Dealing with serious injuries

DEALING WITH DEALING WITH SERIOUS SERIOUS INJURIESINJURIES

CRISIS MANAGEMENTCRISIS MANAGEMENT

DD DANGERDANGER

RR RESPONSERESPONSE

AA AIRWAYAIRWAY

BB BREATHINGBREATHINGCC CIRCULATIONCIRCULATION

DANGER – DANGER – Remove Remove DangersDangers

Check the surrounding area for dangers, such as biological Check the surrounding area for dangers, such as biological hazards, electrical wiring, glass, hazardous fumes, etc. hazards, electrical wiring, glass, hazardous fumes, etc. Only proceed if the area is safe. You cannot help anyone if Only proceed if the area is safe. You cannot help anyone if you are injured yourself.you are injured yourself.

Check for and control dangers to; yourself, the injured Check for and control dangers to; yourself, the injured athlete and other peopleathlete and other people

Remove the danger or remove the injured athlete from the Remove the danger or remove the injured athlete from the dangerdanger

An athlete may be worsened by moving them, in most An athlete may be worsened by moving them, in most cases the game will stop until they are moved.cases the game will stop until they are moved.

A collapsed or injured athlete should be moved if; ensures A collapsed or injured athlete should be moved if; ensures the safety of the athlete, extreme weather conditions make the safety of the athlete, extreme weather conditions make it essential, to care for ABC and to control severe bleeding.it essential, to care for ABC and to control severe bleeding.

Biological hazards (secretions from the nose and mouth – Biological hazards (secretions from the nose and mouth – saliva and mucus, vomit, blood and any other bodily fluids) saliva and mucus, vomit, blood and any other bodily fluids) present a risk of transmitting infectious disease and should present a risk of transmitting infectious disease and should be controlled before continuing further management eg be controlled before continuing further management eg wearing protective gloves.wearing protective gloves.

RESPONSE – RESPONSE – “Shake and “Shake and Shout”Shout”

Check for response using “Shake and Shout”, gently Check for response using “Shake and Shout”, gently shake the athlete by the shoulder, give the athlete a shake the athlete by the shoulder, give the athlete a simple command eg “open your eyes” or “squeeze my simple command eg “open your eyes” or “squeeze my hand, let it go”.hand, let it go”.

Infants and small children should never be shaken; they Infants and small children should never be shaken; they should be assessed by shouting and gentle stimulation.should be assessed by shouting and gentle stimulation.

If the athlete respondsIf the athlete responds (can speak or obey a command) (can speak or obey a command) they are conscious and should be; assisted into a position they are conscious and should be; assisted into a position of comfort, checked for and managed bleeding, check for of comfort, checked for and managed bleeding, check for and manage any other injuries (STOP) and observed until and manage any other injuries (STOP) and observed until an ambulance arrives.an ambulance arrives.

If the athlete does not respondIf the athlete does not respond or gives an abnormal or gives an abnormal response (doesn’t open eyes, cannot speak, cannot obey response (doesn’t open eyes, cannot speak, cannot obey a command or gives an unintelligible response) he/she is a command or gives an unintelligible response) he/she is unconscious or semi conscious and should be; gently unconscious or semi conscious and should be; gently turned on the side whilst caring for the neck and head, turned on the side whilst caring for the neck and head, clear and open the airway, not be left alone and an clear and open the airway, not be left alone and an ambulance will need to be called.ambulance will need to be called.

AIRWAY – AIRWAY – Open and Clear Open and Clear airwayairway

An airway obstruction is when the airway is blocked and An airway obstruction is when the airway is blocked and affecting the oxygen intake. It may be caused by; affecting the oxygen intake. It may be caused by; internal structures (tongue, epiglottis), foreign material internal structures (tongue, epiglottis), foreign material (food, mouthguard, vomit) and unconsciousness. (food, mouthguard, vomit) and unconsciousness. In an unconscious athlete the airway takes In an unconscious athlete the airway takes precedence over all other injuries including spinal.precedence over all other injuries including spinal.

1.1. Roll the athlete into the side position to clear the airwayRoll the athlete into the side position to clear the airwaya.a. Kneel beside the athleteKneel beside the athleteb.b. Place athletes farther arm at a right angle to the bodyPlace athletes farther arm at a right angle to the bodyc.c. Place the arm nearest you across the chest with the fingers at Place the arm nearest you across the chest with the fingers at

the top of the shoulderthe top of the shoulderd.d. Bend the knee closest to you to right angles at the hip and the Bend the knee closest to you to right angles at the hip and the

kneekneee.e. Place one hand on the athletes shoulder and grasp the thigh with Place one hand on the athletes shoulder and grasp the thigh with

the other handthe other handf.f. Gently roll the athlete away from you, ensuring head and body Gently roll the athlete away from you, ensuring head and body

alignment are maintainedalignment are maintainedg.g. Keep upper leg bent during turn and while checking airway and Keep upper leg bent during turn and while checking airway and

breathingbreathing

AIRWAY – AIRWAY – continued….continued….Head tilt and jaw support will open the Head tilt and jaw support will open the airway in most situations and must be airway in most situations and must be performed on an athlete on their side.performed on an athlete on their side.

2.2. Open the mouth and use your fingers to Open the mouth and use your fingers to remove any visible foreign material from remove any visible foreign material from the mouththe mouth

3.3. Place one hand on the athlete’s forehead Place one hand on the athlete’s forehead and the other on the chin and gently tilt and the other on the chin and gently tilt the head backwards and slightly down. the head backwards and slightly down. This will allow fluid to drain from the This will allow fluid to drain from the mouth and for gravity to keep the tongue mouth and for gravity to keep the tongue forward to clear the airway.forward to clear the airway.

BREATHING – BREATHING – Look, listen Look, listen & feel& feel

With the athlete lying on their side and the head in With the athlete lying on their side and the head in backward tilt and jaw supported; backward tilt and jaw supported; looklook for the rise for the rise and the fall of the chest and upper abdomen,and the fall of the chest and upper abdomen, listen listen for the sound of air leaving the mouth and nose and for the sound of air leaving the mouth and nose and feelfeel for the air and leaving the mouth and nose by for the air and leaving the mouth and nose by placing your cheek close to the mouth and nose ANDplacing your cheek close to the mouth and nose AND feel feel for the movement of the upper abdomen and for the movement of the upper abdomen and chest by placing the palm of your hand on the lower chest by placing the palm of your hand on the lower end of the athletes ribcage.end of the athletes ribcage.

If breathing is present;If breathing is present; leave in the side position, leave in the side position, ensure the head is in a backward tilt and face is ensure the head is in a backward tilt and face is slightly downwards, observe ABC, check for and slightly downwards, observe ABC, check for and manage bleeding, check for and manage any other manage bleeding, check for and manage any other injuries (STOP) and await the ambulance.injuries (STOP) and await the ambulance.

If breathing is not present;If breathing is not present; turn the athlete on turn the athlete on their back, ensure head tilt and jaw support and their back, ensure head tilt and jaw support and commence EAR (Expired Air Resuscitation) commence EAR (Expired Air Resuscitation)

CIRCULATION – CIRCULATION – Check Check pulsepulse

Feel for a carotid pulse at the neck:Feel for a carotid pulse at the neck:1.1. Maintain backward head tiltMaintain backward head tilt2.2. Place 2 – 3 fingers of the hand that was supporting the Place 2 – 3 fingers of the hand that was supporting the

jaw gently on the Adams apple and slide them into the jaw gently on the Adams apple and slide them into the groove between the large muscle of the neck and the groove between the large muscle of the neck and the Adams appleAdams apple

3.3. Feel gently but firmly with the flat portions of the Feel gently but firmly with the flat portions of the fingers. DO NOT use the fingertips as they are less fingers. DO NOT use the fingertips as they are less sensitivesensitive

4.4. Feel the pulse for up to 10 secondsFeel the pulse for up to 10 seconds

If the pulse is present and the athlete is not If the pulse is present and the athlete is not breathingbreathing; continue EAR at 15 inflations/minute (1 ; continue EAR at 15 inflations/minute (1 breath every 3 – 4 seconds), check for breathing and breath every 3 – 4 seconds), check for breathing and pulse at 1 minute and then every 2 minutes, continue pulse at 1 minute and then every 2 minutes, continue EAR until breathing returns or ambulance arrivesEAR until breathing returns or ambulance arrives

If there is no breathing and no pulse and the If there is no breathing and no pulse and the athlete is unconscious commence CPR athlete is unconscious commence CPR immediately.immediately.

DRABC FLOWCHARTDRABC FLOWCHART

Make comfortable Observe ABC Check & manage

bleeding Check & manage other

injuries

Send for medical assistance Roll into side position

Tilt head backwards

and slightly down Open mouth and clear

objects Open airway

Stabilise side position Observe ABC Check for and manage

bleeding Check for & manage

other injuries

Turn athlete onto back Commence EAR Give 5 full inflations in 10 seconds

Continue EAR

15 per minute Check BC after

1min and then every 2

Commence CPR 1 rescuer 2:15, 2 rescuers 1:5 Check BC after 1 minute and then every 2 Continue until an ambulance arrives or pulse/breathing returns

AIRWAY Check airway is clear and open

DANGER Control dangers to self and others

RESPONSE “Shake and Shout”

BREATHING “Look, Listen and Feel”

CIRCULATION Check pulse

NO

NO

YES

NO

YES

NO

YES

YES

NO

EXPIRED AIR EXPIRED AIR RESUSITATION (EAR)RESUSITATION (EAR)

EE EXPIREDEXPIREDAA AIRAIRRR RESUSCITATIONRESUSCITATION

Keeping the airway open – head tilt and jaw Keeping the airway open – head tilt and jaw support:support:

1.1. If not breathing, roll the athlete onto the backIf not breathing, roll the athlete onto the back2.2. Kneel alongside the head and neckKneel alongside the head and neck3.3. Place one hand on the athlete’s foreheadPlace one hand on the athlete’s forehead4.4. Place the other hand on the chin using the pistol gripPlace the other hand on the chin using the pistol grip

• Knuckle of bent middle finger underneath point of chinKnuckle of bent middle finger underneath point of chin• Index finger extended along the line of the jawIndex finger extended along the line of the jaw• Thumb along the front of the jaw (in groove between lip and Thumb along the front of the jaw (in groove between lip and

chin)chin)• Ensure there is no pressure from fingers on the soft tissue of Ensure there is no pressure from fingers on the soft tissue of

the neckthe neck

5.5. Gently tilt the head back while supporting the jaw Gently tilt the head back while supporting the jaw forward at the point of the jawforward at the point of the jaw

MOUTH TO MOUTH - MOUTH TO MOUTH - EAREAR

Having checked for dangers, opened the airway and Having checked for dangers, opened the airway and checked that there is no response or breathing:checked that there is no response or breathing:

1.1. Kneel alongside the athlete’s head and neckKneel alongside the athlete’s head and neck2.2. Turn the athlete on their backTurn the athlete on their back3.3. Ensure head tilt and jaw support Ensure head tilt and jaw support 4.4. Use the hand on the chin to maintain jaw support and ensure Use the hand on the chin to maintain jaw support and ensure

the athlete’s mouth is slightly open. Do not open the athletes the athlete’s mouth is slightly open. Do not open the athletes mouth too wide as this may cause further airway obstructionmouth too wide as this may cause further airway obstruction

5.5. Pinch the athletes nostrils with your thumb and first finger Pinch the athletes nostrils with your thumb and first finger (keep the heel of the hand on the forehead to maintain head (keep the heel of the hand on the forehead to maintain head tilt) or seal the nostrils with your cheek when you breathe into tilt) or seal the nostrils with your cheek when you breathe into the athletes mouththe athletes mouth

6.6. Take a deep breath and open your mouth widelyTake a deep breath and open your mouth widely7.7. place your mouth over the athletes mouth ensuring a tight place your mouth over the athletes mouth ensuring a tight

sealseal8.8. Blow firmly into the athlete’s mouth, until the athletes chest Blow firmly into the athlete’s mouth, until the athletes chest

rises. Look for the rise of the athletes chest after each breathrises. Look for the rise of the athletes chest after each breath9.9. Remove your mouth from the athletes mouth and turn head to Remove your mouth from the athletes mouth and turn head to

look for the fall of the chest: listen and feel for the escape of look for the fall of the chest: listen and feel for the escape of air from the athletes mouthair from the athletes mouth

10.10. Give five full inflations in ten secondsGive five full inflations in ten seconds

MOUTH TO MOUTH – EAR MOUTH TO MOUTH – EAR cont..cont..

If the chest does not rise, check for:If the chest does not rise, check for: Airway obstructionAirway obstruction

head tilt head tilt jaw supportjaw support tongue or foreign object obstructing the airway (if there tongue or foreign object obstructing the airway (if there

is a foreign object, roll them onto their side and remove, is a foreign object, roll them onto their side and remove, then roll onto back and commence CPR)then roll onto back and commence CPR)

Insufficient air being blown into the lungs Insufficient air being blown into the lungs Inadequate air seal, causing leaks at the nose or Inadequate air seal, causing leaks at the nose or

the mouththe mouthReassess, give another breath and check for Reassess, give another breath and check for the rise of the chest. If there is still no rise the rise of the chest. If there is still no rise there may be an obstruction which will need there may be an obstruction which will need to be clearedto be cleared

If the chest does rise:If the chest does rise: Give 5 full inflations in 10 secondsGive 5 full inflations in 10 seconds Feel for a carotid pulseFeel for a carotid pulse

CARDIO PULMONARY CARDIO PULMONARY RESUSCITATION (CPR)RESUSCITATION (CPR)

CC CARDIOCARDIOPP PULMONARYPULMONARYRR RESUSCITATIONRESUSCITATION

‘‘Any CPR, even if the technique is not Any CPR, even if the technique is not perfect, is better than none!!’perfect, is better than none!!’

CPR is a combination of inflating the lungs CPR is a combination of inflating the lungs (EAR) and compressing the heart (ECC) to (EAR) and compressing the heart (ECC) to revive an athlete. The aim is to ensure that revive an athlete. The aim is to ensure that oxygen is delivered to the brain so as to oxygen is delivered to the brain so as to prevent irreversible damage. By prevent irreversible damage. By performing CPR you give the individual a performing CPR you give the individual a chance of survival, no CPR – no chance. chance of survival, no CPR – no chance.

PERFORMING CPR – EXTERNAL PERFORMING CPR – EXTERNAL CARDIAC COMPRESSIONS (ECC)CARDIAC COMPRESSIONS (ECC)

1.1. Kneel alongside the athletes chest, knees close to Kneel alongside the athletes chest, knees close to the side of the athletethe side of the athlete

2.2. Locate the compression point (lower half of the Locate the compression point (lower half of the sternum)sternum)

Find the bottom of the sternum (where it joins the ribs) by Find the bottom of the sternum (where it joins the ribs) by feeling along the lowest rib on both sides, moving from feeling along the lowest rib on both sides, moving from the outside until they meet with the sternum, leave one the outside until they meet with the sternum, leave one index finger on this pointindex finger on this point

Find the top of the sternum by feeling the groove between Find the top of the sternum by feeling the groove between the clavicles, leave the other index finger on this pointthe clavicles, leave the other index finger on this point

Find the mid point of the sternum by extending the Find the mid point of the sternum by extending the thumbs of both hands equal distances until they meet in thumbs of both hands equal distances until they meet in the middle.the middle.

3.3. Keep the thumb of the upper hand on the mid Keep the thumb of the upper hand on the mid point of the sternum and place the heel of the point of the sternum and place the heel of the other hand on the lower half of the sternum. Keep other hand on the lower half of the sternum. Keep the fingers relaxed, parallel to the ribs and slightly the fingers relaxed, parallel to the ribs and slightly raised so pressure will not be applied to the ribs.raised so pressure will not be applied to the ribs.

PERFORMING CPR – EXTERNAL PERFORMING CPR – EXTERNAL CARDIAC COMPRESSIONS (ECC) CARDIAC COMPRESSIONS (ECC)

cont…cont…4.4. Place the other hand securely on top of the first Place the other hand securely on top of the first

by:by: grasping the wrist or,grasping the wrist or, placing the heel of the second hand on the back of the first placing the heel of the second hand on the back of the first

hand and interlocking the fingershand and interlocking the fingers

5.5.

Apply compression through the heel of the bottom Apply compression through the heel of the bottom hand using your body weight to depress the lower hand using your body weight to depress the lower half of the sternum approximately 4 – 5 cm. You half of the sternum approximately 4 – 5 cm. You should exert pressure from directly above the should exert pressure from directly above the sternum and keep your compressing arm straight. sternum and keep your compressing arm straight. Generate the compression by pivoting at the hips Generate the compression by pivoting at the hips to produce a rhythmical cycle with equal time for to produce a rhythmical cycle with equal time for compressions and relaxation.compressions and relaxation.

6.6. Apply 15 compressions in 10 – 12 seconds, then Apply 15 compressions in 10 – 12 seconds, then give 2 breaths in 3 – 5 seconds. Continue CPR at give 2 breaths in 3 – 5 seconds. Continue CPR at minimum of 4 cycles per minute.minimum of 4 cycles per minute.


cont…cont…When performing ECC it is possible that When performing ECC it is possible that ribs may break, reassess compression site ribs may break, reassess compression site and depth and then continue – it is better and depth and then continue – it is better to break ribs than stop performing CPR.to break ribs than stop performing CPR.

When performing CPR avoid:When performing CPR avoid: Rocking backwards and forwardRocking backwards and forward

Bending the armsBending the arms Using quick jabs of depressive forceUsing quick jabs of depressive force

Allowing the lower hand to slip from its Allowing the lower hand to slip from its correct position on the lower half of the correct position on the lower half of the

sternumsternum Keeping pressure on the chest eg allow Keeping pressure on the chest eg allow

the chest to rise fullythe chest to rise fully


cont…cont… 1 person rescuer1 person rescuer

15 compressions and 2 inflations (in 15 compressions and 2 inflations (in approximately 15 seconds)approximately 15 seconds)

4 cycles per minute (minimum)4 cycles per minute (minimum) check breathing and pulse after 1 check breathing and pulse after 1

minute and then every 2 minutesminute and then every 2 minutes

1 minute1 minute

1 cycle1 cycle 1 cycle1 cycle 1 cycle1 cycle 1 cycle1 cycle

10 – 12 seconds10 – 12 seconds

15 compressions15 compressions3 – 5 seconds3 – 5 seconds

2 inflations2 inflations


cont…cont… 2 person rescue team2 person rescue team

5 compressions and 1 inflation (in approximately 5 5 compressions and 1 inflation (in approximately 5 seconds)seconds)

12 cycles per minute12 cycles per minute The rescuer performing CPR should check for effective The rescuer performing CPR should check for effective

compressions and return of pulse after 1 minute and compressions and return of pulse after 1 minute and then every 2then every 2

With 2 rescuers there should be no pause in With 2 rescuers there should be no pause in compressions to allow for inflations. The rescuer compressions to allow for inflations. The rescuer performing ECC should count out loud so the inflations performing ECC should count out loud so the inflations are performed without pausing.are performed without pausing.

1 minute1 minute

1 1

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5 compressions5 compressions 1 inflation1 inflation


cont…cont…Recovery checks during CPR:Recovery checks during CPR:Check for breathing and pulse after 1 minute and Check for breathing and pulse after 1 minute and then every 2 minutesthen every 2 minutes1.1. Check the effectiveness of CPRCheck the effectiveness of CPR – When performing CPR – When performing CPR

the assistant should be able to feel the carotid pulse as the assistant should be able to feel the carotid pulse as chest compressions are occurring. With 2 person CPR the chest compressions are occurring. With 2 person CPR the person performing EAR should feel for the pulse.person performing EAR should feel for the pulse.

2.2. If the pulse is not felt during compressionsIf the pulse is not felt during compressions – advice the – advice the rescuer performing ECC and check the position of the hands rescuer performing ECC and check the position of the hands and the force and depth of compressionsand the force and depth of compressions

3.3. If a pulse is felt with each compressionIf a pulse is felt with each compression – immediately – immediately following an inflation stop CPR and check for a spontaneous following an inflation stop CPR and check for a spontaneous pulse for 5 seconds and if there is no pulse continue CPRpulse for 5 seconds and if there is no pulse continue CPR

4.4. If a spontaneous pulse is felt during a recovery checkIf a spontaneous pulse is felt during a recovery check – – stop ECC, check for breathing, continue EAR until breathing stop ECC, check for breathing, continue EAR until breathing occurs and check for the return of breathing and pulse occurs and check for the return of breathing and pulse every 2 minutes.every 2 minutes.

If the athlete regains and maintains a pulse and If the athlete regains and maintains a pulse and breathing – place the athlete into the side position breathing – place the athlete into the side position and constantly observe ABC until the ambulance and constantly observe ABC until the ambulance arrives.arrives.


cont…cont… Continue CPR until:Continue CPR until:

Pulse returns and then continue EAR until Pulse returns and then continue EAR until breathing resumesbreathing resumes

Athlete recoversAthlete recovers A doctor pronounces the athlete deadA doctor pronounces the athlete dead Expert assistance arrivesExpert assistance arrives It is physically impossible to continueIt is physically impossible to continue

It is important to call an ambulance as It is important to call an ambulance as soon as possible. In most parts of soon as possible. In most parts of Australia it is ‘000’, mobile phones are Australia it is ‘000’, mobile phones are either ‘000’ or ‘112’ and can be used either ‘000’ or ‘112’ and can be used even if the keypad is locked or the sim even if the keypad is locked or the sim card is missing.card is missing.


cont…cont… Resuscitating children (aged 1 – 8 Resuscitating children (aged 1 – 8

years):years):1.1. When checking for breathing the child’s head When checking for breathing the child’s head

should be in a neutral position or slight tilt – should be in a neutral position or slight tilt – depending on the age of the childdepending on the age of the child

2.2. When resuscitating a child use jaw support and When resuscitating a child use jaw support and slight head tilt slight head tilt

3.3. The rate of breathing is slightly quicker – 1 The rate of breathing is slightly quicker – 1 inflation every 3 seconds or 20 per minute and inflation every 3 seconds or 20 per minute and puff gently do not blowpuff gently do not blow

4.4. only one heel of the hand is used during only one heel of the hand is used during compressions to a depth of 2 – 3 cms using the compressions to a depth of 2 – 3 cms using the following ratiosfollowing ratios 1 rescuer: Ratio 2:15 (in 10 seconds) at 6 cycles / minute1 rescuer: Ratio 2:15 (in 10 seconds) at 6 cycles / minute 2 rescuers: Ratio 1:5 (in 3 seconds) at 20 cycles / minute2 rescuers: Ratio 1:5 (in 3 seconds) at 20 cycles / minute


cont…cont… Comparison of children and adult Comparison of children and adult

Resuscitation:Resuscitation:Expired Air Resuscitation

Adult Child

15 breaths/minute (1 every 4 seconds)

20 breaths /minute ( 1 every 3 seconds)

Cardiopulmonary Resuscitation Adult Child

1 person rescuer

2 person rescuer

1 person rescuer

2 person rescuer

Ratio 2:15 1:5 2:15 1:5

Time / cycle 15 seconds 5 seconds 10 seconds 3 seconds

Min. cycles / minute

4 12 12 20

Inflations / minute

8 12 12 20

Compressions / minute

60 60 100 100

Compression point

Lower half of sternum




Depth of compression

4 – 5 cm 4 – 5 cm 2 – 3 cm 2 – 3 cm

AIRWAY OBSTRUCTIONAIRWAY OBSTRUCTIONChoking athlete:Choking athlete:

Signs:Signs: Athlete is unconsciousAthlete is unconscious Noisy, laboured breathingNoisy, laboured breathing WheezingWheezing Depending on the severity the Depending on the severity the

athlete may be distressed and athlete may be distressed and appear to be chokingappear to be choking

Management:Management: DO NOT interveneDO NOT intervene Encourage athlete to relax Encourage athlete to relax

and coughand cough Allow athlete to adopt the Allow athlete to adopt the

most comfortable positionmost comfortable position Refer to a hospital or doctorRefer to a hospital or doctor

Non Breathing athlete:Non Breathing athlete: When managing an unconscious When managing an unconscious

athlete at may not be apparent athlete at may not be apparent that the airway is obstructed that the airway is obstructed until EAR is commenced, thenuntil EAR is commenced, then

The chest will fail to rise despite The chest will fail to rise despite correct techniquecorrect technique

Resistance is felt during inflationResistance is felt during inflation Management:Management:

If finger sweeps do not clear the If finger sweeps do not clear the airway, position the head in a low airway, position the head in a low position to utilise the effects of position to utilise the effects of gravity, then apply 4 rapid back gravity, then apply 4 rapid back blows with the heel of the hand blows with the heel of the hand between the shoulder blades of between the shoulder blades of the athlete.the athlete.

If back blows and gravity do not If back blows and gravity do not dislodge the obstruction then dislodge the obstruction then apply lateral chest thrusts (with apply lateral chest thrusts (with the athlete on their side, place the the athlete on their side, place the palms of 2 hands on the side of palms of 2 hands on the side of the athletes chest close to the arm the athletes chest close to the arm pit and well clear of the ribs, pit and well clear of the ribs, apply four firm lateral chest apply four firm lateral chest thrusts).thrusts).

Lateral chest thrusts should only Lateral chest thrusts should only be applied for a be applied for a COMPLETE COMPLETE airway obstruction. airway obstruction. DO NOT DO NOT apply if the athlete is coughing apply if the athlete is coughing and spluttering.and spluttering.

SPINAL AND HEAD SPINAL AND HEAD INJURIESINJURIES

Spinal injuriesSpinal injuries are very serious and must be considered:are very serious and must be considered: In any incident where the athlete has been unconscious or In any incident where the athlete has been unconscious or

had a period of unconsciousnesshad a period of unconsciousness In any athlete who has:In any athlete who has:

pain or tenderness in the back or neckpain or tenderness in the back or neck an altered range of movement in the back or neck eg weakness an altered range of movement in the back or neck eg weakness

or inability to moveor inability to move altered sensation in any body part eg pins and needlesaltered sensation in any body part eg pins and needles

If a spinal injury is suspected or indicated:If a spinal injury is suspected or indicated: Conscious athleteConscious athlete – tell them not to move, DO NOT move – tell them not to move, DO NOT move

the athlete unless danger is present (if an athlete has to be the athlete unless danger is present (if an athlete has to be moved take extreme care to ensure the head and neck are moved take extreme care to ensure the head and neck are kept in alignment with the body and that the injured athlete kept in alignment with the body and that the injured athlete is fully supported) and call an ambulance.is fully supported) and call an ambulance.

Unconscious athleteUnconscious athlete – ABC takes priority over the injury, – ABC takes priority over the injury, follow DRABC maintaining care with ensuring that there is follow DRABC maintaining care with ensuring that there is no twisting or movement of the head or the neck (especially no twisting or movement of the head or the neck (especially if having to turn the athlete onto their side).if having to turn the athlete onto their side).Techniques that are least likely to cause movement should Techniques that are least likely to cause movement should be used eg jaw thrust rather than head tilt.be used eg jaw thrust rather than head tilt.

SPINAL AND HEAD SPINAL AND HEAD INJURIES cont…INJURIES cont…

Head injuriesHead injuries must be associated with:must be associated with: Spinal injurySpinal injury Damage to the airwayDamage to the airway BleedingBleeding Altered consciousnessAltered consciousness

Any athlete who has lost consciousness for any period of time:Any athlete who has lost consciousness for any period of time: Should Should NOTNOT be allowed to resume play be allowed to resume play SHOULDSHOULD be referred to a doctor or hospital for assessment be referred to a doctor or hospital for assessment

Any athlete who has sustained a head injury but not lost Any athlete who has sustained a head injury but not lost consciousness:consciousness:

Should NOT be allowed to return to playShould NOT be allowed to return to play SHOULD have their parent notified and told to observe the athleteSHOULD have their parent notified and told to observe the athlete

If any of the following are noticed by the parent, the athlete If any of the following are noticed by the parent, the athlete requires urgent medical attention:requires urgent medical attention:

Persistent or worsening headachesPersistent or worsening headaches Excessive drowsinessExcessive drowsiness Unusual behaviour, such as confusionUnusual behaviour, such as confusion Weakness in the limbs or uncoordinated movementWeakness in the limbs or uncoordinated movement Slurred speechSlurred speech Vomiting or nauseaVomiting or nausea Seizure or obvious loss of consciousnessSeizure or obvious loss of consciousness Bleeding or discharge from ears, nose or mouthBleeding or discharge from ears, nose or mouth

BLEEDING AND SHOCKBLEEDING AND SHOCKBleedingBleeding is the escape of blood from the blood is the escape of blood from the blood vessels. Severe bleeding is very serious and must be vessels. Severe bleeding is very serious and must be controlled very quickly. There are two types of controlled very quickly. There are two types of bleeding; internal and external.bleeding; internal and external.External bleedingExternal bleeding RecognitionRecognition – is obvious and visible on the surface of the – is obvious and visible on the surface of the

bodybody Hygiene infection controlHygiene infection control – is extremely important when – is extremely important when

dealing with blood. All precautions must be taken to reduce dealing with blood. All precautions must be taken to reduce the risk of transmitting infectious disease. Strategies the risk of transmitting infectious disease. Strategies include:include:

avoid contact between blood and your skin and eyesavoid contact between blood and your skin and eyes wear protective gloves, though do not delay management in wear protective gloves, though do not delay management in

obtaining glovesobtaining gloves encourage the athlete to apply pressure themselvesencourage the athlete to apply pressure themselves cover your own open cuts with moisture proof dressingcover your own open cuts with moisture proof dressing

ManagementManagement – the aim is to minimise the amount of blood – the aim is to minimise the amount of blood lost, prevent further infection and prevent further damage.lost, prevent further infection and prevent further damage.

If bleeding is not stoppingIf bleeding is not stopping – leave the dressing in place, – leave the dressing in place, relocate or replace the first pad until adequate pressure is relocate or replace the first pad until adequate pressure is achieved and check that the bleeding is controlled.achieved and check that the bleeding is controlled.

MANAGEMENT OF MANAGEMENT OF EXTERNAL BLEEDINGEXTERNAL BLEEDING

INTERNAL BLEEDINGINTERNAL BLEEDINGIs usually invisible to the eye and very difficult to detect. Is usually invisible to the eye and very difficult to detect. The bleeding may be into an organ, tissue or body cavity.The bleeding may be into an organ, tissue or body cavity.

Recognition –Recognition – may be accompanied by the signs and may be accompanied by the signs and symptoms of shock as well as:symptoms of shock as well as: pain or tenderness over or around the affected areapain or tenderness over or around the affected area swellingswelling coughing bloodcoughing blood vomiting bloodvomiting blood blood in the urine or faecesblood in the urine or faeces blood discharging from the ear or nose (head injury)blood discharging from the ear or nose (head injury)

Management – Management – lay athlete downlay athlete down if the athlete is vomiting, place in side positionif the athlete is vomiting, place in side position raise the legs above the level of the heart (if injuries allow)raise the legs above the level of the heart (if injuries allow) seek medical assistance urgentlyseek medical assistance urgently monitor ABCmonitor ABC Do not allow the athlete to eat or drinkDo not allow the athlete to eat or drink Loosen tight clothingLoosen tight clothing Reassure the athleteReassure the athlete

SHOCKSHOCKShock is the condition when Shock is the condition when there is a gradual collapse of there is a gradual collapse of the circulatory system. the circulatory system. Shock may occur with severe Shock may occur with severe bleeding, major fractures, bleeding, major fractures, severe diarrhoea and severe diarrhoea and vomiting, severe sweating vomiting, severe sweating and dehydration or any and dehydration or any traumatic injury. It is traumatic injury. It is important that the potential important that the potential for shock is recognised as for shock is recognised as early as possible and early as possible and managed appropriately, if managed appropriately, if not shock can lead to death.not shock can lead to death.

Recognition:Recognition: Pale, cool, clammy skinPale, cool, clammy skin Weak and rapid pulseWeak and rapid pulse Rapid and shallow breathingRapid and shallow breathing Dizziness or feeling faintDizziness or feeling faint Anxiety and restlessnessAnxiety and restlessness ThirstThirst Nausea and vomitingNausea and vomiting

ManagementManagement DRABCDRABC Control external bleedingControl external bleeding Seek medical assistance Seek medical assistance

immediatelyimmediately Position athlete depending Position athlete depending

on the cause of the shock (in on the cause of the shock (in side position where side position where comfortable, or in position of comfortable, or in position of greatest comfort)greatest comfort)

Place a conscious athlete Place a conscious athlete who feels faint on their back who feels faint on their back and raise their legs above and raise their legs above the level of the heartthe level of the heart

Manage any injuries presentManage any injuries present Maintain body temperature Maintain body temperature

(DO NOT overheat the (DO NOT overheat the athlete)athlete)

Loosen any tight clothingLoosen any tight clothing Reassure and keep the Reassure and keep the

athlete calm and at restathlete calm and at rest Do not allow the athlete to Do not allow the athlete to

eat or drinkeat or drink

CHEST, ABDOMEN AND CHEST, ABDOMEN AND LIMBSLIMBS

Chest injuriesChest injuries are common in are common in contact sports. Ask the athletecontact sports. Ask the athlete

Do you have any pain in the chest?Do you have any pain in the chest? Does it hurt if you take a deep Does it hurt if you take a deep

breath? breath? If yes refer to health professionalsIf yes refer to health professionals Common injuries to the chest Common injuries to the chest

include - Nipple chaffing (apply include - Nipple chaffing (apply Vaseline, protective tape and Vaseline, protective tape and wear appropriate clothing), soft wear appropriate clothing), soft tissue injury to the breast (RICER tissue injury to the breast (RICER no HARM, wear firm support), no HARM, wear firm support), bruising of chest wall (RICER no bruising of chest wall (RICER no HARM, look for signs of internal HARM, look for signs of internal bleeding and refer), fractured rib bleeding and refer), fractured rib (fracture management, refer), (fracture management, refer), collapsed lung (refer).collapsed lung (refer).

Major abdominal injuries are most uncommon in sport.

Injuries include – winding (rest until normal breathing resumes), stitch (‘running through’ the stitch or rest), internal bleeding (refer immediately), contusion/bruise (RICER no HARM, look for signs of internal bleeding, refer), strained abdominal muscle (RICER no HARM, look for signs of internal bleeding, refer)

Factors to consider with Factors to consider with limb limb injuriesinjuries include: include: Is there any injury to soft Is there any injury to soft

tissues?tissues? Is there any injury to hard Is there any injury to hard

tissues?tissues? Is there any skin injuries? Is there any skin injuries?

Use TOTAPS to assess these factors.Use TOTAPS to assess these factors.

BIBLIOGRAPHYBIBLIOGRAPHY

Education

Dealing with serious injuries