.

• Manual Conveyance:

  • Used for mildly injured athletes across long distances when walking is impractical.

  • Two-person lift carry ("convenient carry") performed following complete diagnostic screening.

• Stretcher Carrying:

  • The safest mode of patient transport.

  • Patient is gently lifted onto a rigid stretcher supporting all anatomical segments.

  • Indicated when sitting transport is uncomfortable or clinically unsafe.

Assistive Devices: Crutch and Cane Fitting and Gait Mechanics

• Indications: Used when full lower extremity weight bearing is contraindicated due to acute tissue trauma, surgery, or fracture.

• Risks of Improper Fitting: Improper sizing or faulty biomechanics leads to compensatory gait deviations, fall risks, nerve compressions, or secondary tissue injury.

Fitting Parameters

• Position patient standing in upright posture wearing flat-soled athletic shoes.

• Crutch Position:

  • Crutch tips placed $6\,\text{inches}$ ($15\,\text{cm}$) lateral to the outer shoe sole and $2\,\text{inches}$ ($5\,\text{cm}$) anterior to the shoe toe.

  • Top axillary pad must sit $1\,\text{inch}$ ($2.5\,\text{cm}$) below the anterior axillary fold.

  • Handgrip height adjusted so the elbow maintains a $30^\circ$ angle of flexion.

• Cane Position:

  • Height measured from the floor surface to the level of the patient's greater trochanter.

Gait Patterns and Mechanics

• Single Crutch / Cane Placement: The assistive device (cane or single crutch) must ALWAYS be held on the unaffected (uninjured) side.

• Tripod Method (Non-Weight Bearing / NWB):

  • Crutches advance forward first, forming a tripod base.

  • Patient swings uninjured leg through without allowing the injured limb to contact the ground.

• Four-Point Crutch Gait:

  • Patient moves crutch and opposite foot forward sequentially in partial weight-bearing states.

• Stair Climbing Mechanics:

  • Ascending Stairs ("Up with the good"):

  1. Support body weight on crutches.

  2. Step up onto the step with the unaffected (uninjured) leg.

  3. Transfer body weight to the unaffected leg.

  4. Pull the affected leg and crutches up to the same step.

  • Descending Stairs ("Down with the bad"):

  1. Lower crutches and affected leg down onto the lower step.

  2. Shift body weight to crutches.

  3. Step down with the unaffected leg onto the same step.

• Weight-Bearing Progression Continuum:

  • Non-Weight Bearing (NWB) $\rightarrow$ Touchdown Weight Bearing (TDWB) $\rightarrow$ Partial Weight Bearing (PWB) $\rightarrow$ Full Weight Bearing (FWB).