chapter 6 KNES

inflammatory phase movement

the advantages of movement during the _______________ include: encouraging venous return encouraging fluid resorption encouraging phagocytosis preventing contracture and loss of range of motion 85

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

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

medical emergency fracture

_____________ while waiting for medical assistance to arrive, the following actions should be considered in managing the condition: control any bleeding (application of gentle pressure) immobilizing the injured area in the position it was found applying cold to the area if shock is suspected, then providing treatment for shock 86

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 -Documentation of annual review and rehearsal slide 2; starts talking about on pg 76

universal precuations

______________ 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

closed wound care

_______________ focuses on immediately reducing inflammation, pain, and secondary hypoxia; the process for providing immediate management for an acute closed soft tissue injury includes several components, commonly referred to as the PRICE principle (i.e. protected rest, ice, compression, and elevation 82 •PRICE -Protected Rest -Ice -Elevation -Compression

stages of cold sensation

________________ include: initial cold sensation (0-3 minutes) burning and aching sensation 2-7 minutes numbing sensation (anesthesia) 5 to 12 minutes 83

cold packs

________________ should be applied to the injured area as soon as possible following the injury; the length of application time can range from 15 to 30 minutes; the time for a larger muscle mass, such as the quadriceps, would be 30 minutes and for a smaller site, such as a finger, 15 minutes should be sufficient; cold applications should be repeated every 1 to 2 hours while the patient is awake and continue for at least 72 hours post injury; during the application, the patient can expect to experience progressive sensations, namely cold, burning, aching, and analgesia (numbing) 83

indications for applying cold

_________________ include: acute or chronic pain acute or chronic muscle spasm/ guarding acute inflammation or injury postsurgical pain and edema neuralgia superficial first-degree burns used with exercises to: facilitate mobilization relieve pain decrease muscle spasticity 83

open wound conditions warranting referal

_________________ include: life-threatening wounds (EMS should be activated) uncontrolled bleeding inability to cleanse all the debris from a wound a wound that potentially requires stitches a penetrating wound (a tetanus shot may be necessary to avoid serious infection) 82 Identify conditions that warrant immediate referral: -Life-threatening wounds -Uncontrolled bleeding -Inability to cleanse all the debris from the wound -A wound that needs stitches -A penetrating wound slide 8

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

fracture red flags to alert EMS

_________________- include: an open or compound fracture suspected multiple fractures suspected fracture of the femur, hip, pelvis, vertebra (E.g. cervical; lumbar), or skull a limb or joint presents with significant deformation the toes or fingers of the involved extremity are pale, blue, cold, or numb (suggesting circulatory compromise) signs and symptoms of shock 86 -Open or compound fracture -Suspected multiple fractures -Suspected fracture of the femur, hip, pelvis, vertebrae, or skull -A limb or joint presents with significant deformation -Distal extremities (toes/fingers) are pale, blue, cold, or numb -Signs and symptoms of shock slide 10

elevation of injured body part

__________________ at least 6-10 inches above the heart can reduce bleeding in the area, encourage venous return, and prevent pooling of blood in the extremities; __________________ should be performed as often as possible during the 72 hours postinjury; if the injury is to the lower extremity, in preparation for sleeping, raising the end of mattress (using a hard object, e.g. a suitcase) will permit elevation throughout the night; while the use of several pillows under the lower extremity is a viable option, there could be a tendency for the pillows to move and compromise the elevation 84

contraindications for applying cold

__________________ include: decreased cold sensitivity and/or hypersensitivity cold allergy/ cold-induced ultricaria circulatory or sensory impairment rayund's phenomenon advanced diabetes hypertension uncovered open wounds cardiac/respiratory disorders nerve plsy arthritis 93

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

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/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

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

fracture

a ____________- can range in severity from a minor injury to a life-threatening emergency; as such, the immediate management of a _____________ must take into consideration the nature and severity of the _____________; IN ALL INSTANCES, MEDICAL ATTENTION IS REQUIRED 85

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 documenet 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

splints

consideration should be given to purchasing commercial-type _____________ as part of an institution's first aid supplies; it is important that the _________________ purchased are suited for use by the coach as compared to those ____________- (e.g. air splints) that should only be used by trained medical personnel (e.g. EMTs; athletic trainers); in the absence of commercial ____________, __________ can be made from materials that will provide rigidity, such as magazines, strips of wood, and cardboard; in a similar manner to the treatment of closed wound injuries, cold packs can be applied to reduce swelling, and the area elevated, as the physiological effects of both will minimize the secondary injury zone and optimize the healing process 85

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

inflammatory phase movement

during the ________________ can be initiated when bleeding has stopped; bleeding can persist for up to 36 hours; the type of movement should be gentle and controlled motions that progress to routine activities of daily living; for example, if the injury is an ankle sprain, the movements could include wiggling the toes, performing plantar flexion and dorsiflexion within pain-free limits, and using the foot and ankle to make the letters of the alphabet; the next step in the progression would be to initiate walking within the parameters of being pain-free and maintaining a normal gait (i.e. without a limp) 85

establishing specific responsibilities

during the event, _________________ for the following may be appropriate: 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 protectie 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

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

protected rest

following an injury, the area should be _______________ to avoid further damage to the involved tissues; if continued unrestricted activity is permitted, it could result in increased bleeding, increased pain, and delayed healing; if the injury is to a lower extremity and the individual is unable to walk pain-free without a limp, the individual should be placed on crutches and an appropriate protective device applied to limit unnecessary movement of the injured joint; if the injury is to an upper extremity and the individual is unable to move the limb without pain, then the individual should be fitted with an appropriate splint or brace 84

emergency plan administrator review

following any implementation of the __________________, 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

communication and documentation

following the event, the emergency plan should identify the personnel responsible for follow up ________________, 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

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

fracture

if a suspected _______________ to an extremity is associated with minor trauma, the inital focus of hte immediate management should include splinting the extremity in the position in which it is found and immobilizing the joint above and below the fracture site; there should be no attempt to realign the bone or move the individual until the suspected fracture is stable; immobilization is necessary to prevent any further damage to the bone and surrounding tissues (e.g. blood vessels; nerves; muslce) and it should aid in reducing pain 85

fracture

if a suspected ________________ is associated with a major trauma or injury, it should be treated as a medical emergency; such a condition warrants activation of the emergency medical plan, including summoning of 911 85

stitches

if the coach suspects that a wound requires _______________, arrangements should be made to have hte individual seek medical attention at an emergency room or urgent care center; if necessary, __________ should be applied within 6 hours to avoid contaimination of the wound; if a physician's evaluation suggests contamination, a wound cannot be ____________, as doing so would compromise the healing process 82

dressed and bandaged securely

if the evaluation suggests that the wound does not require immediate medical attention, the individual may be permitted to return to activity after the wound has been ____________________; if the wound resulted in blood on the individual's clothing, the clothing should be changed prior to be changed prior to return to activity if it appears wet or has soaked through the fabric; if the blood presents as small droplets of dried blood, it is not necessary to change the clothing 82

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

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 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

medical emergency fracture

in a situation considered a __________________, IT IS BEST TO AVOID MOVING OR TRANSPORTING THE INDIVIDUAL; *because movement could aggravate the condition, the individual should remain in the position found and paramedics should handle transport* 86

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

immobilization and remobilization

in general, soft tissues respond to the physical demands placed on them, causing the formation of collagen to remodel or realign along the lines of stress, thus promoting healthy joint biomecahnics (Wolff's law); continuous passive motion can prevent joint adhesions and stiffness, and decrease joint hemiarthrosis (blood in the joint) and pain; early motion, and loading and unloading of joints, through partial weight-bearing exercises maintain joint lubrication to nourish articular cartilage, menisci, and ligaments; this leads to an optimal environment for proper collagen fibril formation 85

options to manage injury

in general, the _____________________ 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

open wound management

in individual should be instructed to change the dressing daily; as part of that process, potential signs of infection should be assessed, including localized head, swelling, redness, pus, and pain; body temperature should also be taken as an elevated temperature could be indicative of infection; if signs of infection are present, the individual should seek medical attention 82

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

cold, wet compression

in the immediate management of injury, the use of a ___________________ is advantageous; using an elastic wrap to secure the cold agent to the body part produces a significant reduction in subcutaneous tissue temperatures as compared with simply placing the cold agent on the skin; one layer of the wrap should be applied to the injured site prior to placing an ice bag over the area; the remainder of the wrap should be used to secure the ice bag in place; when the treatment time for the cold back is complete, a dry compression wrap should be applied; the compression wrap should be worn throughout the day and night 84

open wound management

in the process of cleaning the wound, the coach must evaluate the wound to determine whether immediate or emergency care is required when the wound is clean and the bleeding has stopped, the next step is to dress the wound with a sterile bandage; the bandage could be a simple gauze pad or an occlusive type pad; in addition, an antiseptic ointment can be used to reduce bacterial growth; if the wound is a laceration, incision, or avulsion, butterfly strips can be used to join the edges of the wound; if the wound is deep enough that subcutaneous fat is visible or wide enough that it cannot be easily closed, it may require stitches; in addition, location of the wound can be a factor in determining the need for stitches; specifically, if the wound site is an area that readily stretches or moves, a medical professional should evaluate the condition 82

fracture

individuals with a suspected _______________ should be advised to seek treatment at an urgent care center or emergency room; _______________, even those minor in nature, should be treated as soon as possible to avoid complications and optimize the conditions for proper healing 85

cold packs

instant (checmical) ______________- are convenient to carry in a first aid kit, disposable after a single use, and can conform to a body part; each bag contains two chemicals separated by a plastic barrier; when the barrier is ruptured, the chemicals mix, producing cold; disadvantages of this type of application are the short duration of the cold application, the expense in using the pack only once, and the potential for the pack tearing or leaking; the chemical substance that produces the cold has an alkaline pH, which can cause burns, if the liquid substance comes in contact with the skin; as such, the PACKS SHOULD NEVER BE SQUEEZED OR USED ABOUT THE FACE, and if possible, should be placed inside another plastic bag 83

coach

it is not within the standards of care of a ______________ to prescribe therapeutic exercises; however, a general understanding of the role of movement in the healing of soft tissue injury enables the _______________ to educate and advocate for injured individuals; in particular, it would be advantageous for the coach to understand the importance of movement during the inflammatory phase of healing 85

ice

plastic bags filled with crushed __________ or small cubes can be safely applied to the skin without danger of frostbite; __________ bags can be molded to the body's contours, held in place by a cold compression wrap, and elevated above the heart to minimize swelling and pooling of fluids in the interstitial tissue spaces 83

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

application of a compression

the ___________________ following an acute injury can aid in reduction of swelling to the injured site; _________________ decreases hemorrhage, reduces the space available for the seepage, and encourages fluid absorption; in doing so it promotes rather than delays healing; an exception for the use of ______________ in managing soft tissue injury is any injury in which the additional compression would compound the trauma; for example, the addition of a _______________to an acute compartment syndrome in the lower leg is contraindicated 84

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

cold

the extent of a soft tissue injury can be significantly affected by altering the temperature of the injured tissues; within minutes of an injury, the application of ______________ can lead to vasoconstriction at the cellular level and decreased tissue metabolism (i.e., decreases the need for oxygen), which reduces secondary hypoxia; capillary permeability and pain are decreased, and the release of inflammatory mediators and prostaglandin synthesis are inhibited; as temperature of peripheral nerves decreases, a corresponding decrease in seen in pain perception; because nerve impulses are inhibited and muscle spindle activity is decreased, muscles in spasm are relaxed, breaking the pain-spasm cycle and leading to an analgesic, or pain-free effect; as such, cold is the modality of choice during the acute phase of injury 83

open wound management control of bleeding

the first step in _________________ is to control the bleeding; in order to initiate the healing process, the blood must clot; clotting will not take place when blood is flowing; the best method for controlling bleeding is the application of direct pressure; using gauze pads to apply the pressure to the would will promote the clotting process; while applying direct pressure, elevating the wound to a position above the heart will slow the flow of blood and make it easier to control the bleeding; if bleeding cannot be controlled using direct pressure and elevation, indirect pressure should be applied; specifically, pressure should be applied to sites where the blood vessel is relatively superficial and at a spot between the wound and the heart; sites for indirect pressure to stop blood flow include __________________: the upper arm for the brachial artery the groin region for the femoral artery the posterior knee for the popliteal artery 81 •Control the Bleeding (1st step) -Use gauze pads to apply pressure to the wound to promote the clotting process -Elevate the wound while direct pressure is maintained -If direct pressure does not control the bleeding, indirect pressure can be applied •Brachial artery (upper arm) •Groin region (femoral artery) •Posterior knee (popliteal artery) slide 7

recordkeeping/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

protected rest

the length of time for _______________ will vary relative to the severity of the injury; mild injuries may only require 24 hour rest, while a major injury could require at least 72 hours of rest; ________________ does not imply cessation of activity, but simply means relative rest, decreasing activity to a level below that required in participation in sport or physical activity, but tolerated by the recently injured tissue or joint 84

application of a compression

the most common __________________ requires an elastic wrap or bandage; the wrap should be applied in a DISTAL TO PROXIMAL direction to avoid forcing extracellular fluid into the distal aspect of an extremity; the wrap should be applied with sufficient tension to ensure compression without impairing blood supply; as a general rule, the patient should feel the firmness of the wrap, but should not experience a throbbing sensation; another way to ensure that a wrap is not overly tight is to assess the distal pulse of the involved limb; if a wrap is too tight, it should be removed and re-applied, not simply removed 84

open wound management

the next step in ___________________ is to clean the wound; mild soap and water should be used ot clean the wound and the area around it (i.e. at least twice the size of the wound; the area should be cleaned and rinsed thoroughly, ensuring removal of any debris or soap; saline water can also be used to cleanse the wound; in fact, saline is often preferred over water as it is less irritating than water 81 •Clean the Wound -Mild soap and water -Remove all debris Identify conditions that warrant immediate referral: -Life-threatening wounds -Uncontrolled bleeding -Inability to cleanse all the debris from the wound -A wound that needs stitches -A penetrating wound slide 8

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

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

immobilization and remobilization

while the protected rest is an important component of injury management, it is equally as important to appreciate the effects of both _______________ on injured tissues; in certain instances, immobilization can prolong the repair and regeneration of damaged tissues, while early controlled mobilization can optimize the healing process; for example, immobilization can lead to a loss of muscle strength within 24 hours; this is manifested with decreases in the muscle fiber size, total muscle weight, mitochondria (energy source of the cell) size and number, muscle tension produced, and resting levels of glycogen and adenosine triphosphate, which reduces muscle endurance; in comparison, muscle regeneration begins within 3-5 days after mobilization; in a similar manner, ligaments adapt to normal stress by remodeling in response to the mechanical demands placed on them; stress leads to a stiffer, stronger ligament, whereas immobilization leads to a weaker, more compliant structure; this causes a decrease in the tensile strength, thus reducing the ability of ligaments to provide joint stability 84

cold

while there are a variety of options for applying __________ (e.g. ____________ packs, ice massage, cold whirlpool, vapocoolant sprats), coaches should consider using an ice bag (e.g. crushed or cubed) or an instant cold pack; for practical reasons, these methods are relatively convenient options; from a physiological perspective, it is not appropriate to use ice massage or whirlpool in the immediate management of an injury; the massaging effect produced by these techniques is not a desirable effect, until bleeding has subsided 83

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