Risk Management Flashcards
Three Goals for the Prevention Action Plan
- Good coaches carefully plan practices so that athlete compete and play in an environment that is safe
- Good coaches emphasize basic skills and techniques that are designed to prevent injury
- An athlete will be confident if they are trying their best in an environment that affords them an all-out effort
Pre-Participation consideration actions: Medical screening
- Pre-participation exam (PPE)
- Physical Fitness Profile (PFP)
- Necessary at the start of any training
- Educate individuals regarding risk of participation
- Identify factors that place the at risk of injury
- Exam requirement are risk-dependent and age-dependent
- Par-Q
General Medical History
- Athlete fills out medical history card prior to team/sport involvement
- Athlete’s GP fills out a medical card
What can a Pre-Participation Exam (PPE) look like?
- Medical History
- Physical Exam
- Respiratory Exam
- Eye exam
- Dental Exam
- Neurological Exam
- Cardiovascular Exam
What can a Physical Fitness Profile (PFP) look like?
- Anthropometry
- Body Composition
- Flexibility
- Strength/Power/Speed
- Agility/Balance/Reaction
-Cardiovascular Endurance - Maturation/Growth
Medical Screening: Who to conduct? (PPE)
PPE
- Primary Care Physician
- Paediatrician
- Orthopaedic Surgeon
- Dentist
Timeline
- Days prior to training or centralization camp (up to within 6 weeks of start)
Frequency
- Annually
Medical Screening: Who to conduct? (PFP)
PFP
- Lab testing by Exercise Physiologists
- Kinesiology Students
- Strength and Conditioning Coach
Timeline
- Days prior to training or centralization camp following PPE
Frequency: Bi-annually; before and after training camp (once final team selection made)
Contraindications to Participation
Contraindicators are disqualifying factors for participation (in high-risk sports):
* Neurological (concussion)
* Single organ (eye, kidney, testicle)
* Eye (retinal detach, recent eye surgery)
* Pulmonary (lung infection)
* Cardiovascular (abnormal enlarged heart,
infection, murmurs or conditions,
pacemaker, previous MI, on
anticoagulants)
* Abdominal (partially undescended testes,
enlarges liver or spleen, kidney)
* Genital/Urinary system (missing one kidney,
infection 6 weeks following appendectomy)
* Musculoskeletal (incomplete healing,
inflammatory arthritis, hip disease,
back/neck pain)
* Skin (bacterial or viral infection)
* Ear, Nose, Throat (recent middle ear operation)
* Heme (hemophilia, HIV/Aids, Amenorrhea)
What is an Emergency Action Plan (EAP)?
- Serves as a blueprint on how to respond to emergency situations
- Written document that is comprehensive yet flexible to adapt to any emergency situation
When to refer to an EAP?
- Evaluate extent of injury
- Determine minor:
- Rest at home/sidelines
- See a physician; now or later?
- See a physiotherapist, chiropractor, etc. - Determine moderate to severe:
- Initiate EAP
- Hospital Emergency Room (how will you get there?)
- Call an ambulance
- Transport self
- Transport by another - Walk in clinic?
- MD’s office
Predetermined emergency action plans allow for what?
Allows for proper assessment and care of athletes who suffered injury or sudden illness.
EAP’s should be prepared in conjunction with…?
- Local paramedics
- Hospital emergency departments
- Sport physician
- School nurse
- Other allied healthcare professional associated with the team/event
EAP should be initiated under life threatening conditions like…?
- Obstructed airway
- Respiratory failure
- Cardiac arrest
- Severe heat
problems - Head/brain
damage - Cervical spine
injury
EAP should be initiated under serious conditions like..?
- Severe bleeding
- Joint dislocation
- Fractures
Definition of unconsciousness and the causes
The inability to respond to any sensory stimuli (exception is deep pain)
* Lethargic
* Stupor
* Coma
Causes may be:
Direct blow to the head
* Diabetes
* Epilepsy
* Anaphylactic shock
Primary Survey for Unconsciousness
- Airway
- Breathing
- Circulation
- The ABC’S
- CPR guidelines have changed it to C-A-B
- Compression, Airway, Breathing
Second Survey for Unconsciousness
Continue to monitor ABC’s
* Collect thorough history of injury
* Document level of consciousness
* Measure respiration
* Check the eyes/pupils
* Monitor skin colour and temperature
* Look for signs of trauma
(bleeding/posture)
* SCAT6 card (Sport Concussion
Assessment Tool)
Normal Respiratory Rates for different ages?
Newborn: 30-40 breaths/minute
Infants: 30-60 breaths/minute
Toddle: 26-32 breaths/minute
Child: 20-30 breaths/minute
Adolescent: 16-20 breaths/minute
Adult: 16-22 breaths/minute
If you suspect a spine injury..?
- Athlete should not be moved unless is essential
- Equipment is in the way
- Cannot access ABC’S
- Wait until EMS arrives
- Managed as though a spine injury exists
- ABC’s
- Neurological
- Status of LOC
- Activate EMS
- Learn appropriate holds to maintain spine alignment and recruit bystander help
Face Mask and Helmet Removal
- Face mask should be removed (in most cases)
- Remove as quickly as possible (even if conscious)
- Need appropriate tools for removal
- DO NOT remove helmet
- Potential for injury during helmet removal can be increased by the presence of shoulder pads that elevate the trunk
If you do have to take the helmet off…?
- Hockey helmet
- Splay helmet with fingers
- Have someone slide helmet up and off
- Football helmets
- Remove cheek pads
- Tilt helmet off occiput and remove without spreading helmet apart
Environmental Factor: Thunder and lighting
- 30 seconds flash-to-bag ratio
- Can also be stopped at first sigh of lighting
- 30 minutes must pass after thunder/lightning episode before activity resumed
Safe Shelter
* Grounded building or vehicle with metal roof
* Cell phone use is OK to dial 911
Environmental Factors: Extreme Temperatures (Hot/Cold)
- Risk of hyperthermia or hypothermia
- Monitor and modify or cancel as indicated
- Avoid peak hours in the
heat - Ensure access to dry
and/or shaded areas - More rest and hydration
breaks as needed - Rain + cold
temperatures - Who is at risk?
Dehydration - Excessive or improper
clothing - Low fitness level
- Fatigue
- Age (less 15 or greater 40)
- Obesity
- People on sidelines or in
stands
First Aid Kit Content (a few examples)
- Basic Kit Contents Athletic Tape (1.5”)
- Nail Clippers
- Steri-Strips
- Sugar Sunscreen
- Gloves (latex)
- Towel (Clean)
- Gauze (sterile and non-sterile)
- Band-Aids
- Tweezers
- Emergency Protocol
- Utility Scissors
- Injury Reporting Forms
Personnel in EAP
- What certifications/roles are required for the team ERT (emergency response team)
members? - Who will be the call person? (should include back up personnel)
- Who will be the charge person? (should include back up personnel)
- Establish how communication will occur (i.e., radio, phone, voice commands, hand signals) and who will maintain that equipment
Facility Policies in EAP
- All areas of the training facility are checked regularly for safety hazards.
- Phones (cell phones and land lines where necessary) and other emergency supplies are in
working order and accessible - EMS information and access routes into and out of the facilities are updated and posted next to
telephones (land lines if necessary) (attach with assignment) - ERT members are familiar with access into and out of the facility during an evacuation or during
an EMS call - Visiting teams receive information about EAP and emergency equipment available to them
- What other factors/issues could affect implementation of the EAP (i.e., weather, power outage,
earthquake, special event, construction?)
In the event of an Emergency…
- Detail the roles of each of the ERT
members provided by the team. - Run through your EAP in the
order of how your ERT should
respond. - Under what conditions should
you activate your EAP? - When should EMS be
contacted? - How much and how detailed should the information be that is provided to EMS by the call person?
After the Emergency…
- Who will inform the individual’s emergency contact person that an emergency has
occurred? - Who will ensure that ALL documentation has
been filled out correctly? - Should an incident report be created?
- When should a debriefing session be held?
- Who should attend a debriefing session?
- What should be discussed at a debriefing session?
What is an athletic injury?
- Disruption in tissue continuity
- Resulting from athletic or sports related activity
- Causing cessation of participation or restriction of usual activity
- Occurs when the forces applied to the body exceed the body’s ability to absorb the forces
- When this happens, structures start to tear
Forces and Injury
- Sources of Forces
- May be created inside the body (e.g., muscle contraction (eccentric especially) too powerful for
connective tissue) - May be created outside the body (e.g., running into object, another person, repeat landing)
- Spectrum: Minor to Life threatening
How athletic injuries occur?
- Mechanism of Injury:
- application location, magnitude, and direction of which excess forces/stresses are applied to the body.
- Example - Direct blow, indirect blow, chronic overuse
- Type of Injuries
- Exposed: disrupt skin continuity
*Unexposed: internal, skin not broken
What are the different mechanisms?
- Indirect
- example: FOOSH (aka skier’s/gamekeeper’s thumb)
- Direct
- Example: plant and twist, direct contact
- chronic/repetitive overuse
Direct Mechanism: Hematoma
- A localized mass of blood and
lymph confined within a space or
tissue - Blood collects and pools under the skin outside the blood vessel
- Symptoms are usually more severe than a bruise
- Caused by greater trauma
- May need surgical drainage
Direct Mechanism: Contusion (bruise)
- Caused by a direct blow to the
body - Compression injury involving
accumulation of blood and
lymph within a muscle - Can cause damage to the skin
and deeper tissue
Indirect Mechanism: Muscle Strain
- Injury to a muscle or tendon from over-exertion
- Minor:
- over stretch a muscle or tendon
- Severe:
- Partial/Complete tear in these tissues
What are the different grades?
- Grade 1: Stretching, small tears
- Grade 2: Larger, but incomplete
- Grade 3: Complete tear
Ligament Sprain
- A stretching or tearing of
ligaments - Ligaments: fibrous tissue
that connect two bones
together in your joints - Most common sprain is your
ankle
What are the grades for a sprain?
- Grade 1: Small tears, stable
-Grade 2: Larger tear, some laxity endpoint
-Grade 3: Complete tear, laxity, no endpoint
Dislocation definition
-An injury in where the bone is forced from its normal position and out of joint
- Causes: Trauma, Fall or collision
Subluxation
- Incomplete or partial dislocation of a joint
- Not moving how it should or it is misaligned
- Luxation: is a complete separation of the joints
What is a fracture and what types are there?
- Disruption of the continuity of a bone
- Traverse
- Linear
-Oblique non-displaced
-Oblique displaced - Spiral
- Greenstick
- Comminuted
Avulsion Fractures
- Small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone
- Common in young atheletes
- Hip, elbow, and ankle are the most common locations
Salter-Harris Fracture Classification
Type 1: Separation through the physis
Type 2: Fracture though a portion of the physis that extends through the metaphysis
Type 3: Fracture through a portion of the physis that extends through the epiphysis and into the joint
Type 4: Fracture across the metaphysis, physis and epiphysis
Type 5: Crush injury to the physis
What is a stress fracture?
- A fracture resulting from repeated loading with relatively low magnitudes forces
Myositis
Inflammation of connective tissue within a muscle
Myositis Ossification
- Bone tissue forms within a muscle
- Repetitive trauma to a muscle can develop MO
Tendinitis
- inflammation of a tendon
- tearing of tendon fibers
Tendinosis
- Tendon condition associated with degeneration rather than with inflammation
- Accumulate of small tears that failed to heal over time
Tenosynovitis
- Inflammation of a tendon sheath
- Example: De Quervain’s tenosynovitis
Bursitis
- Inflammation of a bursa
- Bursa is a fibrous sac membrane containing synovial fluid
- Typically found between tendons and bones
- Acts to decrease friction during movement
Commotio Cordis
- A sudden blunt impact to the chest
- Sudden distortion of the myocardium resulting in ventricular fibrillation
- Causes sudden cardiac arrest in an otherwise normal heart
What’s the difference between cardiac arrest and heart attack?
- Cardiac arrest is an electrical problem
- Heart attack is a circulation problem
Ventricular Fibrillation
- Type of arrhythmia (irregular heartbeat)
- Affect the heart’s ventricles
- Ventricles contract rapidly and uncoordinated
- The heart foes not pump blood to the rest of the body
- Need immediate medical attention
- Most frequent cause of sudden cardiac death
