Emergency Procedures

1
Chapter 2

• Emergency Procedures

2
The Emergency Action Plan

• A process for activating EMS
• Should be written for each activity site
• Plan should answer questions in Box 2-1
• Individual responsibilities and protocols should
  be reviewed
• Should meet annually with EMS to review
  procedures
• Should be practiced regularly

3
The Emergency Action PlanContinued

• EAP members should be certified in first aid and
  CPR
• Emergency medical supplies and equipment should
  be easily accessible ATCs responsibility
• The most medically qualified on-site individual
  should assume responsibility

4
Emergency Situations

• Primary survey
• Assess life threatening conditions Box 2-4
• A,B,Cs
• Triage-assessing all injuries quickly and then
  returning to the more serious injuries
  immediately - MASH
• Secondary survey
• Detailed head to toe assessment
• Signs measurable objective findings-bleeding,
  fluid
• Symptoms subjective info provided by person

5
Secondary SurveyHOPS

• If the athlete is talking and moving, start your
  2nd survey if they are unconscious call 911 if
  they are unconscious and ABCs are adequate begin
  2nd survey
• History
• Observation
• Palpation
• Special Test

6
History

• History-gather subjective information via a
  series of questions see Field Strategy 2.2
• Type of pain, Location of Pain, Mechanism of
  injury, Nauseous or sick to stomach, any ringing
  in the ears, sensations in body
• Questions should be open ended
• A person who is not fully responsive may have a
  head or neck injury
• Diplopia double vision

7
Observation

• Survey the scene as you come on to it
• Look dont touch What to look for
• Bleeding, discoloration, swelling, obvious
  deformity, fluid from ears/nose, state of athlete
  (alert, lethargic, restless), pupil size,
  tracking, and reaction to light
• Observe bilaterally

8
Palpation

• Using your hands to feel for abnormalities in
  bone or soft tissue
• Palpate bilaterally- good (uninjured) then bad
  (injured) palpate for
• Local heat, swelling, deformity, crepitus, point
  tenderness, muscle spasm, pain, sensations at
  site of injury and below
• Start away from the injury and move toward start
  with light touches and increase pressure

9
Special Test

• Limited in an emergency situation main job is to
  determine if possible spinal cord injury
• Avoid any unnecessary movement
• Motor test muscle test-ask to wiggle fingers
  and toes, then compare bilateral grip and foot
  strength
• If athlete is unconscious, try painful
  stimulation- pinching the soft tissue in the
  armpit may make their eyelid flutter or
  involuntary movement away from the stimulus
• If no response, do not move, wait for EMS, and
  monitor ABC

10
Unconscious Athlete

• Call 911 for all unconscious athletes
• Head injuries are 1 cause for loss of
  consciousness
• Use Glasgow coma scale to quantify
• http//www.neuroskills.com/tbi/glasgow.shtml
• Always assume serious neck injury
• See guidelines to help an unconscious
  athlete-p.17 1-10.

11
Hemorrhage

• Three types of bleeding
• Arterial bright red, spurting
• Venous dark bluish-red, steady flow
• Capillary red, oozing
• Treatment
• Direct pressure
• Elevation (if no fracture)
• Pressure points (femoral/brachial arteries)

12
Wound Cleansing

• Wear gloves
• Clean wound with saline, mild soap
• Dont use alcohol or concentrated peroxide (water
  it down)
• Soak wounds (if appropriate) in betadine solution
• Apply ointments (neosporine etc)

13
Wound Dressing

• Apply Occlusive dressings
• Second skin
• Duoderm
• Covering wound
• Use telfa pad/ ointment/ tape
• Allow the wound to breath at night in a
  controlled environment-cover before sleeping in
  the beginning

14
Fractures

• C/S-direct contact, fall, dynamic overload
• Signs swelling, bruising, deformity, shortening
  of the limb, crepitus, disability
• Types-open (c),closed (s), transverse,
  epiphyseal, avulsion
• Five ways of recognizing fracture Figure 4-12
• Palpation
• Percussion
• Vibration
• Compression (be careful)
• Distraction (be careful)

15
Treating Fractures

• Splint before moving-Follow 1st Aid/Safety Rules
• Types of splints
• Anatomic
• Stiff/rigid
• Soft
• Vacuum
• Check skin color, temp, and capillary refill
  before and after splinting

16
Shock

• Shock can occur with any injury involving pain,
  bleeding, internal trauma, fracture, or spinal
  injury
• Occurs when the heart is unable to exert
  adequate pressure to circulate enough oxygenated
  blood to the vital organs.
• S/S- Box 2-6 p.18
• Treatment-Elevate legs, keep warm, monitor ABCs
  See P. 18

17
Heat injuries

• Ways of cooling body Box 2-8
• Evaporation (sweat)
• Conduction (coming in contact with cool object)
• Convection (air/water flow)
• Dehydration increases chances for heat illness

18
Preventing Heat Illness

• Identify at risk individuals-children pre-season
  athletes
• Acclimatize athletes 7-10 days 2-4 hrs/day
• Wear appropriate clothing-light weight,
  light-colored, porous
• Fluid hydration-should be often and unlimited
  8-12 cups 24 hrs before 5-10oz during every 15
  mins 24 oz after for every lb lost
• Weight Charts

19
Preventing Heat Illness-Cont

• Temperature/ humidity guide workouts-Fig
  2-2http//www.srh.noaa.gov/elp/wxcalc/heatindex.h
  tml
• Allow humidity and temperature to guide workouts
• Practice schedules

20
Types of heat illness

• Heat cramps
• Muscle spasms caused by electrolyte loss-early in
  season
• Heat exhaustion
• More common early in season
• S/Sx (signs and symptoms) dizziness, headache,
  profuse sweating, rapid breathing, gray skin,
  rapid weak pulse, uncoordinated gait, elevated
  temp, nausea

21
Types of Heat Illness (2)

• Heat stroke
• Bodys temp control mechanisms have shut down
• MEDICAL EMERGENCY-CALL 911
• S/Sx unconscious, sweating has stopped, shallow
  breathing, hot dry red skin, rapid strong pulse
  (bounding), high body temp, convulsions,
  seizures, comma

22
Treating Heat Illness

• Move person to cool place
• Remove equipment/unnecessary clothes
• Lie person on back, with feet elevated
• Give cool fluids (unless unconscious)
• Specifics See table 2.1
• Heat cramps stretch, ice, drink cool fluids
• Heat exhaustion call EMS (if necessary), rest
  in cool room utilize cool/wet towels
• Heat Stroke call EMS, RAPID COOLING

23
Hypothermia

• Reduced core body temperature
• S/Sx intense shivering, inability to perform
  tasks, speaking difficult, incoordination, in
  severe cases unconscious (see table 2.2)
• Treatment Maintain ABCs, Activate EMS, remove
  wet clothing, jewelry, give warm fluids, re-warm
  person

24
Frostbite

• Most common in fingertips, toes, earlobes, tip of
  nose
• Occurs when soft tissue freezes
• Superficial Involves skin and superficial tissue
• Deep Involves subcutaneous layers, tissue
  destruction
• S/Sx red swollen skin diffuse numbness, skin
  turns yellow-white/ blue with waxy look
• Treatment remove wet clothing re-warm area
  immediately cover with sterile dressing
  transport to hospital

25
Vital Sign Assessment

• Respirations (Normal (N) 12(A)-20(C)
• Skin Color
• Rubor red skin
• Pallor pale skin
• Pupils (light reflex) and vision
• Pulse (N60-80)
• Blood pressure