Best Practices: The Big 5. Christianne M Eason, PhD, ATC Lasell College Newton, Massachusetts

Transcription

1 Best Practices: The Big 5 Christianne M Eason, PhD, ATC Lasell College Newton, Massachusetts

2 I ve been an expert witness on 35 cases where deaths have happened in sport and in almost all the cases, the death was preventable with relatively simple policies and procedures ~Doug Casa, Korey Stringer Institute

3 Objectives Identify and review top 5 leading causes of death in secondary school athletes 1. Exhertional Heat Stroke 2. Sudden Cardiac Death 3. Asthma 4. Diabetes 5. Catastrophic Spinal Injuries Discuss appropriate policies and procedures for prevention and treatment of each COD Prevention, Recognition, and Treatment

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5 Some Statistics There were approximately 120 sports-related deaths of young athletes in , 50 in 2010, and 40 in 2011 There are 3x as many catastrophic football injuries among high school athletes as college athletes Hx of injury is often a risk factor for future injury. Prevention is critical 62% of organized sports-related injuries occur during practices Youth Sport Safety Alliance, Preventing Sudden Death in Youth Sports

6 Top 5 List 1. Sudden Cardiac Death 2. Cervical Spine Injuries 3. Heat Stroke 4. Complications from Sickle Cell Trait 5. General Medical Conditions Diabetes EIA and EIB

7 Incidence of SCD Maron et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, Circulation

8 What Can Cause Sudden Cardiac Death in Young People? The causes of sudden cardiac death in young people vary. About 2/3 of the time, death is due to a heart abnormality HCM Coronary artery abnormalities Structural Abnormalities Heart Muscle Inflammation SCD can also be caused by acute trauma Commotio Cordis

9 Look for these Sx Although pain is the most common descriptor, some patients may use other descriptors: discomfort, pressure, ache, burning, fullness Men Chest pain, angina and/or ear or neck pain Severe headache Excessive breathlessness Vague malaise Dizziness/palpitations Increasing fatigue Women Center chest pain that comes and goes Lightheadedness SOB with/without chest discomfort Uncomfortable pressure/ squeezing/fullness Nausea/vomiting Cold sweat Indigestion/heartburn/GI sx Pain / discomfort one of both arms / back / neck / jaw / stomach 0f 121 young competitive athletes who died from SCD, 18% experienced probable cardiac sx in the 36 months proceeding death

10 How to Prevent SCD Practice the EAP Educate parents, coaches, and parents Equipping facilities with an AED so that in event of emergency the AED can be available to analyze heart rhythm in one minute of the collapse All coaches should be CPR and AED certified Gradual increase in activity Include cardiac related examinations in PPE

11 How Do You Know if this is Cardiac Arrest? In Responsive Patient Monitor Vitals Pulse and breathing rate and quality, BP, skin temp and color Heath Hx S Signs/Symptoms A - Allergies M - Medications P - Past health information L Last intake E Events leading up In Unresponsive Patient ABCs Airway Breathing Circulation AED-rhythm assessment Check for pacemaker or medical alert bracelet Question bystanders

12 Cervical Spine Injuries Sports constitute about 8% of cervical spine injuries, with American football having the highest incidence rate Cervical spine injuries are the result of deformation to the cervical spinal column that can cause damage to the spinal column Injuries to the C5 vertebrae and higher can be fatal because it may inhibit ventilation

13 Preventing Cervical Spine Injuries Instruct proper tackling techniques Enforce rules for safety Properly fit and maintain protective equipment Practice skills to manage cervical spine injury Have the appropriate tools to remove protective equipment safely

14 Assessing Cervical Spine Injuries Assess breathing (10-30 is WNL) Assess pulse Assess neurological status Palpate cervical spine Perform upper/lower extremity sensory and motor assessment Presence of any of these 4 SX warrants CSI management protocol: 1. unconsciousness 2. bilateral neurological complaints 3. significant cervical spine pain 4. obvious spinal column deformity

15 Heat Stroke While EHI is not always a life threatening condition, EHS can lead to fatality if not recognized and treated properly EHS can happen at anytime and in the absence of high environmental temperatures While not all EHS cases are preventable schools should have equipment and supplies ready and available to properly assess and treat

16 Heat Stroke Prevention Ensure Hydration Wear loose-fitting, absorbent, moisture wicking clothes Follow acclimatization guidelines Ensure proper medical coverage Establish guidelines for hot, humid weather including: WBGT Time of activity Intensity/duration Equipment Rest/water breaks

17 CIAC Handbook 1. Football physical conditioning practice must be conducted for at least five (5) days prior to contact and may begin no earlier than Friday, August 19, 2016 for those who conducted traditional spring football practice or Monday, August 15, 2016 for those schools who chose not to conduct traditional spring football practice. 2. On days 1-5 There cannot be more than one practice session per day AND the total practice time must not exceed three hours in any one day. 3. On days 1 and 2 footballs may not be used for the first hour on either day. Only helmets may be used on both days. 4. On days 3-5 Footballs may not be used for the first hour on each day. Only helmets and shoulder pads may be used AND contact ONLY with sleds and tackling dummies may be initiated. 5. A coach must be present at all conditioning sessions. 6. On days 6-14 A double practice day in full gear must be followed by a single practice day in full gear. On single practice days, one walk through without full gear is permissible as long as it is separated from the full practice by at least three hours. When a double practice day in full gear is followed by a day of rest then another double practice day in full gear is permitted after the rest day. 7. On any double practice day, neither practice should exceed three hours in duration and no more than five total hours of practice in the day. Warm-up, stretching, cool down, walk through, conditioning and weight room activities are included as part of the practice time. The two practices should be separated by at least three continuous hours in a cool environment.

18 EHS Recognition Rectal temperature > 104F (40C) CNS dysfunction Nausea or vomiting Diarrhea Muscle cramps Staggering or sluggish feeling Profuse sweating Decreasing performance Dry mouth/thirst Rapid pulse, low BP, quick breathing Other factors Athlete is out of shape or obese It s a hot humid day Practice is at beginning of season First day in full pads What else could this be? - Heat exhaustion - Exertional hyponatremia - Concussion - Cardiac arrest

19 Treating an Individual with EHS Remove equipment and excess clothing Cool athlete as quickly as possible Whole body ice immersion is preferable stir water and add ice throughout temp should be 35-58F Take athlete to cold shower or move to shade and use rotating cold wet towels to cover as much body surface as possible Maintain airway, breathing, circulation Activate EMS once cooling has been initiated Monitor vitals Cease cooling when rectal temperature reaches F ( C)

20 General Medical - ASTHMA S/S SOB Wheezing Cough Headache Stomach cramps Pain or tightness in chest nausea S/S may not reach maximum severity until 15 minutes after cessation of exercise Tx Cessation of activity Administration of relief medication via MDI category medication Timeline / delivery S/S typically start 6-8 minutes after onset of strenuous exercise examples function Bronchodilators Beta agonists Short acting Albuterol Rescue Anti- Inflammatory Long acting Serevent Control Steroidal MDI Flovent Control Oral Drugs Prednisone Control Nonsteroidal MDI Intal, Tilade Control Oral Drugs Singulair Control

21 Nonpharmacologic Management of Asthma Education about asthma self-management is essential advice about environmental measures inhaler-use technique Importance of regular follow-up Mechanical barriers such as face masks may help reduce the effects of cold air exposure in winter-sports athletes or the inhalation of particulate air pollutants. A pre-exercise warm-up (i.e., low-intensity or variable-intensity precompetitive exercise) can result in a reduction in exercise bronchoconstriction in more than half of persons Whenever possible, it is preferable to avoid exercise close to busy roads or, for sensitized athletes, to avoid exercise activities and timing that would result in high allergen exposure, such as running through a ragweed field in the autumn. Improved ventilation of pool environments, measures to reduce chloramine formation in chlorinated pools Boulet L, O Byrne PM. N Engl J Med 2015;372:

22 Specific Issues in the Management of Asthma in Athletes. Boulet L, L, O Byrne O Byrne PM. PM. N Engl N Engl J Med J Med 2015;372: ;372:

23 Diabetes Prevention is key! Proper documentation of condition Blood sugar should be well controlled before exercise Have sugary snacks on hand Only give insulin injections in the abdomen Maintain proper hydration Be ready to test blood glucose before and during exercise

24 General Medical - DIABETES If glucose levels are normal : should be instructed to consume 10-20g of CHO before exercise Due to risk of developing hypoglycemia If glucose levels are > 250mg/dL exercise should be delayed Indicates insulin deficiency Plasma Blood Glucose (mg/dl) Age Group Preprandial Postprandial Bedtime HbA1c 6 to 12yrs old nr <8% 13-19yrs old nr <7.5% Adults <180 nr <7% - Preprandial = before a meal - Postprandial = occurring after a meal

25 Conclusions: The initiating factor that spurred the change varied, yet shared leadership and communication fundamentally allowed for successful adoption of the policy. Our participants were influenced by the recommendations from national governing bodies, which align with the institutional change theory

26 Thank You Questions?