From Field to Gurney - Cornhusker State Games

Report
St. Elizabeth Sports & Physical Therapy
Darcie Christensen, PT, ATC
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Identify the key components of Emergency Action
Plans (EAP’s)
Identify members and describe roles of the
emergency response team
Recognize when it is appropriate to employ the use of
a spine board
Discuss basic technique for placing an individual on a
spine board
Review the current research about equipment issues
and the spine injured athlete and discuss the
document Pre-hospital Care of the Spine Injured
Athlete
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Athletic health care providers review prior to
the start of each sport covered or new field
Determines the role and location of each
person present (ie. AT, EMT, MD)
Establish how communication will occur
(primary and backup)
What emergency equipment is present?
Where is it located?
NATA Official Statement on Athletic Health Care
Provider “Time Outs” Before Athletic Events, 2012
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Where is the ambulance located? Is it
dedicated or on stand-by? If not on site, what
is mechanism for calling one?
In the event of transport, what is the
designated hospital?
Are there any issues that could potentially
impact the EAP?
NATA Official Statement on Athletic Health Care
Provider “Time Outs” Before Athletic Events, 2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681208/pdf/attr-44-03-306.pdf
• A variety of healthcare professionals may be
involved in on-field management of suspected
head and/or spine injury
• Development of guidelines is imperative
• When dealing with a potential life threatening
situation, the scene of the injury is not the time
nor the place for healthcare professionals to
decide on appropriate treatment on such a
potentially controversial area.
Developed by the Inter-Association Task
Force
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Prehospital Care of the
Spine-Injured Athlete
 Developed by the Inter-
Association Task Force
 Task force was created
by the National Athletic
Trainers’ Association in
1998
 Document released in
2001
Free download at www.nata.org
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National Association of EMT’s
National Athletic Trainer’s Association
Professional Football Athletic Trainer’s
Society
American Association of Neurological
Surgeons
American College of Emergency Physicians
National Registry of EMTs
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Initial Assessment
Primary Survey
Level of Consciousness
Neurologic Screening
EAP Activation
Transportation
Equipment Removal
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Initial Assessment- Organized process to
quickly obtain information vital to care.
 Primary Survey- LOC-ABC
 Provide Immediate basic life support measures as
needed.
 Quickly make decision regarding transport
 Secondary Survey performed either on-site or
during transport
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Neurologic Assessment should be performed
before and after full body immobilization
 Pulse
 Motor
 Sensation
 Capillary Refill/Circulation
Neck
Evaluation
Flow Chart
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Body Substance Isolation
Establish mechanism of Injury
Head person establishes C-spine
 once established it is not relinquished
 person at the head gives ALL commands/counts
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Every emergency situation is different
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Individual circumstances must dictate appropriate actions.
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C-Spine established
 Place/Maintain head in neutral in-line position
 Assess consciousness of the athlete
 Calm the athlete, ask questions
 Assess PSMC Function
▪ Pulse, Sensory, Motor, Capillary Refill/Circulation
 When do we activate EMS?
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Loss of Consciousness or altered level of
consciousness.
Bilateral neurologic findings or complaints.
Significant midline spine pain
Obvious deformity
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Point Tenderness over the
cervical spine with or without
deformity
Unrelenting neck pain or
muscle spasm in the cervical
region with or without
palpation
Presence of muscular
weakness in extremities
Loss of coordinated
movement
Paralysis or inability to move
a body part
Abnormal Sensations in the
head, neck, trunk, or
extremities
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Absent or weak reflexes
Loss of bladder or bowel
control
Suspicious mechanism
Athletes inability or
unwillingness to move the
neck
Priapism
Respiratory Distress
Neurogenic Shock
 Decreased Blood Pressure
 Increased Pulse
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A “Gut” feeling
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Current recommendations for the
acute treatment are to immobilize
the head and neck in neutral
alignment prior to transfer to
minimize motion that occurs
during this process. Unless…
Movement causes or increases
pain, neurologic sx, or muscle
spasm.
Movement compromises airway.
It is physically difficult to perform
the movement
Resistance is encountered
The patient expresses
apprehension
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Apply Cervical collar (if possible)
Position Assistants
 Person at the head gives the commands
▪ Log Roll (only option in prone patient)
▪ Six person lift
▪ Feed and Pull method to center on the board.
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Secure athlete to spine board with
appropriate straps, blocks, towels, etc.
Re-Check P-S-M-C
Review of research used in the
development of Prehospital Care of the
Spine Injured Athlete and current research
conducted since that time.
“Helmet and shoulder pad removal in the unstable
cervical spine is a complex maneuver.”
“In the unstable C1-C2 segment, helmet removal causes
more angulation in flexion, more distraction, and more
narrowing of the space available for the cord.”
“Abnormal intervertebral motion, even as little as 1mm, may
cause significant neurologic damage. This is especially
true in the subaxial spine. In this region, the cord
demonstrates an exceptional intolerance of even small
amounts… and can lead to further neurologic injury in
the athlete in whom the spinal cord and
osseoligamentous structures are already compromised.”
Palumbo M., et. al., The American Journal of Sports Medicine, 1996.
Emergency Care and Transportation of the Sick and Injured, American Academy of Orthopedic
Surgeons, 1987.
McLain, R., Aretakis A., & Moseley, T.A., The Spine Journal, 1994.
Owen, J., Naito, M., & Bridwell, K.H., The Spine Journal, 1990.
Towbin, A., Archives of Pathology, 1964.
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WHEN TO REMOVE
1. When equipment prevents access to the airway
or chest for primary life support measures.
2. If the equipment does not maintain cervical
spine or provide adequate immobilization of the
head.
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Face Mask
 When to Remove
▪ Anytime spinal injury is suspected
▪ As soon as decision is made to transport
▪ Prior to transportation regardless of current respiratory
status
 Combined Tool Approach
▪ Tools should be readily available
▪ Cordless screw driver, FM Extractor, Anvil Pruning
Sheers, Screw Drive, Trainers Angel.
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FMS Extractor
Trainer’s Angels
Pruning shears
Cordless screwdriver
Handheld screwdriver
Dremel
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Be familiar with all types of equipment
used.
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Do not “flip” the mask
 Studies show increased movement from
torque involved in rotating facemask
Prior to facemask
removal, pocket mask
may be positioned
through facemask for
ventilatory assistance
 Following removal, BVM
may be used.
 Utilize Oxygen if
available
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“The Inter-Association Task Force recommends that
neither the football helmet nor the shoulder pads be
removed before transportation.”
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“The Inter-Association Task Force recommends the
face mask be removed as quickly as possible any
time a player is suspected of having a spinal injury,
even if the player is still conscious.”
With the face mask removed, you have access to the airway
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Six-plus – person lift
 preferred if enough personnel available
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Log Roll
 ½ log roll, position spine board, complete log roll
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Responders need to be trained
 Avoid the lay person if possible
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Person at the head is in charge!
Other sports offer the same challenges in
terms of preparing the spine-injured
athlete for transport
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Working on ice
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Helmets and chin straps can be loose
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As soon as you lift the mask, it becomes similar to a motorcycle
helmet
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Shoulder pads vary in thickness/fit
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Goalie gear
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Differences in gear
regulations
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Larger face masks
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Multiple straps
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Goalie gear
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Rib & kidney protectors
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Chin straps in face mask
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Differences in gear
regulations
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Familiarize yourself with a variety of
equipment and removal tools
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Communicate with personnel before the
game
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Host an in-service
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Case by case basis
Updating protocols, communication,
practicing action plans, and other efforts
can keep our athletes safe!
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Meet each other before the game or event
and talk about expectations and roles
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Learn about each other’s training and
knowledge bases
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Familiarize each other with the equipment
you have available
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Discuss preferences and share stories
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Example of Spine Boarding Process
 http://www.youtube.com/watch?v=GCqtAQ6uslo
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Example of Face Mask Removal
 http://www.youtube.com/watch?v=bZG3mgTmN-Y
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Example of Equipment Removal
 http://www.youtube.com/watch?v=OcRNEr32AQ0
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Rusty McKune, ATC
University of Nebraska Medical Center
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Denise Fandel, MBA, CAE
Executive Director at Board of Certification(BOC)
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Bailes, et al., Management of Cervical Spine Injuries in Athletes, Journal of Athletic Training, 2007; 42(1): 126–134.
Banerjee, R., Palumbo, M., & Fadale, P., Catastrophic Cervical Spine Injuries in the Collision Sport Athlete, Part 1 :
Epidemiology, Functional Anatomy and Diagnosis, American Journal of Sports Medicine, 2004, 32, p. 1077-1086.
Banerjee, R., Palumbo, M., & Fadale, P., Catastrophic Cervical Spine Injuries in the Collision Sport Athlete, Part 2 :
Principles of Emergency Care, American Journal of Sports Medicine, 2004, (7), p. 1760-1764.
Barrett, T.W., et. al., Injuries Missed by Limited Computed Tomographic Imaging of Patients with Cervical Spine
Injuries, Vol. 47(20, February 2006, p. 129-133.
Belanger, E. & Levi, A., The Acute and Chronic Management of Spinal Cord Injury, Journal of the American
College of Surgeons, May 2000: 190 (5), p. 589-604.
Brolinson, P. G., & Cibor, G. M., Editorial: Knowing More than the Score: Providing Sideline Medical Care
Coverage for Athletic Competition, Journal of the American Ortohpedic Association, 2011: 101(9), p. 495-496.
Dahl, M., et. al., Helmet and Shoulder Pad Removal in Football Players With Unstable Cervical Spine Injuries,
Journal of Applied Biomechanics, 2009, 25, p. 119-132.
Dick, R., et. al., Descriptive Epidemiology of Collegiate Men’s Football Injuries: National Collegiate Athletic
Association Injury Surveillance System, 1988-1989 Through 2003-2004.
Donaldson, et. al., Helmet and Shoulder Pad Removal From a Player With Suspected Cervical Spine Injury: A
Cadaveric Model, Spine 23(16), 1729-1732.
Douglas, K., The Answer is On! A Response to the Initial Lateral Cervical Spine Film for the Athlete with a
Suspected Neck Injury: Helmet and Shoulder Pads On or Off?, Clincial Journal of Sports Medicine, 2003: 13(1), p.
57-58.
Feld, F., Management of the Critically Injured Football Player, Journal of Athletic Training, 1993: 28(3), p. 206-212.
Gale, S.D., Decoster, L. C., & Swartz, E. E., The Combined Tool Approach for Face Mask Removal During On-Field
Conditions, Journal of Athletic Training, Vol. 43 (1), 2008, p. 14-20.
Frohna, W., Emergency Department Evaluation and Treatment of the Neck and Cervical Spine Injuries, p. 740793.
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Frohna, W., Emergency Department Evaluation and Treatment of the Neck and Cervical Spine Injuries, p. 740793.
Gatti, J. M., Protective Equipment in the C-spine-injured Athlete, Traumarounds, Winter 2009/2010, p. 4-5.
Ghiselli, G., Schaadt, G., & Mcallister, D., On-the-field evaluation of an athlete with a head or neck injury, Clinics
in Sports Medicine, 22 (2003), p. 445–465.
Hardy, et. al., From Sideline to Inline, JEMS, July 2009, p. 72-76.
Jagannathan, J., et. al., Cervical Spine Injuries in Pediatric Athletes: Mechanisms and Management,
Neurosurgery Focus, 21(4), 2006, p. 1-5.
Jenkins, et. al., Removal Tools are Faster and Produce Less Force and Torque on the Helmet Than Cutting Tools
During Face-Mask Retraction, Journal of Athletic Training, 2002: 37(3), p. 246-251.
LaPrade, R. F., et. al., Cervical Spine Alignment in the Immobilized Ice Hockey Player: A Computed Tomographic
Analysis of the Effects of Helmet Removal, American Journal of Sports Medicine, 28(6), 2011, p. 800-803.
LaPrade, R., et. al., An Evaluation of Head Movement in Backboard-Immobilized Helmeted Football, Lacrosse,
and Ice Hockey Players, Clinical Journal of Sport Medicine, Vol. 11, p. 82–86.
Miele, Norwig, & Bailes, Sideline and ringside evaluation for brain and spinal injuries, Neurosurg. Focus 21 (4):E8,
2006.
Pre-Hospital Cervical Spinal Immobilization Following Trauma, The Section on Disorders of the Spine and
Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological
Surgeons, September 2001.
Prehospital Care of the Spine-Injured Athlete by the Inter-Association Task Force For Appropriate Care of the
Spine-Injured Athlete
Rihn, J.A., et. al., Cervical Spine Injuries in American Football, Sports Medicine, 39(9), 2009, p. 697-708.
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Swartz, E.E., et. al., Football Equipment Design Affects Face Mask Removal Efficiency, The
American Journal of Sports Medicine, Vol. 33 (8), 2005, p. 1210-1219.
Swartz, E., et. al., NATA Position Statement: Acute Management of the Cervical Spine– Injured
Athlete, Journal of Athletic Training, 2009, 44(3), p. 306–331.
Thomas, B., McCullen, G., & Hansen, A., Cervical Spine Injuries in Football Players, Journal of the
American Academy of Orthopaedic Surgeons, Vol. 7 (5), 2004, p. 338-347.
Tierney, R. T., et. al., Head Position and Football Equipment Influence Cervical Spinal-Cord Space
During Immobilization, Journal of Athletic Training, 37 (2), 2002, p. 185-189.
Treme, G., et. al., Cervical Spine Alignment in the Youth Football Athlete: Recommendations for
Emergency Transportation, American Journal of Sports Medicine, 36(8), 2008, p. 1582-1585.
Veenema, K. et. al., The Initial Lateral Cervical Spine Film for the Athlete with a Suspected Neck
Injury: Helmet and Shoulder Pads On or Off?, Clinical Journal of Sports Medicine, 12:123-126.
Waeckerle, J. F. & Kleiner, D. M., Editorial: Protective Athletic Equipment and Cervical Spine
Imaging, Annals of Emergency Medicine, 38 (1), July 2001, p. 65-67.
Waninger, K., Management of the Helmeted Athlete With Suspected Cervical Spine Injury,
American Journal of Sports Medicine, 2004 (32), p. 1331-1350.
Waninger, K., et. al., An Evaluation of Head Movement in Backboard-Immobilized Helmeted
Football, Lacrosse, and Ice Hockey Players, Clinical Journal of Sports Medicine, 11, p. 82-86.
Whiteside, J., Management of Head and Neck Injuries by the Sideline Physician, American Family
Physician, 2006: 74(8), p. 1357-1362.
Wieder, B., Cervical Spine Injury in Athletes, CNI Review Medical Journal, 11(1), 2000.
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