Valley View ISD Athletic Training Emergency Action Plan

Transcription

1 Valley View ISD Athletic Training Emergency Action Plan

2 Contents Overview:... 3 Situations When 911 Should be Called Are:... 3 Emergency Personnel:... 4 Emergency Team Members:... 4 Medical Care Chain of Command:... 5 Emergency Medical Care Responsibilities:... 5 Local Medical Facilities:... 6 Emergency Communications:... 6 Life-Threatening Emergency:... 7 NON-Life-Threatening Emergency:... 7 Venue Specific EAP s... 9 Basketball/Volleyball Gymnasium/Field House... 9 John Kassen Football Field/Track Softball Field Baseball Field Weight Room Helicopter Landing Sites: Landing Zone Landing Zone Guidelines for Players/ Spectators During a Serious On-Field Injury: Catastrophic Event Multiple Victims: Triage Plan Scene Size Up: Triage Protocol: Pediatric JumpSTART: Head & Neck Injury: Weather/ Lightning Policy & Procedures: Event Procedures (Lightning): How to Treat a Lightning Strike Victim: Valley View ISD 1

3 Exertional Heat Illness: Heat Cramps Heat Syncope Heat Exhaustion Heat Stroke Heat Illness Return to Play: Prevention & Care of Cold Related Illnesses: UIL Cold Weather Illness Information: Emergency Conditions: Hypo/ Hyperglycemia: Splenic Injury: Kidney Injury: Sudden Cardiac Death Commotio Cordis: Appendix A: Appendix B: Valley View ISD 2

4 Overview: While interscholastic sports promote health, competition, and teamwork, the risks of catastrophic injury and sudden death exists during both practice and competition. The purpose of the (EAP) is to facilitate a prompt, efficient, coordinated response in the case of a medical emergency. All Valley View medical staff members, coaches, and athletic personnel should be familiar with this document and their role and responsibility in an emergency. Annual review and update of the EAP should be conducted with all athletic personnel so that each member of the emergency care team is aware of their respective role in the event of an emergency. Any questions should be directed to the Athletic Trainer (or school administrator, in the absence of a Certified (&/ or Licensed) Athletic Trainer. Situations When 911 Should be Called Are: - An athlete is not breathing - An athlete has lost consciousness - It is suspected that an athlete may have a neck or back injury - An athlete has an obvious or open fracture (bone has punctured through the skin) - Severe heat exhaustion or suspected heat stroke - Severe bleeding that cannot be stopped Valley View ISD 3

5 Emergency Personnel: The first responder in an emergency situation during an athletic practice or competition is typically a member of the sports medicine staff, such as a certified/ licensed athletic trainer. However; the first responder may also be a coach, another member of the school personnel, a student or even a bystander. Certification in cardiopulmonary resuscitation (CPR), first aid, automated external defibrillator (AED), prevention of disease transmission, and emergency plan review is required for all athletics personnel associated with practices, competitions, skill instructions, and strength and conditioning. Copies of training certificates and/ or cards are maintained in the athletic training facility and/ or with the athletic director. The sports medicine team must remain current with all their certifications including CPR/ AED/ First Aid. Emergency Team Members: Valley View Athletic Trainer: 1. Notify immediately in the event of an athletic emergency occurring on campus 2. Responsibilities: a. Evaluate scene and provide appropriate care. b. Activate EMS by calling 911. c. Assign coach/ bystander (if present) to give EMS directions to venue. Valley View Coaches: 1. Responsibilities: a. Act as First Responder when Athletic Trainer is not present b. If Athletic Trainer is not readily available, call 911 c. Assign an athlete or bystander (if present) to notify Athletic Trainer that EMS has been activated. d. Assist in emergency situation by keeping the players and surrounding bystanders a significant distance from the scene of the injury. e. Assist Athletic Trainer as instructed. Valley View Administrators/ Supervisors: 1. Responsibilities: a. Notify their presence to visiting team s coach prior to each contest b. Keep players, parents, and spectators a significant distance away from the scene of an injury c. Assist the Athletic Trainer and Coaching staff as instructed *Roles of these individuals will vary depending on different factors such as team size, athletic venue, preference of Athletic Trainer, ect. Valley View ISD 4

6 Medical Care Chain of Command: The Athletic Training staff will always act as primary care givers at the site of injury or accident (when on-site) and will manage the situation according to the following rank: 1. Team Physician/ Medical Director 2. Athletic Trainer In the event that the Athletic Trainer is not on-site at the time of injury the following chain of command will be used: 1. Head Coach 2. Assistant Coach 3. Student The welfare of the injured athlete is always first and foremost, therefore immediate care is vital. By no means should care wait to be undertaken until the Athletic Trainer arrives on the scene. Proceed as judgment dictates until help arrives. If a severe medical emergency occurs while an Athletic Trainer is not present, immediately call 911 to activate the emergency medical system, and then call the Athletic Trainer to notify him/ her of the situation. Emergency Medical Care Responsibilities: 1. Provide immediate direct medical care during practices and games to any injured athlete and activate the emergency action plan if catastrophic incident occurs. 2. Assist with scene management during an emergency medical event including coordinating with EMS, fire, and police as appropriate. 3. Direction of EMS to scene. 4. Serves as a liaison between visiting teams and VVs medical resources. 5. Serve as a medical care provider to visiting teams traveling without an Athletic Trainer. 6. Make referral decisions concerning injured athletes. 7. Communicate with other healthcare organizations providing direct care to the injured athlete. Valley View ISD 5

7 Local Medical Facilities: North Texas Medical Center Texas Health Presbyterian 1900 Hospital Boulevard 3000 North I-35 Gainesville, TX Denton, TX (940) (940) Valley View Family Medical Clinic 909 Frontage Rd. Valley View, TX (940) Phone Numbers: Fire Department: 911 Police Department: (940) Ambulance/ EMS: 911 Poison Control: Valley View High School Main Office: (940) High School Principal: Jesse Newton (940) Athletic Director: Alan Kassen (940) Athletic Trainer: Adam Hausmann (814) School Nurse: Nurse Mandy Ford (940) Ext. 115 Emergency Communications: In the event of an emergency situation, the first responder must ensure the proper order of communication. Before any calls are made the first responder must decide the student-athlete s condition: life-threatening or non-life threatening. CONTACT TREE First Responder at the scene Life Threatening Condition Non-Life Threatening Condition Call 911 AT Athlete s Parent/Guardian Athletic Director Superintendent Valley View ISD 6

8 Life-Threatening Emergency: Defined as an injury in which the individual s life is placed in danger and/ or there is risk of permanent disability. In this situation the individual will need immediate and proper medical attention and transportation to the hospital. During a life-threatening emergency activate EMS by calling 911, provide appropriate first aid care, and provide EMS with the following: 1. Identify yourself and your role in the emergency 2. Specify your location and telephone number (if calling by phone) 3. Give age/ condition of injured/ ill athlete(s) 4. Give care being provided (CPR/ AED/ First Aid) 5. Give specific directions to the scene of the emergency 6. Do not hang up until directed to do so by the EMS dispatcher a. Monitor vital signs b. Calm and reassure the athlete c. Notify Athletic Trainer as soon as possible The Athletic Trainer will contact student-athlete s parent(s) as well as the Athletic Director. The Athletic Director is then responsible for making the Superintendent aware of the incident. NON-Life-Threatening Emergency: Defined as a situation that does not have an immediate impact on breathing, circulation, or brain function, but may still require medical attention. These injuries can be divided into those needing EMS services, and those needing Athletic Training services. Emergencies Requiring EMS Services Include: Fractured limbs that are difficult to splint, dislocated joints where the person cannot be placed in a comfortable position, head injuries where the athlete s condition deteriorates upon re-evaluation, and severe bleeding that is not life threatening. Action Plan: 1. Stabilize the athlete 2. Call the Athletic Trainer (if not present) 3. Monitor ABC s 4. Decision to call for EMS will be made jointly by the coach and/ or the Athletic Trainer 5. When EMS personnel arrive, the coach releases care of the person to the paramedic or EMT Valley View ISD 7

9 Emergencies Requiring Athletic Training Services Include: Fractures, severe sprains of major joints, joint dislocations, concussion, large contusions, and large open wounds that may need stitches. This may include any injury that is difficult to move without increasing the pain to the athlete. Action Plan: 1. Provide appropriate first aid care 2. Notify Athletic Trainer 3. If unable to contact the Athletic Trainer or unsure of the severity of the injury, send the athlete to the appropriate medical care facility if necessary 4. Notify the parent of the student-athlete if necessary 5. Direct student-athlete to report to the Athletic Training Room the next day Valley View ISD 8

10 Venue Specific EAP s Basketball/Volleyball Gymnasium/Field House 106 Newton Street Valley View, TX Directions: From South bound on I-35 take exit 487 toward I-35 Frontage Rd. Head South on I-35 Frontage Rd., turn right into North gate and gym parking lot. EMS Entrance: EMS to enter through gymnasium doors on front of the building. Working administrator will meet EMS at gymnasium entrance. Emergency Equipment: Splint Kit maintained in the Athletic Training Room. AED is wall mounted on the South-West wall of the gym forum next to the main entrance and exit. Trauma kit & spine board will be provided by EMS upon arrival. Role of First Responders: 1. Immediate care of the injured or ill student-athlete 2. Activation of the emergency medical services (EMS) a. Call 911 Your Name Address: 106 Newton Street Valley View, TX Telephone Number: Number of Individuals Injured Condition of Injured First Aid Treatment already administered Directions: From South bound on I-35 take exit 487 toward I-35 Frontage Rd. Head South on I-35 Frontage Rd., turn right into North gate and gym parking lot. Any other information as requested Listen carefully to instructions and DO NOT HANG UP b. Activate Phone Tree (see page 4) 3. Emergency Equipment Retrieval a. Splint Kit and maintained in the Athletic Training Room. b. AED is wall mounted on the South-West wall of the gym forum next to the main entrance and exit. Trauma kit & spine board will be provided by EMS upon arrival. c. Trauma kit & spine board will be provided by EMS upon arrival. 4. Direct EMS to scene (if not on site for game) a. Open appropriate gates b. Designate individual to flag down EMS and direct to scene c. **Limit scene to first aid providers and move bystanders away from area** Important Phone Numbers Athletic Trainer: Adam Hausmann Athletic Director: Alan Kassen Team Physician: Dr. Paul Whatley High School Principal: Jesse Newton Valley View ISD 9

11 = Ambulance Entrance Valley View ISD 10

12 John Kassen Football Field/Track 809 South Lee St. Valley View, TX Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn left onto North Access Road. EMS Entrance: On the North-West end of the field. Emergency Equipment: AED and splint kit maintained at the finish line or on the home sideline. Trauma kit & spine board will be provided by EMS upon arrival. Role of First Responders: 5. Immediate care of the injured or ill student-athlete 6. Activation of the emergency medical services (EMS) a. Call 911 Your Name Address: 809 South Lee St. Valley View, TX Telephone Number: Number of Individuals Injured Condition of Injured First Aid Treatment already administered Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn left onto North Access Road. Any other information as requested Listen carefully to instructions and DO NOT HANG UP b. Activate Phone Tree (see page 4) 7. Emergency Equipment Retrieval a. Splint Kit will be either at the finish line (track) or on the home team s sideline (football). b. AED will be located at the previous listed locations (above). c. Trauma kit & spine board will be provided by EMS upon arrival. 8. Direct EMS to scene (if not on site for game) a. Open appropriate gates b. Designate individual to flag down EMS and direct to scene c. **Limit scene to first aid providers and move bystanders away from area** Important Phone Numbers Athletic Trainer: Adam Hausmann Athletic Director: Alan Kassen Team Physician: Dr. Paul Whatley High School Principal: Jesse Newton Valley View ISD 11

13 AED = North Access Road = South Access Road Valley View ISD 12

14 Softball Field 805 South Lee St. Valley View, TX Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn left onto North or South Access Road. The field is located behind the Agriculture Building. EMS Entrance: EMS to enter through the North gate by left field (home dugout side). Emergency Equipment: AED, splint kit maintained in home dugout. Trauma kit & spine board will be provided by EMS upon arrival. Role of First Responders: 9. Immediate care of the injured or ill student-athlete 10. Activation of the emergency medical services (EMS) a. Call 911 Your Name Address: 805 South Lee St. Valley View, TX Telephone Number: Number of Individuals Injured Condition of Injured First Aid Treatment already administered Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn left onto North or South Access Road. The field is located behind the Agriculture Building. Any other information as requested b. Activate Phone Tree (see page 4) 11. Emergency Equipment Retrieval a. Splint Kit and AED maintained in the Athletic Training Room, but during softball games will be kept in the home dug-out. b. Trauma kit & spine board will be provided by EMS upon arrival. 12. Direct EMS to scene (if not on site for game) a. Open appropriate gates b. Designate individual to flag down EMS and direct to scene c. **Limit scene to first aid providers and move bystanders away from area** Important Phone Numbers Athletic Trainer: Adam Hausmann Athletic Director: Alan Kassen H Team Physician: Dr. Paul Whatley High School Principal: Jesse Newton Valley View ISD 13

15 AED = North Access Road = South Access Road Valley View ISD 14

16 Baseball Field 805 South Lee St. Valley View, TX Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn left onto North or South Access Road. The field is located South of the football field. EMS Entrance: Beside the home dugout (the West side of the field). Emergency Equipment: AED and splint kit maintained in the home dug out. Trauma kit & spine board will be provided by EMS upon arrival. Role of First Responders: 13. Immediate care of the injured or ill student-athlete 14. Activation of the emergency medical services (EMS) a. Call 911 Your Name Address: 805 South Lee St. Valley View, TX Telephone Number: Number of Individuals Injured Condition of Injured First Aid Treatment already administered Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn left onto North or South Access Road. The field is located South of the football field. Any other information as requested Listen carefully to instructions and DO NOT HANG UP b. Activate Phone Tree (see page 4) 15. Emergency Equipment Retrieval a. Splint Kit will be maintained in the home dug out. b. AED will be located at the previous listed locations (above). c. Trauma kit & spine board will be provided by EMS upon arrival. 16. Direct EMS to scene (if not on site for game) a. Open appropriate gates b. Designate individual to flag down EMS and direct to scene c. **Limit scene to first aid providers and move bystanders away from area** Important Phone Numbers Athletic Trainer: Adam Hausmann Athletic Director: Alan Kassen Team Physician: Dr. Paul Whatley High School Principal: Jesse Newton Valley View ISD 15

17 AED = North Access Road = South Access Road Valley View ISD 16

18 Weight Room 802 South Lee St. Valley View, TX Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn right into Valley View High School parking lot. South gate will be open prior to EMS arrival. EMS Entrance: EMS to enter through South or East garage door. Emergency Equipment: Splint Kit maintained in the Athletic Training Room. AED is wall mounted in the coaches office on the south wall. Trauma kit & spine board will be provided by EMS upon arrival. Role of First Responders: 17. Immediate care of the injured or ill student-athlete 18. Activation of the emergency medical services (EMS) a. Call 911 Your Name Address: 802 South Lee Street, Valley View, TX Telephone Number: Number of Individuals Injured Condition of Injured First Aid Treatment already administered Directions: From South bound on I-35 take exit 486 toward I-35 Frontage Rd. Turn right onto O Brien St then merge onto S Lee St. Turn right into Valley View High School parking lot. South gate will be open prior to EMS arrival. Any other information as requested Listen carefully to instructions and DO NOT HANG UP b. Activate Phone Tree (see page 4) 19. Emergency Equipment Retrieval a. Splint Kit and maintained in the Athletic Training Room. b. AED is wall mounted in the coaches office on the south wall. Trauma kit & spine board will be provided by EMS upon arrival. c. Trauma kit & spine board will be provided by EMS upon arrival. 20. Direct EMS to scene (if not on site for game) a. Open appropriate gates b. Designate individual to flag down EMS and direct to scene c. **Limit scene to first aid providers and move bystanders away from area** Important Phone Numbers Athletic Trainer: Adam Hausmann Athletic Director: Alan Kassen Team Physician: Dr. Paul Whatley High School Principal: Jesse Newton Valley View ISD 17

19 = Ambulance Entrance Valley View ISD 18

20 Helicopter Landing Sites: If in the event a helicopter is needed to transport injury/ injuries, the following locations are the designated Landing Zones (LZ). Landing Zone 1 (Workout Field): GPS Coordinates: N W Landing Zone 1: Valley View ISD 19

21 Landing Zone 2 (Baseball Field): GPS Coordinates: N W Landing Zone 2: Valley View ISD 20

22 Guidelines for Players/ Spectators During a Serious On-Field Injury: Players and coaches should go to and remain in the bench area once medical assistance arrives. Adequate lines of vision between the medical staff and all available emergency personnel should be established and maintained. Players, parents and non-authorized personnel should be kept a significant distance away from the seriously injured player or players. Players and non-medical personnel should not touch, move or roll an injured athlete. Once the medical staff begins to work on an injured player, they should be allowed to perform services without interruption or interference. Players and coaches should avoid dictating medical services to the Athletic Trainer, team physician, or EMS or taking up their time to perform such services. Catastrophic Event Multiple Victims: If a catastrophic event that involves multiple victims occurs, such as a bleacher collapse, the scene must be quickly assessed and triaged. Follow the same chain of command for any serious injury. When speaking to 911 dispatchers, give location and number of victims (overestimate). Victims that can walk should be led away from the scene, triage other victims. Those with life-threatening injuries will be given priority. Triage Plan: Incidents which produce multiple human casualties are somewhat rare but do occur and must be planned for. A multiple or mass casualty incident can be defined as any incident in which more casualties are present than an initial response assignment can reasonably handle. More assets are required for triage, treatment, and transport then can arrive in a timely fashion. Responders are also tasked with assuring and/ or rendering the incident scene safe as well as dealing with the casualties. Triage of any multiple or mass casualty event will follow the Simple Triage and Rapid Treatment (START) Triage Plan. By using START triage, patients are sorted based on objective criteria on how they present. The severity of injury and therefore treatment and/ or transport priority in START triage is sorted by color code; triage tags will be provided by responding EMS. Valley View ISD 21

23 Triage Tag Color Codes: Green Minor injury (walking wounded) Yellow Delayed-can wait RED Immediate! BLACK Deceased While waiting for EMS to arrive the following identifying mark(s) will be used: Triage Tag Color RED YELLOW GREEN Improvised Identifying Mark(s) 1 Stip of white athletic tape across chest #1 Marked on forehead with Sharpie Marker 2 Stips of white athletic tape across chest #2 Marked on forehead with Sharpie Marker 3 Stips of white athletic tape across chest #3 Marked on forehead with Sharpie Marker *Note that only EMS is authorized to mark victims Black Scene Size Up: 1. Conduct a scene size up a. Activate EMS 2. Assure well-being of responders 3. Determine if (or render as possible) the scene safe prior to entering 4. Determine the number of patients. If there are multiple or mass casualties, communicate that to 911 Operator &/ or responding personnel (Over-Estimate) Triage Protocol: 1. Clear out non-injured & walking wounded a. Direct them to designated triage area b. These individuals will be Tagged GREEN 2. Start Where You Stand a. Assess first patient you encounter and continue from there 3. RPM: Respiratory, Perfusion, Mental Status a. Respirations: None? Open the airway Still none? Tag BLACK, deceased (move to next patient) Were respirations restored? Valley View ISD 22

24 Tag RED, immediate Respirations present? Assess respiratory rate RATE ABOVE 30 breaths per minute? Tag RED, immediate RATE BELOW 30 breaths per minute? Move on to assess Perfusion Criteria b. Perfusion: Radial Pulse Absent or Capillary Refill >2 seconds Tag RED, immediate Radial Pulse Present or Capillary Refill <2 seconds Move on to assess Mental Status c. Mental Status: Cannot follow simple commands? (Unconscious or altered mental status) Tag RED, immediate CAN follow simple commands Tag YELLOW, delayed If a patient falls into the RED TAG category on your first assessment, STOP right there, TAG/ MARK them and move on to the next patient. Attempt only to correct airway problems or uncontrolled bleeding before moving on to the next patient. Now that patients have been triaged, more focused treatment can begin. Moving victims to treatment areas may be needed. Those tagged RED or marked with #1 s are treated (or moved to treatment areas) first, followed by those tagged YELLOW or marked with #2 s. Valley View ISD 23

25 Pediatric JumpSTART: JumpSTART provides an objective structure to help assure responders triage injured children. Designed for children ages 1-8 years old o Respirations: None? Open the airway If the patient starts breathing tag RED If apneic and no pulse tag BLACK If apneic with pulse, try 5 rescue breaths If still apneic tag BLACK If starts breathing tag RED Respirations < 15 or > 45 tag RED Respirations go to next step Pulse/ Perfusion o Pulse/ Perfusion: No distal pulse tag RED Pulse present go to next step Mental o Mental Status: Alert, responds to verbal or responds to pain, tag YELLOW Inappropriate response, posturing or unresponsive, tag RED Valley View ISD 24

26 Head & Neck Injury: Athletic participation carries with it the risk of catastrophic cervical spine injury. Because of the potential for permanent neurological injury or death associated with cervical spine injury, proper on-field management is of utmost importance. Sports medicine professionals support the practice of not removing football helmets and shoulder pads when there is even the slightest chance of cervical spine injury for the following reasons: 1. The football helmet and/ or shoulder pads do not hinder proper head and neck immobilization techniques. 2. The football helmet does not hinder the ability of the examiner to visualize facial and cranial injuries. 3. The football helmet with the facemask removed and/ or shoulder pads allows for proper management and control of the airway during CPR. 4. The football helmet will tend to protect against hyper-flexion of the cervical spine in the presence of shoulder pads. Evaluation: If an athlete has a suspected cervical spine injury, the first action should be to apply manual cervical spine stabilization o Calmly instruct the athlete not to move. Assess breathing/ circulatory status (normal breaths per minute) Assess pulse (quality, rate, and rhythm) Assess neurologic status/ level of consciousness If conscious, ask patient what symptoms they are experiencing Palpate cervical spine and surrounding musculature Perform upper/ lower extremity sensory and motor assessment (if appropriate) If assessment reports abnormal finding, prepare for emergency transport Clinical Indicators Warranting Activation of Cervical Spine Injury Management Protocol: 1. Unconsciousness (or altered consciousness) 2. Bilateral neurologic complaints/ findings 3. Significant cervical spine pain (with or without palpation) 4. Obvious spinal column deformity Valley View ISD 25

27 Immediate Care of All Suspected Spine Injuries: Any athlete suspected of having a spinal injury should not be moved and should be managed as though a spinal injury exists. The athlete s airway, breathing and circulation, neurological status, and level of consciousness should be assessed. The athlete should not be moved unless absolutely essential to maintain airway, breathing, or circulation. If the athlete must be moved to maintain airway, breathing, or circulation, the athlete should be placed in a supine position while maintaining spinal immobilization. When moving a suspected spine-injured athlete, the head and trunk should be moved as a unit. EMS must be activated immediately. Football Face Mask Removal: It is imperative that all coaches, athletic trainers, team physicians and EMS personnel practice the use of the different face mask removal tools and familiarize themselves with how the face mask is to be removed from every helmet currently on the market. The face mask should be removed prior to transportation, regardless of the athlete s respiratory status. Those involved in the pre-hospital care of injured football players should have the tools for face mask removal readily available. o A backup removal tool should also be on hand if the first tool of choice fails. Football Helmet Removal: 1. The athletic helmet and chin strap should only be removed: If the helmet and chin strap do not hold the head securely, such that immobilization of the helmet does not also immobilize the head. If the design of the helmet and chin strap is such that even after removal of the face mask the airway cannot be controlled or ventilation provided. If the face mask cannot be removed after a reasonable time period. If the helmet prevents immobilization for transportation in an appropriate position. 2. If the helmet does need to be removed: Spinal immobilization must be maintained while removing the helmet Helmet removal should be frequently practiced under proper supervision. Specific guidelines for helmet removal need to be developed. In most circumstances, it may be helpful to remove cheek padding and/ or deflate air padding prior to helmet removal. Valley View ISD 26

28 Cervical Spine Injury Prevention: Instruct proper tackling technique: no axial loading (spearing, which occurs when the head and neck is flexed between and serves as the point of contact). This is the most common cause of cervical spine injuries in sport. Have medical staff to cover exercise sessions and games. Enforce rules for safety. Properly fit and maintain protective equipment. Use protective equipment that meets safety standards (e.g., NOCSAE for football helmets). Continually stay up to date and rehearse skills to manage cervical spine injury. Properly identify predisposing conditions (e.g., cervical stenosis, etc.). Have multiple tools/ mechanisms to remove protective equipment safely. Valley View ISD 27

29 Weather/ Lightning Policy & Procedures: All coaches and athletes will use the guidelines set forth by the NATA in the event of lightning. Weather and lightning conditions will be monitored by the Athletic Trainer by using SkyScan Lightning Detector, WeatherBug Spark, as well as other weather monitoring technology. The Athletic Trainer will alert coaches prior to practice of forecasted storms. The Athletic Trainer will give coaches lightning alerts in the follow sequence: Lightning Alerts: Lightning Distance: Actions: "Heads Up" Within 15mi (13nmi) Be prepared to activate safety procedures "Clear Within 10mi (8.68nmi) Initiate safety procedures Field(s)" "Danger" Within 8mi (6.95nmi) All athletes, coaches, & spectators should be in building "All Clear" Lightning has not been detected at 10mi (8.68nmi) for 30min Safe to resume activity Locations not safe from lightning: Picnic & park shelters, athletic storage sheds, dugouts, tents, press box, open garages, & mobile refreshment stands. If the Athletic Trainer is not present to provide alerts in person, coaches will receive alerts in any of the following ways: 1.) Athletic Trainer comes and alerts coach in person; 2.) Athletic Trainer calls head coach; 3.) Athletic Trainer calls assistant coach (if head coach did not answer initial phone call); 4.) Athletic Trainer text messages head and assistant coaches. Coaches may also use their own discretion if at any time lightning is visible, and/ or they feel their athletes are in an unsafe situation. Event Procedures (Lightning): Prior to Competition: The Athletic Trainer will greet officials, explain that we have means to monitor lightning, and offer to notify the officials during the game if there is imminent danger from lightning. Announcement of Suspension of Activity: Once it is determined that there is danger of lightning in the area, the Athletic Trainer will notify the head coach and officials, and subsequently summon athletes from the playing field. Evacuation of the Playing Field: Immediately following the announcement of suspension of activity, all athletes, coaches, officials, support staff, and fans are to evacuate to an enclosed grounded structure. Valley View ISD 28

30 Evacuation of Stands: During competition, once the officials signal to suspend activity, a member of the Athletic Department support staff will announce via PA system: May I have your attention. We have been notified of approaching inclement weather. Activity will be cease until we have determined it is safe and the risk of lightning is diminished. We advise you to seek appropriate shelter in the Agricultural Barn. Though protection from lightning is not guaranteed, you may seek shelter in automobiles. Thank you for your cooperation. Resumption of Activity: Activity may resume once the Athletic Trainer gives permission. Thirty (30) minutes after the last lightning strike within 10 miles (8.68nmi). Look for these symptoms in athletes when a lightning strike is suspected: Minor Moderate Severe Temporary to no LOC Possible blindness, deafness, tympanic ruptrure Confusion/ amnesia Disorientation, combative, or comatose Possible temporary paralysis of extremities (may be pale, blue, pulseless) Hypovolemtic shock alook for blunt abdominal trauma Brain damage Hypoxia secondary to cardiac arrest Blunt trauma fractures and intracranial injuries Stable vital signs (possible hypertension) Temporary cardiopulmonary standstill Possible parasthesia, muscle pain, headache lasting days to months 1st & 2nd degree burns usually occur a few hours after injury Valley View ISD 29

31 How to Treat a Lightning Strike Victim: There is no need to worry about getting an electric shock from the victim. The flow of electricity traveled through the victim and there is no charge that is stored. In the event of a lightning strike the following steps should be taken to ensure your safety and to treat the appropriate people: 1. Make sure the scene is safe to treat the lightning victims. You should not place yourself in harm if danger is imminent. 2. Activate EMS (or have someone else activate EMS if you are the one providing care). 3. Be prepared to treat people in cardiac arrest, have severe burns, shock, fractures, another trauma. 4. Treat the victim that appears dead first (if there are more than one victim). This victim is in the most severe condition and timely care needs to be taken to maximize chances of survival. 5. If needed and capable move the victim to a safe area for treatment. Valley View ISD 30

32 Exertional Heat Illness: Heat illnesses are a spectrum of illness that occur due to heat exposure. This heat exposure can come from either environmental heat (air temperature) or simply intense exercise. As with all emergency conditions, there are measures that can be taken to prevent heat illnesses. The key determinant for good prognosis following a heat illness is rapid recognition and treatment. Heat Cramps Painful cramps involving abdominal muscles and extremities caused by intense, prolonged exercise in the heat and depletion of salt and water due to sweating. Prevention: o Acclimatizing athletes to environment o Gradual progression of intensity and duration of practice/ exercise o Educating athletes to replace fluids and salt lost in their sweat o Maintain a balanced electrolyte level before, during, and after athletic event. Symptoms: o Dehydration, thirst, sweating, transient muscle cramps and fatigue o Painful, involuntary muscle spasms (usually occurring in the legs) associated with exercise in the heat when athletes have been sweating profusely o A precursor to the initial onset of cramps involves muscle twitches or fasciculations. If this occurs, remove athlete from the heat and encourage rehydration with an electrolyte beverage Treatment: o Remove athlete from exercise session or practice and have them rest in the shade or an air-conditioned room o Stretch, massage and knead the muscles that are cramping in its full-length position o Provide the athlete with cold fluids, such as water or an electrolyte sports drink to replace sweat losses o Provide food high in salt content to replenish the electrolytes lost from sweat. o In cases of heat cramps that persist, use ice massage on the affected muscle May return to activity when cramps are gone, providing they display no other signs or symptoms of other illness. If systemic cramps do not subside after one hour of rest and other treatment outlined above, they will be referred to a physician. Valley View ISD 31

33 Heat Syncope Weakness, fatigue and fainting due to loos of salt and water in sweat and exercise in the heat. Prevention: o Acclimatizing athletes to environment o Gradual progression of intensity and duration of practice/ exercise o Educating athletes to replace fluids and salt lost in their sweat Symptoms: o Dizziness or lightheadedness o Loss of consciousness o Pale or sweaty skin o Weakness o Tunnel vision o Decreased or weak pulse Treatment: o Typical recovery within minutes o Move athlete to shaded/ cool area to decrease body temperature o Sit or lie down as soon as the athlete begins to feel symptoms o Monitor vital signs to ensure the athlete does not also acquire another medical condition o Elevate legs to promote blood returning to the heart o Rehydrate with water or sports beverage May return to activity once symptoms have resolved and any other medical conditions have been ruled out and cleared by the athletic trainer. Valley View ISD 32

34 Heat Exhaustion Inability to continue exercise in the heat due to cardiovascular insufficiency and energy depletion that may or may not be associated with physical collapse. Prevention: o Acclimatizing athletes to environment o Gradual progression of intensity and duration of practice/ exercise o Educating athletes to replace fluids and salt lost in their sweat o Appropriate work to rest ratios based on environmental conditions Symptoms: o Fatigue o Nausea o Fainting o Weakness o Vomiting o Dizziness/ light-headedness o Pale o Chills o Diarrhea o Heavy sweating o Decreased urine output/ dehydration o Irritability o Headache o Sodium loss o Decreased blood pressure o Decreased muscle coordination o Hyperventilation o Core body temperature between C ( F) Treatment: o Removed from activity o Move athlete to shaded/ cool area to decrease body temperature o Elevate legs to promote venous return o Cool the athlete with fans, rotating ice towels, or ice bags o Provide oral fluids for rehydration If signs/ symptoms do not subside, the athlete will be referred to a physician for evaluation. Valley View ISD 33

35 Heat Stroke An acute medical emergency related to thermoregulatory failure. Associated with nausea, seizures, disorientation, and possible unconsciousness or coma. It may occur suddenly without being preceded by any other clinical signs. The individual is usually unconscious with a high body temperature and a hot dry skin (heat stroke victims, contrary to popular belief, may sweat profusely). Prevention: 1. Ensure Hydration a. Measure athletes weight before and after each practice to ensure they do not lose more than 2% of their pre-workout weight i. Equation: (Pre-exercise weight post-exercise weight / pre-exercise weight) x 100. ii. By the time next practice begins, athletes should ingest fluids and weight the original weight. b. Encourage drinking throughout practice 2. Wear loose-fitting, absorbent or moisture wicking clothing 3. Practice and perform conditioning drills at appropriate times during the day, avoid the hottest part of the day (10:00-17:00). 4. Ensure proper body cooling methods are available, including a cold water immersion tub, ice towels, access to water & ice; equipment will be prepared prior to practice beginning. 5. Pre-season heat acclimatization will be followed. Symptoms: Core temperature greater than 104 F (40 C) Irrational behavior, irritability, emotional instability Altered consciousness, coma Disorientation or dizziness Headache Confusion or just look out of it Nausea or vomiting Diarrhea Muscle cramps, loss of muscle function/ balance, inability to walk Collapse, staggering or sluggish feeling Profuse sweating Decreasing performance or weakness Dehydration, dry mouth, thirst Rapid pulse, low blood pressure, quick breathing Valley View ISD 34

36 Treatment: Remove all equipment and excess clothing Cool the athlete as quickly as possible within 30 minutes via whole body ice water immersion (See Appendix A) If immersion is not possible, take athlete into a cold shower or move to shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible. Maintain airway, breathing and circulation After cooling has been initiated, activate EMS o Coach or other available help can activate EMS once Heat Stroke is recognized Monitor vital signs o Including oral temperature if athlete s condition permits Cold water and/ or electrolyte drinks may be given if level of consciousness permits (See Appendix B) Heat Illness Return to Play: After a heat illness occurs, there may be physiological changes, such as heat tolerance, that are temporarily, and occasionally, permanently compromised. Long-term complication and morbidity are directly related to the time that the core body temperature remained above the critical threshold. To safely return an athlete to full participation, a specific return-to-play (RTP) strategy should be implemented. The RTP is as followed: Physician clearance prior to return to physical activity o The athlete must be asymptomatic and lab tests must be normal The athlete should avoid exercise for at least one (1) week after the incident The athlete should begin a gradual RTP protocol in which they are under the direct supervision of an appropriate health-care professional Step 1: Refrain from exercise/ activity for at least 7 days following release of medical care. Step 2: Following up in about 1 week for physical exam and repeat lab testing or diagnostic imaging of affected organs that may be indicated, based on the physician s evaluation Step 3: When cleared for activity (note must be received), begin exercise in a cool, climate controlled environment and gradually increase the duration and intensity and heat exposure for two (2) week period to acclimatize and demonstrate heat tolerance Valley View ISD 35

37 This would be an example plan of return to play: RTP After Heat Illness: Step A: 3-5 days of easy to moderate activity/ exercise (HR: BPM) in a climate controlled environment; followed by 3-5 days of strenuous activity/ exercise (HR: 180+BPM) in a climate controlled environment Step B: 3-5 days of easy to moderate activity/ exercise (HR: BPM) in heat followed by 3-5 days of strenuous activity/ exercise (HR: 180+BPM) in heat Step C (if applicable): Easy to moderate activity/ exercise (HR: BPM) in heat with equipment followed by 3-5 days of strenuous activity/ exercise (HR: 180+BPM) in heat with equipment Prevention & Care of Cold Related Illnesses: Cold weather is defined as any temperature that can negatively affect the body s regulatory system. These do not have to be freezing temperatures. Cold Weather Caution: When temperature or wind-chill (which is lower than actual temperature) is from 40 F - 30 F No modification of practice, but a warning will be given to coaches & athletes Coaches & Athletic Trainer emphasizing the importance of following UIL Cold Weather Illness Recommendations Watching those high risk athletes Cold Weather Warning: When temperature or wind chill is from 30 F - 20 F, there may be a modified outside participation of 45 minutes. Warm-up to be started indoors to not take away from 45min. A practice that keeps individuals moving, try to avoid working up a big sweat in the first 20 minutes, having them be wet, and then sit around watching Wearing a hat that covers the ears, and some sort of gloves to cover the hands are required Keeping a very close eye on those high risk athletes If available, a cool-down indoors Cold Weather Termination: When temperature or wind chill reaches 19 F and below, there may be a termination of outside practices and games. Valley View ISD 36

38 UIL Cold Weather Illness Information: Hypothermia: Hypothermia is a decrease in core body temperature. 1. Mild Hypothermia shivering, cold sensation, goose bumps, numb hands 2. Moderate Hypothermia intense shivering, muscle incoordination, slow & labored movements, mild confusion, difficulty speaking, signs of depression, withdrawn 3. Severe Hypothermia shivering stops, exposed skin is bluish & puffy, inability to walk, poor muscle coordination, muscle rigidity, decrease in pulse & respiration rate, unconsciousness Management: Remove athlete from cold environment Remove wet clothing & replace with dry clothing &/ or blankets Refer all moderate cases to the emergency room once safe to transport Treat severe hypothermia as a medical emergency! Wrap the athlete in an insulated blanket & seek emergency medical care immediately Frostbite: Thermal injury to the skin caused by cold exposure. 1. Frostnip skin appears white & waxy or gray & mottled; possible numbness & pain 2. Superficial Frostbite skin appears white, mottled or gray; feels hard or rubbery but deeper tissue is soft, insensitive to touch. 3. Deep Frostbite skin is white & has a wooden feel, numbness & anesthesia. Management: Do not rub the area Gently rewarm the area by blowing warm air onto the area, placing the area against a warm body part, or placing the affected area into a warm ( F) water for several minutes If not absolutely certain that the tissue will stay warm after rewarming, do not rewarm it. **Refreezing newly thawed frostbitten tissue can cause extensive tissue damage! If a person is also suffering from hypothermia, the first concern is core rewarming Prevention: The best method of management is prevention. Dress in layers Cover the head to prevent excessive heat loss from the head & neck Stay dry by wearing a wicking fabric next to the body & a breathable, water repellent outer layer Stay adequately hydrated Eat regular meals Avoid alcohol, caffeine, & nicotine Valley View ISD 37

39 Educate participants, coaches, officials & administrators in recognition of cold-related illnesses Consider cancellation of athletic events if weather conditions warrant If unsure whether an athlete is hypothermic, err on the side of caution & treat accordingly Recognition, Management & Prevention of Cold Exposure: Although excessive & prolonged exposure to cold may be an infrequent problem in Texas high school athletics, the prevention, recognition and management of cold-related conditions are still an important consideration for coaches, administrators & athletic trainers. The human s body s mechanisms of heat retention are significantly less efficient than our ability to dissipate heat. During the day, the temperature may be moderate and the sun shining, but as the sun sets & the temperature begins to fall, when coupled with conditions of exhaustion, dehydration & wet clothing associated with physical activity, the risk of cold-related pathology can increase. Understanding the mechanisms of heat retention & production are essential to the prevention & management of cold-related illnesses & injuries: Vasoconstriction Decreases blood flow to the periphery to prevent loss of body heat Shivering While involuntary shivering generates heat through increased muscle activity, it may also hinder an athlete s sport performance & ability to perform behavioral tasks to aid in heat retention Activity Increase Increases heat production through a general increase in metabolic activity. Quick bouts of intense activity can generate incredible amounts of heat Behavioral Responses Adjusting the number & type of clothing layers will result in heat regulation by controlling the amount of heat lost by the body Valley View ISD 38

40 Recognition of Cold-Related Issues: There are several factors influencing one s susceptibility or risk of cold related injury or illness. These factors can be additive. Thus, it is essential to appreciate each of these factors, along with the associated signs & symptoms of hypothermia & frostbite. Risk Factors: Low air temperature When cold exposure exceeds or overwhelms the body s ability to compensate for heat loss due to the external environment. Wind chill Interaction of the wind speed & air temperatures Moisture Wet skin freezes at a higher temperature than dry skin Exposed skin Heat loss occurs primarily through convection & radiation to the external environment, but may also include evaporation if the skin is moist. This is a concern for those exercising & sweating in cold environments. Insulation The amount of insulation from cold & moisture significantly affects thermoregulation Dehydration Negatively influences metabolic & thermoregulation Alcohol Increases peripheral blood flow & heat loss; can also disrupt the shivering mechanism Caffeine Acts as a diuretic, causing water loss & dehydration Tobacco Acts as a vasoconstrictor; increasing the risk of frostbite Valley View ISD 39

41 Emergency Conditions: Hypo/ Hyperglycemia: Type I Diabetes Mellitus, or insulin-dependent diabetes, is a condition where the pancreas does not produce any or enough insulin. Type II Diabetes Mellitus occurs when the body becomes resistant to the effects of insulin or doesn t make enough insulin to handle all the glucose in the blood. Type II Diabetes usually begins with insulin resistance. The pancreas can keep up with the resistance by producing more insulin, but in time will lose the ability to secrete insulin in effective doses. Hypoglycemia (low blood glucose, <70mg/dL) can have a rapid onset and is dangerous if not handled appropriately. Hyperglycemia (high blood glucose, >180mg/dL) does not typically have an acute risk of death; however, it does carry long-term consequences. Prevention: Athletes are encouraged to wear medical identification bracelets at all times Take medications in appropriate doses at recommended times Eat regular meals and snacks Establish and follow diabetes care plan For Sports & Exercise: o Check blood glucose before activity Avoid exercise if glucose level: <100mg/dL >250mg/dL with ketones present >300mg/dL regardless of ketones presence o Plan meals/ snacks to be eaten before & after activity Should contain carbohydrate and protein o Consult physician on altering insulin dosages before activity Special considerations: insulin delivery via pump Pump should be disconnected for collision sports o Athlete should monitor blood glucose carefully during participation when pump is disconnected Pumps do not need to be disconnected for non-collision sports, however: o Exercise facilitates glucose uptake by muscle o Not as much insulin will be necessary o Type of exercise affects glucose levels differently o Check blood glucose during and after activity Type I diabetic athletes can experience late hypoglycemia after exercise. These athletes should consume carbohydrates before bed to prevent hypoglycemia while sleeping Valley View ISD 40

42 Recognition: Normal blood glucose is mg/dL Signs & Symptoms Hunger Shakiness Nervousness Pallor Hypoglycemia (<70mg/dL) Cool, Clammy Skin Dizziness/ Light Headed Sleepiness Confusion Difficulty Speaking Anxiety Weakness Causes Missed Meal/ Snack Delayed Meal/ Snack Not Eating Enough Physical Activity Alcohol Environmental Heat Stress Signs & Symptoms Gradual Onset Flushed, Warm Skin Frequent Urination Irregular Breathing Fruity/ Acidic Breath Nausea Hyperglycemia (>180mg/dL) Drowsiness Disorientation Causes Insulin Not Taken Miscalculated Insulin Dosage Pump Malfunction Consumed More Than Planned Exercise Less Than Planned Emotional Stress Valley View ISD 41

43 Valley View ISD 42

44 Splenic Injury: Splenic rupture occurs when the spleen is placed under intense pressure/ duress, strong enough to tear or separate the outer lining of the organ. A ruptured spleen accounts for 10% of all abdominal injuries. When a blunt abdominal trauma is present, the spleen is the most frequently and often the only injured organ. Often, an athlete returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma. A splenic rupture typically results in severe pain and internal bleeding. However, some cases have exhibited only mild symptoms and symptoms may appear delayed as opposed to immediate presentation. Normal physical exams following abdominal trauma does not rule out a splenic rupture. Because of this, a splenic rupture is considered a medical emergency, both to repair/ save the organ, and to limit the loss of blood from the cardiovascular system. The condition is usually caused by a sudden and direct blow to the abdomen, but spontaneous rupture is also possible if the spleen is enlarged or has been enlarged in the past, due to mononucleosis, infection, or chronic excessive consumption of alcohol. Splenic Injury Due to Infectious Mononucleosis (IM): Often, an athlete returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma. It is important that individuals who have been recently diagnosed with IM meet with their doctor for clearance to return to sports. Premature return to sports with an enlarged spleen puts an individual at an increased risk for splenic rupture. Signs & Symptoms of Splenic Injury: Not all signs & symptoms occur immediately after a splenic injury. If this condition is suspected, continue to monitor the athlete for hours after the incident to see if signs & symptoms do occur. Right quadrant/ left quadrant pain Left shoulder pain Severe or mild pain Rebound tenderness Muscle guarding Nausea Profuse sweating or hot and cold sensations Abdominal distension or ecchymosis Light headedness or syncope Fatigue Low blood pressure Blurred vision Treatment: Check and monitor vital signs Activate EMS Valley View ISD 43

45 Return-to-Play: Once released from hospital, the athlete will follow up with primary care physician, written physician releases from primary care physician and surgeon are required. The athlete will need to follow gradual return to play over the course of 2-3 weeks to allow healing of organ tissue. The athlete should be monitored very closely by the athletic trainer and coaches to ensure athlete safety and no return of signs or symptoms. Kidney Injury: Kidneys are the third most common solid organ injury in blunt abdominal trauma. Kidney rupture is similar to splenic rupture in that it is usually caused by a direct blow to the abdomen, side, or mid-to-low back which causes damage or a tear to the organ. The kidneys are well protected by the ribs, abdominal muscles, back muscles, and supporting fascia. However, the lower poles of the kidneys are inferior to the 12 th ribs and are therefore more susceptible to trauma. Signs & Symptoms of Kidney Injury: Hematuria (blood in urine) Most common presenting sign of renal injury Right or left abdominal pain, mild or severe depending on rupture Muscle guarding Low back pain Abdominal bruising, swelling, and pain Signs of internal bleeding o Decreased alertness o Dizziness o Fatigue o Blurred vision o Low BP o Nausea o Vomiting Decreased urine output or inability to urinate Fever In severe cases shock may result increased HR, pale, cool skin Treatment: Monitor vital signs Activate EMS Valley View ISD 44

46 Sudden Cardiac Death Sudden cardiac death (SCD) is the number one cause of exercise related death in young athletes and is due to a cardiovascular disorder. For youth congenital cardiac conditions are the majority of causes for exercise related SCD. In the United States SCD is seen in all sports but mostly in basketball and football due to higher participation levels. Males are more likely to suffer from this condition as well as athletes of the African-American ethnicity. Prevention: Practice EAP to ensure that all members of the Athletic Department are ready to appropriately act if this condition occurs Educating athletes, coaches, and parents on recognition of signs/ symptoms of coronary artery disease (CAD) Placing automated external defibrillators (AED s) strategically around campus and having an AED at athletic events Include cardiac related examinations in the preparticipation exam (PPE) to screen for family history of heart disease Signs & Symptoms: Men: Chest pain, angina and/ or ear/ neck pain Severe headache Vague malaise Dizziness/ palpitations Increasing fatigue Indigestion/ heartburn/ gastrointestinal symptoms Women: Center chest pain, comes and goes Lightheadedness Shortness of breath with/ without chest discomfort Uncomfortable pressure/ squeezing/ fullness Nausea/ vomiting Cold sweat Pain/ discomfort one or both (arms/ back/ neck/ jaw/ stomach) Treatment: Activate EMS Attach AED Perform CPR as instructed Valley View ISD 45

47 Responsive Individual: o Monitor vitals o Health History: S Signs/ Symptoms A Allergies M Medications P Past Health Information L Last Intake E Events Leading Up Unresponsive Individual: o Assess Airway, Circulation, & Breathing o AED rhythm assessment o Check for pace maker & medical alert bracelet o Ask questions to bystanders Return-to-Play: When cleared by cardiologist. Commotio Cordis: Commotio Cordis refers to the sudden arrhythmic death caused by a low/ mild chest wall impact. Commotio Cordis is seen mostly in athletes between the ages of 8 and 18 who are partaking in sports with projectiles such as baseballs, hockey pucks, or lacrosse balls. These projectiles can strike the athletes in the middle of the chest with a low impact but enough to cause the heart to enter an arrhythmia. The heart is most vulnerable when it is struck at the beginning of the T- wave, if chest is hit by projectile during this time period Commotio Cordis is likely to occur. Without immediate CPR and defibrillation, the prognosis of Commotio Cordis is not very good. This condition is extremely dangers with rare survival. Prevention: Have athletic trainer present at practices and games Educate coaches, parents, and athletes how to perform CPR and use an AED Educate coaches, parents, and athletes of signs of Commotio Cordis Have an AED accessible near playing fields at all times Ensure coaches know where to locate the AED Ensure there is an EAP in place Ensure protective equipment is properly fitted Teach athletes how to avoid being hit with the ball/ puck Avoid strength disparities among participants and coaches Valley View ISD 46

48 Symptoms of Commotio Cordis: Mechanism of injury being hit in chest by projectile There should be no apparent trauma The athlete will typically stumble forward for a few seconds, which is followed by unconsciousness, no breathing, and no pulse An AED will indicate the athlete is in ventricular fibrillation Treatment: Use AED and defibrillate as quickly as possible o For every 1 minute delay in getting shocked by the AED there is a 10% decline in survival rate o Using an AED is the best practice and gives the athlete the greatest chance of survival Immediately activate EMS and EAP Continue AED use and CPR until EMS arrives and takes over Return-to-Play: Before returning to play the athlete should have a full cardiac evaluation by a physician and/ or cardiologist Physician and/ or cardiologist clearance is necessary The athletic trainer should use clinical judgement during RTP and should carefully watch the athlete to ensure a cardiac episode does not occur Adjust practice by adding personal protection such as chest padding or switching to safety balls to decrease the chance of another incident Valley View ISD 47

49 Appendix A: Valley View ISD 48

50 Valley View ISD 49

51 Appendix B: Valley View ISD 50

52 Valley View ISD 51