1. Emergency Action Plans
Jennifer L. Doherty, MS, ATC/L
Florida International University

2. The Sports Medicine Team
Sports Medicine Team must work together to properly execute an EAP
ATCs, Team Physician, EMTs, ATSs, others?
TIME and TEAMWORK is critical
ATC is usually the first on the scene

3. Emergency Action Plan (EAP)
Primary concerns:
Check the scene (is it safe?)
Initial Survey
Activate EAP/EMS
Establish and maintain CV function
Secondary concern:
Establish level CNS function
Treat/Prepare the victim to be transported

4. Developing an EAP Separate plans should be developed for each facility
Outline personnel and role
Identify necessary equipment
Establish equipment and helmet removal policies and procedures
Availability of phones and access to 911
Coach should be familiar with community-based emergency health care delivery plan
Be aware of communication, transportation, treatment policies

5. Developing an EAP Community-based care (continued)
Individual calling medical personnel must relay the following: 1) type of emergency 2) suspected injury 3) present condition 4) current assistance 5) location of phone being used and 6) location of emergency
Keys to gates/locks must be easily accessible
Key facility and school administrators must be aware of emergency action plans and be aware of specific roles
Individual should be assigned to accompany athlete to hospital

6. Developing an EAP
Is each member of the Sports Medicine Team aware of his/her role and responsibilities?
Who is the sports medicine team leader?
Who makes the call?
Who meets the EMTs?
Who rides with the athlete in the ambulance?

7. Developing an EAP
Are the location of phones and emergency phone numbers known?
Who has the keys to open gates/padlocks/buildings?
What is the address of the field and the location of suitable entrances?

8. Developing an EAP What information should be given over the phone?
Type of emergency situation
Demographics of the athlete
Type of suspected injury
Present condition of the athlete
Current assistance being given
Location
Directions

9. Executing an EAP Developing a site specific plan
Delegating specific duties for each member of the sports medicine team
Contacting other entities to offer input on an EAP (i.e. Local EMS, campus police)
Reviewing an EAP as a team
Identify potential weakness and create back-up plans
PRACTICE MAKES PERFECT!

11. Principles of Assessment
Appropriate acute care cannot be provided without a systematic assessment occurring on the playing field first
On-field assessment
Determines nature of injury
Provides information regarding direction of treatment
Divided into primary and secondary survey

12. Primary survey
Performed initially to establish presence of life-threatening condition
Airway, breathing, circulation, shock and severe bleeding
Used to correct life-threatening conditions

13. Secondary survey Life-threatening condition ruled out
Gather specific information about injury
Assess vital signs and perform more detailed evaluation of conditions that do not pose life-threatening consequences

14. The Unconscious Athlete
Assume life-threatening condition
Note body position and LOC
Check and establish airway, breathing, circulation (ABC)
Assume neck and spine injury
Once stabilized, a secondary survey should be performed

15. Opening the Airway Head-tilt, chin lift method
Push down on the forehead and lifting the jaw moves the tongue from the back of the throat

16. Modified technique can be used when neck injury is suspected
Modified jaw thrust maneuver

17. Establishing Breathing
Look, listen, and feel
Pinch nose, hold head back
Take deep breath, create seal around lips, and perform 2 slow breaths
Each breath should last 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.

18. Means of Artificial Respiration

19. Establishing Circulation
Locate carotid artery and palpate pulse while maintaining head-tilt position

20. Locate the center of the breastbone
Place one hand with the edge of the palm on the center of the breast bone
Place other hand on top with fingers parallel and directed away from athletic trainer

21. Keep elbows locked with shoulders directly above patient
Compress chest ”
30 times per 2 breaths
For child (<8yr.) 30:2 ratio should also be used
Compress chest inches
Look for movement and recheck for breathing every two minutes.
If not present continue cycle

22. Obstructed Airway Management
Choking is a possibility in many activities
Mouth pieces, broken dental work, tongue, gum, blood clots from head and facial trauma, and vomit can obstruct the airway
Individual cannot breath, speak, or cough, may become cyanotic
The standing abdominal thrust technique with back blows can be used to clear the airway

23. Stand behind athlete with one fist against the body and other over top just above the navel
Provide forceful thrusts to abdomen (up and in).
Next perform 5 back blows just between the scapula with the patient in a bent over position
Repeat these steps until the obstruction is clear

24. If athlete becomes unconscious, open airway and attempt to ventilate
If airway still obstructed, re-tilt and re-ventilate
If no ventilation, perform 5 chest thrusts, finger sweep to clear obstruction, and two breaths.
Be sure not to push object in further with sweep
Repeat cycle until air goes in
When athlete begins to breath on own, place in comfortable recovery position while lying on their side

25. Index finger should be inserted in mouth along cheek
Using hooking maneuver, pull across to free impediment
Attempt to ventilate twice after each sweep until athlete is breathing

26. Automatic External Defibrillator (AED)
Device that evaluates heart rhythms of victims experiencing cardiac arrest
Can deliver electrical charge to the heart
Fully automated - minimal training required
Electrodes are placed at the left apex and right base of chest - when turned on, machine indicates if and when defibrillation necessary

27. Conducting a Secondary Survey
Once athlete is deemed stable, secondary survey can begin
Recognizing vital signs
Heart rate and breathing rate
Blood pressure
Temperature
Skin color
Pupils
Movement
Presence of pain
Level of consciousness

28. On-Field Injury Inspection
Determine injury severity and transportation from field
Must use logical process to adequately evaluate extent of trauma
Knowledge of mechanisms of injury and major signs and symptoms are critical

29. Gently palpate to aid in determining nature of injury
Once the mechanism has been determined, specific information can be gathered concerning the affected area
Brief history
Visual observations
Gently palpate to aid in determining nature of injury
Determine extent of point tenderness, irritation and deformity

30. Decisions can be made with regard to:
Seriousness of injury
Type of first aid and immobilization
Whether condition require immediate referral to physician for further assessment
Manner of transportation from injury site to sidelines, training room or hospital
Individual performing initial assessments should document findings of exam and actions taken

31. Off-Field Assessment
Performed by athletic trainer or physician once athlete has been removed from site of injury
Divided into 4 segments
History
Observation
Physical examination
Special tests

32. Off-Field Assessment History Visual Observation
Obtain information about injury
Listen to athlete and how key questions are answered
Visual Observation
Inspection of injured and non-injured areas
Look for gross deformity, swelling, skin discoloration

33. Off-Field Assessment Palpation Special Test
Assess bony and soft tissue
Systematic evaluation beginning with light pressure and progressing to deeper palpation – beginning away from injured area
Special Test
Designed for every body region for detecting specific pathologies
Used to substantiate findings from other testing

34. Immediate Treatment Following Acute Injury
Control via PRICE
PROTECTION
REST
ICE
COMPRESSION
ELEVATION
Primary goal is to limit swelling and extent of hemorrhaging
If controlled initially, rehabilitation time will be greatly reduced

35. PROTECTION
Prevents further injury
Immobilization and appropriate forms of transportation will prevent further damage
REST
Allows healing to begin immediately
Days of rest differ according to extent of injury
Rest should occur 72 hours before rehab begins

36. ICE (Cold Application)
Initial treatment of acute injuries
Used for strains, sprains, contusions, and inflammatory conditions
Used to decrease pain
Promotes vasoconstriction
Lowers metabolism and tissue demand for oxygen
Ice should be applied for 20 min.
Repeat every /2 hrs.
Applied during the first 72 hrs.

37. COMPRESSION Decreases space allowed for swelling to accumulate
Important adjunct to elevation and cryotherapy, and may be most important component
A number of means of compression can be utilized (Ace wraps, foam cut to fit specific areas for focal compression)
Compression should be maintained daily and throughout the night for at least 72 hours

38. ELEVATION Reduces internal bleeding due to forces of gravity
Prevents pooling of blood and aids in drainage
Greater elevation = more effective reduction in swelling

39. Emergency Action Plan
Must be executed with techniques that will not result in additional injury
No excuse for poor handling
Planning is necessary and practice is essential
Additional equipment may be required