Sideline Injury Management on Different Field Surfaces and

Conditions

Matthew Brewer, MS, ATC/R

Certified Athletic Trainer

Children’s Hospital ColoradoSports Medicine Program

Orthopedics Institute

Presentation Outline

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• Discuss why sideline management of injuries is essential

• Identify different sports that have different surfaces

• Discuss how different surfaces can pose challenges for sideline management and injury evaluation

• Discuss proper injury evaluation techniques on these surfaces and give strategies about when, where, and how to implement them

• Identify and discuss different environmental/weather concerns that can further challenge injury management on sidelines

• To be able to give the most accurate and immediate care for all types of injuries sustained in sports

• National Center for Sports Safety reports over 3.5 million children >14 years receive medical treatment for sports related injuries per year.

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Why is Sideline Management Important?

Gym

nast

ics

Baseb

all

Footb

all

Volley

ball

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100,000200,000300,000400,000500,000600,000700,000800,000

Sport Related Injuries

Sports

Inju

ries

• Number of sport related injuries for each sport are as follows:• Gymnastics — 99,722• Basketball — 680,307• Baseball — 170,902• Softball — 118,354• Football — 413,620• Soccer — 163,003• Volleyball — 55,860• Track & Field — 15,113• Hockey — 63,945

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What Does This All Have To Do With Sideline Management?

• Number of sport related injuries for each sport are as follows:• Gymnastics — 99,722• Basketball — 680,307• Baseball — 170,902• Softball — 118,354• Football — 413,620• Soccer — 163,003• Volleyball — 55,860• Track & Field — 15,113

• Hockey — 63,945

Different Surfaces

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Immediate Care and Stabilization on High Friction Surfaces

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Low Friction and Uncommon Surfaces

• Following sports and surfaces pose a bigger challenge for injury evaluation and stabilization than previous.

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Sideline Management of Water Related Injuries

• Recreational swimming and diving third most common physical activity, and the most common in children.

• An estimated 111,341 patients were treated in emergency departments in 17 year period, with injuries to head and neck being most common (38.2%)

• Patients aged 10-14 years comprised largest group (36.3%)

• Leading cause of injury was interference with diving board or platform (43.9%)

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Pool Stabilization

Video

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Water Injury Management and Stabilization

• If athlete is conscious and injured but cannot move with no head/neck injury suspected, roll onto back and use passive towing technique.

• If athlete is unconscious and not breathing and no head/cervical injury suspected, get to pool deck and begin CPR ASAP-precautions for AED placement with water!

• Once on land/deck, perform full evaluation.

Prentice, W. 2003

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Water Injury Management and Stabilization

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Water Injury Management and Stabilization

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Skiing and Snowboarding Injuries

• Over 40 fatalities have been reported in over 10 years.

• According to the National Orthopedics and Neurosurgery Center, more than 39,000 children and adolescents ages five to 14 were treated in hospital emergency rooms for snowboarding/skiing-related injuries.

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Emergency Evaluation and Stabilization on Snow

Video

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Immediate Injury Assessment and Stabilization on snow

• Different equipment concerns with these sports.

• No need to take helmet off since full access can be gained to airway

• High velocity impacts

• Stabilize and evaluate on scene

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Immediate Injury Assessment and Stabilization on Snow

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Environmental Concerns Effecting Injury Evaluation and Sideline Management

• Heat Illness• Move to cooler environment ASAP• Take appropriate steps to cool athlete (Ice towels, cold emersion, ect). • If athlete is injured and experiencing heat related illness-problems

magnified• Barriers to evaporation• Give fluids and ice if possible to continue cooling athlete• Lying on ground can potentially burn skin

• Try to shade athlete as much as possible and cool ground around them to prevent burns

• Binkley et al. 2008.

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Environmental Concerns Effecting Injury Evaluation and Sideline Management

• Cold Weather• Large population of outdoor sports in Colorado• Military, football, baseball, soccer, lacrosse, track/field, skiing season all

have the potential for cold injuries• Three categories-decreased core temperature (hypothermia), non-freezing

injuries to extremities (chilblains), and freezing injury to extremities (frostbite)

• Signs of mild hypothermia include vigorous shivering, increased blood pressure, core body temperature <98.6C, lethargy, apathy, and amnesia. Decreased vital signs, loss of consciousness, impaired motor and mental function, loss of speech, and core temperature >90.6C are signs of severe hypothermia, MEDICAL EMERGENCY!

• Waxenberg. et al 2008. 18

Management of Cold Injuries

• Re-warm athlete ASAP

• Remove wet clothing while insulating them with dry clothing and blankets

• Move to warmer and dry environment

• Apply heat to areas of heat transfer including groin, armpits, and chest wall

• Encourage shivering, while providing warm non-alcoholic fluids

• Monitor closely and refer to EMS if necessary

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Lightning and Severe Weather

• 2nd most common storm related death in the U.S.

• 1 out of 10 lightning strike victims die - cardiac arrest accounts for majority of fatal injures, while severe neurological impairment can cause permanent disability

• The location, elevation, climate, and vast amount of people who enjoy outdoor activities (sports, hiking, biking, camping, etc) makes Colorado and the Rocky Mountains vulnerable to lightning injuries

• The most active time for storm and lightning development occurs between 11a and 9p April-September-PRIME TIME for both sports and outdoor events

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When is a Storm Too Close? • Lightning can strike up to 20 miles away from nearest cloud

• If you see lightning, extreme caution needs to taken

• 20 mile rule-begin preparations to postpone game/practice

• 6 miles accepted distance to seek shelter immediately

• Different ways to determine proximity of lightning• 30/30 rule, lightning detectors, text/instant messaging• NATA position statement on lightning promotes 30/30 rule

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Walsh. K 2000

Additional Things to Consider with Lightning

• The JAT, 2000, reported that the most common sites for fatalities in Colorado associated with lightning included open fields (27%), near trees (16%), and close to water (13%)

• All fatalities normally have 1 common link-being near tallest object in immediate area

• EAP should have comprehensive

lightning and evacuation plan with

approved shelter• Sports such as track, golf, cross country,

& large outdoor venues need to have additional

time to evacuate given the large area and number of people present

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Conclusions

• Different surfaces and conditions pose different challenges for sideline management and stabilization of injuries

• Many associated challenges can be decreased by having thorough and detailed EAP

• This EAP must be practiced and rehearsed with everyone involved

• Plan accordingly for adverse filed and weather conditions, and know what to do in each situation

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Questions???

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Work Cited

Binkley, H., Beckett. J., Casa. D., Kleiner. D., & Plummer. P. National Athletic Trainer’s Association Position Statement: Exertional Heat Illness. NATA Position, Consensus, Official Support Statements. Dallas, TX. 2008 PP. 12-26.

Cappaert. T., Stone. J., Castellani. J., Krause. B., Smith. D., & Stephens. B. National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries. Journal of Athletic Training, 43. 2008. PP. 640-658.

Cooper. M., & Kulkarni. R. Lightning Injuries. Medscape References. http://emedicine.medscape.com/article/770642-overview

Chang. D., & Bosco. J. Cervical Spine Injuries in the Athlete. Bulletin of the NYU Hospital for Joint Disease, 64. 2006. PP. 119-129.

Day. C., Stolz. U., Mehan. T., Smith. G., & McKenzie. L. Diving Related Injuries in Children <20 Years Old Treated in Emergency Departments in the United States: 1990-2006. Pediatrics, 122. 2008. PP. E388-E394.

Prentice. W. Arnheim’s (2003) Principles of Athletic Training A Competency Based Approach. New York, New York: McGraw-Hill Higher Education. PP. 332-335.

Walsh. K., Bennett. B., Cooper. M., Holle. R., Kithil. R., & Lopez. R. (200) . National Athletic Trainer’s Association Position Statement: Lightning Safety for Athletics and Recreation. Journal of Athletic Training, 35. 471-477.

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