Emergency Action Emergency Action PlansPlansJennifer L. Doherty, MS, ATC/LJennifer L. Doherty, MS, ATC/L

Florida International UniversityFlorida International University

The Sports Medicine The Sports Medicine TeamTeam

Sports Medicine Team must work Sports Medicine Team must work together to properly execute an EAPtogether to properly execute an EAP ATCs, Team Physician, EMTs, ATSs, ATCs, Team Physician, EMTs, ATSs,

others?others?

TIME and TEAMWORK is critical TIME and TEAMWORK is critical ATC is usually the first on the sceneATC is usually the first on the scene

Emergency Action Plan Emergency Action Plan (EAP)(EAP)

Primary concerns: Primary concerns: Check the scene (is it safe?)Check the scene (is it safe?) Initial Survey Initial Survey Activate EAP/EMSActivate EAP/EMS Establish and maintain CV functionEstablish and maintain CV function

Secondary concern: Secondary concern: Establish level CNS functionEstablish level CNS function Treat/Prepare the victim to be transportedTreat/Prepare the victim to be transported

Developing an EAPDeveloping an EAP

Separate plans should be developed for each Separate plans should be developed for each facilityfacility Outline personnel and roleOutline personnel and role Identify necessary equipmentIdentify necessary equipment

Establish equipment and helmet removal Establish equipment and helmet removal policies and procedurespolicies and procedures

Availability of phones and access to 911Availability of phones and access to 911 Coach should be familiar with community-Coach should be familiar with community-

based emergency health care delivery planbased emergency health care delivery plan Be aware of communication, transportation, Be aware of communication, transportation,

treatment policiestreatment policies

Developing an EAPDeveloping an EAP

Community-based care (continued)Community-based care (continued) Individual calling medical personnel must relay the Individual calling medical personnel must relay the

following: 1) type of emergency 2) suspected injury following: 1) type of emergency 2) suspected injury 3) present condition 4) current assistance 5) location 3) present condition 4) current assistance 5) location of phone being used and 6) location of emergency of phone being used and 6) location of emergency

Keys to gates/locks must be easily accessibleKeys to gates/locks must be easily accessible Key facility and school administrators must be Key facility and school administrators must be

aware of emergency action plans and be aware aware of emergency action plans and be aware of specific rolesof specific roles

Individual should be assigned to accompany Individual should be assigned to accompany athlete to hospitalathlete to hospital

Developing an EAPDeveloping an EAP

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

ambulance?ambulance?

Developing an EAPDeveloping an EAP

Are the location of phones and Are the location of phones and emergency phone numbers known?emergency phone numbers known?

Who has the keys to open Who has the keys to open gates/padlocks/buildings?gates/padlocks/buildings?

What is the address of the field and the What is the address of the field and the location of suitable entrances?location of suitable entrances?

Developing an EAPDeveloping an EAP

What information should be given over the What information should be given over the phone?phone? Type of emergency situationType of emergency situation Demographics of the athleteDemographics of the athlete Type of suspected injuryType of suspected injury Present condition of the athletePresent condition of the athlete Current assistance being givenCurrent assistance being given LocationLocation DirectionsDirections

Executing an EAPExecuting an EAP

Developing a site specific planDeveloping a site specific plan Delegating specific duties for each member of Delegating specific duties for each member of

the sports medicine teamthe sports medicine team Contacting other entities to offer input on an Contacting other entities to offer input on an

EAP (i.e. Local EMS, campus police)EAP (i.e. Local EMS, campus police) Reviewing an EAP as a teamReviewing an EAP as a team

Identify potential weakness and create back-up Identify potential weakness and create back-up plansplans

PRACTICE MAKES PERFECT!PRACTICE MAKES PERFECT!

INJURY

Unconscious Athlete Conscious Athlete

Primary Survey

ResponsivenessAirway

BreathingCirculation

Secondary Survey

Vital SignsHistory

Musculoskeletal Evaluation

Treatment Considerations

Transportation

Principles of AssessmentPrinciples of Assessment

Appropriate acute care cannot be Appropriate acute care cannot be provided without a systematic assessment provided without a systematic assessment occurring on the playing field firstoccurring on the playing field first

On-field assessmentOn-field assessment Determines nature of injuryDetermines nature of injury Provides information regarding direction of Provides information regarding direction of

treatmenttreatment Divided into primary and secondary surveyDivided into primary and secondary survey

Performed initially to establish presence Performed initially to establish presence of life-threatening conditionof life-threatening condition

Airway, breathing, circulation, shock Airway, breathing, circulation, shock and severe bleeding and severe bleeding

Used to correct life-threatening Used to correct life-threatening conditionsconditions

Primary surveyPrimary survey

Secondary surveySecondary survey

Life-threatening condition ruled outLife-threatening condition ruled out Gather specific information about injuryGather specific information about injury Assess vital signs and perform more Assess vital signs and perform more

detailed evaluation of conditions that do detailed evaluation of conditions that do not pose life-threatening consequencesnot pose life-threatening consequences

TheThe Unconscious AthleteUnconscious Athlete

Assume life-threatening conditionAssume life-threatening condition Note body position and LOCNote body position and LOC Check and establish airway, breathing, Check and establish airway, breathing,

circulation (ABC)circulation (ABC) Assume neck and spine injuryAssume neck and spine injury

Once stabilized, a secondary survey Once stabilized, a secondary survey should be performedshould be performed

Opening the AirwayOpening the Airway

Head-tilt, chin lift Head-tilt, chin lift methodmethod

Push down on the Push down on the forehead and lifting forehead and lifting the jaw moves the the jaw moves the tongue from the back tongue from the back of the throatof the throat

Modified Modified technique can technique can be used when be used when neck injury is neck injury is suspectedsuspected

Modified jaw Modified jaw thrust thrust maneuvermaneuver

Establishing BreathingEstablishing Breathing

Look, listen, and feelLook, listen, and feel Pinch nose, hold Pinch nose, hold

head backhead back Take deep breath, Take deep breath,

create seal around create seal around lips, and perform 2 lips, and perform 2 slow breaths slow breaths Each breath should Each breath should

last 1 secondlast 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 Means of Artificial RespirationRespiration

Establishing CirculationEstablishing Circulation

Locate Locate carotid artery carotid artery and palpate and palpate pulse while pulse while maintaining maintaining head-tilt head-tilt positionposition

Locate the center Locate the center of the breastboneof the breastbone

Place one hand Place one hand with the edge of with the edge of the palm on the the palm on the center of the center of the breast bonebreast bone

Place other hand Place other hand on top with fingers on top with fingers parallel and parallel and directed away from directed away from athletic trainerathletic trainer

Keep elbows locked Keep elbows locked with shoulders directly with shoulders directly above patientabove patient

Compress chest 1.5 - 2” Compress chest 1.5 - 2” 30 times per 2 30 times per 2

breathsbreaths For child (<8yr.) 30:2 For child (<8yr.) 30:2

ratio should also be ratio should also be usedused Compress chest 1-1.5 Compress chest 1-1.5

inchesinches Look for movement and Look for movement and

recheck for breathing recheck for breathing every two minutes. every two minutes. If not present If not present

continue cyclecontinue cycle

Obstructed Airway Obstructed Airway ManagementManagement

Choking is a possibility in many activitiesChoking is a possibility in many activities Mouth pieces, broken dental work, tongue, Mouth pieces, broken dental work, tongue,

gum, blood clots from head and facial gum, blood clots from head and facial trauma, and vomit can obstruct the airwaytrauma, and vomit can obstruct the airway

Individual cannot breath, speak, or Individual cannot breath, speak, or cough, may become cyanoticcough, may become cyanotic

The standing abdominal thrust technique The standing abdominal thrust technique with back blows can be used to clear the with back blows can be used to clear the airwayairway

Stand behind athlete Stand behind athlete with one fist against with one fist against the body and other the body and other over top just above over top just above the navelthe navel

Provide forceful Provide forceful thrusts to abdomen thrusts to abdomen (up and in).(up and in).

Next perform 5 back Next perform 5 back blows just between blows just between the scapula with the the scapula with the patient in a bent over patient in a bent over positionposition

Repeat these steps Repeat these steps until the obstruction until the obstruction is clearis clear

If athlete becomes unconscious, open airway If athlete becomes unconscious, open airway and attempt to ventilateand attempt to ventilate

If airway still obstructed, re-tilt and re-ventilateIf airway still obstructed, re-tilt and re-ventilate If no ventilation, perform 5 chest thrusts, finger If no ventilation, perform 5 chest thrusts, finger

sweep to clear obstruction, and two breaths.sweep to clear obstruction, and two breaths. Be sure not to push object in further with sweepBe sure not to push object in further with sweep

Repeat cycle until air goes inRepeat cycle until air goes in When athlete begins to breath on own, place in When athlete begins to breath on own, place in

comfortable recovery position while lying on comfortable recovery position while lying on their sidetheir side

Index finger Index finger should be inserted should be inserted in mouth along in mouth along cheekcheek

Using hooking Using hooking maneuver, pull maneuver, pull across to free across to free impedimentimpediment

Attempt to Attempt to ventilate twice ventilate twice after each sweep after each sweep until athlete is until athlete is breathingbreathing

Automatic External Automatic External Defibrillator (AED)Defibrillator (AED)

Device that evaluates heart rhythms of Device that evaluates heart rhythms of victims experiencing cardiac arrestvictims experiencing cardiac arrest

Can deliver electrical charge to the heartCan deliver electrical charge to the heart Fully automated - minimal training Fully automated - minimal training

requiredrequired Electrodes are placed at the left apex Electrodes are placed at the left apex

and right base of chest - when turned on, and right base of chest - when turned on, machine indicates if and when machine indicates if and when defibrillation necessarydefibrillation necessary

Conducting a Secondary Conducting a Secondary SurveySurvey

Once athlete is Once athlete is deemed stable, deemed stable, secondary survey secondary survey can begincan begin

Recognizing vital signsRecognizing vital signs Heart rate and breathing Heart rate and breathing

raterate Blood pressureBlood pressure TemperatureTemperature Skin colorSkin color PupilsPupils MovementMovement Presence of painPresence of pain Level of consciousnessLevel of consciousness

On-Field Injury On-Field Injury InspectionInspection

Determine injury severity and Determine injury severity and transportation from fieldtransportation from field

Must use logical process to adequately Must use logical process to adequately evaluate extent of traumaevaluate extent of trauma

Knowledge of mechanisms of injury and Knowledge of mechanisms of injury and major signs and symptoms are criticalmajor signs and symptoms are critical

Once the mechanism has been determined, Once the mechanism has been determined, specific information can be gathered specific information can be gathered concerning the affected areaconcerning the affected area Brief historyBrief history Visual observationsVisual observations

Gently palpate to aid in determining nature Gently palpate to aid in determining nature of injuryof injury Determine extent of point tenderness, irritation Determine extent of point tenderness, irritation

and deformityand deformity

Decisions can be made with regard to:Decisions can be made with regard to: Seriousness of injurySeriousness of injury Type of first aid and immobilizationType of first aid and immobilization Whether condition require immediate referral to Whether condition require immediate referral to

physician for further assessmentphysician for further assessment Manner of transportation from injury site to sidelines, Manner of transportation from injury site to sidelines,

training room or hospitaltraining room or hospital

Individual performing initial assessments should Individual performing initial assessments should document findings of exam and actions takendocument findings of exam and actions taken

Off-Field AssessmentOff-Field Assessment

Performed by athletic trainer or physician Performed by athletic trainer or physician once athlete has been removed from site once athlete has been removed from site of injuryof injury

Divided into 4 segmentsDivided into 4 segments HistoryHistory ObservationObservation Physical examinationPhysical examination Special testsSpecial tests

History History Obtain information about injuryObtain information about injury Listen to athlete and how key questions Listen to athlete and how key questions

are answeredare answered

Visual ObservationVisual Observation Inspection of injured and non-injured areasInspection of injured and non-injured areas Look for gross deformity, swelling, skin Look for gross deformity, swelling, skin

discoloration discoloration

Off-Field AssessmentOff-Field Assessment

PalpationPalpation Assess bony and soft tissueAssess bony and soft tissue Systematic evaluation beginning with light Systematic evaluation beginning with light

pressure and progressing to deeper palpation – pressure and progressing to deeper palpation – beginning away from injured areabeginning away from injured area

Special TestSpecial Test Designed for every body region for detecting Designed for every body region for detecting

specific pathologiesspecific pathologies Used to substantiate findings from other testingUsed to substantiate findings from other testing

Off-Field AssessmentOff-Field Assessment

Immediate Treatment Immediate Treatment Following Acute InjuryFollowing Acute Injury

Primary goal is to Primary goal is to limit swelling and limit swelling and extent of extent of hemorrhaging hemorrhaging

If controlled initially, If controlled initially, rehabilitation time will rehabilitation time will be greatly reducedbe greatly reduced

Control via PRICEControl via PRICE PROTECTIONPROTECTION RESTREST ICEICE COMPRESSIONCOMPRESSION ELEVATIONELEVATION

PROTECTIONPROTECTION Prevents further injuryPrevents further injury Immobilization and appropriate forms of Immobilization and appropriate forms of

transportation will prevent further damagetransportation will prevent further damage REST REST

Allows healing to begin immediatelyAllows healing to begin immediately Days of rest differ according to extent of injuryDays of rest differ according to extent of injury Rest should occur 72 hours before rehab Rest should occur 72 hours before rehab

beginsbegins

ICE (Cold Application)ICE (Cold Application) Initial treatment of acute injuriesInitial treatment of acute injuries

Used for strains, sprains, contusions, and inflammatory Used for strains, sprains, contusions, and inflammatory conditionsconditions

Used to decrease painUsed to decrease pain Promotes vasoconstrictionPromotes vasoconstriction Lowers metabolism and tissue demand for oxygen Lowers metabolism and tissue demand for oxygen

Ice should be applied for 20 min.Ice should be applied for 20 min. Repeat every 1 - 1 1/2 hrs. Repeat every 1 - 1 1/2 hrs. Applied during the first 72 hrs.Applied during the first 72 hrs.

COMPRESSIONCOMPRESSION Decreases space allowed for swelling to Decreases space allowed for swelling to

accumulateaccumulate Important adjunct to elevation and cryotherapy, Important adjunct to elevation and cryotherapy,

and may be most important componentand may be most important component A number of means of compression can be A number of means of compression can be

utilized (Ace wraps, foam cut to fit specific utilized (Ace wraps, foam cut to fit specific areas for focal compression)areas for focal compression)

Compression should be maintained daily and Compression should be maintained daily and throughout the night for at least 72 hoursthroughout the night for at least 72 hours

ELEVATIONELEVATION Reduces internal bleeding due to forces of Reduces internal bleeding due to forces of

gravitygravity Prevents pooling of blood and aids in Prevents pooling of blood and aids in

drainage drainage Greater elevation = more effective reduction Greater elevation = more effective reduction

in swellingin swelling

Emergency Action PlanEmergency Action Plan

Must be executed with techniques that Must be executed with techniques that will not result in additional injurywill not result in additional injury

No excuse for poor handling No excuse for poor handling Planning is necessary and practice is Planning is necessary and practice is

essential essential Additional equipment may be requiredAdditional equipment may be required