Ron Straight MEd, ALS Paramedic

OBJECTIVES• State the methods used to help prepare first-responders for sports related injuries.

• Demonstrate the approach to managing unresponsive, injured athletes.

• Describe the on-field assessment of a head-injured athlete and potential cervical-spine-injured athlete.

• Demonstrate techniques for equipment removal and describe when necessary.

• Demonstrate the techniques for stabilizing injured athletes in various locations or environments such as on a field of play, in a swimming pool, on a trampoline, on ice, on a steep slope or in the snow.

• Critically assess and determine more effective techniques to manage a potentially life-threatening injured athlete.

REPOSITIONING TECHNIQUES

• Helmet removal

• Modified jaw maneuver

• Vise grip• Long and short grip

• Transfer grip• Head repositioning

• One and two person supine airway roll• One and two person prone airway roll• Prone, head up against an abutment roll

• Assisting intubation

• Equipment removal

INJURIES IN CONTEXT

Patients in unusual locations

INJURIES IN CONTEXT

Patients in unusual locations

-prone in the mud-standing

-head up against the goal post/wall etc.

-ice rink (hair)

-confined space

-steep slope

-unruly/combative

-ski slope

-on a trampoline -swimming pool

-sitting

The ApproachRecognition - An appreciation of an injury is always better if the

actual mechanism of injury was visualized. Witnesses, replay?

Reaction/Signaling - A procedure should have been set up to ensure an efficient response with no interference from other bystanders.

Rescue Scene -Mechanism of injury/gather information en route/ Cervical spinal/Hazards

Initial Approach -On approach think of the medical history of the patient, the injuries specific to that facet of the sport and the mechanism of the presenting injury.

Limb fractures/injuries

Traumatic InjuriesTraumatic Injuries

Limb fractures/injuries

Traumatic InjuriesTraumatic Injuries

Chest injuries

Abdominal injuries

Head injuries

Concussions in SportConcussions in SportIn a study by the Glasgow group,

32% of those who DIED from brain injury talked after the trauma.

"In various combinations and various severities, the resultant cellular dysfunction (of brain injury) defines the nature and extent of the primary injury, the outcome of which may not become apparent for several days or even weeks after injury." (Graham, Gennarelli, Greenfield's Neuropathology, 1996, page 197.)

“ Okay, so how many people actually suffer concussions like this?”

"When you think that 300,000 people in the United States sustain this kind of brain injury [each year], it really is a silent epidemic," said George A. Zitnay, Ph.D., president of the Brain Injury Association in Washington, D.C.

20% of high school football players experience a concussion each year.

Athletes most at risk for a sport-related concussion participate in football, boxing, hockey, lacrosse, rugby, equestrian events, and snow skiing.

• Having sustained one concussion increases the risk four to six times of sustaining another concussion.• The effects of concussion are cumulative over the span of an athlete's career.• Multiple concussions may increase the risk of degenerative brain diseases such as Alzheimer's, cerebral atrophy, and Parkinsonian-like symptomatology.

Other Facts About Concussions

If concussion is overlooked and an athlete is allowed to return to play, he or she runs the risk of suffering a second concussion

before recovering from the first, which causes rapid brain swelling

resulting in coma and death, said David Thurman, M.D., of the National Center for Injury Prevention and Control

in Atlanta.

“So what happens if we send them back in after a concussion?”

Post-Concussion Syndrome (PCS), and Second Impact Syndrome

•In the case where an athlete does not fully recover from a concussion and then experiences a second concussion, usually within a week's time, second impact syndrome may occur.

•This rare condition often is fatal due to rapid cerebral swelling. It most often occurs in young athletes and in children under the age of 21 years.

•Careful concussion assessment and identification are imperative to help prevent brain damage, post-concussion syndrome (PCS), and second impact syndrome.

Post-Concussion Syndrome (PCS)

•One severe concussion or successive mild or moderate concussions can cause permanent damage to the brain or can cause postconcussive syndrome.

•The symptoms of postconcussive syndrome include headaches, dizziness, insomnia, poor concentration, memory difficulties, irritability, personality changes, anxiety, or depression.

•As many as 30% of professional football players have symptoms of this disorder.

Limb fractures/injuries

Chest injuries

Abdominal injuries

Head injuries

Traumatic InjuriesTraumatic Injuries

Cervical spine injuries

Marfan’s Syndrome is a defect in connective tissue that has widespread effects involving skeletal, eye, and cardiovascular structures that may lead to mitral valve disease and a dissecting aortic aneurysm -thoracic aneurysm pain due to aortic dissection

Medical ConditionsMedical Conditions

Mitral Valve Prolapse (MVP) results in complications like

dysrhythmias, sudden death, infective endocarditis, cerebral ischemia and mitral regurgitation

Pneoumothorax has been associated with Marfan’s syndrome and mitral valve prolapse

Diabetes

Medical Conditions (cont’d)Medical Conditions (cont’d)

Seizures

Mentally handicapped

Physically handicapped

Hypothermia

Environmental InjuriesEnvironmental Injuries

Frost bite

Heat disorders

Sun burn/blister

Drowning

Event Pressure

• Peer pressure

• Coaching pressure

• Event significance

• Significance of Role

• Parental pressure

• Monetary factor

How to Rule-Out a spinal step-by-step

Managing The Unruly, Possible Spine Injured Patient

Next Session

Scenarios

1) A hockey player is checked head long into the boards and is face down not breathing. In three minutes the patient begins to breathe shallowly (diaphramatically only), stertorously and erratically. The patient remains unconscious and when turned has blood and emesis in his/her mouth. The patient seizures at one point.

Scenarios 2) An athlete collides with other athletes or an object and appears to be knocked out or dazed. • On your approach the athlete gets up and tries to say they are okay and want to keep playing. • On palpation you can feel a bump on the back of their head.

• The athlete does not really remember what happened and is a bit slow to answer. • When tested they cannot perform the finger to nose test or tandem walk very well.

• When the player is asked to move their head they experience pain when flexing.

SCENARIOS

3) An athlete is on their side and unresponsive. They had a collision and were found on the ground. As you begin to assess the athlete, they awaken and are confused and combative.

SCENARIOS4) You respond to a ski hill to transport an injured snow boarder. The patient was apparently knocked out after hitting a branch while “glade” boarding. The patroller says the patient has no neck injury and was brought down in a toboggan.

“I did a call last Sunday to a rugby game where a player

was seizing.

I rode in with the EMT Intermediate or PCP crew, the

patient and the trainer.

Would you like to hear and watch the postictal concussed

patient converse with us?”