Emergency Care in Physiotherapy: an overview of environment related conditions

1. Emergency Care in Athletic Training
Chapter 8
Keith Gorse, Robert Blanc, Francis Feld and Mathew Radelet
Presentation Prepared by:
Dr Asma Lashari
University of Health Sciences

2. 1. Heat exposure and illness including heat
exhaustion and heat stroke
2. Cold exposure and illness including
hypothermia
and frostbite
3. Severe thunderstorms and lightning
emergencies
4. Altitude illness including acute mountain
sickness
5. Prevention and care of environmental
emergencies
in athletic

6. • Caused by muscle fatigue
• Water and electrolyte loss via the sweating
mechanism.
• Heat cramps in Calf and Hamstring muscles.
• Intense pain and muscle spasms during prolonged
exercise.

7. • Hyerthermia due to dehydration and a dangerously elevated core
temperature
• An athlete suffering from heat exhaustion will experience difficulty
losing heat, but the body’s cooling mechanism will remain intact.

8. Breakdown of the body’s heat regulation mechanism resulting in a
dangerously high core temperature.

9. 1. Athletic trainers are present at all sporting events.
2. Pre-participation physical examination for those athletes that may be predisposed to
heat illness.
3. Educate athletes and coaches regarding recognition, care and the risks associated with
playing in the heat and humidity.
4. Develop practice and game guidelines for hot and humid weather using the heat index
table.
5. Measure humidity by wet-bulb globe temperature (WBGT) using a sling psychrometer
before events.
6. Adjust practice and game times with respect to heat and humidity factors.
7. Before event, make sure that the athlete is in proper condition for the heat and
humidity.
8. Availability of fluid replacement before, during, and after athletic activities. Unlimited
access to water and sports drinks, to be consumed freely.
9. Minimum equipment and clothing worn by the athlete during athletic activity.
10. Weigh athletes before and after athletic activities when the weather is hot and humid.
This is done to estimate amount of body water lost during activity.

13.  Body’s organs can be damaged by hypothermia.
 If the body temperature drops too low and stays low for more than a couple
of hours, the body’s organs can begin to shut down, and death will
ultimately result.
 Rewarming the athlete must be done slowly to prevent a rush of blood to the
surface of the body away from the vital organs that need blood.

14.  The nerves, blood vessels, and other cells of the body are temporarily
frozen by exposure to cold temperature.
 At extremities: the toes, fingers, tip of the nose, earlobes, and cheeks.
 Levels of severity
◦ Frostnip:
 skin appears white and waxy.
 Numbness or pain in affected areas.
 No skin blistering occurs.
◦ Superficial frostbite:
 Skin appears white, blue, or gray.
 Superficial skin feels hard but deeper is soft and insensitive to touch.
 Serious medical condition; permanent damage is imminent.
 Skin blistering to affected areas is possible.
◦ Deep frostbite:
 Skin is white or blue and has a hard, wooden feel.
 The tissue underneath is hard and cold to touch.
 The entire area is numb. Skin blistering occurs to affected areas.
 It is a life-threatening emergency because of probable hypothermia and later
risk of infection to affected body parts.

19. Injury from lightning can occur via five mechanisms:
1. Direct strike: most commonly occurs to the head, and
lightning current enters the orifices.
2. Contact strike: most commonly occurs when the lightning
victim is touching an object that is in the pathway of the
lightning current.
3. Side flash: most commonly occurs when the lightning
strikes an object near the victim and then jumps from the
object to the victim.
4. Ground current: most commonly occurs when the
lightning current flowing in the ground radiates outward
in waves from the strike point.
5. Blunt injury: most commonly occurs when the lightning
current causes violent muscular contractions that throw
victims a distance from strike point.

20. 1. Establish a chain of command to remove individuals from the athletic field.
2. Name a designated weather watcher to consider and then communicate possible
threatening weather to the chain of command.
3. Weather monitoring system to receive forecasts and warnings.
4. Designate a safe shelter, with four solid walls, electrical wiring.
5. Use the flash-to-bang count to determine when to go to safety.
6. Wait at least 30 minutes after the last lightning flash before resuming an activity.
7. Do not take shelter under or near trees, flagpoles, or light poles.

21. 8. For those individuals who are caught in the
open and who feel their hair stand on end,
feel their skin tingle, or hear “crackling”
noises, assume the lightning safety
position. This position includes crouching
on the ground, with weight on the balls of
the feet, feet together, head lowered, and
ears covered. Never lie flat on the ground.
9. First aid procedures in managing victims of
a lightning strike.
10. All individuals have the right to leave an
athletic site to seek a safe shelter if the
person feels in danger of impending
lightning activity—without fear of penalty
from anyone.
11. Blue sky and the absence of rain are not
protection from lightning. It does not have
to be raining for lightning to strike.