This document provides information on common medical conditions and injuries that may occur in sports. It is grouped into modules covering concussions, pulmonary and cardiac emergencies, musculoskeletal injuries like fractures and strains, environmental considerations like heat illness, and other topics. For each condition, it describes signs, symptoms, and emergency treatment procedures. Scenarios are also provided to demonstrate how to handle potential injuries and illnesses.

2. MODULE GROUPINGS
Concussions
Emergency Conditions: Pulmonary, Breathing, and Cardiac Emergencies
Other conditions that may affect sports: Diabetes, Allergies, Shock
Musculoskeletal Injuries: Neck and Spine Injuries, Sprains & Strains,
Fractures & Dislocations, Overuse Injuries, Growth Plate Injuries
Environmental Considerations: Heat Illness, Lightning and Thunder
Mouth Guards and Dental Injuries
EAP
Emergency Contacts

4. CONCUSSIONS
Facts
 Don’t necessarily result in loss of consciousness
 Invisible injury – may not show up on tests and scans in ED
 Disruptions in brain’s physiology cause the brain to work longer and harder on
simple tasks, resulting in symptoms
 May or may not result from a blow to the head – a blow to the body resulting in
a whiplash mechanism may be enough to cause concussion

5. CONCUSSIONS
• Common Symptoms:
• Symptoms may develop minutes, hours, or even days after a potential impact.
• ANY suspicion of a concussion should result in removal from play!
• A suspected concussion should be referred to a physician or athletic trainer for
follow up
Physical Cognitive/Mental Emotional Sleep
Headache Feeling mentally foggy Irritability Trouble falling asleep
Dizziness Feeling slowed down Sadness Sleeping more than
usual
Balance problems Difficulty concentrating Nervousness Sleeping less than
usual
Nausea/Vomiting Difficulty remembering More emotional
than usual
Trouble staying
asleep
Fatigue Difficulty focusing
Sensitivity to light
Sensitivity to noise

6. CONCUSSIONS
• Remember, “When in doubt, sit them out!”
• The Heads Up Concussion training course offered by the CDC is a great
resource -
https://www.cdc.gov/headsup/youthsports/training/index.html
• Scenario: Youth football athlete gets tackled to the ground. You don’t
see him hit his head, but he comes off the field complaining of
headache, dizziness, and seems to be confused. What is your first
step?

8. PULMONARY CONDITIONS
• Asthma
 Often triggered by exercise, cold or dry air, smoke, or allergen particles in the
air
 First treatment should be removal from activity and use of an inhaler
prescribed to the athlete
 If the athlete doesn’t have their inhaler or symptoms don’t improve,
CALL 911
• Pneumothorax- collapsed lung
 A condition in which air or gas in the chest cavity gets between the lung and
chest wall, causing the lung to collapse
 Usually caused by blunt trauma to the chest
 May complain of chest pain and tightness, and display shortness of breath
and increased heart rate.
 Don’t confuse with asthma. CALL 911

9. • Cardiac Problems should be
identified on a pre-participation
physical prior to participation in
athletics.
• However, sudden cardiac arrest
(SCA) can occur with little or no
warning in a non-traumatic
manner in young athletes.
• The athlete typically appears in
good health, but may display
some of the warning signs
listed.
• Ensure all coaches and
assistant coaches are CPR
Certified and be sure there is an
AED (automated external
defibrillator) nearby, if possible.
• If SCA is suspected, CALL 911
CARDIAC EMERGENCIES Warning Signs of Cardiac Problems
Chest pain or light-
headedness with
exertion
Irregular heartbeat
Rapid heart rate
(tachycardia)
Fainting during
exercise (syncope)
Irregular/difficulty
breathing
Dizziness
Excessive/unexplained
shortness of breath or
fatigue with exercise
High blood pressure

10. SCENARIO
A high school soccer player is playing in the second half of the game and is
standing alone with the ball. Suddenly, she loses consciousness and
falls to the ground. When you get to her, you feel for a pulse in her neck
and don’t feel anything there. What should you do?

12. DIABETES
• Diabetes is a condition in which the body is unable to either produce
insulin or use it effectively.
• If an athlete’s blood sugar dips too low, they may go into hypoglycemic
shock
Diabetic Shock Signs and Symptoms
Clammy skin Slurred speech
Poor balance Tremors
Extreme irritability Blurry vision
Convulsions Other neurological effects

13. DIABETES
• Interview all parents of players to determine athletes’ diabetic status
• If any athletes are diabetic, ask parents for an emergency plan from the
child’s doctor
• Be sure to keep fruit juice or some high glucose snack in team first aid
kit
• Treatment, should athlete go into hypoglycemic shock, includes
 Remove from play
 Give fast acting glucose (glucose tablets or fruit juice) then long acting
glucose (cheese and crackers or peanut butter)
 If symptoms resolve, follow return to play plan from child’s doctor
 If symptoms worsen, CALL 911

14. ALLERGIES
• Some people are susceptible to severe allergic reactions to substances
(anaphylaxis)
 Insect venom (bee stings)
 Food (nuts)
 Medications
• Possible signs of anaphylaxis
 Pale skin
 Rash
 Facial, throat, or mouth swelling
 Weak rapid pulse
 Rapid shallow breathing or difficulty breathing

15. ALLERGIES
Treatment for Unknown Allergy Treatment for Known allergy
Remove athlete from play Remove athlete from play
Allow athlete to sit down ** If they have a prescribed EpiPen,
Use immediately.
For an Insect bite or sting, remove stinger if able and apply
ice to area
Call 911
Monitor the athlete Contact parents if not present
If symptoms resolve within 15 min, consider allowing
athlete to return to play with parental permission.
If symptoms have not resolved Call 911

16. SHOCK
• Shock is a condition that occurs when tissues in the body do not
receive adequate blood flow, often due to excessive internal or external
bleeding
• Possible signs and symptoms
 Moist, pale, cool, clammy skin
 Weak, rapid pulse
 Rapid, shallow breathing
 Nausea or vomiting
 Restlessness, Irritability
 Weakness and fatigue
 Dizziness or fainting

17. SHOCK
• Treatment:
 CALL 911
 Keep athlete still
 Maintain body temperature if possible
 Loosen clothing
 Have athlete lie down, and elevate feet and legs
 Turn on their side if they vomit or start bleeding from the mouth

18. SCENARIO
Your team is participating in a practice outside on a warm summer day.
You have seen bugs, including wasps, buzzing around. Suddenly, one
of your athletes rushes over complaining of shortness of breath. You
notice their face starting to swell. You do know this athlete is allergic to
bee stings. What condition do you suspect? What should your first
step be?

20. NECK AND SPINE INJURIES
• Common in sports such as football, soccer, hockey, and lacrosse.
• Any suspected neck or spine injured athlete should be removed from
play
• Possible signs and symptoms include:
 Tenderness over any bony prominence in the neck/back
 Numbness/tingling in arms legs, or down spine
 Inability to feel or move face or limbs
 Muscle Spasm
 Deformity
• Serious head/neck injury should always be suspected if the athlete
loses consciousness, even temporarily

21. NECK AND SPINE INJURIES
If you suspect a player has a spinal injury:
 DO NOT move the athlete unless medical personnel are present
 DO NOT allow the athlete to move him or herself; reassure and stay calm
 Stabilize the head and neck in the position it is in and keep play away from
injured athlete
 CALL 911 immediately

22. FRACTURES AND DISLOCATIONS
• Fracture – broken bone
 Crack in the middle of the bone
 May or may not be displaced, or out of alignment
• Dislocation – Joint injury, ends of the bone out of place
 May or may not involve a fracture
 Sometimes look more deformed than a fracture
• Keep in mind, if you coach youth sports involving kids who are still
growing, the bones will most likely break along the area of growth- the
growth plate. These should always be referred to a pediatric
orthopedist.

23. Signs and Symptoms
(not all need to be
present)
 Obvious deformity
 Feeling or hearing a pop or
snap
 Swelling
 Tender over a specific area of
the bone
 Numbness
 Loss of function (can’t use or
move)
 Can’t bear weight
Treatment
 Control bleeding
 Splint to ensure athlete does
not move the injured area
(possible video to
demonstrate splinting
technique)
 Ice to help with pain and
swelling
 If pain is severe or the athlete
is unable to move, CALL
911.
 Otherwise, ensure follow up
with physician.
 DO NOT attempt to
reduce/relocate
FRACTURES AND DISLOCATIONS

24. SCENARIO
A middle school football player gets tackled and falls to the ground, face
down. It looked as though it may have been head to head contact.
Once he falls, he doesn’t move. You run out to the player, who is
unconscious. As you start to assess, he regains consciousness and
starts trying to roll over and sit up. How could you provide best care to
this possibly spine injured athlete?

25. Sprain
Overstretching of a
ligament that
connects bone to
bone
Strain
Overstretching of a
tendon that connects
muscle to bone
SPRAINS AND STRAINS
Grades of Sprains and Strains
Grade I Mild = Tissue is stretched. May have slight swelling, a mild loss in range of
motion, However, there is NO loss of function and minimal pain.
Grade II Moderate = Partial tearing of some tissue. Moderate amount of swelling
may be present along with bruising or discoloration. There is a moderate
loss in range of motion and strength to the joint and more pain. There is
some decrease in stability and all of this increases the loss of function.
Grade III Severe = Complete tearing of one or more structures. Significant swelling is
almost always present along with more intense pain. Discoloration may be
seen. Near complete loss of range of motion and strength. There is a
marked decrease in stability producing a significant loss of function. Often
difficult to bear weight.

26. SPRAINS AND STRAINS
Treatment – P.R.I.C.E.
 P – Protect. Splint, Sling, Brace, and/or remove from play. Crutches may also
be utilized
 R – Rest. No activity until evaluated by a doctor or athletic trainer
 I – Ice. Apply an ice bag no longer than 15-20 minutes at a time. Place a thin
barrier between ice and skin, especially if using a commercial ice pack.
 C – Compress. Use an ACE bandage to control swelling. Leave fingers/toes
exposed.
 E – Elevate. Above the level of the heart to allow gravity to assist in decreasing
swelling.

27. OVERUSE INJURIES
• Overuse Injuries tend to develop over time, are subtle to recognize, and are
often due to increases in physical activity load and/or improper mechanics
and form.
• Easily prevented with proper training and stretching
• Ease kids into practices at the beginning of the season
• Slowly ramp up volume of training
• Include stretching in a warm up and cool down at every practice
• Always emphasize proper technique and form
• Pain follows a specific progression
• Pain after physical activity
• Pain during physical activity, not affecting performance
• Pain during physical activity, restricting performance
• Chronic, persistent pain, even at rest
• It is important to address pain right away, as these injuries become more
difficult to treat and get rid of the longer they persist.

28. OVERUSE INJURIES
• How to treat overuse injuries
• Cut back the intensity, frequency, and/or duration of the sport or activity
• Educate on proper training and form
• Be sure to include a proper warm up and cool down
• Use ice and or over the counter medications to alleviate minor aches and pains
• Refer to a physician if the injury does not go away after a few days
• Prevention
• Avoid Sport Specialization! Encourage kids to be multi-sport athletes until at
least age 15
• Include at least 1 or 2 days off of a particular sport each week
• Encourage at least 10 consecutive weeks off a particular sport each year (can
play a different sport during that time)

29. GROWTH PLATE INJURIES
• Because a child’s bones are still growing, they have open growth
plates. These growth plates are the area growth in the bone originates,
and they tend to be the weakest area of the bones.
• If a child is going to break their bone, chances are good they will break
it at the growth plate.

30. GROWTH PLATE INJURIES
• Little League Elbow
• A condition caused by repetitive throwing in which the growth plate of the inner
elbow becomes inflamed and actually starts to separate.
• More common in children before they have reached skeletal maturity (younger than
16).
• Signs and Symptoms include: inner elbow pain, often without a specific injury, very
slight swelling, warmth and tenderness on the inner elbow.
• Most common in pitchers, especially those who throw breaking pitches
• Treatment includes rest, NSAID medication, stretching and strengthening. In severe
cases, the rest may be prolonged and involve a cast or sling.
• Prevention strategies:
• Rotate pitchers to other positions that don’t require hard throwing (1st or 2nd base)
• Follow recommended pitch counts
• Use good techniques – emphasize control, accuracy, and good mechanics
• Allow rest between throwing sessions

31. GROWTH PLATE INJURIES
• Little League Shoulder
• Inflammation of the growth plate at the top of the upper arm bone, by the
shoulder.
• More common in athletes aged 11-18, especially baseball pitchers, or others
who have repetitive overhead motion such as volleyball or tennis players
• Signs and Symptoms include tenderness over the top of the shoulder, pain
during serving or throwing, and pain that can be felt for hours-days after
throwing.
• Treatment includes NSAID medication and rest, sometimes for several months.
• Prevention strategies are the same as those listed for LLE.
MAXIMUM PITCHING LIMITS
AGE PER DAY PER WEEK PER SEASON PER YEAR
7-8 50 75 1000 2000
9-10 75 100 1000 3000
11-12 85 125 1000 3000
13-16 95 * * *
17-18 105 * * *
DAYS OF REST REQUIRED FOR PITCHES THROWN IN A DAY
AGE 0 DAY REST 1 DAY REST 2 DAYS REST 3 DAYS REST 4 DAYS REST
14 & Under 1-20 21-35 36-50 51-65 66+
15-18 1-30 31-45 46-60 61-75 76+

32. SCENARIO
You coach a little league baseball team, with kids aged 10 and under. Your
best pitcher starts to develop pain on the inside of his elbow. You do
your best to limit pitch counts and although you have shown the team
what a fast ball looks like, you don’t have the kids throw breaking
pitches. You also know this child plays on at least one other team. He
has only been complaining about elbow pain for a week, but when
questioned, states it has been hurting for much longer, but he thought
he was being ‘tough’ by not letting you know. He doesn’t remember an
injury to the area starting the pain. Which condition do you suspect?
What should your next steps be?

34. HEAT ILLNESS
• Occurs when an athlete is subjected to extreme temperatures and
humidity, and the body is unable to cool itself.
• Typically related to dehydration and/or poor acclimatization
• Heat Cramps
 Sweating and muscle cramps, typically in the legs.
 Treatment includes: fluid replacement and gently stretching the cramping
muscle.

35. HEAT ILLNESS
• Heat Exhaustion
 Involves headache, nausea, chills unsteadiness, fatigue, dizziness, rapid
pulse, cool & pale skin, and profuse sweating
 Treatment includes: removal from play, getting the athlete to a cool area,
cooling them down in any way possible (water, wet towels, ice packs on
armpits, neck, groin)
 Fluid replacement if conscious
 If conditions worsen or do not resolve within 2-3 hours, CALL 911.
 DO NOT allow athlete to return to play on the same day

36. HEAT ILLNESS
• Heat Stroke
 Involves incoherent speech, confusion, combativeness, loss of consciousness,
rapid or irregular pulse, warm, dry skin, and lack of sweating
 Treatment includes: immediate cooling by immersing the athlete in a cold water
tub up to the neck, CALL 911
• Heat Illness is 100% preventable. Prevention methods include:
 Slowly acclimate to practicing in warm weather
 Avoid the heat during off days and times
 Wear appropriate clothing
 Give frequent water breaks
 Provide a cooling station
 Consider re-arranging practices to avoid the hottest parts of the day, if possible
 Ensure adequate hydration before practice

37. LIGHTNING AND THUNDER
• Ensure there is a designated person with authority to suspend play who makes the
decision to halt play. If that person decides continuing to play is unsafe, take
appropriate actions immediately.
• Follow a reliable means for monitoring weather (i.e. national weather service)
• Any time thunder can be heard, lightning is close enough to be a hazard. Play
should be suspended and everyone should move indoors.
• If lightning is seen, immediately evacuate the area and move to a safe location
(indoors, inside a car)
• Unsafe locations: under a tree, under the bleachers, in a press box, storage shed,
or dugout.
• Wait at least 30 minutes after hearing thunder or seeing lightning before resuming
play. The clock starts over after every new flash or sound of thunder!
• IF SOMEONE IS STRUCK BY LIGHTNING: Ensure your safety first, then attempt to
move the victim to a safer location. CALL 911. Administer care within your scope
(CPR, first aid as needed).

38. ENVIRONMENTAL CONDITIONS
Scenario: You are at a softball game with your team. It is a very hot
summer day. You have been encouraging your team to drink as much
as possible, but you notice one of your athletes is in the dug out and
seems to be acting strangely. She is slumped on the bench and
although she is sweating profusely, her pulse is very fast. She states
she feels nauseous and has a headache. Which condition do you
suspect? How should you help her?

40. MOUTH GUARDS AND DENTAL INJURIES
• An athlete is 60 times more likely to sustain damage to the teeth when
not wearing a protective mouth guard for high risk activities.
• 3 types of dental injuries may be prevented with mouth guards
 Avulsion: entire tooth knocked out
 Fracture: tooth broken
 Luxation: tooth is in the socket, but in the wrong position
• Treatment for a dental injury includes
 Gently rinse off any dirt or debris with water
 Reposition the tooth in the socket if it is avulsed. Have athlete stabilize by
biting down gently, and transport to dentist immediately.
 If unable to re-implant, you can use: tooth preserving kit, cold milk, saline
soaked gauze, or under a CONSCIOUS athlete’s tongue.
 For best chance of survival, tooth needs to be treated within 30 minutes

41. SCENARIO
• Your basketball team is playing in an away tournament, about 4 hours
away from home. One of your team members forgot her mouth guard
and takes an elbow to the teeth. Her front tooth completely falls out.
Once the refs stop play, you are able to locate the tooth. Which is the
BEST situation for dealing with the tooth?