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On-field emergencies- A Sports Physiotherapist’s Perspective

Dr.  Neeraj  Kumar PT BPT, MSPT Professor & Vice Principal, Dr.APJ Abdul  Kalam  College of  Physiotherapy Pravara  Institute of Medical Sciences (Deemed to be University) Loni , Dist.-  Ahmednagar , Maharashtra, www.pravara.com

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Dr. A.P.J. Abdul  Kalam  College of Physiotherapy

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Pravara  Institute of Medical Sciences  (Deemed to be University)

( Estd .- 1976 as Dept of Physiotherapy to provide patient care)

Dept of Orthopaedics PT Dept of  Neuro  PT Dept of  Cardiorespiratory  PT Dept of Community PT Dept of Paediatrics PT Smt.  Sindhutai  E.  Vikhe   Patil  Spinal Cord      Injury Rehabilitation  Center Prosthetic and Orthotic Lab Kinesiotherapy  lab Electrotherapy &  Electrodiagnosis  Lab

We impart: BPT  (from 1997) MPT  (from 2004) - in all above 5  depts PhD  (from 2010) - in all above 5  depts

www.pravara.com , 02422-271489,  contact@pmtpims.org ,  principal.cpt@pmtpims.org

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Preparation for emergencies Classification  Assessment of Life threatening situation Procedure for unconscious athletes Assessment of serious injuries Minor injuries and their management Triage  Criteria for return to play Medical bag to cater emergencies

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1. 	 Appropriate personnel , equipment for transport and stabilization. 2.	 Ensure appropriate communications  – network on  place prior to emergency.  3.	 Rehearse emergency responses  to ensure system in  place.

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4.	 Cardiovascular  – Basic life support qualified personnel.  5.	 Have a prepared emergency plan .  6.	 Neurological  – Initial assessment – motor, sensory-immediate 			transport – treat as neck injury.  7.	 Anaphylaxis  – Asthma, Bee sting.

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8.   Gastro _ intestinal  – rupture Spleen , Bowel. 9.     Genito -Urinary   –  Haematuria , then  remove from field.  10.   Hypoglycaemia . 11.   Hyperthermia   and  Hypothermia.  Dislocation s  – Knee, Elbow, Ankle, Foot, Hip -   		 neurovascular  complications.

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CLASSIFICATION  of the  INJURED ATHLETE  on the  FIELD

Life threatening injuries which requires emergency management Injuries that prevent further participation Injuries that permit continuation of play after treatment

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‘ Inju ries or Conditions that impair, or have the potential to impair vital function, of the CNS and Cardio-Respiratory system are considered Emergency  situations’

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ASSESSMENT of  LIFE  THREATENING INJURIES  – 4  phases.

Rapid primary evaluation– establish scene  safety  Emergency or immediate treatment after primary  examination  Detailed secondary  evaluation  Institution of definitive care based on secondary  assessment

NB.	  There are 02 assessment phases and 02 treatment phases.

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RESPONSIVENESS AIRWAY BREATHING CIRCULATION

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Cardio Pulmonary emergency.  Unconscious athlete.  Hemorrhages.  Fractures.  Shock.  Hyperthermia  – Heat stress.  Hypothermia  –  Cold stress.

Other Emergency  Situations  in  the  Field  -

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Primary EVALUATION  –  of Life Threatening Injuries.

The Protocol is:- Airway maintenance. Breathing.  C-spine control. D. Disability and Neurological status. E. Expose complete (undress) patient.

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Ensure patent down to level of larynx  –   clear  foreign bodies,  teeth. Possible co-existence of C-spine   fracture -     hyperextension should never occur , immobilize  head  and 	neck.  Assume C-spine injury in any injury above Clavicle - 	Maintain Airway.

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Chest injuries that can prevent breathing- Tension Pneumothorax.  Open Pneumothorax.  Flail Chest.

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External bleeding – Direct pressure. Elevation. Pressure points. Internal Hemorrhage – shock.

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Assess Unresponsiveness C-Spine control Proceed  to  ABC Open Airway . Head  tilt/chin lift method - if no neck or head  injury Jaw  thrust  method  Heimlich  maneuver or  	 Abdominal thrust Finger  sweep

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Establish  Breathing Assess by  look, listen, feel  principle Establish  Circulation Carotid pulse  Circulation maintained through  	chest compression  CPR (15:2, with two rescuer)

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Degree of Severity –  on CANTU scale (Mild, moderate, severe). Monitor – suspected concussion.  Guidelines for season. 	 *  First   concussion –     return to play if asymptomatic 							after 1 week. 	*  Second concussion – out one month. 	* Third concussion –   out for season.

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SERIOUS  INJURIES   INJURIES  that  PREVENT  further PARTICIPATION

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PRINCIPLES OF ASSESSMENT OF SEVERE INJURIES

1. Follow correct sequence of  priorities

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Fingers  –   Assess, field side reduction, temporary return to play – 							 must be individualized .	  Elbow – Shoulder Ankle or Foot   –   Field side reduction  depends  		on experience of Team 	Physician then Emergency Transport.

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Knee   	-  may reduce field side, depends on experience, rule out 		                     vascular complications, immediate emergency transport.

Hip              –  Immediate transport.

Patella         –   Reduce field side depends on experience – rule out ACL 								   injury.

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INJURIES  that  PERMIT  PLAY   after  TREATMENT.

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Musculoskeletal injuries Strain Sprain  Abrasion Teeth or mouth injuries Minor external eyes injuries Anterior chamber injuries Photophobia  Nose injuries Fractures- Ear injuries External trauma

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Anterior chamber injuries. Photophobia. Evaluation of visual activity – ROM.

Stop bleeding before returning to play. Fracture –continue play in non contact sport.

External trauma – suture, strapping. Loss of hearing – evaluate.

Saline or milk  preservation Transport to appropriate facility Evaluation of additional trauma – fracture mandible, mastoid.

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Sport Related Injuries  are  Assessed   using the -

HOPS FORMAT . History of injury.  Observation and Inspection. Palpation. Special Tests . ( Hops Format uses both – Subjective and Objective information)

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TRIAGE – Steps Assessment of injured persons quickly. Returning to most seriously injured and assess again. Immediate treatment to that person.

TRIAGE  - Assessment of all injured persons to  determine priority of care.

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Check surrounding area for objects or      	structures that can contribute to injury.      Scan the body and note body       	positions or deformity.     Unconscious patients summon medical assistance.      Decerebrate  rigidity-extension in all 4 extremities .      Decorticate rigidity-extension of legs,       	flexion  of elbows.

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No potential threat to life or limbs. Minimal potential for further injury. Painless weight  bearing . Informed consent – with respect to potential for further 			injury where there is no threat to life or limb.

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Medical Bag and Supplies to Cater for Emergencies.

Circulation supplies . 	 * IV catheters. * IV fluids. * Tourniquet. * Defibrillator device .

Transport supplies . 	 *  Spineboard  with head support.  * Stretcher.

Airway & Ventilation . * Heavy  Scissors or bolt cutters. * Oral  Airways, Nasal Airways. * Cervical  collar – rigid. * Ventilation  masks – pocket type & ventilation bag. *  Endotracheal   tubes, Laryngoscope. *  Portable Suction unit & Oxygen.

“MURPHY’S LAW – if anything can go wrong, it will go wrong.!”

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On-field emergencies- A Sports Physiotherapist's Perspective

 www.pravara.com , 02422-271489,  contact@pmtpims.org ,  principal.cpt@pmtpims.org  

On-field emergencies- A Sports Physiotherapist's Perspective

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