[Melinda J Flegel] Sport First Aid(BookZZ.org)

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SportFirstAidUpdatedEdition

MelindaJ.Flegel,MS,ATC/R,CSCS

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LibraryofCongressCataloginginPublicationData

Flegel,MelindaJ.,1958Sportfirstaid/MelindaJ.Flegel.Updateded.p.cm."ApublicationfortheAmericanSportEducationProgramandtheNationalFederationofStateHighSchoolAssociations."Includesbibliographicalreferencesandindex.ISBN08801155641.Sportsinjuries.2.Firstaidinillnessandinjury.I.Title.RD97.F5251997617.1'0262dc209622584CIP

ISBN:0880115564

Copyright 1992,1997byHumanKineticsPublishers,Inc.

Allrightsreserved.Exceptforuseinareview,thereproductionorutilizationofthisworkinanyformorbyanyelectronic,mechanical,orothermeans,nowknownorhereafterinvented,includingxerography,photocopying,andrecording,andinanyinformationstorageandretrievalsystem,isforbiddenwithoutthewrittenpermissionofthepublisher.

The"Check,Call,Care"materialonpage20appearscourtesyoftheAmericanRedCross.AllRightsReservedinallCountries.

AcquisitionsEditor:JimKestnerDevelopmentalEditor:JessieDawAssistantEditors:LynnM.Hooper,SandraMerzBott,andCoreeSchutterCopyeditor:BarbaraWalshIndexer:TheresaJ.SchaeferTextDesigner:KeithBlombergGraphicArtists:DeniseLowry,JulieOverholt,AngieSnyder,TaraWelsch,andYvonneWinsorCoverDesigner:JackDavisPhotographer(cover):WilmerZehrIllustrator:TimOffensteinPrinter:UnitedGraphics

PrintedintheUnitedStatesofAmerica10987654

HumanKinetics

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Lord...allthatwehaveaccomplishedyouhavedoneforus.Isaiah26:12

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CONTENTS

Acknowledgments vi

Preface vii

LearningSportFirstAid ix

Part1IntroductiontoSportFirstAid

1

Chapter1YourRoleAsaCoach

3

Chapter2SportFirstAidGamePlan

11

PartIIBasicSportFirstAidSkills

25

Chapter3AnatomyandSportInjuryTerminology

27

Chapter4InjuryEvaluation

43

Chapter5FirstAidBasics

51

Chapter6MovinganInjuredAthlete

61

PartIIISportFirstAidforSpecificInjuries

67

Chapter7RespiratoryandCirculatoryEmergencies

69

Chapter8HeadandSpineInjuries

83

Chapter9InternalOrganInjuries

91

Chapter10SuddenIllness

97

Chapter11TemperatureRelatedProblems

105

Chapter12MusculoskeletalInjuries

115

Chapter13SoftTissueInjuriesoftheFaceandHead

151

Chapter14SkinProblems

157

AppendixATheAmericanSportEducationProgramandtheNationalFederationInterscholasticCoachesEducationProgram

163

AppendixBInjuryPreventionStretchingRoutine

167

ImportantSportFirstAidTerms 171

RecommendedReadings 175

References 177

Index 179

AbouttheAuthor 187

AboutASEP 188

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ACKNOWLEDGMENTS

I'dliketoextendaspecialthankstoeveryonewhoparticipatedinthedevelopmentofthisupdatededition:mycolleagueandfriendSusanKundratforprovidingupdatedsportsnutritioninformationeditorsJimKestner,LynnHooper,andJessieDawfortheirsupport,patience,andextraeffortindevelopmentaleditingRainerandJulieMartensandtherestoftheHumanKineticsgangwhomadetheproductionanddistributionofthisbookpossibletheexpertreviewersforofferingvaluablesuggestionsforimprovingthebookandmyfamily,friends,andcoworkersfortheirneverendingsupportandencouragement.

Lastbutnotleast,Iwanttothankyou,thereader,foryourdedicationtosafetyinsportandexercise.

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PREFACE

Beingasuccessfulcoachrequiresknowingmorethanjusttheskillsandstrategiesofasport.Itincludesbeingabletoteachthosetechniquesandtactics,motivateathletes,andmanageamyriadofdetails.Anditinvolvesfulfillingtheoftenforgottenroleofbeingacompetentfirstrespondertoplayers'injuries.

Morethan5.25millionhighschoolstudentsparticipateinsportseachyear.TheNationalAthleticTrainers'Association(NATA,1989b)projectsthatmorethanoneinfiveofthesestudentathletesnearly1.3millionareinjuredannually.Themajorityoftheseinjuries(62%)occurduringpractice,whenmedicalpersonnelsuchasphysiciansandathletictrainersusuallyarenotpresent.Consequently,asthecoach,youaremostoftenresponsibleforadministeringfirstaidtoyourinjuredathletes.

Tohelpyoumeetthischallenge,TheAmericanSportEducationProgram(ASEP)hasdevelopedtheSportFirstAidCourse.ThisupdatededitionoftheoriginalSportFirstAidbookservesasthetextforthatcourse.

TheSportFirstAidCourse,thewidelyusedCoachingPrinciplesCourse,andtherecentlyreleasedDrugsandSportCoursecompriseASEP'sLeaderLevelcurriculum(seeAppendixA).

ThroughacooperativeeffortbetweenASEPandtheNationalFederationofStateHighSchoolAssociations,ASEPisalsotheofficialeducationprogramfortheNationalFederationInterscholasticCoachesAssociation.ThesethreecoursesareknownastheNationalFederationInterscholasticCoachesEducationProgram(NFICEP),andaredeliveredtoInterscholasticcoachesthroughoutthenation.

Throughoutitsdevelopmentandrevision,thisbookwasreviewedbyapanelofexpertsrepresentingeachareaofsportsmedicinespecialization.Theirclosescrutinyandinvaluablefeedbackensurethatthisisascientificallysound,relevant,andcurrenttextforcoaches.

Specifically,SportFirstAidanditsaccompanyingStudyGuidearedesignedtohelpyoudothefollowing:

1.Developabasicknowledgeofsportinjuries

2.Recognizecommonsportinjuries

3.Administerappropriatesportfirstaid

ASEPhopesthatbylearningbasicfirstaidskillsforthesportsetting,coacheslikeyouwillbebetterfirstresponderstoinjuredathletes.Thisisanexcellentopportunityforyoutoexpandyourcoachingskills.Moreover,it'sasignificantsteptowardprovidingasaferandmoreenjoyablesportexperienceforyourathletes.

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LEARNINGSPORTFIRSTAID

CoachMikeAndersonisconductingasmoothrunningmidseasonfootballpracticeonacoldanddampOctoberday.Suddenly,afteronescrimmageplay,hehearsacrycomingfromthepileofplayers.AsCoachAndersonhelpstheplayersunpile,hefindsagroaningKevinGreenonthebottomofthestack.Whenaskedwhathurts,thesecondstringlinemanmoans,"Myback,myback."CoachAndersonisnotsurehowbadtheinjuryisbecauseKevinfrequentlyhascomplainedofinjuryinthepast,sometimesfeigninginjurytoavoidpractice.Notknowingwhattodo,thecoachtakesnoaction,andKevineventuallystrugglestohisfeet.Afterpractice,theathletegoestoadoctorwhodiagnosestheinjuryasaseverebacksprain.Kevinissidelinedfortherestoftheseason.

Coacheswithlittleunderstandingoffirstaidfrequentlychoosethe"donothinguntilIhaveto"option.Why?Primarilybecausetheydon'tfeelcompetentinofferingfirstaidcare.Unfortunately,thisscenarioisalltoocommon.StudieshavefoundthatonlyabouthalfthecoachesnationwidearetrainedineitherfirstaidorCPR(Rowe&Robertson,1986Weidner,1989).

Sowhat'sthebigdeal?Anydelayinfirstaidcarecancausefurtherinjuryorprolonganathlete'srecoverytime.Legwold(1983)reportedthatathleteswhoattendedschoolswhichdidnotemployacertifiedathletictrainersuffereda71%reinjuryrate,whilethoseattendingschoolswithacertifiedstaffathletictrainerhadonlya3%reinjuryrate.

Thenwhynotrelysolelyuponacertifiedathletictrainertoprovidefirstaidcareforathletes?Firstofall,onlyabout19%ofhighschoolsnationwideemployorcontractacertifiedathletictrainer(Curtis,1996).Secondly,itisnearlyimpossibleforoneathletictrainertoattendeverypracticeandcompetitionforaschool'sentireathleticprogram.

Realistically,then,coachesarerelegatedtotheroleoffirstrespondertoanathlete'sinjury.Thisresponsibilityrequiresacommandofsportfirstaidknowledgeandskills.

TheAmericanSportEducationProgram(ASEP)believesthatallcoachesshouldberequiredtosuccessfullycompletetraininginbothsportfirstaidandCPR.Thereason?Athletesdeservecompetentcareinemergenciesthatanuntrainedcoachsimplycannotprovide.

ASEPwantstoemphasizethatthisisasportfirstaidbook,notageneralguidetoanatomicalsitesandmedicalprocedures.Thewordsportinthetitlereflectsthatthecontentsofthistextaretailoredtotheathleticcontext.Firstreferstothecoach'sroleastheinitialrespondertomostathletes'injuries.Andaiddescribesthehelpacoachproperlytrainedinemergencycareprocedurescanprovideinjuredathletes.Inotherwords.SportFirstAidencompassesthebasict

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knowledgeandskillsneededtorecognizesportrelatedinjuries,provideappropriateemergencytreatment,andensureproperfollowupmedicalcare.Itspecificallyinvolvestherecognitionandemergencytreatmentofsportinjuriesontheplayingfield.Mostbasically,itentailslearningwhatyoushoulddoandwhatyoushouldnotdowhenanathletesuffersaninjury.

Sportfirstaiddoesnotpromotediagnosisandtreatmentbycoaches.However,itdoesrequirecoachestomakesurethatinjuredathletesareseenandreleasedbyaphysicianbeforetheyreturntoaction.Anditincludestheseimportanttasks:contactingparentstoinformthemoftheinjury,callingemergencypersonneltotransporttheinjuredathleteifnecessary,assistinginsafelymovingtheinjuredathletetomedicalfacilities,andencouraginganathleteduringtherehabilitationprocess.

PartIofthistextintroducesyoutotheteamworkandpreparationneededforeffectivesportfirstaid.Inchapter1ofthistextyouwilllearnyourroleasacoachonthesportsmedicineteam.Youwillalsolearnhowotherswillexpectyoutofulfillthatrole.Specifically,thetextaddressesparentalandlegalexpectations.You'llmeetthepersonnelwithwhomyou'llbeworking,suchasphysicians,emergencymedicaltechnicians,physicaltherapists,andathletictrainers.Alongwithyou,theymakeupthesportsmedicineteam.Inchapter2,youwillfindouthowtohelppreventsportinjuries.BytrainingyourselfinsportfirstaidandCPR,byconditioningathletesforcompetition,byfittingathleteswithappropriateprotectiveequipment,byenforcingcorrectsporttechniqueandsafetyrulesduringpracticeandgames,andbykeepingplayingareasfreeofsafetyhazards,youcanprovidethesafestsportingenvironmentpossible.

InPartIIyouwilllearnthefundamentalsofsportfirstaid.Thisincludesincreasingyourknowledgeofbasicanatomyandsportfirstaidterminologycoveredinchapter3.Chapter4willexplainhowtoperformquickandaccurateassessmentsofathleticinjuries.Withthesegeneralevaluationguidelines,you'llbepreparedtolearnhowtoprovidebasicemergencycareprocedures,describedinchapter5.Chapter6showsyouhowtosafelymoveaninjuredathletewhennecessary.Thesefundamentalsaretheessentialfoundationonwhichyoucanbuildyourskillsasasportfirstaider.

InPartIIIyouwilllearnthespecificskillsforrespondingtovarioussportinjuries.Althoughchapters7through11coverlesscommoninjuriesandillnesses,theyarenonethelessimportant.Seriousconditionssuchascirculatoryandrespiratoryproblems,headandspineinjuries,internalorganinjuries,suddenillness,andtemperaturerelatedillnessesareexaminedinthesechapters.Theseproblemsdonotoccuroften,butwhentheydo,you'llwanttobepreparedtoprovidequickandappropriatefirstaid,perhapstosaveanathlete'slife.Inchapters12through14you'lllearnhowtorecognizeandadministerfirstaidformorecommonsportrelatedmusculoskeletalproblems,facialinjuries,andskinconditions.You'relikelytousetheseskillsonaweeklyperhapsevendailybasis.

ASEPandtheNationalFederationInterscholasticCoachesAssociationthroughitsNationalFederationInterscholasticCoachesEducationProgram(NFICEP)originallydevelopedthisbookasthetextfortheirASEP/NFICEPSportFirstAidCourse,designedtoprovideinterscholasticandclubsportcoacheswithskillsandabasicunderstandingofsportsinjuries.Thecourseincludesclinic,selfstudy,andtestingphases.ThistextandtheSportFirstAidStudyGuideserveasprimaryresourcesforthecourse.CoacheswhoattendtheSportFirstAidClinicwilllearnemergencycareskillsandinformationthroughlectureandhandsonpracticesessions.Aftertheclinic,coachesmustcompletetheexercisesintheStudyGuideandpassawrittentakehometestinordertoreceiverecognitionforsuccessfullycompletingthecourse.FormoreinformationortofindoutwhenthenextSportFirstAidCoursewillbeofferednearyou,contactASEPbyphone(8007475698)oremail([email protected]),orcheckthecalendaratASEP'swebsite(http:/www.asep.com/).

ArmedwiththeinformationandskillsfromthisSportFirstAidtextandcourse,youwill,ASEPhopes,beabletoconfidentlyandcompetentlyadministerfirstaidtoyourathletes.Thehealthandsuccessofyourathletesdependonit.

PARTIINTRODUCTIONTOSPORTFIRSTAID

Beingacontributingmemberofasuccessfulteamrequiresteamworkandpreparation.Noathletecanwalkontoaplayingfieldandexpecttocontributetowardavictoryifheorsheisoutofshapeandunfamiliarwithhisorherteammates.Beinganeffectivesportfirstaiderisnodifferent.

Youmustknownotonlyyourresponsibilitiesandlimitations,butalsothoseofothermembersofthesportsmedicineteam.Chapter1introducesyoutoyourroleasaplayeronthesportsmedicineteam.You'lllearnwhatparentsandthelegalauthoritiesexpectfromyouasasportfirstaidprovider.Andyouwillbecomefamiliarwithothermembersofthesportsmedicineteamsoyouwillknowhowtointeractwiththemtomakeyoureffortssuccessful.

Justasanathleteneedspreseasonpreparationorconditioningtoachievesuccess,youalsoneedtobepreparedforyourfirstaidduties.Chapter2willhelpyoupreparepreventivestrategiestominimizeinjuriessufferedbyyourathletes.Thesestrategiesincludedevelopingpreseasonconditioningprograms,ensuringasafeplayingenvironment,formulatinganemergencyplan,andenforcingpropersportskillsandsafetyrules.Usingthesestrategies,youcangreatlyreduceyourathletes'riskofinjury.

Chapter1YourRoleasaCoach

Imaginethatyouarecoachingahighschoolsoccerteam.It'sanincrediblyhotandhumidday,andyourstarforwardstaggersoffthefield.Asyougrabtheplayer'sarmandhelphimtothebench,younoticethathisskinfeelsdryandveryhot.Youattempttoaskhimquestions,butherespondswithincoherentmumbling.What'swrongwithhim?Hehasaflushedappearance,socouldhebesufferingfromheatstroke?Someoftheotherplayerssaythatheisadiabetic.Soistheathletesufferingfromaheatoradiabeticillness?Iftheproblemisrelatedtodiabetes,isithyperglycemiaorinsulinshock,andhowdoyouhandleit?Ifyouwaittoolongortreattheconditionimproperly,theathletecoulddie.

Recentstudieshaveshownrelativelyhighinjuryratesamonghighschoolathletes.BasedonresearchconductedbytheNationalAthleticTrainers'Association(NATA,1989a,1989b)from1986through1989,anestimated1.3millionU.S.highschoolathletesareinjuredeachyear.Thismeansthatmorethan1outof5highschoolathletesmayrequiresportfirstaid.Anotherinjurysurveillancestudyconductedfrom1979to1992,inwhichnearly60,000athletesin20highschoolsweremonitored(Rice,1995),foundaninjuryrateof30.6per100athletesperseason.

Table1.1showsabreakdowninthenumberofinjuriesforeachsportthathavebeenfoundduringvariousresearchstudies.

Table1.1InjuryRatesforVariousHighSchoolSports

Sport Injuryrate/sport Source

Basketball(boysandgirls) 22.0% (NATA,1989b)

Basketball(boys) 29.2% (Rice,1995)

Basketball(girls) 34.5% (Rice,1995)

Crosscountry(boys) 38.7% (Rice,1995)

Crosscountry(girls) 61.4% (Rice,1995)

Football 36.0% (NATA,1989a)

Football 58.8% (Rice,1995)

Gymnastics(girls) 38.9% (Rice,1995)

Soccer(boys) 36.4% (Rice,1995)

Soccer(girls) 43.7% (Rice,1995)

Wrestling 27.0% (NATA,1989b)

Wrestling 49.7% (Rice,1995)

Nowifyou'rethinking,''Waitaminute.NooneeversaidanythingaboutcaringforinjurieswhenIagreedtocoach,"you'reprobablyright.Whattheyshouldhavetoldyouisthatthefirstdayyouputthatwhistlearoundyourneck,youindirectlyagreedtoberesponsibleforyourathletes'health.

ExpectationsandDuties

Thinkaboutit.Ascoach,youareoftenthefirstpersontoseeaninjury.Becausethereisusuallynomedicalpersonnelaround,youareresponsibleforadministeringfirstaidcare.Also,youhavetodecidewhetheraninjuredathletecanreturntoplayorshouldbesenttogetmedicalhelp.Certainly,ifyourteamorschoolisassistedbyanathletictrainerorteamphysician,youshouldseektheiradvicebutit'sunlikelythatthosepersonnelwillbepresentforeverypracticeorgame.

Athletestypicallylooktotheircoachesforalltheanswers.However,parents,legalauthorities,andotherplayersonthesportsmedicineteamalsohavecertainexpectationsofcoaches.Yourroleasasportfirstaiderisshapedbyalltheseexpectations.

Parents'Expectations

Parentswilllooktoyoufordirectionwhentheirchildrenareinjured.Theymayaskquestionslikethese:

Whatdoyouthinkiswrongwithmydaughter'sknee?

Willitgetworseifshecontinuesplaying?

Shouldsheseeadoctor?

Doesmysonneedtowearprotectivekneebracesforfootball?

Whatkindoftapingcanyoudotopreventmysonfromreinjuringhisankle?

Whencanhestartcompetingagain?

Andit'snotenoughtosimplyrespond,"Idon'tknow."Youmusteitherhavetheansweror,morelikely,knowhowtogettheanswerquickly.Parentswon'tacceptanythingless.

LegalAuthorities'Expectations

GymnastKimEvansflewofftheunevenbarsonedayandcrashedtothefloor.Becauseshewaslyingfacedownandappearedtobeunconscious,CoachSueCalhounrolledherovertomakesureshewasbreathing.Kimhadsustainedabackfractureand

lostthefunctionofbothlegs.SueCalhounwassuedbyKim'sparentsandfoundnegligentforfailingtoprovideappropriateemergencymedicalassistance.

Unfortunately,withsportscomestheriskofinjurysometimes,veryseriousinjury.ButifCoachCalhounhadhadadequatepreparationandpracticeinsportfirstaid,it'spossiblethatKim'sbackinjurywouldnothavecausednervedamage.And,intheend,CoachCalhounwouldnothavebeenfoundnegligent.

Don'tletthethreatoflawsuitsinterferewithyourlearningsportfirstaidandutilizingittohelpyourathletes.Allyouhavetodoisfollowninesimplelegalduties(Martens,1997).

NineLegalDutiesofaCoach

1.Properlyplantheactivity.

Makesurethatathletesareinpropercondition.

Teachathletesthesportskillsinaprogressionsothattheyareadequatelypreparedtohandlemoredifficultskills.

2.Provideproperinstruction.

Keepuptodateonbetterandsaferwaysofperformingsporttechniques.

Teachathletestherulesandthecorrectskillsandstrategiesofthesport.

3.Provideasafephysicalenvironment.

Monitorcurrentenvironmentalconditions(i.e.,windchill,temperature,andhumidity).

Periodicallyinspectplayingareas,thelockerroom,theweightroom,andthedugoutforhazards.

Removeallhazards.

Preventimproperorunsuperviseduseoffacilities.

4.Provideadequateandproperequipment.

Makesureathletesareusingtopqualityequipment.

Inspecttheequipmentregularly.

Teachathleteshowtofit,use,andinspecttheirequipment.

5.Matchyourathletes.

Matchathletesaccordingtosize,physicalmaturity,skilllevel,andexperience.

6.Evaluateathletesforinjuryorincapacity.

Enforcerulesrequiringallathletestosubmittopreseasonphysicalsandscreeningstodetectpotentialhealthproblems.

Ifanathleteisnotabletocompetewithoutpainorlossoffunction(i.e.,inabilitytowalk,run,jump,throw,etc.withoutrestriction),immediatelyremoveherorhimfromtheactivity.

7.Supervisetheactivityclosely.

Donotallowathletestopracticedifficultorpotentiallydangerousskillswithoutpropersupervision.

Forbidhorseplay.

Donotallowathletestousesportfacilitieswithoutsupervision.

8.Warnofinherentrisks.

Provideparentsandathleteswithbothoralandwrittenstatementsoftheinherenthealthrisksoftheirparticularsport.

9.Provideappropriateemergencyassistance.

Learnsportfirstaid.

Useonlytheskillsthatyouarequalifiedtoadminister.

Ifyouaren'talready,becomefamiliarwitheachoftheselegalduties.Thefirsteightdutiesdealmainlywithpreventivemeasures,explainedmorethoroughlyinchapter2.Mostofthisbookisdesignedtohelpyouhandledutynumber9.

TheNinthLegalDuty

Thelegalsystemhasdefiniteexpectationsinregardtodutynumber9providingappropriateemergencyassistance.Ifanathleteisinjured,youarelegallyexpectedtodothefollowing:

TakeActionWhenNeeded

Thelawassumesthatwhenyouagreedtocoach,youindirectlyagreedtoprovidefirstaidcareforanyinjuryorillnesssufferedbyanyathleteunderyoursupervision.Therefore,ifnomedicalpersonnelarepresentwhenaninjuryoccurs,youareresponsibleforprovidingemergencycare.

ProvideaCertainStandardofCare

Ifyougiveemergencycare,youmustusestandardprocedures.Whatare"standard"procedures?Mostoften,thesearetechniquestaughtinbasicfirstaidandcardiopulmonaryresuscitation(CPR)courses.Tolearnthesestandards,youshouldattendcertificationcoursestaughtbytheAmericanRedCrossortheAmericanHeartAssociation.Ifyouhavetakenothercoursesorattendedworkshopsonemergencymedicalproceduresorathleticinjurycare,youwillalsobeexpectedtoprovidethestandardofcaretaughtinthoseeducationalsettings.

Somestatesexpectcoachestomeetadditionalstandardsofcare.Checkwithyourathleticdirectortofindoutifyourstatehasspecificguidelinesforthequalityofcaretobeprovidedbycoaches.

GoodSamaritanLaw

Manycoachesfailtofullyappreciatetheirlegalresponsibilitiesmanyothersaresofearfulofprovidingemergencymedicalcarethattheyfailtoactpromptlyininjurysituations.Neitherapproachisadequate.

Youcannotignoretheninelegaldutiesofcoaching.Furthermore,youshouldnotbeafraidtotakeactionwheninjuriesoccur.Ifyouprovideemergencycaretothebestofyourability,youmaybeprotectedbywhatiscalledtheGoodSamaritanlaw.

Thislawvariesfromstatetostate,socheckwithyourathleticdirectororstatecoaches'associationtomakesureyouarecovered.Specifically,askwhethertheGoodSamaritanlawprotectsyouif,ingoodfaith,youdothebestyoucaninadministeringinitialemergencycare.Andwhetheritdoesordoesn't,don'tjuststandonthesidelines.

Learnmoreaboutsportfirstaidsoyouwillbeaconfidentandcompetentfirstrespondertoyourathletes'injuries.

Consent

Legally,youmusthaveanadult'sconsentbeforeyoucangivefirstaidcare.Forminors,obtainasignedwrittenconsentformfromtheirparentsbeforetheseasonbegins.Forinjuredadultathletes,youshouldspecificallyaskthemwhethertheywantyourhelp.Iftheyareunconscious,consentisusuallyimplied.Iftheyrefusehelp,youarenotrequiredtoprovideit.Infact,ifyoustillattempttogivecare,theycansueyouforassault.

Soasyoucansee,theexpectationsofthelegalcommunityregardingcoaches'emergencycarebehaviorarequitehigh.Youmustbepreparedtomeetthem.AndagoodplacetostartisbyconsultingtheCoachesGuidetoSportLaw(Nygaard&Boone,1985),whichyoucanobtainthroughASEP.

YourRoleontheSportsMedicineTeam

Asacoach,youareanimportantmemberofthesportsmedicineteam.Youcanassistthesportsmedicineprofessionalsbydoingthefollowing:

Helptopreventinjuriesthroughtheuseofpropertrainingmethods,safeandeffectivesporttechniqueinstruction,andcloseandconstantsupervision.

Preventfurtherharmtoaninjuredathlete.

Ensurethataninjuredathletereceivespromptmedicalattention.

Provideinformationregardinganathlete'sinjury.

Actasaliaisonbetweenemergencyprofessionalsandtheinjuredathlete.

Provideemergencycareifamedicalprofessionalisunavailable.

Tobeavitalpartoftheteam,youhavetobefamiliarwithyourteammatesthehealthprofessionalswhowillassistyouincaringforaninjuredathlete.

EmergencyMedicalPersonnel

EmergencyMedicalTechnicians(EMTs)andparamedicsarespeciallytrainedtohandlemedicalemergenciesandseriousinjuries.Theyarehighlyskilledinevaluatingandmonitoringinjuriesandseriousmedicalproblems,aswellasprovidingbasicmedicalcare.Theyarealsoverycompetentinimmobilizingpeoplewithseriousinjuriesandprovidingswiftandsafetransportationtoemergencymedicalfacilities.

Youshouldtrytobecomefamiliarwiththeemergencymedicalpersonnelinyourarea.Thesepeopleareoftenwillingtovolunteertheirtimeandrescuevehiclestoprovideemergencycareduringtournamentsandcontestsinvolvingcontactsportssuchasfootballorwrestling.

Oncetherescuesquadarrives,letthemtakeoverthecareoftheathlete.Remember,theyhandlehealthemergencieseverydayandarebettertrainedfordoingsothanyou.Yourroleshouldbesimplytoassistthemasneeded.Inthatregard,bepreparedto

1.takechargeofcrowdcontrol,

2.assistinmovingtheathlete,and

3.provideinformationonhowtheinjuryoccurred.

Unfortunately,EMTsarenotalwaysreadilyavailable.Ifemergencypersonnelarenotpresentwhenanathleteisinjured,yourroleisto

1.protecttheathletefromfurtherharm,

2.sendsomeonetocallemergencymedicalpersonnel,ifnecessary,

3.evaluatetheinjury,

4.administerfirstaid,and

5.provideinformationonhowtheinjuryoccurred.

Physicians

Theheadcoachofthesportsmedicineteamisthephysician.Heorshealoneisqualifiedtodiagnoseathleticinjuries.Further,thephysicianisalsotheindividualwhoshoulddirectalltreatmentandrehabilitationofaninjuryandsupervisetheactionsofothermembersoftheteam.

Thequestionyoumightaskisthis:Outofallthetypesofphysiciansavailable,whichoneshouldaninjuredathleteseeafamilypractitioner,pediatrician,orthopedist,podiatrist?Theanswerisultimatelyuptotheathlete'sparentsorlegalguardian,buttheymayaskforyouradvice.Tohelpyourespondknowledgeably,hereisabriefdescriptionofthecommoncategoriesofsportphysicians.

TypesofPhysicians

Althoughanyphysiciancandiagnoseanddirectthetreatmentofaninjuredathlete,aphysicianwhospecializesinsportsmedicineisadefiniteplus.Thesesportsmedicinespecialistsaresensitivetothespecialneedsofathletesandwilldoalltheycantogetathletesbacktofullparticipationasquicklyandassafelyaspossible.

Familypractitionersspecializeingeneralmedicineforfamilies.Thisincludesinfantsallthewaythroughtoseniorcitizens.

Pediatriciansspecializeinprovidingmedicalcareforchildren.Thisusuallyencompassesinfantstoteenagers.

Orthopedistsaresometimescalledbonedoctors.Actually,theyaretrainedintheclinicalandsurgicalcareofinjuriestothebones,muscles,andotherjointtissuessuchascartilage,tendons,andligaments.

Podiatrists,orfootdoctors,providemedicalandsurgicalcareforlegandfootproblemsonly.Theyalsomakespecialsupportinsertsforshoestocorrectalignmentproblemsofthefeetandlegs.

Manyofthephysicianspecialtygroups,suchasorthopedicsandpediatrics,offerspecialsportsmedicinetrainingcoursestotheirmembers.Whenseekingspecificcareforaninjuredathlete,youmaywanttofindaparticularphysicianwhohassportsmedicinetrainingwithinhisorherfieldofspecialization.Checktheyellowpagesofyourphonebookunder"Physicians"andlookforthosethatlistservicesinsportsmedicine.PhysiciancostswillvarydependingontheservicesrenderedandwhetherXraysaretaken.

Ifyoucannotfindaphysicianwithsportsmedicinetraining,thenaphysicianwhoispersonallyactiveinsportsandexercisemaybeagoodalternative.Suchaphysicianisalso

likelytobesensitivetoaninjuredathlete'suniqueneeds.

Asacoach,youshouldattempttoestablishacloseworkingrelationshipwithaphysician.Youmayaskforhisorherassistanceinconductingteamphysicalsorinteachingsportsmedicinebasicstoyourcoachingstaff.Manyphysiciansvolunteertheirtimetoprovidemedicalcoverageforhomegames.Theymayalsooffertoassistyouwithpreseasonphysicalsandscreenings.

Onceanathletehasbeenexaminedbyaphysician,it'simportantthatyousupportthephysician'srecommendations.Thisincludesfollowinganyrestrictionsonanathlete'splayingtime.Iftheparentorlegalguardianisnotsatisfiedwiththephysician'sdiagnosisandtreatment,seekingasecondopinionmaybewarranted.However,itisunethicalforeithertheparents/guardiansoryoutosendanathletetoadifferentphysicianinanattempttogetpermissionfortheathletetoresumeactivity.

PhysicalTherapists(PTs)

Physicaltherapistsarelicensedhealthprofessionalswhorehabilitateindividualssufferingfromdiseaseorinjury.Theyaretrainedtoanalyzeapatient'sstrength,jointmotion,coordination,andotherphysicalattributesandtheninstructthepatientinanindividualizedrehabilitationprogram.Therapistsarealsotrainedinadministeringmodalitiessuchaswhirlpools,massage,ultrasound,musclestimulation,andmanipulationstohelpeasepain,decreaseswelling,andpromotetissuehealing.

Physicaltherapists,orPTsastheyareoftencalled,aretrainedtohandleawidevarietyofmedicalproblems,includingcerebralpalsy,strokes,heartproblems,paraplegia,andburns.PTsmayalsospecializeinhandlingsportinjuries.Todoso,theymustcompleteseveralyearsofclinicalsportsmedicineexperienceandsuccessfullypassasportphysicaltherapyexamination.Suchindividualsarethenrecognizedassportphysicaltherapists.

Anathleterequiringtheservicesofaphysicaltherapistshouldcheckwithalocalsportsmedicineclinic,physicaltherapyclinic,orhospitalphysicaltherapydepartmentorshouldobtainareferralbyaphysician.Physi

ForSportRehabilitation

DONOT...

...changeanathlete'srehabilitationprogram.

...trytodecidewhenanathlete'srehabilitationiscomplete.

cianreferralisnotnecessaryinsomestates,however.Therehabilitationprogramthataphysicaltherapistprescribestoaninjuredathletecanbecrucialtotheathlete'scompleterecovery.

Youcanalsohelpbyencouragingathletestodotheirrehabilitationexercises.

Thedecisiontoalterordiscontinueanathlete'srehabilitationprogrammustbemadebyaqualifiedphysicaltherapist.PTscanalsohelpyouevaluateyourathletes'fitnesscomponentssuchasstrength,flexibility,andcoordination.Andtheycanprovideassistanceasyouscreenandconditionyourathletes.Finally,physicaltherapistscanofferyouvaluabletipsonproperexercisetechniqueforyourathletes.

CertifiedAthleticTrainers(ATC)

Athletictrainersarenationallycertifiedalliedhealthprofessionalstrainedintherecognition,treatment,rehabilitation,andpreventionofathleticinjuries.Theyevaluateandprovideimmediatecareforinjuriesontheplayingfield,court,andrunningtrack.ATCsalsofitathleteswithprotectivepaddingandequipmentandprovidesupportivetapingandprotectivebandaging.Athletictrainersmustworkunderthesupervisionofaphysicianandmostoftenworkathighschools,colleges,andsportsmedicineorphysicaltherapycenters.

Ifyouworkwithanathletictrainer,itisherorhisroletoevaluateandcareforaninjuredathlete.Duringpracticesandgames,itisthetrainer'sresponsibilitytodecidewhetherarecentlyinjuredathletecanresumeplayingormustrest.Thetrainercanalsohelptopreventinjuriesbyscreeningathletesanddevelopingandimplementingpreseasonconditioningprograms.

SportFirstAidRecap

1.Youplayavitalroleonthesportsmedicineteam,providingemergencycareforinjuredathletesifmedicalpersonnelarenotpresent.

2.Athletesandtheirparentsexpectyou,asacoach,tobeacompetentfirstaidprovider.

3.Oneoftheninelegaldutiesofcoachesistoprovideappropriatemedicalassistance.Thelawrequiresyoutoactandtoprovideastandardofcarecommensuratewithyourtraining.Youcanberulednegligentifyoufailtodoso.

4.Youcanbeabighelptothehealthprofessionalswhoarequalifiedtocareforinjuredathletes.Attimes,yourbiggestcontributionwillbeprovidinginformationregardinghowaninjuryoccurredandencouragingtheathleteduringrehabilitation.

Chapter2SportFirstAidGamePlan

Duringpreseasonconditioning,highjumperSeanMorrishurtshiskneewhiledoingexplosiveplyometricpowertraining.CoachFlintneedsonlytoglanceattheinjurytonoticeanobviousdeformitytoSean'sknee.ThecoachcanseethatSeanisinalotofpain,sohewantstogetmedicalhelpasquicklyaspossible.Hesendsoneoftheothertrackathletestocallforhelp.Afterdiscoveringthatthecoach'sofficeislocked,theathletereturnstogetCoachFlint'sofficekeys,onlytofindthecoachfarfromthehighjumppit,searchingfranticallyforasplintforSean'sleg.Afterseveralminutes,CoachFlintreturnsandgivestheathletehiskeystotheoffice.Seanistreatedandtransportedbyemergencymedicalpersonnelnearlyanhourafterhewashurt.

Togetyourteamreadyforgames,youhavetoplanpractices,developplayingstrategies,andprepareyourplayers.Throughexperienceyouknowthatthispregameplanningprocessisessentialtosuccess.Thesameistrueforsportfirstaid.Tohandleinjurieseffectively,youhavetoplanforthem.Butyoucannotlearnhowtoprepareforinjuriesthroughtrialanderror.

Indeed,youractionsduringthefirstfewminutesofaninjuryarecritical.Theremaybebloodloss,swelling,breathingdifficulties,andawholehostofotherproblems.Ifyouactquicklyandappropriately,youcanminimizethedamagecreatedbytheinjury.Ultimately,thiswillhelptospeedaninjuredathlete'srecovery.

So,toensurethatyoursportfirstaidgameplanisready,readthischaptercloselyanduseittoprepare.Thesearethekeypartsofthefirstaidstrategytomakeyouaneffectivecontributor:

Learningsportfirstaid

Keepingathletes'healthrecords

Checkingfacilitiesandequipment

Gettingplayersreadytoperform

Developinganemergencyplan

LearningSportFirstAid

Muchofourlearninghappensinprogressivestages.So,toprepareyoutoassumeyourfirstaidresponsibilities,thisbookwilltakeyouthroughathreesteplearningprocessinwhichyou

1.learnthebasicsofsportfirstaid,

2.learnhowtorecognizecommonsportinjuries,and

3.learnhowtoprovideappropriatefirstaidforthesecommoninjuries.

Youalsoneedtoknowhowtoprepareaninjuredathletefortransportationtomedicalfacilitiesandhowtocontactappropriatemedicalpersonnel.ThisbookandtheASEP/NFICEPLeaderLevelSportFirstAidCoursewillhelpyoulearnallthesethingsandmore.

However,ASEPstronglyrecommendsthatyousupplementwhatyoulearnfromthisbookandfromthecoursewithcertificationinbasicfirstaidandcardiopulmonaryresuscitation(CPR).TheAmericanRedCrossofferscertificationinbothareas,whiletheAmericanHeartAssociationoffersCPRcertification.Theprocedurestaughtintheseprogramsarerecognizednationallyasstandardsforprovidingfirstaidcare.IfyoubecomecertifiedineitherfirstaidorCPR,youwillbeexpectedtoprovidethestandardofcaretaughtinthecertificationprogram.

EveryCoachShouldBeCertifiedinCPR!

KeepingCurrent

Becausesomanyimprovementsareconstantlybeingmadeinsportsmedicine,youcannotjustlearnsportfirstaidonceandthinkyou'resetforlife.Youcanbecertainthatthesportfirstaidtechniquesusedinthefuturewillbemuchdifferentandbetterthanthemethodsadvocatednow.Sokeepyourselfuptodatewiththelatestinsportfirstaidbydoingthefollowing:

Readcurrentsportsmedicinebooksandarticlestolearnthenewesttechniques.SomeexcellentsourcesofinformationarelistedintheRecommendedReadingsonpage175.

KeepyourfirstaidandCPRcertificationscurrent.Firstaidcertificationsgenerallyexpireafter3years,whereasCPRcardsmustberenewedeveryyear.Recertificationisvitalitenablesyoutostayuponthelatestfirstaidtechniques.

Attendsportsmedicineandsportfirstaidseminarsandclinics.TheASEP/NFICEPLeaderLevelSportFirstAidCoursewillbeupdatedasadvancesinthisareawarrant,soplantoattendanothercourseinthenextfewyears(seeAppendixA).

RecognizingLimitations

Althoughyoumayeducateyourselfextensivelyinsportfirstaid,don'tattemptthedutiesofaphysician.Recognizeyourlimitations.Don'ttrytogivecareunlessyou'requalifiedtodoit.Also,ifmedicalpersonnelarepresent,givethemcompletecontroltohandleanyinjuriesassistthemiftheyrequestit.Thedamageyoucancausebyoversteppingthelimitsofyourtrainingmaybesufferedbyanathleteformanyyears.Andifyoudoactirresponsiblyandharmanathlete,youwillprobablybethetargetofalawsuit.

KeepingAthletes'HealthRecords

Likemostcoaches,youprobablyhavestatisticalrecordsofyourteam'sgameperformancesfiledawayinyouroffice.Butdoyouhaveafilingcabinetforplayers'healthinformation?Ifnot,getone.Thencollectfromeachplayerthesethreeitems:

Consentform

Healthhistoryform

Emergencyinformationcard

ConsentForm

Aswediscussedinchapter1regardinglegalduties,youcannotgivefirstaidcaretoaminorunlessyouhaveconsent.Beforetheseason,youmusthaveparentsorlegalguardianscompleteandreturnanexplicitlywordedconsentformfortheirchildren.AformsimilartotheoneshowninFigure2.1informstheparent(s)orguardian(s)oftheinherentrisksofsportandrequestspermissionforthechildtobetreatedforinjury.

HealthHistoryForm

Itisveryimportantforyoutoknowwhetheranyofyourathleteshavehealthproblemsthatcouldaffecttheirsportparticipation.Diabetes,asthma,epilepsy,heartmurmurs,

Figure2.1Informedconsentform.

andskinconditionsaresomeofthehealthproblemsyoushouldknowabout.Ifaphysicianclearsanathletewithahealthproblemforparticipation,youshouldhavearecordofthefollowing:

1.Thehealthproblem

2.Specialmedicationstheathletemayneedtotake

3.Activityrestrictionsfortheathlete

Ahealthhistoryform(seeFigure2.2)willgiveyouthisinformation.

EmergencyInformationCard

Intheeventofanemergency,youmustbeabletocontacttheathlete'sparentsorguardianandphysician.Anemergencyinformationcard(seeFigure2.3)willgiveyoutheirnamesandnumbers.Itshouldalsoalertyoutoinformationonanypreexistingmedicalproblemsthatmayinfluencethetreatmentofanathlete.

Thiscardmustbecompletedbytheathlete'sparentsbeforetheseason.Incaseswhereyouarepracticingorplayingawayfromyouroffice,youwillwanttotakeacopyofthecard.

CheckingFacilitiesandEquipment

Althoughpreparationandcareoftheplayingareamaybetheresponsibilityofagroundskeeperorjanitor,youarestillresponsibleforcheckingitssafety.Litter,slipperyfloors,brokengoals,wornplayingsurfaces,andcountlessotherproblemscanleadtoinjury.Besuretocheckforanyhazardsandhavethemfixedbeforetheseason.SeeASEP's

Figure2.2Healthhistoryform.

Figure2.3Emergencyinformationcard.

SuccessfulCoaching(Martens,1997),pages161164,forachecklist.

Sportsequipmentalsoneedstobecheckedbeforetheseason.Youmustinspectsticks,rackets,bats,gymnasticapparatus,andotherequipmentfordamage.Andbesurethatgoalposts,netstandards,landingpits,andgymnasticapparatusarewellpadded.

You'llalsowanttohavesomeveryvaluableequipmentonhandincaseofinjury.Thiswillmakeupthefirstaidkit.Youshouldhaveafirstaidkitandicecooleronthesidelinesofeverypracticeandgame.

Whenpreparingyourfirstaidkit,omitallmedicines,bothoverthecounterandprescriptiondrugsitisillegalforyoutogiveanykindofmedicinetoathletes.Thisincludesaspirinoranyotheroverthecounterpainmedicine.

Don'tincludeiodineeither.Itmaycauseanallergicreactioninsomeindividuals.Stockyourkitonlywiththoseitemsnecessaryforadministeringbasicsportfirstaid.

GettingPlayersReadytoPerform

Athleteswhoarenotinshapearemorelikelytobeinjured.Yet,manycoachesfrequentlyneglectmeasurestoensurethateveryathleteisfittoplay.Youcangetaheadofothercoaches'programsbyinstitutingthesevitalmethodsforpreventinginjuries:

Preseasonphysicalexam

Preseasonscreening

Preseasonconditioning

Properwarmupandcooldown

Protectiveequipment,bracing,andtaping

Correctskillinstruction

Soundnutritionalguidance

Banonhorseplay

PreseasonPhysicalExam

Thefirststepinpreparinganathleteforsportparticipationistorequireapreseasonphysical.Thisshouldbeaverythoroughexaminationconductedbyaphysician.

Duringthephysicalthephysicianshouldperformageneralhealthexam,aswellascirculatory,respiratory,neurological,orthopedic,vision,andhearingexaminations.Theathleteshouldalsoundergoroutinebloodandurineanalyses.Thephysicianshouldnoteandconsideranypreexistingorpotentialhealthproblemswhendecidingwhetheranathleteisclearedtoparticipate.

Allathletesmustturnintheirphysicalformspriortotheseason.Allformsshouldbekeptonfileforfuturereference.

DISQUALIFYINGMEDICALCONDITIONS

Somecommonproblemsfoundbytheexaminingphysicianthatcoulddisqualifyathletesfromcompetitionorlimittheirparticipationincludethefollowing:

Diabetes

Asthma

Heartconditions

Highbloodpressure

Epilepsy

Previousheadinjuries

Previousspinalinjuries

Chronicorthopedicproblems(e.g.,unstableknees,ankles,shoulders)

PreseasonScreening

Althoughthephysicalexamwilldetectspecifichealthproblems,itdoesnotprovideinsightaboutanathlete'soverallfitness.Coachesobtainthisinformationthroughpreseasonscreening.

Preseasonscreeningshouldbeconductedintheoffseasonbyaspeciallytrainedhealthorfitnessprofessional,suchasaphysicaltherapistorathletictrainer.Eachathleteshouldbeevaluatedforthefollowing:

Strengthinthemusclegroupsmostoftenusedintheparticularsportforexample,afootballplayer'sneckstrengthorabasketballplayer'sanklestrength

Flexibilityortightnessinthemajormusclegroups

Cardiovascularendurance(especiallyforenduranceathletessuchascrosscountryrunners,trackathletes,triathletes,andcyclists)

Bodycompositionorpercentbodyfat(especiallyimportantforwrestlers,gymnasts,andtrackathleteswhoseverelyrestricttheirdietstocontroltheirweight)

Thesetestspinpointpotentialfitnessproblemsthatcanleadtoinjury.Coachesorathletictrainersshouldteachathletesconditioningexercisestohelpthemimproveanyproblemsbeforetheseason.

PreseasonConditioning

Coachesshouldhaveathletesstartaconditioningprogrambeforetheseasontogettheminshape.Theconditioningexercisesfocusonmusclestrength,endurance,flexibility,power,andspeedneededforthesport.Togetinshape,athletesmustbeginworkingoutatleast6to8weeksbeforetheseason.Ittakesatleastthatlongforathletestoachieveanyimprovementsinthesefitnessattributes.

Toimprovestrength,athletesneedtoperformatleastthreesetsof6to8repetitionsofeachexercise,3daysaweek.Postpubescentathletesshouldliftatleast70%oftheirmaximumtogainstrength.Withprepubescentathletes,toavoidweightliftingrelatedinjuries,emphasizeactivitiesthatrequiretheathletestosupporttheirownbodyweight(e.g.,pushups).Training3daysaweekforatleast20continuousminutesisnecessarytoimprovecardiovascularendurance.Also,athletesshouldperformstretchingexercisesatleast5daysaweek.

Thesearejustthemostbasicguidelinesfortrainingathletes.Formoreinformationonpreseasonscreeningandconditioning,consultASEP'sCoachesGuidetoSportPhysiology(Sharkey,1986).

ProperWarmupandCooldown

Besurethatyourathleteswarmupbeforetheirconditioningworkouts,practices,andgames.Thisdoesn'tmeangoingout5minutesbeforepracticeandhittingorthrowingafewballs.Aproperwarmupisanexerciseroutinethatpreparesthebodyforvigorousphysicalactivity.Athletesshouldwarmupatleast15minutespriortoactivityusingthissequence:

1.Generalbodywarmup.Haveathletesjogorbikeatalowintensityorperformlightcalisthenicsfor5to10minutes.Theintensityofthegeneralwarmupshouldcauseaslightincreaseintheheartandbreathingrates.Itshouldalsocausetheathletetobreakintoa

StockingtheFirstAidKit

Awellstockedfirstaidkitshouldincludethefollowingitems:

Listofemergencyphonenumbers

Changeforapayphone

Faceshield(forrescuebreathingandCPR)

Bandagescissors

Plasticbagsforcrushedice

3inchand4inchelasticwraps

Triangularbandages

Sterilegauzepads3inchand4inchsquares

Salinesolutionforeyes

Contactlenscase

Mirror

Penlight

Tonguedepressors

Cottonswabs

Butterflystrips

Bandagestripsassortedsizes

Alcoholorperoxide

Antibacterialsoap

Firstaidcreamorantibacterialointment

Petroleumjelly

Tapeadherentandtaperemover

11/2inchwhiteathletictape

Prewrap

Sterilegauzerolls

Insectstingkit

Safetypins

1/8inch,1/4inch,and1/2inchfoamrubber

Examinationgloves

Thermometer

lightsweat.Thishelpstopreparetheheart,lungs,muscles,andtendonsforvigorousactivity.Ultimatelyithelpstopreventinjuryaswellasimproveperformance.

2.Stretchingexercises.Afterageneralwarmup,athletesshouldstretchthemajormusclesofthe

shoulders,

armsandforearms,

trunk(backandabdominalareas),

thighs,and

lowerlegs.

Eachmusclegroupshouldbestretchedinoneormorerepetitionsforatotalof15to30secondsduringthewarmup.Topreventathletesfrombouncingwhilestretching,youmaywanttomakesurethattheyholdastretchforatleast10seconds.Thepurposeofwarmupstretchingistoloosenupthemusclesforactivity(seeAppendixB).

3.Sportspecificdrills.Thesearedrillsinwhichathletespracticetheskillsoftheparticularsport.Forexample,sportspecificsoftballdrillsincludebattingandthrowing.Intennisandracquetballdrills,playerspracticeservesaswellasbackhandandforehandshots.

Attheendofeachpractice,workout,game,meet,ormatch,athletesshouldgraduallycooltheirbodiesdown.Inotherwords,theyshouldslowlyreducetheintensityoftheiractivityuntiltheirheartandbreathingratesdroptonearnormalrestinglevels.Suddenlystoppingexerciseinhibitsone'srecoveryfromactivityandcanleadtoproblemssuchasfainting.Athletesshouldperformcooldownactivitiessuchaswalkingorjoggingfor5to10minutes.

Thecooldownshouldconcludewithstretching.Sincethemusclesareverywarmafteractivity,theywillstretchmoreeasilyandmaintainthestretchedpositionlonger.That'swhythecooldownperiodisaprimetimeforathletestoachievelongtermimprovementsintheirflexibility.Eachmusclegroupshouldbestretchedforatotalof2to3minutes.Ingeneral,musclesneedtobestretchedforatotalof2to5minutesadaytoobtainlastingimprovementsinlength.Stretchesforeachmusclegroupcanbeperformedallatonceorbebrokendownintorepetitionsperformedthroughouttheday.

ProtectiveEquipment,Bracing,andTaping

Everyathleteneedstobeinstructedinthefittingandwearingofsafetyequipmentforhisorherparticularsport.Thisisespeciallytrueinfootball,wherehelmetsmustbespeciallyfittedandtheathletesarerequiredtowearalloftheirprotectivepads.Youshouldbefamiliarwiththeprotectiveequipmentrequiredforyoursportandhowtofititproperly.

Twooftenneglectedbutimportantpiecesofequipmentaresafetyglassesorgoggles,andmouthpieces.Ifthereisanychanceofeyeinjury,particularlyincontactorracketsports,athletesmustwearsafetyeyewear.Also,expensivedentalrepairscanbeavoidedifathletesincontactsportswearprotectivemouthguards.

Whataboutprotectivebracingandtaping?Youmayhaveheardaboutcoacheswhorequirecertainfootballplayerstowearprophylactickneebracesorbasketballplayerstotapetheirankles,eventhoughtheathleteshavenotsufferedpreviousinjuriesintheseareas.Thecoachesfeelthatbracesortapewillhelppreventinjury.

TOBRACEORNOTTOBRACE?

Areprotectivebracingandtapingallthey'recrackeduptobe?Theyarecertainlynosubstituteforbeinginshape.Rememberthatstrength,flexibility,endurance,andpowerarethekeystopreventinginjury.Bracingandtapingareofsecondaryimportance.Theresultsofstudiesinvestigatingtheeffectivenessofprotectivebracingandtapingareinconclusive.Itisverydifficulttoprovewhetheradecreaseininjuriescanbeattributedtowearingaprotectivebrace.Ultimatelytheissueofpreventivebracingandtapingisdecidedbytheindividualpreferenceandfinancialstatusoftheathleticprogramandathlete.

CorrectSkillInstruction

Manyathletesareinjuredbecausetheyuseincorrecttechnique.Infootball,sincespeartacklingwiththeheadwasruledillegal,thenumberofheadandneckinjuriesamongplayers

hasdecreased.Baseballorsoftballplayerswhodiveheadfirstintothebaseinsteadofslidingfeetfirstarepronetotooth,head,andneckinjuries.Manytennisplayerssufferfromtenniselbowbecausetheyuseincorrectbackhandtechniques.

Youcanhelppreventtheseandotherinjuriesbysimplyteachingyourathletessafeandproperperformancetechniques.Andkeepaneyeouttocorrectathleteswhousepotentiallyharmfultechniques.Warnthemofthepossibleinjuriestheycouldsuffer,thenreinstructthemintheappropriatemaneuvers.

SoundNutritionalGuidance

Encourageyourathletestoeatbalancedmealsaccordingtothefoodguidepyramid.Figure2.4outlinesthecomponentsandamountsofeachdietarysourcerecommendedforathletes.

Alsoencourageathletestodrinkplentyofwateralldaylong.Particularlyimportant,athletesshoulddrink1to2cupsofwater30minutesbeforeexerciseand1/2to1cupevery15to20minutesduringpracticesorgames.Foractivitieslastingover60minutes,athletesmaybenefitfromasportdrink,whichisgenerallyacombinationofacarbohydratesource,theelectrolytespotassiumandsodium,andwater.Asportdrinkwiththepropercarbohydratecontentof6to7%(1417gramsofcarbohydrateper240ml)mayenhancefluidabsorptionandprovidescontinuouscarbohydratestoworkingmuscles.

ForHydration

DONOT...

...giveathletessalttabletstopreventdehydration.Excesssaltinthestomachactuallypullswaterintothestomach.Thisleaveslesswatertohelpcoolthebodythroughsweat.

Contrarytopopularbelief,athletesdonotneedtotakevitamin,mineral,protein,orcarbohydratesupplements.Byeatingabalanceddiet,theywillgetallofthenutrientstheyneedforcompetition.

EatingontheRoad

Anadequate,highcarbohydrate,moderateprotein,lowfatdietcanbeobtainedontheroadwithalittleplanningandorganization.Ifbudgetsallow,bringalongdriedfruits,juices,lowfatgranolabars,andothersnacksthatofferhealthyalternativestovendingmachines.Inaddition,manyrestaurantswillhonorspecialrequestsforteams,suchaspastabars,lowfatsandwichoptions,andfreshfruitsandvegetables.Encourageathletestoconsumejuicesandskimmilkproductsasopposedtosoftdrinksbaked,broiled,orboiledmeatsinsteadoffriedmeatsandplentyofcarbohydraterichfoodssuchaspotatoes,rice,pasta,breads,bagels,fruits,andvegetables.Portionsmustbeappropriate,andbesuretoplanmealstoallow

Figure2.4Thefoodguidepyramid.

EATINGFORPERFORMANCE

Tohelppreventupsetstomachsduringcompetition,athletesshould

eatatleast3to4hoursbeforecompetition

avoidfoodsthatarehighinfatsuchasfrenchfries,potatochips,andpeanutbutter

avoidfoodsthatarehighinbulksuchaslettuce,beans,cabbage,spinach,andnuts

avoidfoodsthatarehighinsugarsuchascandybars,cakes,doughnuts,andhoney

eatplentyofhighcarbohydratefoodsthatareeasilydigested,suchaspasta,breads,lowfibercereals,fruitjuices,potatoes,andbananasand

eatfoodsthatarefamiliartotheathletethepregamemealisnotimetotrynewfoods.

adequatetimefordigestionbeforeacompetition.

Anadequatedietforanathleteissimilartogasolineforanautomobile.It'sfuelforperformance.Tobetterinformyourathletesaboutthe''octane"intheirdiets,andtolearnmoreaboutsportdrinksandothernutritionalissues,readASEP'sCoachesGuidetoSportNutrition(Eisenman,Johnson,andBenson,1990)forfurtherinformation.

BanonHorseplay

Althoughjokingandkiddingarebasicallyharmless,horseplaycandefinitelyleadtoinjury.Establishtheruleof"nohorseplay"atthestartoftheseasonandenforceitatalltimes.Yourteamwillgetmoreaccomplishedduringpractices,anditislesslikelythatyourplayerswillbeinjured.

DevelopinganEmergencyPlan

Thefinalstepinpreparingforsportsinjuriesistodevelopanemergencyplan.Toconductathoroughevaluationofaninjuredathlete,activatetheemergencymedicalsystem(EMS),

andprovideeffectivefirstaid,usethefollowingresponseplanadaptedfromtheAmericanRedCross:

CheckHowdoIevaluate(check)aninjuredathlete?

CallHowdoIactivate(call)theEMS?

CareHowwillfirstaidcarebeprovided?

HowdoIEvaluate(Check)anInjuredAthlete?

First,yourplanneedstospecifyhowyouwillevaluateaninjuredathlete.Evaluatinginjuriesisthetopicofchapter4.

HowDoIActivate(Call)theEMS?

Next,yourplanshouldindicatehowtoactivatetheEMS.Thissectionpresentsaplanformakingsurethisstepishandledefficientlyandwithoutconfusion.Ifmedicalpersonnelarenotpresent,youshouldprovidefirstaidcare.But,howdoyousendformedicalassistancewhileyouaretendingtotheathlete?Tohelpeverythinggomoresmoothlyintheeventofaninjury,developaplanforactivatingtheemergencymedicalsystembeforetheseason.Here'saneffectivestepbystepapproachyoumighttry.

1.Delegatetheresponsibilityofseekingmedicalhelptosomeoneelse.Thiscanbeeitheranassistantcoach,aparent,oranathlete.Butitmustbeanadultwhoiscalmandresponsible.Makesurethatthispersonisonhandbeforeeverypracticeandgame.

2.Writeoutalistofemergencytelephonenumbers.Thislistshouldbetakentoeverypracticeandgameandshouldincludephonenumbersforthefollowing:

EmergencyNumbers

RescueUnit____________

Hospital______________

Physician______________

Police________________

Firedepartment

Ifyouaretravelingtoanawaygame,talktothehostcoachespriortothegameaboutemergencyservices.

Figure2.5Emergencyresponsecard.

Figure2.6Injuryreportform.

3.Takeeachathlete'semergencyinformationcardtoeverypracticeandgame.Thisisespeciallyimportantifanathleteisunconsciousandunabletotellyouwhoyoushouldcontactortogivethatperson'sphonenumber.

4.Giveanemergencyresponsecard(seeFigure2.5)tothecontactpersoncallingforemergencyassistance.Thiscardwillnotonlyhelpthecallerremembertoprovidecriticalinformationtotheemergencycarestaff,butit'llalsohelpthecallerkeepcalm,knowingthateverythingsheorheneedstocommunicateisspelledoutonthecard.

5.Completeaninjuryreportformandkeepitonfileforanyinjurythatoccurs.ItshouldprovidetheinformationrequestedinthesampleshowninFigure2.6.

HowWillFirstAidCareBeProvided?

Finally,yourplanneedstoindicatehowfirstaidcarewillbeprovided.Ifmedicalpersonnelareonhandatthetimeoftheinjury,youshouldprovideassistancetothemifneededwhiletheyassumethecareoftheinjuredathlete.Ifmedicalpersonnelarenotpresent,youshouldprovidefirstaidcaretotheextentofyourqualifications.Chapters5and6coverfirstaidbasicsandtheproperwaytomoveaninjuredathlete.PartIIIdiscussescareofspecificinjuries.

HandlingMinorInjuries

Manyinjuriesdon'trequireemergencymedicalattention.Anathletewhoslightlytwistsanankle,getsthe"windknockedout"ofhimorher,orsuffersaminorbruiseisnotinseriouscondition.However,don'ttakethesenoncriticaltypesofinjurieslightly.Theycanseverelyimpairperformanceandshouldbe

EMERGENCYSTEPS

Ifaninjurydoesoccur,youremergencyplanshouldfollowthissequence:

1.Checktheathlete'slevelofconsciousness.

2.Sendacontactpersontoactivate(call)theemergencymedicalsystemandcalltheathlete'sparents.

3.Sendsomeonetowaitfortherescueteamanddirectthemtotheinjuredathlete.

4.Assess(check)theinjury.

5.Administerfirstaid(care).

6.Assistemergencymedicalpersonnelinpreparingtheathletefortransportationtoamedicalfacility.

7.Appointsomeonetogowiththeathleteiftheparentsarenotavailable.Thispersonshouldberesponsible,calm,andfamiliarwiththeathlete.Assistantcoachesorparentsarebestforthisjob.

8.Completeaninjuryreportformwhiletheincidentisstillfreshinyourmind.

checkedcloselytoensurethatnofurthercomplicationsexist.

Forthesesocalled"minor"injuries,takethesesteps:

1.Evaluatetheinjury.

2.Administerfirstaid.

3.Removetheathletefromparticipationiftheathleteisinagreatdealofpainorsuffersfromalossoffunction(can'twalk,run,jump,throw,etc.).

4.Contacttheathlete'sparents.

5.Completeaninjuryreportformwhiletheincidentisstillfreshinyourmind.

6.Discusstheinjurywiththeparents.

7.Suggestthattheathleteseeaphysiciantoruleoutaseriousinjury.

SportFirstAidRecap

1.Thekeytocontrollingandpreventinginjuriesisproperpreparation.You'llbebetterabletocontrolandpreventaninjurysituationifyouprepareyourselftohandleit.

2.Studyingsportsmedicineliterature,completingfirstaidandCPRcertifications,andattendingsportsmedicineseminarsareexcellentwaystoprepareyourselfforhandlinginjuries.

3.Preparingforinjuriesalsorequirestakingcareofadministrativepaperworksuchasparentalconsentformsandhealthhistoryforms.

4.Asacoach,youshouldoverseetheconditionofplayingareasandplayingequipment.Findandrepairanydefectsbeforethestartoftheseason.

5.Preparingplayersforcompetitioncangreatlyreducetheriskofinjury.Athletesshouldundergoextensivephysicalexaminationsandpreseasonscreeningtopinpointanypotentialhealthorfitnessproblems.

6.Preseasonconditioningalongwithwarmupandcooldownexercisesareessentialforpreventinginjury.

7.Tominimizeconfusionandensurethataninjuredathletereceivespromptmedicalattention,developanemergencyplan.Outlinewhoisresponsibleforwhatduties,howadutyshouldbecarriedout,whencertainactionsshouldbetaken,andwhatpaperworkneedstobecompleted.

8.Youneedtoteachathletescorrectsportskilltechniquesandrepeatedlywarnthemagainsttechniquesthatarepotentiallydangerous.

9.Enforcepoliciesthatrequireathletestowearprotectiveequipmentandrefrainfromhorseplay.

PARTIIBASICSPORTFIRSTAIDSKILLS

Let'sassumethatyou'veenactedalloftheplanningandpreparationmeasuresdescribedinPartI.Nowtheseasonhasstarted,andyou'rewatchingyourteam'sfirstscrimmage.Youturnandseeaplayercrashtotheground,thenyouhearthescreamofpain.Nosportsmedicinespecialistisonhand,andimmediateattentionisrequired.Whatdoyoudo?

a.Runforthehills.

b.Ignoretheathleteandcontinuewithpractice.

c.Takeadeepbreathandtendtotheathlete.

Surelyyouansweredc,butwasthatactuallyyourfirstresponse?Ifyourgutreactionwasaorb,don'tworry,you'renotalone.Mostpeoplewouldratherwalkacrosshotcoalsthantrytoevaluateandtreataninjury.They'reafraidthey'lloverlookaninjury,makeawrongdecision,orgivethewrongcare.

Preparationisthekeytoeliminatingtheanxietyoveradministeringsportfirstaid.Justlikeyourathletes,you'llbemoreconfidentandsuccessfulifyoumasterthebasicskillsandlearnthebasicrulesandstrategies.Chapter3willhelpyoudevelopabasicknowledgeofanatomy,whichisessentialtoyourbeingabletoadministerappropriatesportfirstaid.Also,theGlossaryinthebackofthebook(pages171174)willhelpyoulearnthetermscommonlyusedinsportsmedicine.Onceyou'vedevelopedasoundknowledgebase,you'llbetterunderstandtheguidelinesforevaluatinginjuriespresentedinchapter4.

Justasyouwoulddevelopstrategiestobreakateam'splayertoplayerdefense,thesportfirstaidtacticsoutlinedinchapter5willhelpyouhandleanycommonsportfirstaidproblem.Thesearethebasicformations,ifyouwill,fromwhichyouwillrunallofyourspecificemergencyplays.

Finally,inchapter6,you'lllearnwaystoassistinsafelymovinganinjuredathlete.Thesecretsherearecautionandpropertechnique,dependingonthetypeofinjuryincurred.

Thechaptersinthissectionwillhelpyoutaketheguessworkandfearoutofadministeringsportfirstaid.Withthesecommonguidelinesunderstood,you'llfindevaluatingandtreatinginjuredathleteseasierandlessintimidating.

Chapter3AnatomyandSportInjuryTerminology

Imaginethatyouarecoachingavarsityvolleyballteam.Aplayerreturnsfromseeingthephysicianandtellsyou,"ThedoctorsaidIhavearecurrentsubluxatingshoulderandhe'dlikemetodosomerotatorcuffstrengthening."Youhopethattheathletewillexplainfurther,soyoudon'thavetosuffertheembarrassmentofherrealizingthatyouhaven'taclueastowhatshe'stalkingabout.

Recurrentsubluxation?Rotatorcuff?Ifyou'reunfamiliarwithbasicanatomicalterminology,thesewordsprobablysoundforeigntoyou.

Inthischapteryou'llexploreanatomicalandsportinjuryterminology.Withabetterunderstandingoftheseareas,you'llbeableto

1.improveyourunderstandingofphysicians'diagnosesandorders,and

2.betterrelateanathlete'ssymptomsandproblemstoparents,guardians,orsportsmedicineprofessionals.

Beforewegetintoevaluatingandtreatingspecificsportinjuries,let'sreviewbasichumananatomy.Asyouknow,thebodycanbedividedintoseveralsystems,andwithinthesesystemsareseveralbodyconstituents.Eachsystemisvitaltosupportinglife.Eachisalsopronetocertaininjuriesandillnesses.

MusculoskeletalSystem

Let'slookfirstatthefoundationofthebodythemusculoskeletalsystem.Asthenameindicates,thissystemismadeupofbones,muscles,andjoints.

Bones

Theskeleton(bones)isthebody'sinfrastructure.Itstwoprimaryfunctionsare

tosupportthebody,and

toprotectimportantorganssuchasthebrain,lungs,andheart.

AsillustratedinFigure3.1,thebonesareeffectivelypositionedandsizedtoservethesetwofunctions.

Muscles

Musclesarefibrouselastictissuesthatmovebones.Themostcommonmusclegroupsinjuredinsportareasfollows(seeFigure3.2):

Rotatorcufflocatedontheshoulderblade,thesemusclesareinvolvedinthrowingmotions.

Quadricepslocatedonthefrontofthethigh,thesemusclesstraightenthekneeandmoveorbendthethighforward.

Hamstringlocatedonthebackofthethigh,thesemusclesbendthekneeandmovethethighbackward.

Calflocatedonthebackofthelowerleg,thesemusclespointthefootdownandalsohelpbendtheknee.

Ligaments

Ligamentsarebandsoftissuethattypicallyservetoconnectbonesatjoints.Theirmajordutyistoholdthebonestogethertheyarethereforeextremelyimportanttojointstability.

Tendons

Tendonsarefibrouselastictissuesthatattachmuscletobone.

Thesetendonsarecommonlyinjuredinsport(seeFigure3.3):

Achilles(heel)

Patellar(kneecap)

Biceps(upperarm)

Rotatorcuff(shoulder)

Cartilage

Cartilageisagristlytypeoftissuemostoftenfoundontheendsofbones.Ithelpsabsorbtheshockofboneshittingeachotherandreducesthefrictionofbonesrubbingtogether.

Figure3.1Skeletalsystem.Frontview(a)andbackview(b).

Figure3.2Fourmusclegroups.

Bursa

Bursaaresmall,fluidfilledsacslocatedbetweenbones,muscles,tendons,andothertissues.Theyhelptoreducefrictionbetweentissues.

Joints

Thebody,however,wouldbeimmobileifnotforthemovementaffordedbythejointstheplaceswherebonesjoin.Jointsinthebodyaremadeupofligaments,tendons,cartilage,andbursa(seeFigure3.4).Primaryjointsincludetheknee,elbow,shoulder,andankle.

NeurologicalSystem

Asacoach,youappreciatetheimportanceofthementalaspectofyoursport.Furthermore,youknowhownervescanaffectyourplayers'performance.Sotheneurologicalsystemthebody'scontrolcenterisakeycomponentofthebodythatyoumustunderstand(seeFigure3.5).

Thebrainisthecontrolcenterthatcoordinatesthefunctioningofallbodytissues.Digestion,breathingandheartrates,musclecontraction,andmostotherbodilyfunctionsdependonsignalsfromthebrain.Thebrainsendsthesedirectionstothetissuesthroughasystemofnerves.

Figure3.3Fourtendons.

Figure3.4Jointstructure.

Thespinalcordisthemaintrunkfromwhichthenervesbranch.Itisprotectedbyacolumnofbonescalledthespinalcolumn.Thebones,orvertebrae,ofthespinalcolumnareheldtogetherbyligaments(seeFigure3.6).Throughthenervesthebraincansendoutelectricalimpulsestothevarioustissuestomakethemfunction.Thebrainalsoreceivesfeedbackfromthetissuesthroughthenerves.

Figure3.5Neurologicalsystem.

Figure3.6Spinestructures.

DigestiveSystem

Thedigestivesystemisthebody'senergysupplycenter.Theorgansthatcomposeitassistinbreakingdownfoodintoenergysubstancesthatthemusclesandothertissuescanthenuse(seeFigure3.7).Thissystemisverysensitivetotheanxietyathletesexperiencebeforeengaginginsportsevents.Sotheterms''butterfliesinthestomach"or"chokingunderpressure"maydescribeanathlete'sactualphysicalsensations!

CirculatoryandRespiratorySystems

Withthedigestivesystemastheenergysupplier,thecirculatoryandrespiratorysystemscombinetoserveasthebody'senergyreleaser.Thesetwosystemsworktogethertosupplytheoxygenthebodyneedstosustainlife.Oxygenhelpsreleasetheenergyfromfoodtofuelusingtissues.Shutofftheoxygensupplytothebody,andthebodyshutsdown.

Figure3.7Digestivesystem.

ThecirculatorysystemconsistsofthebloodtransportingnetworkshowninFigure3.8.Notehowthecentralpumpinthisnetwork,theheart,mustprovidebloodtoeverypartofthebody.

Therespiratorysystemisthebody'sairtransportingnetwork.Therespiratoryorgansarelocatedintheheadandchestarea(seeFigure3.9).Thoughlessextensivethanthecirculatorysystem,thatdoesn'tmeanthattherespiratorysystemislessimportant.Allyouhavetodoisholdyourbreathandpinchyournoseshutforawhiletorealizehowmuchwerelyonourabilitytobreathe.

TheRespiratoryandCirculatorySystemsatWork

Apersonbreathesinoxygenfilledairthroughthenose,mouth,orboth.Thisairthentravelsdownthewindpipeortracheauntilitreachesthelungs.Insidethelungs,theoxygenpassesthroughtinysacscalledaveoliandintothin

Figure3.8Circulatorysystem.

bloodvesselscalledcapillaries.Thecapillariesjointogetherintolargebloodvesselscalledpulmonaryveins,whichtaketheoxygenfilledbloodtotheheart.

Theheartpumpstheoxygenfilledbloodthroughthearteriestothebodytissues.Inthetissues,oxygenisusedtoreleaseenergyandisbrokendowntoawasteproductcalledcarbondioxide.Thecapillariespickupthecarbondioxide,andthisblood,calledvenousorlowoxygenblood,returnstotheheartviatheveins.Theheartpumpsthelowoxygenbloodtothelungs,whereitgetsridofthecarbondioxideandpicksupnewsuppliesofoxygenfromtheair.

AsynopsisofthiscirculatorycycleisillustratedinFigure3.10.

UrinarySystem

Aftertheenergyissupplied(bydigestion)andreleasedforthebodytouse(bycirculationandrespiration),thebyproductsneedtobedisposedof.Theurinarysystemridsthebodyofwasteproductsfromenergybreakdown.TheorgansshowninFigure3.11participateinthisprocess.

Wasteproductsarebroughttothekidneysthroughtheblood(circulatorysystem).Thekidneysfilteroutthewasteproductsfromthebloodandcombinethemwithwatertomakeurine.Theurineisreleasedfromthekidneysandtravelsthroughtheureterstothebladder.Thebladderstorestheurineuntilitisreleasedfromthebody.

InterdependenceoftheBodySystems

Asyoucansee,thebody'ssystemsandorgansdependoneachother.Thewayonesystemfunctionswillaffecteveryothersystem.Thatiswhyaninjuryorillnessinanybodypartcancauseproblemswithotherparts.

Figure3.9Respiratorysystem.

Figure3.10Functionofthecirculorespiratorysystem.

Figure3.11Urinarysystem.

Withagreaterappreciationofthebody'smakeup,let'slookatsomeoftheinjuriesthatcanalterthebody'sfunctioning.Specifically,we'llexaminethoseinjuriesmostlikelytooccurinsports.

SportInjury

Athletescanbestrickenwithanynumberofphysicalailments.Soweneedaclassificationsystemtocommunicateeffectivelyaboutsportinjury.Andthisclassificationsystemisessentialforprevention,identification,andtreatmentofeachparticularproblem.

Allinjuriesandillnessescanbecategorizedaccordingtothelengthoftimetheytaketodevelop.Thesearethetwomostcommontimerelatedclassesofinjuries:

Acuteoccurringsuddenly

Examples:Brokenbones,cuts,bruises,appendicitis,etc.

Chronicdevelopingorlastingoveralongperiod

Examples:Shinsplints,tenniselbow,diabetes,epilepsy,etc.

Butknowingonlythetermofonsetishardlysufficientinformation.Afterall,first

aidforanacutebonefracturediffersmarkedlyfromthatforanacuteincision.So,tofurtherclarifythevarioustypesofinjuries,we'llclassifythemaccordingtothetypeofbodystructuresthataredamaged.Thesearethetwomostcommoncategoriesforbodyconstituents:

Softtissuesnerves,bloodvessels,muscles,skin,organs,tendons,cartilage,ligaments,bursa,etc.

Examples:Pulledmuscles,bruises,etc.

Hardtissuesbones

Examples:Fractures,stressfractures,etc.

Injuriescanalsobeclassifiedaccordingtohowtheyoccur.Thisinformationisextremelyhelpfulwhencheckingforinjury.Itcanprovideduesastothetypeofinjury.Sportinjuriesareoftencausedbythefollowingmechanisms:

DirectblowAdirectblowtoaspecificbodypartcancausebleeding,superficialanddeeptissuebruising,brokenbones,orjointinjuries.Collidingwithanotherathleteorwithsportsequipmentandfallingonahardsurfacearecommonexamplesofadirectblowmechanisminsport(seeFigure3.12).

TorsionAtorsioninjuryisatwistinginjury.Examplesofthismechanismincludecuttingandpivotingmotionsinfootballandbasketballandtwistingofarmsorlegsinwrestling.Torsionortwistingoftenresultsinjointinjuriesorbrokenbones(seeFigure3.13).

ShearingAshearinginjuryisafrictioninjurycausedbytwosurfacesrubbingtogether.Contactbetweentheskinandthegroundcancauseashearinginjuryduringasoftballorbaseballslide.Shearingusuallycausesskininjuries,butcanaffectothertissuesaswell(seeFigure3.14).

Usingourtimerelatedandbodystructureclassifications,wecanthenexaminethesimilaritiesbetweeninjuriesthatfallintooneofthesefourcategories:acutesofttissue,chronicsofttissue,acutehardtissue,andchronic

Figure3.12Directblow.

Figure3.13Torsion.

hardtissue.Solet'stakealookatspecificinjuriesthatfitthesedescriptions.

AcuteSoftTissueInjuries

Manysportinjuriesoccursuddenlytosofttissueslikeskin,muscle,ligaments,tendons,organs,bloodvessels,andnerves.Thereareseveraldifferenttypesofacutesofttissueinjuries:

Contusions

Abrasions

Punctures

Cuts

Lacerations

Incisions

Avulsions

Sprains

Strains

Cartilagetears

Dislocationsandsubluxations

Figure3.14Shearingortearing.

Contusions

Contusions,orbruises,areacommonsofttissueinjury.Asaresultofadirectblow,tissueandcapillariesaredamagedandlosefluidandblood.Thiscausespain,swelling,anddiscoloration.Contusionstotheskinareminor,butcontusionstoboneandmusclecancauselossoffunction(seeFigure3.15).Contusionstotheheart,lungs,brain,kidneys,orotherorganscanbelifethreatening.

Figure3.15Thighcontusion.

Abrasions

Inabrasions,frictionorscrapinginjurestheouterlayerofatissue.Mostabrasionsoccurtotheskin,suchasturfburnsandstrawberries(seeFigure3.16).Thecornea,orouterlayeroftheeye,canalsobeabradedorscratchedbydustandotherobjects.

Punctures

Puncturesarenarrowstabwoundstotheskinandinternalorgans.You'veprobablyseenskinpuncturescausedbytrackspikes,woodsplin

Figure3.16Legabrasion.

ters,fishinghooks,ornails,asshowninFigure3.17.Althoughsuperficialskinpuncturesmaynotbleedmuch,theyshouldnotbetreatedlightlybecausebacteriaandothermaterialsmaycollectinthewoundandcauseinfection.

Lungsandotherinternalorganscanbepuncturedbysharpobjectssuchasjavelins.Theseinjuriesarelifethreateningandrequireprompttreatment.

Figure3.17Footpuncture.

Cuts

Softtissuemaybecutortorninthreegeneralways.Followingarebriefdescriptionsandillustrationsofthesetypesofcuts:lacerations,incisions,andavulsions.

Lacerations.Lacerationsarejaggedsofttissuecuts(seeFigure3.18)causedbyablowfromabluntobject.Theyaredeeperthanabrasionsandcausesteadybleeding.Forexample,abasketballplayercansufferalacerationabovetheeyeaftercatchinganelbowtotheface.

Figure3.18Faciallaceration.

Incisions.Incisionsaresmoothcutscausedbyverysharpglassormetalobjects(seeFigure3.19).Theyusuallybleedheavilyandquickly.Coachescanhelpathletesavoidmostsituationswhereincisionsoccurbyconductingregularthoroughinspectionsoffacilitiesandequipment.

Avulsions.Avulsionsarecompletetissuetears.Athleteswhowearearringsareespeciallypronetoavulsionsoftheearlobe(seeFigure3.20).Also,athleteswearingringscansufferfingeravulsions.That'swhywearingjewelryshouldbeforbiddenineverytypeofathleticevent.

Sprains

Sprainsoccurwhenligamentsarestretched,torn,orboth(seeFigure3.21).Theyarecausedbyadirectblowortwisting/torsion.

Aligamentspraincancauseajointtoloseitsstability.Remember,ligamentssupporta

Figure3.19Armincision.

jointbyholdingthebonestogether.Withoutsupport,theboneswillnotstayinplace.Oncestretchedortorn,ligamentsdonotnecessarilyregaintheiroriginallengthandmayheallengthenedorstretched.Thatiswhysprainedanklesandkneescanbereinjured.

Strains

Ifamuscleortendonisforcefullyshortenedorstretched,itcanbecomestrained.Astrain,

Figure3.20Earlobeavulsion.

Figure3.21Sprains.

likeasprain,isastretchingortearinginjury(seeFigure3.22)strains,however,occuronlyinmusclesandtendons(you'llrecallthatsprainsoccuronlyinligaments).Ifsevere,astraincandisruptamuscle'sand/ortendon'sabilitytomovethebones.

CartilageTears

Asyou'llremember,cartilagecoverstheendsofbonesandreducesshockandfriction.Ifthebonesofajointaretwistedandcompressed,theymaypinchandtearthecartilage.Thisinjuryfrequentlyoccursintheknee(seeFigure3.23).

DislocationsandSubluxations

Sometimeswhenajointishitortwisted,thebonesmoveoutofposition.Wesaythebones

Figure3.22Strains.

Figure3.23Kneecartilagetear.

ofajointaredislocatediftheystayoutofplaceuntilaphysicianrepositionsthem.Ifthebones"popout"ofplacebutimmediately"pop"backin,asubluxationhasoccurred.Themostcommondislocationsandsubluxationsinsportsoccurtotheshoulder(seeFigure3.24),elbow,fingers,andkneecap.

Dislocationsandsubluxationsmostofteninjurethesofttissuesaroundajoint.Forexample,ligamentsareoftensprainedduringdislocationsandsubluxationsbecausetheirtissuesarestretchedortornwhenthebonesmoveoutofplace.Bonescanalsobreakduringtheseinjuries,althoughthisisnotacommonoccurrence.Thatiswhydislocationsandsubluxationsareclassifiedasacutesofttissueinjuries.

ChronicSoftTissueInjuries

Chronicinjuriestothemuscles,tendons,andbursaarecausedbyrepeatedblows,overstretching,repeatedfriction,oroveruse.Theseinjuriestypicallyoccurinathleteswhoareweakandinflexibleorwhoexerciseexcessively.

ChronicMuscleStrain

Ifamuscleisrepeatedlyoverworkedoroverstretched,achronicstraincanresult.Thistype

Figure3.24Shoulderdislocation.

ofinjurydevelopsoveraperiodofweeksormonthsandcanlastjustaslong.Suchstrainsaredifferentfromacutestrains,becausetheyarenotcausedbyonespecificepisodeofinjury,suchaspullingupfromasprint.

Bursitis

Bursacanbecomeswollenandsoreiftheysufferfromrepeatedblowsorirritation.Elbowandkneecap(seeFigure3.25)bursitisarethemostcommontypesinsports.

Tendinitis

Justasbursabecomeirritated,tendonscanalsobeirritatedbyrepeatedoverstretchingoroveruse.Thismostoftenoccursintendonsthataretightorweak.Thepatella(kneecap),Achilles(heel),biceps,androtatorcuff(shoulder)tendonsareespeciallypronetoirritationinsports.InflexibleandweakpatellarandAchillestendonscanbeoverstressedbyrepeatedrunningandjumpingactivities.Thebicepsandrotatorcufftendonsareusuallyoverstressedwhenanathletethrowswithaweakandinflexibleshoulder.

AcuteHardTissue(Bone)Injuries

We'veallseenaplayergethitorlandhardontheground,andhaveperhapsevenheardthesnapofabone.Althoughtheskeletonisstrong,thereisalimittohowmuchpunishmentitcantake.Let'snowlookatthosetypesofinjuriestobonethatoftenoccurbeforeanathleterealizeswhat'shappened.

Fractures

Sticksandstonesaren'ttheonlythingsthatcanbreakbones.Anaggressivetackleorapoorlyexecutedslidecandoitalso.Insport,bonesthataretwistedorhittoohardcanbreakorfracture.Youshouldbeabletorecognizethevarioustypesoffractures(seeFigure3.26).

ClosedFractures.Closedfracturesarebyfarthemostcommonfracturesthatoccurinsport.Althoughtheyaremostoftendetectedbecausetheycauseanoticeabledeformity,notallfracturescausedeformity.Twocommonclosedfracturesinsportareasfollows:

Figure3.25Kneebursitis.

Figure3.26Closedandopenfractures.

Avulsionfracturestheseoccurwhensprainedligamentspulloffapieceofbone.Thiscanfrequentlytakeplaceintheankle(seefigure3.27)andfinger.

Epiphyseal(growthplate)fracturesgrowthplatesattheendsofbonesaresoftandespeciallypronetoinjury.Afractureoftheepiphysiscanaffectabone'sgrowth.Acommongrowthplatefractureoccursintheelbowofbaseballpitchers,asshowninFigure3.28.

OpenFractures.Arareoccurrenceinsport,anopenfractureiseasilydetectedbyadeformityandopenwound.Youwillbeabletoseeatleastoneofthebonespokingthroughtheskin.Becausetheboneandmuscletissuesareexposed,thefirstaidprovidermusttakegreatcaretocoveropenfractureswithsterilegauze.

ChronicHardTissue(Bone)Injuries

Subjectedtorepeatedwearandtearoveranextendedperiodoftime,bonescansufferchronicconditionsthatcanleadtocrackingandabnormalboneyformations.Perhapsthemostcommontypesofchronicboneinjuryarestressfracturesandarthritis.Arthritisisfairlyuncommoninhighschoolathletes,butstressfracturesdooccur,especiallyinbasketballandtrackathletes.

StressFractures

Ifabonesuffersrepeatedstressorshock,itcaneventuallycrack.Thisiscalledastressfracture.Athletesespeciallypronetostressfracturesincluderunnerswhorunmorethan5mileseverydaywithouttakingadayofrest

Figure3.27Ankleavulsionfracture.

Figure3.28Elbowepiphyseal/growthplatefracture.

andbaseballpitcherswhothrowatfullspeedonadailybasis.

Thesearejustafewofthemanyinjuriesthatyoumayencounterasacoach.Formoreinformationonspecificinjuries,seethechaptersinPartIIIthatapplytotheparticularconditionsthatconcernyou.

SportFirstAidRecap

1.Thebodyconsistsofmanysystemsthatdependoneachothertofunctioneffectively.

2.Theneurological,digestive,circulatory,andrespiratorysystemsallsupportthemusculoskeletalsystem,themainsystemutilizedinsport.

3.Injuriescanroughlybecategorizedbythelengthoftimeittakesforthemtooccur(acutevs.chronic)andthestructuresinvolved(softtissuevs.hardtissue).

4.Contusionsarebruisinginjuriestoeithersoftorhardtissue.

5.Lacerations,abrasions,andpuncturesgenerallyaffecttheskin,butalsooccurintheeyeandinternalorgans.

6.Ligamentsconnectbonetoboneandhelpholdthemtogether.

7.Sprainsorstretchingandtearinginjuriesofligamentsarecommoninsport,especiallyattheankle,fingers,andknee.

8.Tendonsattachmuscletobone.

9.Strains(stretchingandtearinginjuriesofmuscleandtendons)arealsocommoninsportandcanbeeitheracute(sudden)orchronic.

10.Closedfracturesarethemostcommonhardtissueinjuriesinsport.

11.Insubluxations,bonesinajointtemporarilymoveoutofplace,whereasindislocationsthebonesstayoutofplace.Inbothtypesofinjury,theligamentsarealsoinjured.

Chapter4InjuryEvaluation

JackieHayesslidesintohome,tyingthescoreofthefirstroundstatetournamentsoftballgame.Whenshereachesthedugout,though,sheisclutchingherrighthandandjumpingupanddown.CoachJonesgrabsJackie'shandandimmediatelyyanksoffherbattingglove.Hecan'treallydetectanythingwrongwiththehand,butJackiecomplainsthatherthumbhurts.Becausehecan'tactuallyseeaninjuryanddoesn'tknowwhatelsetodo,hetightlytapesJackie'sthumbandputsherbackintothegametocatch.Aftercatchingonepitch,Jackiecollapseswithpain.

Ifyoudon'thaveanyproceduresestablishedforconductinganinjuryevaluation,youmightoverlookaninjury.Andifyouhavenothinginyourfirstaidguidelinesaboutmovinganinjuredathleteorallowingahurtplayertoresumeparticipation,youmaycausefurtherharmtotheathlete.

Thischapterwon'ttellyouhowtodiagnoseaninjury,butitmayhelpyoupreventaninjuryfromgettingworse.Anditwillcertainlyhelpyoumoreeffectivelyaddressthenextinjurysituationthatyouencounter.

PreevaluationSteps

Asyourunoutontothecourt,field,ortracktoattendtoaninjuredathlete,youmusthaveyourthoughtsinorder.Beforeyouevaluatetheinjury,yourprimaryconcernistochecktheathlete's

1.safety,

2.position,and

3.equipment.

Safety

Whenanathletegoesdown,yourimmediateresponseshouldbetoprotecthimorherfromfurtherharm.First,instructallotherplayersandbystanderstoleavetheathletealone.Theycancausefurtherinjurybytryingtomoveanathlete.Youmayevenneedtoreroutetrafficorspectatorstomakesureeveryonestaysclearoftheathlete.

Trytocalmtheathleteandkeephimorherfrommovinguntilyouhaveevaluatedtheinjury.Mostinjuredathletesrollaroundorjumpupanddownbecauseofpainthisextramovementmaycausefurtherharm.

Position

Alwaysletthemedicalpersonnelmoveaseriouslyinjuredathlete.However,ifyoumustdoit,makesureyouknowtheguidelinesandproceduresoutlinedinchapter6ofthisbook.

ForaSeriouslyInjuredAthlete

DONOT...

...movetheathleteunlessheorsheisatriskoffurtherinjury.

...altertheathlete'spositionunlessitpreventsyoufromevaluatingortreatingtheinjury.

Equipment

Referbacktotheopeningofthischapter.InthecaseofJackieHayesandherthumbinjury,shouldCoachJoneshaveremovedherbattingglove?Manycoachesfaceasimilarquestionwhentryingtodecidewhethertoremovetheshoeofanathletewithanankleinjury.Whatshouldyoudointhissituation?

OnRemovingEquipment

DONOT...

...removeequipmentifdoingsowillfurtherharmanathlete.You'llwastevaluabletimethatyoushouldusetocheckandcarefortheinjury.Theonlyexceptionisafootballhelmetfacemask.Ifafacemaskispreventingyoufromcheckinganathlete'sairwayorbreathing,simplycut(ascalpelorsharpknifeworksbest)thestrapsortabsonthesideofthehelmetthatareholdingthemaskinplace.ThenyoucancarefullypullbackthemasktothepositionshowninFigure4.1.Donotuseboltcuttersonthetabsbecausetheywilljartheathlete'shead.Anotheralternativeistouseafaceshield(Figure4.6)thatincludesabreathingtube.Inthiscase,sliptheshieldunderthefacemask,makesurethebreathingtubesticksupthroughthefacemask,andbeginrescuebreathingorCPR.Thiswillultimatelysavetimeandcauselessjostlingoftheathlete.

Figure4.1Facemaskremoval.

Evaluating(Checking)theAthlete

Havingconsideredtheathlete'ssafety,position,andequipment,youcanconductyourevaluation.Asyoumovequicklytowardtheinjuredathletetoevaluatetheinjury,followthesesteps:

1.Remaincalm.Anathletewhoisinpainwillbeupset.Youwillonlyupsettheathletemorebygettingexcited,makingyourevaluationmoredifficult.

2.Rememberanypreexistinghealthproblems.Doestheathletehaveahistoryofasthma,heartproblems,kidneydisorders,neurologicalproblems,diabetes,orseizures?Hasheorsheeversufferedasimilarinjury?Thisinformationprovidescluestowhatmaybewrongwiththeathlete.Itwillalsodictatethecareyouprovide.

3.Recallthemechanismofinjury,orhowtheinjuryoccurred.Wasthereadirecthittoacertainareaofthebody?Wasajointorbodyparttwisted?Thisinformationgivesyouinsightintowhattypeofinjuryyou'redealingwith.

Onceyoureachtheathlete,checkwhetherheorsheisconsciousorunconscious.Dothisbyfirstcallingouttheathlete'snameifyougetnoresponse,thenpinchtheskinbetweentheathlete'sthumbandindexfingerandseewhetherheorsheresponds.Iftheathletestilldoesnotrespond,sendsomeonetocallforemergencymedicalassistance.

PrimarySurvey

Afterdetermininganathlete'slevelofconsciousnessandsendingforemergencymedi

calassistance,performaprimarysurveytocheckhisorhervitalsigns(breathingandheartrates).ThinkofitascheckingtheABCs:

AAirway

BBreathing

CCirculation

ABCsfortheConsciousAthlete

Iftheathleteisconscious,don'tassumethatheorshehasanadequateairway,normalbreathing,oranormalpulse(heartrate).CheckeachoftheABCstobesure.

Airway

Checktheairwaybylisteningforanygaspingorchokingnoises,bycheckingfortheuniversalchokingsignal(theathletegrabshisorherthroat),andalsobyaskingtheathlete,''Canyouspeak?"Iftheathletecantalk,youcanassumethatforthetimebeing,theairwayisopen.

Iftheathleteisunabletospeak,ask,"Areyouchoking?"Ifheorsherespondsbynodding"yes,"orbygraspingthethroat(theuniversalchokingsign),youmustprovidefirstaidcare,inthiscasetheHeimlichmaneuver.Thisprocedureisdescribedonpages7072.

Breathing

Iftheathleteishavingdifficultybreathing,butisabletospeakcontinuewithyourinjurysurveyuntilyoudeterminewhatiscausingthebreathingproblems.Anathletemayhavehadthe"windknockedout"andbeunabletocatchhisorherbreath.Thisandotherbreathingconditionsarefurtherdiscussedinchapter7.

Circulation

Atthispoint,checkthepulse(heartrate)ateitherthewrist(radial)orneck(carotid).Althoughthecarotidpulseiseasiertofeelthantheradial,becarefulnottopushtoohard,orelseyoumayreducethebloodsupplytotheathlete'sbrain.Whentakingapulse,youwilltrytodeterminetherate,regularity,andstrengthoftheheartbeat.Becauseyourthumbhasitsownpulse,besuretouseyourotherfingerstotakesomeoneelse'spulse.SeeFigure4.2forcorrectpositioning.

Figure4.2Twopulses.

Remember,iftheathletehasbeenactive,thepulseandbreathingrateswillbefasterthantherestingrates.Table4.1providesthenormalrestingheartandbreathingratesforvariousages.Iftheathleteisbreathingnormallyandhasanormalpulse,youcanproceedtothesecondarysurvey(pp.4850).

Table4.1NormalRestingHeartandBreathingRates

Agegroup Heartrate*Breathingrate**

Children(5to12years) 60120 20

Adolescents(12to18years) 7585 1220

Adults 60100 1215

*Beatsperminute **Breathsperminute

ABCsfortheUnconsciousAthlete

TimWattsisslammedtothematduringawrestlingmatch.Afterhittingthemat,Tim'sbodyimmediatelygoeslimp.TherefereestopsthematchandCoachThompsonchecksTim'sresponsivenessbycallingouthisnameandtappinghimontheshoulder.Timdoesn'trespond.CoachThompsonwantstomakesurethatTimhasanairwayandisbreathingproperly,butTimislyingfacedownonthemat.WhatshouldCoachThompsondo?

Airway

Thepositionofanunconsciousathleteisaconcernwhenyou'retryingtochecktheairway.Youmustbeabletoeitherfeeltheathlete'sbreathorseebreathingmovements.

Iftheathleteislyingonhisorherback,leanoverandplaceyourearandcheeknexttotheathlete'snoseandmouthasinFigure4.3.

Figure4.3Checkingforbreathing.

Whileinthispositionyouwillattempttodothefollowing:

1.Lookforbreathingmovements.Isthechestrisingandfalling?Isthebreathingshallowordeep?

2.Listenforbreathingsoundscomingfromthenoseormouth.Arethereanyunusualsoundssuchasgasping,wheezing,orlaboredbreathing?

3.Feelwithyourcheekwhetherairismovinginandoutofthenoseormouth.

Iftheathleteislyingonhisorhersideorstomach,youmustbemoreresourceful.Herearethreewaysthatyoumightcheckforbreathinginsuchinstances.

1.Placeyourhandneartheathlete'smouth.Feelforbreathing.Atthesametime,watchtheribcageforrespiratorymovements.

2.Placeamirrorneartheathlete'snoseandmouth.Themirrorwillfogiftheathleteisbreathing.

3.Movetheathlete.Ifallelsefails,movetheathlete.Alwaysassumethattheathletehasaneckorspinalinjurymakesuretheathlete'sheadisstabilizedandthatthewholebodyismovedasaunit.Inchapter6you'lllearnthespecificguidelinesandproceduresformovinganunconsciousathlete.

OpeninganAirway.Ifyoudonotsee,hear,orfeeltheathletebreathing,attempttoestablishanairway.Therearetwomethodsfordoingthis:

HeadTilt/ChinLift(ifnospinalcordinjuryissuspectedseeFigure4.4)

1.Placeyourfingertipsjustbelowtheathlete'schinandgentlyliftthechinforward.

2.Stablizetheathlete'sheadwithyourotherhandontheforehead.

3.Look,listen,andfeelforbreathing.

Figure4.4Headtilt/chinlift.

ChinLift(forunconsciousathleteswithsuspectedneckorspinalcordinjuriescausedbyadirectblowortorsioninjuryseeFigure4.5):

1.Withouttiltingthehead,placeyourfingertipsjustbelowtheathlete'schinandgentlyliftthechinforward.

2.Look,listen,andfeelforbreathing.

3.Ifyoustilldon'tsee,hear,orfeelbreathing,letthechinrelaxandthentrythechinliftagain.

4.Ifthisstilldoesn'twork,trytiltingtheheadveryslightlywhiletryingtoliftthechin.Thismaybeenoughtoopentheairway.

Figure4.5Chinlift.

Breathing

Onceyou'veestablishedanairwaythrougheithertheheadtilt/chinliftorthechinliftonlymethod,whatdoyoudoiftheathletestillisn'tbreathing?Youmustattempttoventilateorinflatethelungs.

FaceShield.Beforewediscusshowtoadministerrescuebreathing,let'stalkaboutfaceshields.WiththeriseinAIDSandhepatitisB,itisrecommendedthatyoucarryafaceshieldinyourfirstaidkit.Thisshieldcanbeplacedoveranathlete'snoseandmouthtoactasabarrierbetweenyouandtheathlete.Thereareseveraldifferenttypesavailable(seeFigure4.6).

Toperformrescuebreathing,followthesesteps:

1.Placeafaceshieldovertheathlete'snoseandmouth.

2.Holdtheathlete'sheadwitheithertheheadtilt/chinliftorthechinliftonly.

3.Iftheshielddoesnotsealoffthenose,pinchthenoseshutandliftthechin(usingheadtilt/chinliftorchinliftonly)asshowninFigure4.7.

4.Sealyourmouthovertheopeningtotheathlete'smouth.

5.Givetwoslow,fullbreathsforadultsortwoslow,gentlebreathsforchildren.

6.Watchtoseewhetherthechestrisesduringthebreaths.

7.Next,turnyourheadtolook,listen,andfeelforthebreathtocomeoutoftheathlete'snoseandmouth.

Figure4.6.(a)Facemaskand(b)shield.

Figure4.7Attemptingtoventilatethelungs.

8.Iftheairdoesn'tgoin,repositiontheathlete'shead(headtilt/chinlift),orinthecaseofasuspectedspineinjury,attemptthechinliftmethodagain.

9.Ifairstilldoesn'tgoin,youmuststartfirstaidforablockedairwaytheHeimlichmaneuver(seepages7071).

Circulation

Afteryou'vegiventhetwofullbreaths,checktheathlete'spulsetodeterminewhethertheheartisbeating.Thisshouldbedonewhileyoulook,listen,andfeelfortheathletetoexhaleorbreatheoutthetwofullbreaths.Checkthecirculationasfollows:

1.Usingthehandnearesttheathlete'sbody,placeyourindexandmiddlefingertipsovertheathlete'sAdam'sapple.

2.Slideyourfingertipsbackandupontothegroovealongthesideoftheneck.Usetheindexandmiddlefinger,butnotthethumb,togentlyapplypressureoverthecarotidartery(seeFigure4.2onpage45).

3.Checkthepulsefor510seconds.

WHENTHEABCs=0

Ifthereisnobreathingorpulseafteryou'vecheckedtheABCs,youshouldtakethefollowingactions:

1.Makesuresomeonehasactivatedtheemergencymedicalsystem.

2.Begincardiopulmonaryresuscitation(CPR).

3.ScanquicklyforanyprofusebleedingwhileyouperformCPR.

4.Ifthereisbleeding,designatesomeonetoapplysterilegauzeanddirectpressureovertheareawhileyougiveCPR.

Figure4.8Primarysurveysummary.

PrimarySurveySummary

Whenanathletegoesdownwithaninjury,youshoulddoasfollows(seeFigure4.8):

1.Checkwhethertheathleteisconsciousorunconscious.

2.Callforemergencymedicalassistance.

3.Ifunconscious,checktheathlete'sABCs:

Airwayuseheadtilt/chinliftorchinliftonly.

Breathinglook,listen,andfeelforbreathing.Ifnone,givetwofullbreaths.

Circulationcheckcarotid(neck)pulse.

4.Iftheathleteisconsciousandabletotalk,checkthesefunctions:

Breathingforirregularities

Pulseforheartorcirculationproblems

5.Ifbothbreathingandpulsearenormal,beginthesecondarysurveytolocateandchecktheextentoftheinjury.

SecondarySurvey

Whenaninjuredathleteisconsciousandhasnormalbreathingandheartrates,youshouldperformasecondarysurvey(check).Duringthissecondarysurvey,youwillpinpointthenature,site,andseverityofaninjury.Aswith

theprimarysurvey,youshouldfollowastandardpatterntomaketheevaluationmorethorough.ThestepsinthesecondarysurveyareeasytorememberwiththeacronymHIT:

HHistory

IInspection

TTouch

History

Ifanathleteisinjured,thesuccessofyourevaluationwilldependonyourgettingahistoryofhowtheinjuryhappened.Yourgoalsinobtainingthehistoryofaninjuryaretodetermineitslocation,mechanism,symptoms,andpreviousoccurrences.

Intakingthehistory,youshould

1.recallwhatyousawandheard,

2.talktotheinjuredplayer,and

3.talktootherathletes.

Ifanathleteisunconsciousorunabletospeak,youwillhavetorelyonwhatyouortheotherathletessaworheard.Also,ifyoudidnotseetheinjuryhappen,youwillhavetoobtainallofthehistoryfromtheathleteaswellasfromotherplayers.

You'llwanttofindanswerstothefollowingquestions:

Wastheinjurycausedbydirectcontactwithanotherplayer,equipment,ortheground?

Wastheinjurycausedbyatwistingorturningmotion?

Wasthereapop,crack,orothernoisewhentheinjuryoccurred?

Wheredoesithurt?

Didtheathletefeelanythingunusualwhentheinjuryhappened?Wastherepain,numbness,tingling,weakness,grating,orasnappingfeeling?

Hastheathletesufferedthisinjurybefore?

Inspection

Afteryou'vefiguredoutwhat'si

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