1. FIRST AID FOR BASEBALL COACHES John K. Murphy, PA-C, JD

2. GOALS This course is designed to instruct coach very basic first aid techniques to protect the players under your guidance. This presentation only provides a brief overview of the issues that you may face during the time you are with these players. Recommend – 8 hour First Aid & CPR Course

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4. LEGAL PROTECTION Good Samaritan Law RCW 4.24.300 –Qualified Immunity from liability for certain types of medical care. –Any person, including but not limited to a volunteer provider of emergency or medical services, who without compensation or the expectation of compensation renders emergency care at the scene of an emergency or who participates in transporting, not for compensation, therefrom an injured person or persons for emergency medical treatment shall not be liable for civil damages resulting from any act or omission in the rendering of such emergency care or in transporting such persons, other than acts or omissions constituting gross negligence or willful or wanton misconduct.

5. AED Defibrillation RCW 70.54.310 –Law outlines the rules associated with the acquisition, training, requirement of medical direction from a licensed physician, maintenance, notification of emergency medical service of the ownership of such equipment and notification of 911 after the use of this equipment. –The law also provides a limited immunity for civil liability associated with the user of the equipment, but specifically restricts immunity based on gross negligence.

6. Zachery Lystedt Law RCW 28A.600.190 Youth athletes who are suspected of sustaining a concussion or head injury be removed from play. "When in doubt, sit them out" School districts to work with the Washington Interscholastic Activities Association (WIAA) to develop information and policies on educating coaches, youth athletes and parents about the nature and risk of concussion, including the dangers of returning to practice or competition after a concussion or head injury. All student athletes and their parents/guardians sign an information sheet about concussion and head injury prior to the youth athlete's initiating practice at the start of each season. Youth athletes who have been removed from play receive written medical clearance prior to returning to play from a licensed health- care provider trained in the evaluation and management of concussion. Private, nonprofit youth sports associations wanting to use publicly owned playfields comply with this law.

7. Concussion signs observed include: Appears dazed Vacant facial expression Confused about assignment Forgets plays, positions or past immediate performance Is unsure of game, score, or opponent Moves clumsily or displays lack of coordination Answers questions slowly Slurred speech Shows behavior or personality changes Can’t recall events prior to hit Can’t recall events after hit Seizures or convulsions Any change in typical behavior or personality Loses consciousness

8. Late symptoms of concussion may include one or more of the following: ** Unconsciousness ** Nausea or vomiting Balance problems or dizziness Blurred, double, or fuzzy vision Pressure in head Neck pain Sensitivity to light or noise Feeling sluggish or slowed down Feeling foggy or groggy Drowsiness Repeating the same question/comment Change in sleep patterns Amnesia “Don’t feel right” Fatigue or low energy Sadness Nervousness or anxiety Irritability More emotional Confusion Concentration or memory problems (forgetting game plays)

9. IMMEDIATE TREATMENT Remove from play Have child evaluated by qualified Health Care provider –MD, DO, PA, Trainer, ARNP Generally observe at home –Any change in signs and Symptoms, immediate return to Emergency Room or Health Care Practitioner

10. January 2009 Coach Pleads Not Guilty to Reckless Homicide January 2009 Football player collapsed from heat stroke during the Aug. 20 practice in the sweltering Kentucky heat and died three days later. Withheld water from players –Core temperature reported at 107 degrees "Good Morning America"The family of the 15-year-old football player sued the coaching staff to bring awareness to hydration and heat-related illnesses so that "maybe this won't happen again," the boy's stepmother told "Good Morning America" The head football coach pleaded not guilty to charges of reckless homicide. –Reckless Homicide - Consciously disregarding a known and substantial risk of harm Criminal Trial – Ended September 2009 – AcquittedCriminal Trial – Ended September 2009 – Acquitted Civil Trial – Family sues – Trial Scheduled 2010Civil Trial – Family sues – Trial Scheduled 2010

11. ----- continued All the coaches were named in a civil lawsuit by Gilpin's parents, accusing the coaches of negligence and "reckless disregard." Gilpin’s parents have filed a civil suit against Stinson and several other school officials. Washington State has a wrongful death statute which allows surviving relatives such as a parent, spouse or child to bring a civil suit on behalf of their deceased loved one.wrongful death statute –In wrongful death cases, the family of the deceased may recover damages against the person whose negligence caused the family member's death

12. SOME IMPORTANT PRINCIPLES WHILE COACHING First - DO-NO-HARM The short person under your care is a child –Do not treat them as professional athletes –Having fun is the primary priority Kids get injured –The LOUDER a child cries the less injury they sustained –The QUIET ones are the one that should worry you Most injuries are minor and can be treated with simple measures It will be highly UNLIKELY that you will encounter a life threatening injury

13. BASIC PRINCIPLES OF FIRST AID A, B, C, D – CALL 911 –Airway Open and listen for air exchange –Breathing Look for obstruction – gum or tobacco – sometimes food –Circulation Create a circulation Control bleeding –Defibrillation if necessary –Call – 911

14. HEAD AND NECK –HEAD - Skull Fractures or facial injuries Depressed or Penetrating Concussion –Eye Injuries –Foreign bodies –Fingers into the eye –Corneal Abrasions/lacerations –Struck by ball –Teeth Injuries –Chipped or loose teeth – see dentist as soon as possible –Tooth displaced - Keep the tooth –Try to re-implant if you have the whole tooth plus the root structure »MAKE SURE IT POINTS THE RIGHT WAY –Place in a cup of milk and have the parent transport to their dentist or the ER –Tuck tooth in-between cheek an gum – transport to dentist or ER –NOSE – Fractures Bleed a lot Direct Pressure on the sides (bridge) of the nose controls bleeding Ice Seek medical attention

15. HEAD AND NECK –NECK - Neck Injuries Stabilize head with hand stabilization Obstructed Airway’s need to be cleared Do not manipulate the head Significant Neck Injury –Numbness, burning sensation –inability to move lower extremities –NEUROLOGIC Epileptic –Head Trauma Induced High internal temperatures –Environmental caused Low Blood Sugar –Diabetic? Current Medical Condition?

16. CHEST AND ABDOMEN –CHEST - Chest Trauma Rib Fractures Respiratory Distress Respiratory Arrest –CARDIAC ARREST - Hit by pitched ball in the chest Heart operates on electrical discharge Cardiac Contusions Pre-disposition with a hidden or occult cardiac defect –ABDOMEN - Abdominal Injuries Spleen Liver Penetrating Injuries

17. ---- continued –RESPIRATORY EMERGENCIES Asthma Allergic Reactions –Bee Stings –Peanuts Epi Pens

18. ARMS AND LEGS Fingers and Toes –SKELETAL - Fractures Fractures –Management – splint, ice and transport Sprains and Strains –Sprain involves the ligaments supporting a joint »Ligaments attach bone to bone –Strains involves muscles and tendons »Tendons anchor muscles to bone

19. Sprains Ice Compression Elevation (ICE)

20. Fractures Splint & Ice, Compression, Elevation (ICE)

21. SKIN Contusions Abrasions Lacerations Punctures

22. EVERYTHING ELSE –ENVIRONMENTAL Dehydration –Periodic Rest and Fluid Replacement Hypothermia –Low body temperature – warm and dry Hyperthermia –High Body Temperature »Heat Exhaustion – stopped sweating – increase body temperature »Heat Stroke – high body temperature, unconsciousness and possible seizures Sunburn –Treat with Aspirin (internally) and White Vinegar (externally)

23. INITIAL INJURY MANAGEMENT Airway Breathing Circulation – if child is laying on ground resist the urge to pick them up Opening and maintaining an airway; Breathing for the ill or injured persons; Check for Circulation –Administering cardiopulmonary resuscitation

24. ----- continued Provide first aid for simple and multiple system trauma –Controlling bleeding, –Bandaging wounds, –Manually stabilizing injured extremities. Liberal Application of ICE on Sprains & Strains –ICE = Ice, Compression, Elevation –Real Ice or Chemical Packs?

25. ACCESS EMS SYSTEM 911 – know your location Call 911 for the following –Cardiac or respiratory arrest –Difficulty in breathing –Uncontrolled bleeding –Fractures that stick through the skin –Unconsciousness –Seizures –Allergic Reaction –Things poking out of - or into them

26. REPORTING THE INCIDENT Liability Issues. –Do the right thing –State provides qualified immunity Provide written documentation to league as per league protocol. –Incident Reporting Form Name Incident Treatment Disposition

27. BIOLOGIC - INFECTIOUS DISEASE PROTECTION If it is wet and not yours, don’t touch it –Wash your hands after treating bloody or snotty kids Lots of product on the market –Wear gloves if available –Don’t freak out if you get blood or body fluid on your skin Transmission of infectious disease is remote through intact skin

28. Play or Not Play This is a decision that you should make after evaluation of the child’s injury. The safe course is to have them sit out for a period of time. DO NOT be influenced by parental desire for “Johnny or Janie” to gut it out – “no blood no foul” is not the rule of the day

29. First Aid Kit Essentials Band-Aids Tape 1” or 1.5 inch Ice Packs – Ziploc bags or chemical Splinting Material –Newspapers –Magazines Disposable gloves Paper Cups 4x4 gauze pads 2” or 3” Gauze Wrap Small Water bottles –Washing off cuts and scrapes –Irrigating the eye Antibiotic Ointment –Neosporin Safety Scissors Tweezers Cell Phone

30. And if all else fails

31. THANK YOU FOR ALL THAT YOU DO PLEASE FEEL FREE TO CONTACT ME IF YOU HAVE A MEDICAL OR LEGAL QUESTION AT: j.k.murphy@comcast.net OR CALL 206-940-6502