Sports medicine physiatrists are well versed in collaborative work with other health professionals, and therefore have a unique ability to function as the leader of the interdisciplinary sports medicine team. The sports medicine event physician must be prepared for any injury that may occur on the field, including neurologic, musculoskeletal, and medical emergencies. Rapid assessment of the situation is necessary so that the medical team can be activated when there is potential for life- or limb-threatening injury. A comprehensive review of every issue that can be encountered on the field is beyond the scope of this chapter, and the focus will be on common sports medicine emergencies.
Proper management of any sporting event emergency requires pre-event preparedness. The first step is determining if an athlete's health puts them at increased risk of injury. For school-based sports, a pre-participation exam is generally required, and the team physician should be aware of any medical conditions that may predispose an athlete to injury or illness. Many adults, and participants in mass participation events, may not have discussed their exercise program with a physician and may have undiagnosed medical conditions that could affect their health during competition.
The medical director or event physician must develop an emergency action plan (EAP). At a minimum, the EAP should incorporate the following: establishment of a chain of command to define the responsibilities of all parties involved, clear protocols for notification of emergency personnel, and access to early defibrillation.1 The EAP should be reviewed and rehearsed at least annually.1 Mass participation events may require additional planning. This includes pre-event planning with emergency responders and area medical facilities, given the potentially large number of injured participants. Planning for potential hazardous conditions and monitoring of weather conditions is also the responsibility of the medical director.2 Detailed responsibilities of the team physician are discussed in Chapter 25.
Initial Assessment of the Injured Athlete
Initial assessment of the collapsed athlete must be performed in a systematic fashion and begins with CAB (circulation, airway, breathing), followed by a focused neurologic evaluation.3 While previously known as the ABCs, newer recommendations emphasize that maintenance of circulation is the primary goal of cardiopulmonary resuscitation (CPR). Any athlete with altered consciousness must also be presumed to have suffered a cervical spinal cord injury, and strict spine precautions should be put in place, particularly for the contact sport athlete or an unwitnessed fall (Table 27–1).
Table 27–1Indications for Initiation of Cervical Spine Precautions4 |Favorite Table|Download (.pdf) Table 27–1 Indications for Initiation of Cervical Spine Precautions4
Altered mental status
Mechanism consistent with potential for injury
Bilateral neurologic signs or symptoms
Midline cervical pain
Obvious spinal column deformity