Sideline Injury Management on
Different Field Surfaces and
Conditions
Matthew Brewer, MS, ATC/R
Certified Athletic Trainer
Children’s Hospital Colorado
Sports Medicine Program
Orthopedics Institute
Presentation Outline
• Discuss why sideline management of injuries is essential
• Identify different sports that have different surfaces
• Discuss how different surfaces can pose challenges for
sideline management and injury evaluation
• Discuss proper injury evaluation techniques on these
surfaces and give strategies about when, where, and how
to implement them
• Identify and discuss different environmental/weather
concerns that can further challenge injury management on
sidelines
2
Why is Sideline Management Important?
Sport Related Injuries
Hockey
Track & Field
Volleyball
Soccer
Football
Softball
Baseball
Basketball
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
0
Gymnastics
•
most accurate and
immediate care for all
types of injuries sustained
in sports
National Center for Sports
Safety reports over 3.5
million children >14 years
receive medical treatment
for sports related injuries
per year.
Injuries
• To be able to give the
Sports
3
What Does This All Have To Do With
Sideline Management?
• Number of sport related
injuries for each sport are
as follows:
• Gymnastics — 99,722
• Basketball — 680,307
• Baseball — 170,902
• Softball — 118,354
• Football — 413,620
• Soccer — 163,003
• Volleyball — 55,860
• Track & Field — 15,113
• Hockey — 63,945
• Number of sport related
injuries for each sport are
as follows:
• Gymnastics — 99,722
• Basketball — 680,307
• Baseball — 170,902
• Softball — 118,354
• Football — 413,620
• Soccer — 163,003
• Volleyball — 55,860
• Track & Field — 15,113
•
Hockey — 63,945
4
Different Surfaces
5
Immediate Care and Stabilization on High
Friction Surfaces
6
Low Friction and Uncommon Surfaces
• Following sports and surfaces pose a bigger challenge for
injury evaluation and stabilization than previous.
7
Sideline Management of
Water Related Injuries
• Recreational swimming and diving third most common
•
•
•
physical activity, and the most common in children.
An estimated 111,341 patients were treated in emergency
departments in 17 year period, with injuries to head and neck
being most common (38.2%)
Patients aged 10-14 years comprised largest group (36.3%)
Leading cause of injury was interference with diving board or
platform (43.9%)
8
Pool Stabilization
Video
9
Water Injury Management and Stabilization
• If athlete is conscious and injured but cannot move with no
•
•
head/neck injury suspected, roll onto back and use
passive towing technique.
If athlete is unconscious and not breathing and no
head/cervical injury suspected, get to pool deck and begin
CPR ASAP-precautions for AED placement with water!
Once on land/deck, perform full evaluation.
Prentice, W. 2003
10
Water Injury Management and Stabilization
11
Water Injury Management and Stabilization
12
Skiing and Snowboarding Injuries
• Over 40 fatalities have been reported in over 10 years.
• According to the National Orthopedics and Neurosurgery
Center, more than 39,000 children and adolescents ages
five to 14 were treated in hospital emergency rooms for
snowboarding/skiing-related injuries.
13
Emergency Evaluation and Stabilization
on Snow
Video
14
Immediate Injury Assessment and
Stabilization on snow
• Different equipment concerns with these sports.
• No need to take helmet off since full access can be gained
•
•
to airway
High velocity impacts
Stabilize and evaluate on scene
15
Immediate Injury Assessment and
Stabilization on Snow
16
Environmental Concerns Effecting Injury
Evaluation and Sideline Management
• Heat Illness
• Move to cooler environment ASAP
• Take appropriate steps to cool athlete (Ice towels, cold emersion, ect).
• If athlete is injured and experiencing heat related illness-problems
magnified
• Barriers to evaporation
• Give fluids and ice if possible to continue cooling athlete
• Lying on ground can potentially burn skin
• Try to shade athlete as much as possible and cool ground around
them to prevent burns
• Binkley et al. 2008.
17
Environmental Concerns Effecting Injury
Evaluation and Sideline Management
• Cold Weather
• Large population of outdoor sports in Colorado
• Military, football, baseball, soccer, lacrosse, track/field, skiing season all
have the potential for cold injuries
• Three categories-decreased core temperature (hypothermia), non-freezing
injuries to extremities (chilblains), and freezing injury to extremities
(frostbite)
• Signs of mild hypothermia include vigorous shivering, increased blood
pressure, core body temperature <98.6C, lethargy, apathy, and
amnesia. Decreased vital signs, loss of consciousness, impaired
motor and mental function, loss of speech, and core temperature
>90.6C are signs of severe hypothermia, MEDICAL EMERGENCY!
•
Waxenberg. et al 2008
.18
Management of Cold Injuries
• Re-warm athlete ASAP
• Remove wet clothing while insulating them with
•
•
•
•
dry clothing and blankets
Move to warmer and dry environment
Apply heat to areas of heat transfer including
groin, armpits, and chest wall
Encourage shivering, while providing warm nonalcoholic fluids
Monitor closely and refer to EMS if necessary
19
Lightning and Severe Weather
• 2nd most common storm related death in the U.S.
• 1 out of 10 lightning strike victims die - cardiac arrest
•
•
accounts for majority of fatal injures, while severe
neurological impairment can cause permanent disability
The location, elevation, climate, and vast amount of people
who enjoy outdoor activities (sports, hiking, biking, camping,
etc) makes Colorado and the Rocky Mountains vulnerable
to lightning injuries
The most active time for storm and lightning development
occurs between 11a and 9p April-September-PRIME TIME
for both sports and outdoor events
20
When is a Storm Too Close?
•
•
•
•
•
Lightning can strike up to 20 miles away from nearest cloud
If you see lightning, extreme caution needs to taken
20 mile rule-begin preparations to postpone game/practice
6 miles accepted distance to seek shelter immediately
Different ways to determine proximity of lightning
• 30/30 rule, lightning detectors, text/instant messaging
• NATA position statement on lightning promotes 30/30 rule
Walsh. K 2000
21
Additional Things to Consider with Lightning
• The JAT, 2000, reported that the most common sites
•
•
for fatalities in Colorado associated with lightning
included open fields (27%), near trees (16%), and close
to water (13%)
All fatalities normally have 1 common link-being near
tallest object in immediate area
EAP should have comprehensive
lightning and evacuation plan with
approved shelter
• Sports such as track, golf, cross country,
& large outdoor venues need to have additional
time to evacuate given the large area and number of people present
22
Conclusions
• Different surfaces and conditions pose different challenges
•
•
•
for sideline management and stabilization of injuries
Many associated challenges can be decreased by having
thorough and detailed EAP
This EAP must be practiced and rehearsed with everyone
involved
Plan accordingly for adverse filed and weather conditions,
and know what to do in each situation
23
Questions???
24
Work Cited
Binkley, H., Beckett. J., Casa. D., Kleiner. D., & Plummer. P. National Athletic Trainer’s Association Position
Statement: Exertional Heat Illness. NATA Position, Consensus, Official Support Statements. Dallas, TX. 2008
PP. 12-26.
Cappaert. T., Stone. J., Castellani. J., Krause. B., Smith. D., & Stephens. B. National Athletic Trainers’ Association
Position Statement: Environmental Cold Injuries. Journal of Athletic Training, 43. 2008. PP. 640-658.
Cooper. M., & Kulkarni. R. Lightning Injuries. Medscape References.
http://emedicine.medscape.com/article/770642-overview
Chang. D., & Bosco. J. Cervical Spine Injuries in the Athlete. Bulletin of the NYU Hospital for Joint Disease, 64.
2006. PP. 119-129.
Day. C., Stolz. U., Mehan. T., Smith. G., & McKenzie. L. Diving Related Injuries in Children <20 Years Old Treated
in Emergency Departments in the United States: 1990-2006. Pediatrics, 122. 2008. PP. E388-E394.
Prentice. W. Arnheim’s (2003) Principles of Athletic Training A Competency Based Approach. New York, New
York: McGraw-Hill Higher Education. PP. 332-335.
Walsh. K., Bennett. B., Cooper. M., Holle. R., Kithil. R., & Lopez. R. (200) . National Athletic Trainer’s Association
Position Statement: Lightning Safety for Athletics and Recreation. Journal of Athletic Training, 35. 471-477.
25