Rosnah Mat Yatim

Physiotherapist

Institut Sukan Negara

ON-FIELD MANAGEMENTINSTITUT SUKAN

NEGARA MALAYSIA

Principles of management

• A team approach

• Advance preparation

• Rapid assessment

• Timely life-and limb-saving interventions

• Early transportation to an appropriate level medical facility

• Regular reassessment

Preparation

• Personnel and training

- first aid and CPR training

- advances EMS, ACLS/ATLS

• Equipment

- AED, airways and ventilation

adjuncts, spinal board,

splints, medication, others

Approach to the acutely ill

or injured athlete1. Establish of scene safety

2. A rapid primary survey with resuscitation and immediate treatment of life-and limb-threatening problems

3. A detailed secondary survey

4. Initiation of definitive care based on the secondary survey

Three levels of injury priority

• First Priority

– Injuries that pose an immediate threat to life: Airway obstruction / Cardiac arrest / Uncontrolled bleeding

• Second Priority

– Urgent injuries that are potential threats to life or limb:

• Head injury / Spinal injury

• Serious limb injuries with blood vessel / nerve injury

• Third Priority (Thankfully the most common type!!)

– Mild limb injuries – sprain / strain

– Cuts and bruises

How is an emergency defined?

• An unexpected serious occurrence that may cause injuries that require immediate medical attention

What becomes very critical in an emergency situation?

What must all sports programs have?

• An emergency plan� Contact numbers

� Location

� Designated person

� Security

� Personnel and qualifications

Once the rescue squad is called, who should have the final say on how the athlete is to be transported?

• The emergency medical technicians/ team leader

TL

Once the rescue squad is called, what role does the physiotherapist assume?

• An assistive role

What does the on-the-field assessment help determine?

• The nature of the injury and provides direction in the decision-making process concerning the emergency care that must be rendered.

How is the on-the-field assessment subdivided?

• Primary survey and secondary survey

When is the primary survey done

and what does it determine?

• Determine status of life threatening or limb threatening conditions

• Life threatening conditions (CAB’s)� Other vital signs and severe bleeding

� Treat emergency conditions or move on to secondary

survey depending on your findings

The unconscious athlete must always be considered to have?

• A life-threatening injury

When is the secondary survey done and what does it determine?

• Occurs when primary survey is concluded or deemed unnecessary

� No life threatening conditions, patient is breathing and

any bleeding is under control

• Examination to determine presence of other injuries

� Rapid examination to determine seriousness of injury

and if and how patient should be moved

� Determine nature of injury or illness and identify positive

findings for referral to medical professional

What decisions can be made from the secondary survey?

• Seriousness of the injury

• Type of first aid required

• Whether injury warrants physician referral

• Type of transportation needed

Ten Keys When Dealing with an

Injured Player On and Off The

Field

1. Recognize that an

injury or illness exists

2. Don’t Panic

Staying calm, helps keep the injured athlete, coaches or parents calm as well

3. Mentally prepare yourself for

the possibility of a significant

injury but know that

severe injuries

are infrequent

4. Survey the scene

• Has the play stopped?

• Is the injured athlete moving?

• If yes, then the athlete has a heart beat, probably is conscious and probably does not have a neck injury

5. When you reach the

athlete on the field….

What is your action????

Sports injury assessmentAssessing injuries with TOTAPS

TALK Ask the player what happened. Where does it hurt?

What kind of pain is it?

OBSERVE Look at the affected area for redness or swelling. Is the

injured side different from the other side?

TOUCH Touch will indicate warmth for inflammation – touch

also assesses pain.

ACTIVE MOVEMENT Ask the injured player to move the injured part without

any help.

PASSIVE MOVEMENT If the player can move the injured part, carefully try to

move it yourself through its full range of motion.

SPECIAL SKILLS Did the active and passive movement produce pain? If

no, can the player stand and demonstrate some of the

skills from the game carefully? If an injury is identified,

remove the player from the activity immediately.

A- AIRWAY

a) What to ask the athlete

� Are you OK?

� Where does it hurt?

� Do you remember what happened?

� If the athlete can answer these you know that they are breathing, have a pulse and are conscious.

� Go to letter D.

� If the athlete does not answer you, suspect no pulse, no breathing and possibly a head and/or neck injury.

Call 999. Go to letter B

B- BREATHING

b) Is the athlete breathing?

Look – Listen and Feel for Breathing

� i) Look for the chest to rise and fall

� ii) Listen for wheezing, gurgling and breath sounds

� iii) Feel the breath hit your ear

� If no breathing, go to letter C.

� If the athlete is breathing , monitor their breathing and go to letter C.

C-CIRCULATION

c) Does the athlete have a pulse?

� Check pulse at the neck.

� If no pulse, Start CPR (2:30)

� If the athlete has a pulse monitor their vital signs and go to letter D.

D- DISABILITY

d) Look for any deformities

� Is the athlete in an abnormal position?

� Can you see any swelling, bleeding, or protruding bones?

� If no, Go to Letter E

� If yes, then assume a possible fracture has occurred. Do not move the athlete and if 999 has not been called, do so now.

E- EXPOSURE/

ENVIRONMENT

e) Look for any bleeding

• Check for excessive bleeding that may be life threatening

• Check skin discoloration or warmth for internal bleeding

• If Yes, try to control it with direct pressure on the injury with a gauze pad or clean towel.

• If No, monitor vitals and go to #6

6. Determine if the athlete

should be moved

• If 999 was called do not move the athlete

• If emergency medical attention is not needed, and the athlete is able to move without harming themselves, assist them off of the field.

7. Monitor the player OFF

the field

• Signs and symptoms of injury may appear once the athlete is off the field

• Never leave the athlete alone until serious injury is ruled out

8. Return to play

• Only allow the player to return if they are capable of playing at 100% with no signs and symptoms present

9. Parental or guardian

permission and

notification

• Notify the parent if an injury occurred that

precluded the athletes ability to continue play

• If the player is under the age of 18, always get

parental or guardian permission before treating

the player.

• This may be done before the season begins or

by the permission of the parent at the field of

play

10. Follow-up treatment

and return to play

• Consider requiring physician clearance to return to play

• Make sure the athlete sees a physician if they continue to have signs and symptoms

BASIC LIFE SUPPORT FLOW CHART

Continue CPR until responsiveness or normal breathing return

Terima kasih