for sports physiotherapists

1. On Field AssessmentOn Field Assessment
&&
Emergency CareEmergency Care

2. How is an emergency defined?How is an emergency defined?
An unexpected serious occurrence thatAn unexpected serious occurrence that
may cause injuries that require immediatemay cause injuries that require immediate
medical attentionmedical attention

3. What becomes very critical in anWhat becomes very critical in an
emergency situation?emergency situation?
TimeTime

4. What must all sports programs have?What must all sports programs have?
An emergency planAn emergency plan

5. The unconscious athlete must always beThe unconscious athlete must always be
considered to have?considered to have?
A life-threatening injuryA life-threatening injury

6. What situations are considered life-What situations are considered life-
threatening?threatening?
Cardiopulmonary resuscitation (i.e.,Cardiopulmonary resuscitation (i.e.,
obstruction of the airway, no breathing, noobstruction of the airway, no breathing, no
circulation), profuse bleeding, and shockcirculation), profuse bleeding, and shock

7. What are the signs of shock?What are the signs of shock?
Blood pressure is lowBlood pressure is low
Systolic pressure is usually below 90Systolic pressure is usually below 90
mmHgmmHg
Pulse is rapid and weakPulse is rapid and weak
Athlete may be drowsy and appearAthlete may be drowsy and appear
sluggishsluggish
Respiration is shallow and extremely rapidRespiration is shallow and extremely rapid
Skin is pale, cool, and clammySkin is pale, cool, and clammy

8. What vital signs should be observed?What vital signs should be observed?
PulsePulse
RespirationRespiration
Blood pressureBlood pressure
TemperatureTemperature
Skin colorSkin color
PupilsPupils
State of consciousnessState of consciousness
MovementMovement
Abnormal nerve responseAbnormal nerve response

9. On-Field AssessmentOn-Field Assessment
 Instruct coaches and athletes not to move anInstruct coaches and athletes not to move an
injured athlete.injured athlete.
 Know the rules regarding on field assessmentKnow the rules regarding on field assessment
 Goals and PurposesGoals and Purposes
 Rule out life-threatening/serious injuriesRule out life-threatening/serious injuries
 Determine the sight and severityDetermine the sight and severity
 Determine the method of transportDetermine the method of transport

10. On-Field AssessmentOn-Field Assessment
 Primary SurveyPrimary Survey
 Secondary SurveySecondary Survey
 HistoryHistory
 ObservationObservation
 ScreeningScreening
 Immediate Action PlanImmediate Action Plan

11. When is the primary survey done and whatWhen is the primary survey done and what
does it determine?does it determine?
Initially, and determines life-threateningInitially, and determines life-threatening
situationssituations

12. On-Field AssessmentOn-Field Assessment
Primary SurveyPrimary Survey
Airway, Breathing, CirculationAirway, Breathing, Circulation
Try to arouse if unconsciousTry to arouse if unconscious
Treat for neck injury if you did not see the injuryTreat for neck injury if you did not see the injury

13. When is the secondary survey done andWhen is the secondary survey done and
what does it determine?what does it determine?
After the primary survey, when all life-After the primary survey, when all life-
threatening situations have been ruled out orthreatening situations have been ruled out or
corrected. It takes a closer look and gatherscorrected. It takes a closer look and gathers
specific information about the injury from thespecific information about the injury from the
athlete. It uncovers problems that do notathlete. It uncovers problems that do not
pose an immediate threat to life, but may dopose an immediate threat to life, but may do
so if they remain uncorrected.so if they remain uncorrected.

14. What decisions can be made from theWhat decisions can be made from the
secondary survey?secondary survey?
Seriousness of the injurySeriousness of the injury
Type of first aid requiredType of first aid required
Whether injury warrants physician referralWhether injury warrants physician referral
Type of transportation neededType of transportation needed

15. On-Field AssessmentOn-Field Assessment
 Secondary SurveySecondary Survey
 HistoryHistory
 Mechanism of injuryMechanism of injury
 Location of the injuryLocation of the injury
 Severity of injurySeverity of injury
 ObservationObservation
 Abnormal positioning of the head, neck, orAbnormal positioning of the head, neck, or
extremitiesextremities
 How is the athlete reacting to the injury?How is the athlete reacting to the injury?
 Does the athlete have bleeding from the headDoes the athlete have bleeding from the head
or other signs of head injury?or other signs of head injury?
 Observe for internal injuriesObserve for internal injuries
 Deformity, swelling, or discoloration of theDeformity, swelling, or discoloration of the
extremities.extremities.
 Asses for ShockAsses for Shock
 Pale, cool, clammy skin, rapid and shallowPale, cool, clammy skin, rapid and shallow
breathing, weak and rapid pulse, nausea,breathing, weak and rapid pulse, nausea,
falling blood pressure.falling blood pressure.

17.  ScreeningScreening
 Rapid evaluation techniquesRapid evaluation techniques
 Immediate Action PlanImmediate Action Plan
 If injury is serious or life-threatening, EMSIf injury is serious or life-threatening, EMS
 If not serious or life-threatening, transport off field for more detailedIf not serious or life-threatening, transport off field for more detailed
assessment off the field.assessment off the field.
On-Field AssessmentOn-Field Assessment
 Sensory and motor testing forSensory and motor testing for
suspected spinal/nerve injury.suspected spinal/nerve injury.
 Neurovascular tests for suspectedNeurovascular tests for suspected
fracture/dislocationfracture/dislocation
 Assessment for head injury if suspectedAssessment for head injury if suspected
 Orthopedic assessmentOrthopedic assessment
 PalpationPalpation
 ROM and strength screenROM and strength screen
 Special testsSpecial tests
 Continued monitoring for shockContinued monitoring for shock

18. Emergency Action PlanEmergency Action Plan
Primary concern is maintainingPrimary concern is maintaining
cardiovascular and CNS functioningcardiovascular and CNS functioning
Key to emergency aid is the initialKey to emergency aid is the initial
evaluation of the injured athleteevaluation of the injured athlete

19. The Unconscious AthleteThe Unconscious Athlete
Provides great dilemma relative to treatmentProvides great dilemma relative to treatment
When acting alone, should contact EMS firstWhen acting alone, should contact EMS first
Must be considered to have life-threateningMust be considered to have life-threatening
conditioncondition
Note body position and level of consciousnessNote body position and level of consciousness
Check and establish airway, breathing, circulationCheck and establish airway, breathing, circulation
(ABC)(ABC)
Assume neck and spine injuryAssume neck and spine injury
Remove helmet only after neck and spine injuryRemove helmet only after neck and spine injury
is ruled out (facemask removal will be required inis ruled out (facemask removal will be required in
the event of CPR)the event of CPR)

20. With athlete supine and not breathing, ABC’sWith athlete supine and not breathing, ABC’s
should be established immediatelyshould be established immediately
If athlete unconscious and breathing, nothingIf athlete unconscious and breathing, nothing
should be done until consciousness resumesshould be done until consciousness resumes
If prone and not breathing, log roll and beginIf prone and not breathing, log roll and begin
CPRCPR
If prone and breathing, nothing should be doneIf prone and breathing, nothing should be done
until consciousness resumes --then carefully loguntil consciousness resumes --then carefully log
roll and continue to monitor ABC’sroll and continue to monitor ABC’s
Life support should be monitored and maintainedLife support should be monitored and maintained
until emergency personnel arriveuntil emergency personnel arrive
Once stabilized, a secondary survey should beOnce stabilized, a secondary survey should be
performedperformed

21. Assessing an Unresponsive PatientAssessing an Unresponsive Patient
If no life-threatening condition performIf no life-threatening condition perform
limited physical examination for otherlimited physical examination for other
injuriesinjuries
Do not move patient unless necessaryDo not move patient unless necessary
Check for serious injuriesCheck for serious injuries
Stabilize head and neckStabilize head and neck

22. Assessing an Unresponsive PatientAssessing an Unresponsive Patient
Ask those at scene:Ask those at scene:
 What happenedWhat happened
 Patient’s mental status before becomingPatient’s mental status before becoming
unresponsiveunresponsive

23. Assessing a Responsive PatientAssessing a Responsive Patient
If nature of injuries suggests potentialIf nature of injuries suggests potential
spinal injury, carefully assess for spinalspinal injury, carefully assess for spinal
injury during physical examinationinjury during physical examination
Ask patient not to move more than youAsk patient not to move more than you
ask during the examinationask during the examination

24. Assessing a Responsive PatientAssessing a Responsive Patient
Ask:Ask:
Does your neck or back hurt?Does your neck or back hurt?
What happened?What happened?
Where does it hurt?Where does it hurt?

25. Physical ExaminationPhysical Examination
Perform standard examinationPerform standard examination
When checking torso, look for impairedWhen checking torso, look for impaired
breathing or loss of bladder/bowel controlbreathing or loss of bladder/bowel control
Compare strength from one side of bodyCompare strength from one side of body
to otherto other
Assess both feet and both hands at sameAssess both feet and both hands at same
timetime

26. Physical ExaminationPhysical Examination
Perform standard examinationPerform standard examination
Don’t assume patient without symptomsDon’t assume patient without symptoms
has no spinal injury. Consider forceshas no spinal injury. Consider forces
involvedinvolved
When in doubt, keep head immobile whileWhen in doubt, keep head immobile while
waiting for additional EMSwaiting for additional EMS

27. Skill:Skill:
Head and Spinal Injury AssessmentHead and Spinal Injury Assessment

28. Check the victim’s head.Check the victim’s head.

29. Check neck for deformity,Check neck for deformity,
swelling, and pain.swelling, and pain.

30. Check sensation in feet.Check sensation in feet.

31. Ask victim to point toes.Ask victim to point toes.

32. Ask victim to push againstAsk victim to push against
your hands with feet.your hands with feet.

33. Check sensation in hands.Check sensation in hands.

34. Ask victim to make a fistAsk victim to make a fist
and curl it in.and curl it in.

35. Ask victim to squeezeAsk victim to squeeze
your hands.your hands.

36. Brain InjuriesBrain Injuries

37. Brain InjuriesBrain Injuries
 Occur with blow to head with/without openOccur with blow to head with/without open
woundwound
 Brain injury likely with skull fractureBrain injury likely with skull fracture
 Brain swelling/bleedingBrain swelling/bleeding

38. Signs and Symptoms of a BrainSigns and Symptoms of a Brain
InjuryInjury
 Severe or persistent headacheSevere or persistent headache
 Altered mental status (confusion,Altered mental status (confusion,
unresponsiveness)unresponsiveness)
 Lack of coordination, movement problemsLack of coordination, movement problems

39. Signs and Symptoms of a BrainSigns and Symptoms of a Brain
Injury ContinuedInjury Continued
Weakness, numbness, loss of sensation,Weakness, numbness, loss of sensation,
paralysisparalysis
Nausea and vomitingNausea and vomiting
SeizuresSeizures
Unequal pupilsUnequal pupils
Problems with vision or speechProblems with vision or speech
Breathing problems or irregularitiesBreathing problems or irregularities

40. ConcussionConcussion
Brain injury involving temporaryBrain injury involving temporary
impairmentimpairment
Usually no head wound or signs andUsually no head wound or signs and
symptoms of more serious head injurysymptoms of more serious head injury
Victim may have been “knocked out” butVictim may have been “knocked out” but
regained consciousness quicklyregained consciousness quickly

41. Signs and Symptoms of ConcussionSigns and Symptoms of Concussion
Temporary confusionTemporary confusion
Memory loss about eventMemory loss about event
Brief loss of responsivenessBrief loss of responsiveness
Mild or moderate altered mental statusMild or moderate altered mental status
Unusual behaviorUnusual behavior
HeadacheHeadache

42. Medical EvaluationMedical Evaluation
Concussion patient may recover quicklyConcussion patient may recover quickly
Difficult to determine injury severityDifficult to determine injury severity
More serious signs and symptoms mayMore serious signs and symptoms may
occur over timeoccur over time
Patients with suspected brain injuriesPatients with suspected brain injuries
require medical evaluationrequire medical evaluation

43. Emergency Care for Head InjuriesEmergency Care for Head Injuries
Perform standard patient carePerform standard patient care
Use the jaw-thrust to open airwayUse the jaw-thrust to open airway
Follow local protocol re: oxygenFollow local protocol re: oxygen
Manually stabilize the head and neckManually stabilize the head and neck
Don’t let patient moveDon’t let patient move

44. Emergency Care for Head InjuriesEmergency Care for Head Injuries
continuedcontinued
Closely monitor mental statusClosely monitor mental status
Control bleeding. No direct pressure onControl bleeding. No direct pressure on
skull fractureskull fracture
Monitor vital signsMonitor vital signs
Expect vomitingExpect vomiting
Provide additional care for skull fractureProvide additional care for skull fracture

45. Skull FractureSkull Fracture
Check for possible skull fracture beforeCheck for possible skull fracture before
applying direct pressure to scalp bleedingapplying direct pressure to scalp bleeding
Direct pressure could push bone fragmentsDirect pressure could push bone fragments
into braininto brain
Skull fracture is life threateningSkull fracture is life threatening

46. Signs of a SkullSigns of a Skull
FractureFracture
 Deformed areaDeformed area
 Depressed or spongy areaDepressed or spongy area
 Blood or fluid from ears or noseBlood or fluid from ears or nose
 Eyelids swollen shut or becoming discoloredEyelids swollen shut or becoming discolored
(bruising)(bruising)

47. Bruising under eyes (raccoon eyes)Bruising under eyes (raccoon eyes)
Bruising behind ears (Battle’s sign)Bruising behind ears (Battle’s sign)
Unequal pupilsUnequal pupils
An object impaled in skullAn object impaled in skull
Signs of a SkullSigns of a Skull
FractureFracture

48. Emergency Care for Skull FracturesEmergency Care for Skull Fractures
Care as for any head/spinal injuryCare as for any head/spinal injury
Don’t clean wound, press on it, or removeDon’t clean wound, press on it, or remove
impaled objectimpaled object
Cover wound with sterile dressingCover wound with sterile dressing

49. Emergency Care for SkullEmergency Care for Skull
FracturesFractures
 If bleeding, applyIf bleeding, apply
pressure only aroundpressure only around
edges of wound. Useedges of wound. Use
a ring dressinga ring dressing
 Do not move victimDo not move victim
unnecessarilyunnecessarily

50. Spinal InjuriesSpinal Injuries

51. Emergency Care for Spinal InjuriesEmergency Care for Spinal Injuries
Perform standard patient carePerform standard patient care
Give general care as for any head/spinalGive general care as for any head/spinal
injuryinjury
Use constant manual stabilization untilUse constant manual stabilization until
patient secured to backboard with headpatient secured to backboard with head
stabilizedstabilized

52. Emergency Care for Spinal InjuriesEmergency Care for Spinal Injuries
Support head in position foundSupport head in position found

53. Emergency Care for Spinal InjuriesEmergency Care for Spinal Injuries
Maintain airway and provide neededMaintain airway and provide needed
ventilation without moving headventilation without moving head
To position patient for ventilations/CPR,To position patient for ventilations/CPR,
keep head in line with bodykeep head in line with body

54. Positioning a Spinal PatientPositioning a Spinal Patient
Move patient only if necessaryMove patient only if necessary
Roll vomiting patient to one side to drainRoll vomiting patient to one side to drain
mouthmouth
Roll facedown patient onto the back forRoll facedown patient onto the back for
ventilations/CPRventilations/CPR
Use log roll to turn patientUse log roll to turn patient
If alone move vomiting patient intoIf alone move vomiting patient into
HAINES recovery positionHAINES recovery position

55. Removing a HelmetRemoving a Helmet

56. Removing a HelmetRemoving a Helmet
 Remove a helmet only to care for life-threateningRemove a helmet only to care for life-threatening
conditioncondition
 Remove helmet, following local protocol, whenRemove helmet, following local protocol, when
faceguard prevents giving ventilationsfaceguard prevents giving ventilations
 With many helmets faceguard can beWith many helmets faceguard can be
removed/pivoted so helmet is left on forremoved/pivoted so helmet is left on for
ventilationsventilations
 For athletic helmets, first unsnap and removeFor athletic helmets, first unsnap and remove
jaw padsjaw pads

57. Removing Motorcycle Helmets withRemoving Motorcycle Helmets with
Non-pivoting FaceguardNon-pivoting Faceguard
 Requires two rescuersRequires two rescuers
 First Rescuer slides one hand under neck toFirst Rescuer slides one hand under neck to
support base of skull and holds lower jaw withsupport base of skull and holds lower jaw with
otherother

58. Removing Motorcycle Helmets with Non-Removing Motorcycle Helmets with Non-
pivoting Faceguard con’tpivoting Faceguard con’t
 Second rescuer tilts helmet back slightly as first rescuerSecond rescuer tilts helmet back slightly as first rescuer
prevents head movementprevents head movement
 Second rescuer pulls helmet back until chin is clear ofSecond rescuer pulls helmet back until chin is clear of
mouth guardmouth guard
 Second rescuer tilts helmet forward slightly movingSecond rescuer tilts helmet forward slightly moving
helmet back past base of skull, then slides it straight offhelmet back past base of skull, then slides it straight off

59. Cervical CollarsCervical Collars
Help stabilize head and neckHelp stabilize head and neck
Most First Responders don’t apply cervicalMost First Responders don’t apply cervical
collars by themselves but may assistcollars by themselves but may assist
EMTsEMTs

60.  Choose correct size. MeasureChoose correct size. Measure
with fingers from top of shoulderwith fingers from top of shoulder
to bottom of chinto bottom of chin
 First rescuer holds head in line.First rescuer holds head in line.
Second rescuer slips backSecond rescuer slips back
section of open collar undersection of open collar under
patient’s neckpatient’s neck
 Correctly position collar to fitCorrectly position collar to fit
chin and neckchin and neck
Applying a Cervical CollarApplying a Cervical Collar
to a Supine Patientto a Supine Patient

61.  Close collar with VelcroClose collar with Velcro
attachmentattachment
 Ensure collar fits correctly,Ensure collar fits correctly,
following manufacturer’sfollowing manufacturer’s
instructionsinstructions
 Continue to manually supportContinue to manually support
head and neck in linehead and neck in line
Applying a CervicalApplying a Cervical
Collar to a SupineCollar to a Supine
Patient ContinuedPatient Continued

62. BackboardingBackboarding
 Potential spinal injury patients usuallyPotential spinal injury patients usually
immobilized on backboard before beingimmobilized on backboard before being
moved to stretchermoved to stretcher
 First Responders may assist emergencyFirst Responders may assist emergency
personnel when positioning patient onpersonnel when positioning patient on
backboardbackboard

63. Backboarding continuedBackboarding continued
Many backboard types are availableMany backboard types are available
Use short backboards for patients inUse short backboards for patients in
seated position or confined spaceseated position or confined space
Use long backboards in most otherUse long backboards in most other
situationssituations

64. Positioning Patients on a LongPositioning Patients on a Long
BackboardBackboard
 Three or more rescuers neededThree or more rescuers needed
 Position long backboard beside patientPosition long backboard beside patient
 One rescuer maintains head in line while otherOne rescuer maintains head in line while other
rescuers take positionrescuers take position
 On cue from rescuer at patient’s head, otherOn cue from rescuer at patient’s head, other
rescuers roll patient toward them as a unitrescuers roll patient toward them as a unit

65. Positioning Patients on a LongPositioning Patients on a Long
Backboard ContinuedBackboard Continued
Slide backboard next to patientSlide backboard next to patient
On cue from rescuer at head, otherOn cue from rescuer at head, other
rescuers roll patient as a unitrescuers roll patient as a unit
Patient is secured to backboard usingPatient is secured to backboard using
strapsstraps

66. ExaminationExamination
 ABCDE Primary SurveyABCDE Primary Survey
 Assume C-spine inujuryAssume C-spine inujury
immobilize c-spine with collar or sand bagsimmobilize c-spine with collar or sand bags
 Airway AssessmentAirway Assessment
 1) Assess ability to speak1) Assess ability to speak
2) Dysphonia2) Dysphonia
3) LOC3) LOC
4) Ability to breathe4) Ability to breathe
5) Apnea5) Apnea
6) Noisy breathing6) Noisy breathing

67.  7) Respiratory distress7) Respiratory distress
8) Extra sounds8) Extra sounds
9) Cyanosis9) Cyanosis
10) Choking sign10) Choking sign
11) Look for causes of airway obstruction11) Look for causes of airway obstruction
12) Look inside mouth12) Look inside mouth
13) Look for facial and neck trauma13) Look for facial and neck trauma
 Jaw thrust to open airway. Suction secretionsJaw thrust to open airway. Suction secretions
which may be obstructing airway.which may be obstructing airway.
If airway compromised, secure with NP airway.If airway compromised, secure with NP airway.
Continously reassess airway.Continously reassess airway.

68.  Breathing AssessmentBreathing Assessment
 Assess respiratory rateAssess respiratory rate
 Would obtain:Would obtain:
O2 saturation, pulse oxymetryO2 saturation, pulse oxymetry
ABGABG
CXRCXR
 Look at:Look at:
 Mental status and for agitationMental status and for agitation
Movement of chest (flail segments)Movement of chest (flail segments)
Accessory muscle useAccessory muscle use
Colour (cyanosis)Colour (cyanosis)
 Listen for:Listen for:
Sounds of airway obstruction, such as stridorSounds of airway obstruction, such as stridor
Breath soundsBreath sounds
Air entry, is it symmetricalAir entry, is it symmetrical
Air escapingAir escaping

69. Palpate:Palpate:
Trachea (for shift)Trachea (for shift)
Chest wall for crepitusChest wall for crepitus
Subcutaneous emphysemaSubcutaneous emphysema
Flail segmentsFlail segments
Sucking chest woundsSucking chest wounds
Chest percussionChest percussion

70.  Circulation Assessment:Circulation Assessment:
 Assess pulse rate and quality (strength)Assess pulse rate and quality (strength)
Obtain blood pressure and pulse pressureObtain blood pressure and pulse pressure
 Assess capillary refillAssess capillary refill
Skin colourSkin colour
Ask about urinary output estimationAsk about urinary output estimation
Stop any major external bleedingStop any major external bleeding
 Insert 2 peripheral large bore IVsInsert 2 peripheral large bore IVs
If difficult, obtain a central IVIf difficult, obtain a central IV
 Disability AssessmentDisability Assessment
 Assess LOC by AVPU: Assess LOC by AVPU:
AlertAlert
Responds to Verbal stimuliResponds to Verbal stimuli
Responds to painResponds to pain
Is UnresponsiveIs Unresponsive

71. Assess pupils for:Assess pupils for:
SizeSize
ReactivityReactivity
Extremity movementExtremity movement
Exposure AssessmentExposure Assessment
Expose patient entirelyExpose patient entirely
Keep patient warmKeep patient warm