Chapter 12: On-the-Field Acute Care and Emergency Procedures

William E. Prentice

OBJECTIVES

When you finish this chapter you should be able to

• Establish a plan for handling emergency situations.

• Explain the importance of knowing cardiopulmonary resuscitation and how to manage an obstructed airway.

• Describe the types of hemorrhage and their management.

• Assess the types of shock and their management.

• Describe the emergency management of musculoskeletal injuries.

• Describe techniques for moving and transporting the injured patient.

KEY TERMS

• primary survey

• secondary survey

• emergency action plan (EAP)

• cardiopulmonary resuscitation (CPR)

• automated external defibrillator (AED)

• airway

• hemorrhage

• shock

• vital signs

• oxygen saturation

• systolic blood pressure

• POLICE

INTRODUCTION

An emergency is defined as "an unforeseen combination of circumstances and the resulting state that calls for immediate action.³⁸" Certainly, most sports injuries do not result in life-or-death emergency situations, but when such situations do arise, prompt care is essential. It has been suggested that the first hour following injury—the so-called Golden Hour—is most critical in treating injury. The Golden Hour refers to the time between injury and the initiation of the appropriate treatment. Although research evidence has shown that the Golden Hour is simply an arbitrary myth, it is certainly true that rapid intervention as soon as possible following traumatic injury improves the patients' chance of survival and thus a successful outcome.⁵⁰ Time is the critical factor, and assistance to the injured person must be based on knowledge of what to do and how to do it—on how to perform effective first aid immediately.³⁹ There is no room for uncertainty, indecision, or error. A mistake in the initial management of an injury can prolong the length of time required for recovery and can potentially create a life-threatening situation for the athlete.⁴

THE EMERGENCY ACTION PLAN

The prime concern of emergency aid is to maintain cardiovascular function and, indirectly, central nervous system function.⁴² Failure of either of these systems may lead to death. Regardless of the setting, whether on an athletic field or in a clinic, hospital, or fitness center, an emergency action plan (EAP) should be developed for every venue in which an athletic trainer works.⁵² The key to emergency aid is the initial evaluation of the injured patient. Time is of the essence, so this evaluation must be done rapidly and accurately, so that proper first aid can be rendered without delay.²³ In some instances, these first steps not only will be lifesaving but also will determine the degree and extent of permanent disability.

As discussed in Chapters 1 and 3, any individual who provides emergency care—the athletic trainer, the team physician, or the coach—must act reasonably and prudently at all times.²⁶ This behavior is especially important ...