Care of the injured athlete

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Care of the injured athlete

• Gymnastics Pit extraction

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Ada County Paramedics

• Steve Cole
• Cool Dude

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Disclaimer

• Although the information presented here is
  developed from practice , and published
  guidelines, it is in no way meant to replace or
  supercede local protocols.
• It is intended for educational and conceptual use
  only.
• Ada County Paramedics accepts no responsibility
  for the use/misuse of the information provided
  here.
• When in doubt, consult with your local medical
  guidance.

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Objectives

• Adapt and refine standard immobilization skills
  to the unstable gymnastics pit environment.
• Gain knowledge on the Ladder approach and Mat
  approach to accessing the injured patient with
  spinal injury.
• Lean the pros and cons of rapid entry and
  delayed entry techniques.

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Background

• 33 of fatal and catastrophic injuries that
  occur in college level winter athletics
  occurred with Gymnastics (in 1998).
• The majority of these were related to spinal
  cord/cervical injury.
• A unique factor in these injuries is that safety
  equipment, like many professional sports, while
  designed to protect the athlete, become a
  hindrance to care in the event the athlete is
  seriously injured.
• As a result of this , new guidelines have been
  published on the care of injured gymnast,
  including spinal immobilization techniques.

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Background

• The greatest hindrance in gymnastics to prompt
  emergency care is the gymnastics pit. These
  pits are either filled with foam chunks/squares
  or a large foam mat.
• The greatest number of lawsuits against gymnastic
  centers currently from injuries sustained by
  visitors (parents) involved in horseplay.

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Gymnastics Pit
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The Gymnastics Pit

• A Typical pit will be 10 by 20 feet and approx.
  6-8 feet deep. This produces a very safe crash
  landing area for the routine mishaps in
  gymnastics.
•  This also creates a very unstable platform to
  access the patient on. Any movement by occupants
  entering the pit will often transfer to the
  patient. The debris in the pit will hinder any
  attempts at immobilization.
• Thus special methods of accessing the patient
  have been developed.
• Some rest on a trampoline style frame and
  suspension system. These are called self
  fluffing
• Some are simply Pits filled with foam chunks

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Local Information

• There are two known pits in Ada County
• BSU- by the pavilion
• Gem State Gymnastics at 5420 West State Street
• When discovering that there is a Gymnastics Pit
  Extraction, please notify other incoming units.

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SPECIAL NOTE

• All of these methods assume that the patient
  does not have any immediate airway, respiratory,
  or cardiac compromise.
• In case of need of life saving interventions
  (like CPR) then rapid extrication by staff on
  hand while maintaining alignment as best as
  possible is recommended.

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Pre- EMS Actions
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The S.T.O.P. ProcedureTaught to trainers

• S Stop all activity around the section
• T Talk to the injured athlete
• O Observe the injured Athlete from outside the
  pit for breathing, movement, etc
• P prevent further injury. Proceed carefully into
  the pit based on perceived need
• Again If an immediate threat to the ABCs is
  perceived then direct entry is indicated.

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S.T.O.P.
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C- Spine Immobilization

• The Jaw thrust is preferred for opening the
  airway in trauma.
• The decision to provide more advanced care in the
  pit is made on a case by case basis
• While most areas have back boards available,
  these will generally only be used before EMS
  arrival if a life threat exists.

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Moving in the pit

• May be over your head
• Will be deeper than it looks
• Sudden movement stir up dust, may cause the
  athlete to move
• We found that taking off boots helped

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Pit extraction Steps

• S.T.O.P. (already discussed)
• Pt. Access
• Pit Entry
• PT immobilization
• PT removal

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Pt. Access

• Three Methods
• Direct entry
• Ladder Access
• Mat Access

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Pt. Access Direct Entry

• Quickest
• No Special Equipment
• The most potential movement to the patient
• Should be done slow
• moving foam as you go

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Pt. Access- Direct Entry
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Pt. Access- Ladder Access

• Uses a standard FD roof ladder (16 feet ) to span
  the pit
• The ladder is placed just above the patients
  head.
• Provides a stable platform for assessment and
  securing c spine.
• FD always has a ladder
• What we found the easiest to do after trying all
  methods

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Pt. Access- Ladder Access
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Pt. Access- Ladder Access
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Pt. Access- MAT Access

• Uses a standard 4 gymnastics mat to access the
  patient
• The Mat distributes the weight of the person
  across the pit
• Some movement may be transferred to the pt
• Must spider crawl
• Always available.

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Pt. Access- MAT Access
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Pt. Access- MAT Access
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Pt. Access- MAT Access

• Though not illustrated in the photos, in larger
  pits, the same technique is used to move mats in
  to each side and provide access to the patient as
  well.
• In the smaller pits, we discovered it to be a
  hindrance.

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Pit Entry/Pt Access- foam removal

• Often the pt. is buried by the foam.
• Foam is moved only when it covers the patient or
  interferes with the ABCs
• The foam beneath the patient provides the support
  for the patient
• Removing foam beneath the patient will cause the
  pt. to sink lower in the pit.

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Pt. Immobilization

• The pt. is often found in a pseudo seating
  position when supine
• However pt may be prone, sideways, or even head
  lowest.
• In our experience 4-5 people were required to
  safely immobilize and remove the pt. from the
  pit.
• 1 on C-Spine, 2 on each side of the pt.

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Pt. Immobilization

• The back board seemed to work best, as when the
  pt. was on the board the board distributed the
  pt.s weight across the foam.
• Other devices may be indicated (KED, Vacuum
  mattress)

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Pt. Immobilization
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Pt. Immobilization
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Pt. Immobilization
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Pt removal

• Once the patient is packaged, we found it easiest
  to remove the pt. by the means we made first
  entry.
• The ladder was by far the easiest in our
  training.
• The mat works well too.
• Wading through the debris, lifting over our head
  was pretty hazardous.

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Pt removal using a Mat
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Pt removal using a ladder
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Pt removal using a ladder
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Summary

• This practice session brought to light a whole
  set of issues not normally encountered
• The most important lesson was to stop and
  carefully assess the situation, just like any
  other rescue
• Utilization of proper resources is the issue

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Questions?