chapter 6 KNES a
legal duty
The team physician, athletic trainer, and coach have a ____________ to develop and implement an emergency plan to provide health care for participants; slide 3 NOT IN BOOK
emergency plan rehearsed
developing an ________________ is one part of planning for the management of injuries; in order to ensure the plan is efficient and effective, it must be ___________; the emergency response team should practice the emergency plan through regular educational workshops and training exercises; the use of interactive or simulation practice exercises can better prepare individuals to assume their roles in rendering emergency care 79
population served
while the immediate on-site treatment for any given musculoskeletal injury may be the same, regardless of the age or gender of the person, the _________________ must be considered in developing an emergency plan; by recognizing that a population may have a higher susceptibility to a specific condition, consideration for the potential consequences associated with that condition can be addressed in advance; for example, elderly participants in an exercise program would be at greater risk for cardiac-related conditions than third-grade students in a physical education class; in a similar manner, a 12-year-old recreational soccer player presents with a predisposition to musculoskeletal injuries different from those of a 30 year old recreational soccer player; it is also important to acknowledge the general cognitive awareness of the population being served; for example, the reaction of a third-grade student having sustained an open fracture of the forearm during an activity in a physical education class is likely to be very different if the same injury were sustained by a tenth-grade student or a 40 year old; in a similar manner, the physical education teacher will have the additional responsibility of supervising and controlling the rest of the third-grade students in the class and, typically, without the initial assistance of another adult 76
Emergency Medical Services System
•Preseason preparation -Meet with representatives from local EMS agencies to discuss, develop, and evaluate plan -Written plan for each activity site -Practice the emergency plan •Responsibilities of medical personnel -Team physician •Prior to season, delineate responsibilities of all personnel •On the field -Athletic trainer •Event setup •Home versus away •Presence or absence of physician SLIDE 4; ALSO SEE RESPONSIBILITIES ABOVE
Emergency Medical Services System
•Process that activates the emergency health care services of the athletic training facility and community to provide immediate health care to an injured individual slide 3 NOT IN BOOK
universal precautions
_____________ include: if possible, wash hands before treatment if possible, cover any existing personal wounds apply gloves (e.g. latex) before initiating treatment; in some instances, it may be appropriate to give the patient a sterile gauze pad to apply to the wound while the gloves are being applied if splattering or splashing of blood is anticipated, wear additional personal protective equipment (e.g. goggles; masks; gowns) if it becomes necessary to treat another individual, apply a new pair of gloves immediately following treatment, thoroughly wash hands and other skin surfaces with soap and warm water; in the absence of soap and water, disposable towel wipes or sanitizing lotions should be used dispose of all contaminated materials (E.g. gloves, gown, gauze pads) in an appropriate container marked for biohazardous waste 80
emergency action plan
______________ requirements: •Serves as a blue print on how to respond to emergencies •Plan should identify -Personnel and qualifications -Equipment -Mechanism of communication -Facilities -Documentation verifying the implementation and evaluation of EAP- emergency action plan -Documentation of annual review and rehearsal slide 2; starts talking about on pg 76
universal precautions
______________ should always be practice in treating any open wound; best practice is to treat the blood of any individual as if it is infected with a bloodborne pathogen 80
during the event, responsibilities
________________ that should be defined could include: assessment of a condition (e.g. specific protocol for a potential head, neck or internal injury) on site treatment of a condition (e.g. application of ice and compression for a soft tissue injury; conditions, whereby protective equipment should not be removed: conditions, whereby an injured participant should not be moved; identification of conditions which warrant activation of the local EMS implementation of the emergency plan (E.g. if the injury requires contacting the parents, who will make the phone call; if the condition requires obtaining the services of local EMS who will make the call) proper disposal of items and equipment exposed to blood or body fluids documentation of actions taken in response of an injury condition 77
documentation
_________________ is essential to verify the implementation of the emergency plan in response to any injury or condition; the actions taken by the coach in assessing and managing the injury should be documented using appropriate forms; these forms should be completed as soon as possible following the incident; any unnecessary delay in completing the forms could result in failure to accurately recall all the actions that took place 79
bloodborne pathogens
_________________, such as Heptitis B virus, Hepatitis C virus, and Human Immunodeficiency Virus are microorganisms present in blood and other body fluids (e.g. semen; vaginal secretions) of infected individuals; the microorganisms can be transmitted when contaminated blood or bodily fluids enter the body of another person 80 •Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) are microorganisms that are present in blood and other bodily fluid slide 6
implementing emergency plan
__________________ include: rehearsing and practice review by administrator or someone not in the plan
communication
__________________ involves attention to other areas including: determining when and who will call 911 (i.e. summon EMS) determining when and who will call the parents of a minor to advise them of an injury sustained by the child the timing of the phone call to the parents should also be determined in advance determining when and who will call or inform personnel affiliated with an institution/ facility (E.g. athletic director; school principle; fitness facility director) of an incident 79
soft tissue injuries
__________________ may involve open wounds (e.g. abrasions; blisters; lacerations; puncture wounds) or closed wounds (e.g. contusions; sprains; strains) 79
following the event
___________________-, the emergency plan should identify the personnel responsible for follow up communication and documentation, as necessary with, the injured participant or their parents and other personnel within the institution/ organization; it is also essential that the plan have specific guidelines for documenting the actions taken by personnel in the implementation of the emergency plan; written documentation should be required for ANY incident that requires a response by facility personnel, not just for those incidents deemed a true emergency; if a coach assesses an injury, determines it to be minor, applies ice and compression, and provides instructions for return to play, the coach should be required to document the event 77
determining when and who will call parents of a minor
__________________________ to advise them of an injury sustained by their child; again, if the coach is not available to make the call, it may become necessary for a student to make the call; the plan should not only ensure that a student member of the emergency response team is prepared to make such a phone call, it should also ensure that parents are advised in advance that in some scenarios, a student will be part of the emergency response team 79
determining when and who will call 911
_____________________ (i.e. summon EMS); again, it becomes important to anticipate potential issues; for example, a school system may already have a plan in place that requires certain personnel be informed before 911 can be called; if so, that policy should be part of the emergency plan; if the decision to call 911 is at the discretion of the coach, there are still items that must be addressed; if the coach is the only adult on-site and is tending to the injured individual, it may become necessary for one of the students on the team to place the call; the role of a student as a member of the emergency response team should be included in the emergency plan 78
notifying institution or facility management
______________________ (e.g. athletic director, school principal, fitness facility director) of an incident; an option for ensuring that necessary personnel have been informed is to create a chain of command; this option should allow for an efficient and effective means for disseminating information as necessary 79
emergency conditions warranting written protocols
______________________ include: on-site management of an unconscious individual head and neck injuries acute cardiac conditions (e.g. cardaic arrest; commotion cordis) acute respiratory distress (e.g. asthma, exercise induced bronchospasm, exposure to allergen) life or limb threatening orthopedic injuries (e.g. femoral fracture, hip dislocation, posterior sternoclavicular dislocation) general medical conditions (e.g. diabetes, sickle cell anemia) environmental conditions (e.g. heat illness)
managing acute injuries or conditions
______________________- is a major responsibility for individuals involved in the instruction, supervision, or administration of programs involving physical activity; in performing this responsibility, the *COACH must be concerned with providing the appropriate medical care for the participant and it must be within the standards of care of a COACH* 75
coach
accidents and injuries are to be expected; participants in sport and physical activity need to understand that certain inherent risks are involved with their participation; the _______________ needs to have that same understanding and, as such, be prepared to provide immediate management for potenital injuries/conditions; _____________ as the first responder when an injury is sustained, the coach is expected to *evaluate the situation, assess the severity of injury, recognize life-threatening conditions, provide immediate care, and initiate procedures, as necessary, to ensure proper referral for ongoing management* 75
emergency action plan
an _____________________ is a well-developed written process that defines the policies and procedures to be used in the management of an acute injury to a participant; the plan should provide direction to those individuals who will have responsibilities in managing the condition; the plan should not be limited to emergency conditions, but rather it should include injuries of varying severity (E.g. mild, moderate, severe, life-threatening); the ______________________ should be a written document that is comprehensive, yet flexible enough to adapt to any emergency situation at any activity venue; while some items should automatically be included in an _______________, no single ______________ can satisfy the needs of every institution, organization, or facility; as such, every program should design a plan specific to their facility, population served, personnel, and any other factors that could influence injury management 75
transmission of bloodborne pathogens
as part of the treatment of an open wound, attention must also be given to managing the TREATMENT SETTING; in the absence of appropriate housekeeping or environmental control procedures, the risk of infection could still be present; procedures to prevent _____________ include: cleaning work surfaces immediately following treatment; an approved biohazard product or bleach and water solution (ratio of 1:10) should be available cleaning floor spills in accordnace with infection control standards; it is important to designate the staff responsible for cleaning various types of SPILLS; for example, if a physical education student sustains an injury that results in blood spots on the gymnasium floor, *the physical education teacher should know in advance, if it is their responsibility to clean the floor* or if it is their responsibility to inform another staff member (E.g. maintenance personnel) of the spill making biohazard waste bags and containers available for dispensing of contaminated disposable materials as well as handling of nondisposable contaminated materials (E.g. clothing; towels) establishing protocols for collection of biohazard materials by an appropriate agency 80
responding to blood or other body fluids exposure
because the potential exists for accidental ____________, A PLAN MUST BE IN PLACE for responding to any such scenario; areas to be addressed include: establishing a protocol for obtaining appropriate medical testing and treatment for the individual exposed to the pathogen developing a reporting system for results of any examinations, medical testing, and follow-up procedures defining procedures for documentation of the incident (e.g. date of incident, nature of the exposure, amount of blood involved in the exposure, follow-up recommendations) identifying personnel who should be informed about the incident establishing procedural steps for ensuring confidentiality of the parties involved 81
emergency response team
every institution/organization should have an _______________; the responsibilities of team members should be clearly defined; in doing so, it is important to recognize that in any given situation, the members of the emergency response team can vary; for example, in a school setting, a nurse may be available during the school day, but not available for after-school activities; in a fitness facility, additional healthcare practitioners (e.g. physician, nurse practitioner) may be available during hours of operation that a cardiac rehabilitation program is conducted rather than the entire time that a facility is open for business 77
independent administrator review
following any implementation of the emergency plan, personnel other than just those individuals involved in implementing the plan (e.g. administrators) should evaluate the process for the purposes of identifying any areas, which require attention; in particular, any obstacles (e.g. breakdown in communication; unforeseen circumstances) that delayed the process should be identified and the appropriate steps taken to rectify the situation in the future implementation of the plan 79
coach
following completion of an on-site assessment, the ______________ must analyze the information obtained and make decisions on the best way to manage the situation; it is especially important to determine whether hte situation can be handled on site or if referral to a physician is warranted 75
potential injuries/ conditions
identifying every ______________ that could be sustained by a participant in sport or physical activity and including it in an emergency plan *is not a reasonable expectation*; however, it is reasonable to anticipate and identify potential emergency conditions that could be associated with some situations; for example, head and neck injuries are more likely to occur in football than tennis; an elderly population is more vulnerable to a cardiac episode than students in an elementary school; an individual with diabetes must be concerned with maintaining appropriate blood glucose levels during participation in physical activity; as such, establishing written protocols for some injuries and conditions can potentially reduce confusion through advanced planning and, in doing so, increase the potential for ensuring appropriate management; written protocols for specific injuries/conditions should be considered for inclusion in the emergency plan 76
external support personnel
if ________________ (e.g. emergency medical technicians (EMT); athletic trainers; parents) are used in the implementation of the emergency plan, their roles, responsibilities, and protocols should also be defined; for example, if an athletic trainer is hired to provide medical coverage for an event, then there must be a clear delineation of the responsibilities regarding services to be provided by that individual; it should not be assumed that the athletic trainer will provide specific services; rather, the services to be provided must be determined in advance; in a school or recreational setting, parents can be a valuable resource; for example, if a school knows that the coach is responsible for providing medical care for participants during away contests, recruiting parents to serve as members of the emergency medical team during away contests could be extremely beneficial; however, in order to avoid confusion and ensure appropriate implementation of the emergency plan, the decision to use parents should be determined in advance, so they can be informed of their roles and responsibilities 78 •Preseason preparation -Meet with representatives from local EMS agencies to discuss, develop, and evaluate plan -WRITTEN PLAN FOR EACH ACTIVITY SITE -Practice the emergency plan •Responsibilities of medical personnel -Team physician •Prior to season, delineate responsibilities of all personnel •On the field -Athletic trainer •Event setup •Home versus away Presence or absence of physician slide 4
OSHA standards hepatitis B
if the nature of a job puts an employee at a reasonable risk of coming into contact with blood or other bodily fluids, employers are required by the ___________________ to offer Hepatitis B vaccinations to their employees; the Hepatitis B vaccination prophylaxis is considered the best defense against contraction of HBV; the vaccination involves a series of three shots over a 6 month period; the CDC reports very small risk of serious side-effects with the vaccination; the most common side-effect is soreness at the injection site; it is believed that the potential risks associated with HBV are far greater than any risk associated with the vaccine; if an employee should decline the vaccination, the decision to decline should be appropriately documented 81
establishing specific responsibilities prior to program
in _____________ of personnel, IT IS NECESSARY TO ADDRESS DUTIES PRIOR TO THE BEGINNING OF A PROGRAM OR EVENT, DURING THE ACTIVITY, and AFTER THE ACTIVITY; areas of importance prior to the initiation of a program or event could include: identifying the personnel responsible for ensuring that first aid kits are appropriately stocked and restocked after use identifying the personnel responsible for ensuring that emergency equipment are available and optional 77
documentation
in addition to _________________ of a specific incident, other information pertaining to the plan should be documented; a procedure should be in place for the verification and _____________ of: must document an ANNUAL REVIEW and REHEARSAL OF THE EMERGENCY PLAN, including notations indicating whether the emergency plan was MODIFIED and, if so, the changes made personnel training and current certification e.g. CPR, BLS, AED, etc. equipment maintenance and replacement as necessary, e.g. AED 79
injury management
in addressing ______________, two broad areas should be considered; one area is the use of an emergency/ action plan to provide direction for the coach in managing a condition; the second area is the on-site treatment appropriate for acute musculoskeletal injuries 75
equipment and supplies
in developing the emergency plan, decisions must be made with regard to the specific equipment and supplies that must e available to implement the plan; in making such decisions, it is essential to ensure that the materials are appropriate to the level of expertise or qualifications of the personnel implementing the plan; for example, it may not be appropriate to have an AED available for use in the absence of personnel trained to use the equipment; the same applies to less-sophisticated equipment, such as crutches; if crutches are to be made available for use by an injured participant, the coach must be familiar with the guidelines for the proper fitting of crutches and instructions on the use of crutches; even the items selected for first aid kits should be predetermined and not left to the discretion of individual personnel; in all instances, personnel should be familiar with the first aid and medical supplies available for their use in advance of making use of them 78
open wounds
in general management of __________________ involves controlling bleeding, evaluating the wound to determine whether emergency treatment is necessary, cleansing the wound, and dressing the wound; in addition, care of open wounds includes following universal precautions to reduce the risk of transmission of bloodborne pathogens 79 •Open Wound Injury Care -KEY: control bleeding and evaluate the wound to determine if emergency treatment is necessary -Cleans and dress the wound -Make sure universal precautions are followed to reduce risk of bloodborne pathogens slide 5
acute injury management
in general, the options available to the coach in _______________ would include: standard acute care (i.e. cold, compression, elevation, protected rest, as appropriate) with no physician referral, but providing the individual with a written instruction sheet identifying signs and symptoms that would necessitate immediate care by a physician standard acute care with physician referral prior to return to activity standard acute care with immediate physician referral (i.e. emergency care facility) summon emergency medical services (EMS) 75
facility access
in some environments, ________________ may not be a concern; however in other settings it should not be overlooked; for example, if an injury occurs during a physical education class being held outdoors, the emergency plan may stipulate that the teacher uses a cell phone to call school personnel for necessary assistance; if the cell phone is not available, it may become necessary to send a student to the school building to obtain help; in many schools, the outside doors are locked during the school day; if the door closest to the outdoor teaching area is not a door that can be readily accessed, the potential time delay to locate an unlocked door could have serious consequences for the injured individual; again, the emergency plan is intended to anticipate any potential problems/issues in advance, so access to the facility should be addressed in developing the plan 78
written plan
regardless of the severity of injury, a _______________ should be in place to direct the coach through the implementation of each option 75
transmission of bloodborne pathogens
research suggests that the risk of ______________ in an athletic or physical activity setting is RELATIVELY LOW; regardless such guidelines are necessary to minimize health risks and to protect both the coach and participant; in developing the guidelines, *several areas should be addressed, including universal precautions, housekeeping, and biohazard waste disposal, accidental exposure, pre-exposure prophylaxis with Hepatitis B vaccine, documentation, and wound management* 80
timing of phone call to parents
the ________________________ should also be determined in advance; for example, if it becomes necessary to activate EMS, it would seem that the parents should be called immediately after the call to 911; an argument could be made that it is not necessary to call the parents until the EMS unit arrives and determines their response; regardless of the decision, the appropriate timing of a phone call to the parents should be determined in advance and included in the emergency plan 79
communication
the availability of a phone is a critical component in the development of an emergency plan; the coach must have access to a working telephone at all times; while the availability of cell phones would seem to negate the importance of this component, it should not be overlooked; a plan must be in place for addressing potential problems with the availability of a cell phone (e.g. the phone loses its charge unexpectedly; phone service is not available in a particular areas) 78
emergency action plan
the development of an __________________ should be recognized as a significant endeavor that requires input from several sources; ____________ should be developed with input form the personnel at the facility, higher authorities to which the institution reports (e.g. individual school as part of a school system; a fitness facility as a company-owned entity), medical personnel (e.g. physicians; representatives from local EMS agencies; athletic trainers), and legal personnel (e.g. school lawyer; company lawyer); in developing the ________________, several areas must be addressed, including the *population being served, potential injuries/conditions, personnel, availability of medical/first aid equipment, facility access, communication, and documentation* 76
facility access
the emergency plan should also identify the process for ensuring that emergency vehicles (e.g. EMS, have easy access to the facility and any outdoor venues; in some settings, the exact location of an outdoor venue may not be readily apparent to a responding EMS unit; if the emergency plan has identified a member(s) of the emergency response team to meet the EMS unit at the main entrance and direct them to the appropriate area, it could reduce an otherwise unforeseen delay in reaching the injured participant 78
qualifications
the emergency plan should be developed with an understanding of the ______________ of personnel that will be part of the emergency plan; the institution/organization would be well advised to require involved personnel to maintain certification in first aid, CPR, AED training; institutions should also consider requiring personnel to be trained in the handling of bloodborne pathogens; an emergency plan for an institution that does not require first aid, CPR, and AED training for their staff would necessitate a very different plan form that of an constitutions requiring such certifications; every institution/organization should have an emergency response team; 77 see below
bloodborne pathogen documentation
the importance of ____________ cannot be overlooked in efforts to prevent the transmission of bloodborne pathogens; the type of records that should be maintained can vary relative to the work setting and practices; in general, records should include: verification of completion of OSHA training HBV vaccinations or declining of the vaccination Medical records for individuals exposed to blood or other body fluids; information required as part of a medical report (e.g. exam results; medical testing) policies and procedures for ensuring the ________________ and maintenance of appropriate information must be regulated; in particular, a process must exist for maintaining confidentiality of medical reports 81
transmission of bloodborne pathogens
the risk for exposure to __________________ can vary relative to the workplace setting; for example, opportunities for exposure are greater for a registered nurse in an emergency room than an athletic trainer in a high school setting; in an athletic or physical activity setting, _______________ could potentially occur through open wounds subsequent to contact between the damaged skin and infected body fluids, and *when contaminated fluids come into contact with the mucous membranes of the eyes, mouth, and nose* 80
