1. Emergency Situations and Response Plans

2. You’re the A. T. C.
You are the Athletic Trainer supervising the soccer game. Based on what you see:
What do you think happened?
What would you need to know?
What would you do?
What equipment might you use?

3. You are the Athletic Trainer employed by the Miami Heat
You are the Athletic Trainer employed by the Miami Heat. Based on what you see: What would be different compared to previous situation?

4. Emergency Responsibilities
Medical conditions that affect athletes:
Asthma
Diabetes
Anaphalaxes
Seizures
Genetic conditions (cardio-respiratory)
Illnesses
Shock
Infections / dermatological conditions

5. Emergency Responsibilities
Injuries that occur to athletes:
Airway obstructions
Unconsciousness / paralysis
Fractures
Sprains & Strains
Bleeding / Open Wounds
Closed Wounds / Bruising
Concussions

6. Emergency Plans Emergencies are inevitable
Plans must take into account any possible scenario & must be shared and practiced by all personnel.

7. Emergency Procedures
Observation & Assessment are 2 critical skills for a responder.
Primary Survey – checks life threating conditions (Circulation/Airway/ Breathing or “Look, Listen & Feel”)
Secondary Survey – head to toe assessment of patient’s condition

8. Assessment Procedures
HOPS & SOAP are 2 recognized acronyms for injury assessment procedures.
H – History
O – Observation
P – Palpation
S – Special Tests
S – Subjective
O – Objective
A – Assessment
P – Plan

9. HOPS
H – History – questions asked of the athlete to determine mechanism and history of the condition/injury
O – Observation – of athlete bilaterally checking for deformity of any kind
P – Palpation – using fingertips to locate an deformity / site of pain
S- Special Tests – testing ROM, stability & strength of injured area

10. SOAP
S – Subjective: detailed information about the injury and the athlete. Includes information about chief complaints, signs and symptoms.
O – Objective: data from tests including inspection, palpation & special tests

11. SOAP
A – Assessment: a detailed statement by the ATC of the type and severity of the injury including problems associated with the injury.
P – Plan: description by the ATC of whether the athlete will be referred, treated or monitored. This includes rehab procedures and goals of the treatment.

12. Questions that should be asked During “H” of HOPS or “S” of SOAP
What happened?
When did it happen?
How did it happen?
Have you ever done this before?
Where does it hurt most?
How bad does it hurt?
What kind of pain do you feel?
What did you feel? Hear?

13. What you should look/check for during “O” of HOPS or SOAP
Does it look normal?
Anything sticking out?
Any unusual depressions?
Does it look like the other ankle?
Any immediate swelling or discoloration?
Palpation: (“P” of HOPS; still “O” of SOAP
feel any deformity?
feel any point tenderness?

14. What things you should assess during “S” of HOPS or “O” of SOAP
Can you move it without increase of pain?
Can they move it?
Can they provide resistance?
Can they do functional movements?

15. What are possible actions (based on your findings) you can take?
Can they stay in the game?
Can they walk off of the field? If so
Do they need treatment? If so what?
Ice? Rest? Re-taping or Padding?
Do they need to be transported?
Helped off? Carried? Carted?
Do they need immobilization?
Do they need to see a Dr. or ER visit?

16. SOAP Note
SOAP Note: a written document of the findings of an injury assessment and recording an athlete’s progress through their rehabilitation.

17. SOAP Note You’re the ATC supervising the soccer game:
List 3 things to do/ask during the S phase of SOAP
List 3 things to do/ask during the O phase of SOAP

18. SOAP Note

19. Phases of Treatment
The extent of the injury influences the rehab activities and goals chosen for treatment.
Rehab programs should all follow a step by step progression starting with initial treatment through sport specific function.

20. IMPRESS I- initial injury (inflammatory) phase
M – mobility restoration phase
P – proprioception phase
R – resistance training phase
E – endurance training phase
S –}
S –} sport specific function phase

21. Initial/Inflammatory Injury Phase
Control inflammation
signs: warmth, redness, swelling, & pain
Inflammation means that the tissue is returning to normal
Treatment = PRICE
Protect, Rest, Ice, Compression, Elevation

22. Mobility Restoration Phase
Edema: thick swelling caused by excessive protein.
3 Phases of Range of Motion Restoration:
Passive (PROM)
Active-Assistance (AAROM)
Active (AROM)

23. Passive ROM (PROM) The ATC moves an athlete’s body segment through ROM
There is no active resistance or assistance by any muscles

24. Active Assistance ROM (AAROM)
The ATC and the athlete move a body segment through ROM together

25. Active ROM (AROM)
The athlete moves through the full ROM without assistance
Now the athlete can start a strength program

26. Establish Flexibility
Still part of the Mobility Restoration Phase
Flexibility refers to the ability to move a joint through a full ROM without restriction

27. Proprioception Phase
The body’s ability to get information to the brain in response to a stimulus arising within the body
Also refers to the body’s ability to sense the position of it’s limbs at any moment
Following an injury, receptors are damaged this makes a joint feel weird or not right
Balance & Coordination will help with this phase

28. Resistance Training Phase
Strengthen muscles, ligaments, and bones
Free weights, resistance bands/tubes, machines, manual resistance

29. Endurance Phase
Muscle Endurance: ability to perform movements over time
Reps? Weight?
Cardio Endurance: perform this as early as tolerated

30. Sport Specific Phase How to progress: Light Functional
Heavy Functional
Limited Practice
Perform functional activities
Slowly get back to practice
Need to know requirements of the sport (movement patterns, degree of strength, speed & endurance needed)
Mimic activities in the sport

31. Athlete can participate if:
Full Range of Motion
Normal Strength
Normal Flexibility
Normal Coordination
Normal Cardio Endurance
Consent of Team Doctor

32. Proper Progression of the Athlete
Remember all athletes progress at a different pace
What principle?
Be as progressive as you can without doing any harm to the athlete

33. THERAPY ELEMENTS thermal mechanical electrical

34. Therapy Elements
You must decide if a therapeutic modality is able to be used for each injury
Indications: reasons that a modality can be used
Contraindications: reasons to not use a certain modality

35. Thermal Elements Transfer heat into or out of the body
Used to make tissues colder or warmer

36. Heating Modalities Heat should NOT be used on: Acute injuries
Warm the body to help the healing process
Should only be used after initial inflammatory phase is over
Use on chronic Sprains/Strains
Heat should NOT be used on:
Acute injuries
Areas of poor circulation
Areas of impaired sensation.

37. Types of Heat Hydrocollator Pack Whirl Pool Moist heat pack 20 minutes
degrees

38. Cooling Modalities
Cryotherapy: use of cold to elicit certain physiological responses
Cool the injured area and constrict blood vessels
Decrease inflammation
Decreases cell metabolism
Decreases pain
Decreases muscle spasms

39. Types of Cooling Modalities
Cryotherapy: Ice Packs/Cryocuff
Chemical Ice Packs
Make sure there is a barrier
Ice Massage
Not used on acute injuries
Ice cups/shin splints

40. Ice Packs Must be in plastic bag Should not be applied:
Open wounds, areas of numbness, someone overly sensitive to cold, cardiac or respiratory problems
20-30 mins at a time
Wait mins before reapplying
Double the amount of time you iced

41. Produce a specific physiological effect with mechanical energy
MECHANICAL ELEMENTS
Produce a specific physiological effect with mechanical energy

42. Ultrasound Thermal modality because it produces a deep-heating effect
Uses sound waves to pass through tissue
Heat is produced by a process called conversion
Has the ability to affect deeper than a hot pack

43. Ultrasound Types Continuous Pulsed Indirect
Sound waves flowing 100% of the time
Pulsed
Can keep the ultrasound head in one place
Must use a Coupling Medium (water, gel, lotion)
Indirect
Done on irregularly shaped areas under water

44. Traction Most commonly done to the vertebrae
Deliberately attempting to separate the joints of the body if they have been compressed or gotten stiff over a period of time
Also causes minimal stretching of ligaments and muscles
Complications: pain, discomfort, muscle spasms, numbness, tingling

45. Massage
Intentional and methodical kneading and stretching of the body’s soft tissues
Used to increase circulation, decrease muscle spasms, relieve swelling

46. Types of Massage
Effleurage: stroking the tissue with palm of your hand in a smooth, rhythmical manner.
Petrissage: kneading of the tissue, in which the skin, muscle and fascia are squeezed between the hands.
Vibration Massage: designed to cause tissue to tremble and shake usually done at joints to improve mobility.
Percussion Massage (Tapotement): a series of light chopping motions
Increases circulation & relaxation
Friction: requires enough pressure to affect the deep tissues.
Helps break up scar tissue and relieve muscle spasms.

47. Intermittent Compression
Useful for reducing swelling & edema following injury
Increases the pressure around the injury site and helps venous blood return from the injured extremity.
Should not be used until a fracture is ruled out or used on compartment syndromes of the lower extremity.
Treatment time: 20 min-1 hour
treatment consists of alternating compression for 45 seconds with 15 seconds off.

48. ELECTRICAL ELEMENTS
Tissues with high water content (muscles) conduct electricity very well

49. Types of Electrical Currents
Direct Currents (DC): electricity moves in one direction as it passes through the tissue circuit.
Alternating Current (AC): electricity moves back and forth between electrodes.
Pulsed Current: interrupted
Uninterrupted: continuous
*All types of currents require electrical pads on the body

50. Electrical Stimulation
High Voltage Pulsed Electrical Muscle Stim: causes a muscle contraction, helps prevent muscle weakness during recovery
Low Intensity Stimulation: (Microcurrent) – thought to mimic the body’s own natural electrical flow & promote healing.
Interferential Current: two electrical currents cross one another, creates a muscle contraction & reduces pain.
Transcutaneous Electrical Nerve Stimulation (TENS): electrical current applied to the skin that is designed to stimulate the region.