The Manual focuses on the fieldside diagnosis and treatment of severe injuries and illnesses that can present at a sports event. It concentrates on basic diagnostic skills and treatment modalities as the sports physician has often limited diagnostic and treatment facilities available. Each chapter concentrates on an illness or anatomical injury and offers a structured diagnostic and therapeutic approach in this difficult pre-hospital environment. The chapters explain what problems are to be expected with specific conditions as well as which treatment plan should be implemented and how to evaluate and reassess those plans.
Table of Contents
List of contributors
Foreword
Preface
About the Authors
1 Emergency Care at the Olympic Games 1
Richard Budgett
Introduction 1
Early Preparations 1
Final Preparations 2
Team and IF Doctors 4
Summary 4
2 Injury and Illness During the 2008 Summer and the 2010 Winter Olympic Games 6
Kathrin Steffen, Torbj rn Soligard and Lars Engebretsen
Vancouver Winter Games 2010 7
Beijing Summer Olympic Games 9
Bibliography 10
3 The Medical Team Response 12
David McDonagh and David Zideman
ABC on the Field of Play 14
Primary Survey 20
Primary Survey 22
Primary Survey 24
Transferring the Athlete from the FOP to the
Fieldside 27
Fieldside Assessment 27
Pupils Pathological Findings 28
Blood Sugar 28
Blood Pressure 29
Athlete Medical Room Treatment 30
Transportation to Hospital 31
Discharge 31
Teamwork 31
Bibliography 32
4 Cardiopulmonary Resuscitation on the Field of Play 33
Ruth Löllgen, Herbert Löllgen, and David Zideman
Sudden Cardiac Arrest on the Field of Play 34
Recognition of Cardiac Arrest 34
Field of Play Airway 36
Foreign Body Airway Obstruction (FBAO or Choking) 37
Field of Play Breathing 38
Recovery Position 38
Field of Play Circulation 38
FoP: Combining Compressions and Ventilations 39
Expired Air Ventilation 39
Bag-Valve-Mask Ventilation (Two Rescuer Technique) 39
FoP Removal 40
Rhythm Analysis 40
Shockable Rhythms 41
Nonshockable Rhythms 42
Reversible Causes (The 4H's and 4T's) 42
Advanced Life Support 42
Advanced Airway 44
Simple Airway Adjuncts 44
Inserting an Oropharyngeal Airway (OPA) 44
Inserting a Nasopharyngeal Airway (NPA) 44
Advanced Airway Adjunct 45
Venous Access 45
Intraosseous Access 45
Drugs 45
Implantable Cardiac Defibrillators (ICDs) 46
Postresuscitation 46
Bibliography 46
5 Cardiac Emergencies on the Field of Play 47
Ruth Löllgen, Herbert Löllgen and David Zideman
Sudden Cardiac Death (SCD) 47
FoP Management Non-traumatic Sudden
Collapse 48
Clinical Findings/Management ACS (Fig 5.1) 50
Clinical Findings/Management AA or AD 52
FoP Management of Myocarditis 52
Clinical Findings/Management Hypertensive Crisis 53
Clinical Findings/Management Bradycardia 54
Clinical Findings/Management Tachycardia 57
Bibliography 57
6 Control of Hemorrhage and Infusion Management 58
Kenneth Wing Cheung Wu and Hiu Fai Ho
Introduction 58
FoP Management 59
External Bleeding Wounds 59
New Trends in Hemorrhage Control 60
Internal Bleeding 60
Infusion Management 61
Conclusion 62
Bibliography 62
7 Anaphylaxis 63
Andy Smith and Jerry Nolan
Introduction 63
Signs and Symptoms 64
Management of Anaphylaxis 64
Bibliography 67
8 Asthma and Respiratory Emergencies 68
Joseph Cummiskey
Observation From Outside the FoP and While Approaching the Patient 68
FoP Management of a Suspected Chest Medical Event 68
Primary Survey 68
Fieldside Management of Chest Medical Conditions 69
Pulmonary Embolism 70
Bronchial Asthma and Exercise-Induced Bronchospasm (EIB) 70
The Effect of Environmental Conditions and Pollutants in Sport Activity 73
Bibliography 76
9 Seizures and Epileptic Emergencies 77
Geraint Fuller
Preparation 77
Fieldside Observation 77
Observations on Approaching the Athlete 78
Clinical Findings/Management Convulsing Athlete 79
Referral or Discharge? 80
Differential Diagnoses of Seizures 80
Bibliography 81
10 Head Injuries 82
David McDonagh and Mike Loosemore
Sideline Observation 83
FoP Management of a Convulsing Athlete 83
Primary Survey Convulsing Patient 84
FoP Management of a Nonconvulsing Athlete with a Head Injury 85
Primary Survey on the FoP 85
FoP Management of Head Injury with a Low GCS 85
Management of Head Injury with a GCS 12 14
on the FoP 85
Fieldside Evaluation 86
Secondary Survey at the Fieldside 86
Management of Patients with Head Injuries 86
Pupil Examination 87
Glasgow Coma Scale 88
Binocular Hematomas Raccoon Eyes 90
Battles Sign 90
A Focused Medical History 90
Transfer to the Hospital 91
When Should the ED Request a Cranial CT? 91
Scalp Lacerations and Bleeding 92
Smelling Salts 92
Bibliography 92
11 Concussion Onfield and Sideline Evaluation 93
Paul McCrory and Michael Turner
Introduction 93
Epidemiology 93
Definition of Concussion 93
Symptoms and Signs of Acute Concussion 94
Fieldside Recognition of Concussion 94
Concussion Injury Severity and Recovery 94
Concussion Management 100
Concussion in Child and Adolescent Athletes 103
Prevention of Concussion 103
Other Specific Issues 104
Conclusion 105
Bibliography 105
12 Throat Injuries 106
Jonathan Hanson, Padraig B. Sheeran, Brian Carlin and David Zideman
Penetrating Trauma 107
Clinical Findings/Management Penetrating Neck Wound 108
Blunt Trauma 108
Clinical Findings/Management Blunt Neck Trauma 108
Clinical Findings/Management Laryngeal Contusion 109
Clinical Findings/Management Laryngeal Fracture 110
Needle Cricothyrotomy 110
Surgical Cricothyrotomy 111
VASCULAR INJURY - Clinical Findings Acute Vascular Neck Injury 112
Clinical Findings Delayed Presentation Vascular Neck Injury 112
Management Aerodigestive Track Injury 113
Bibliography 113
13 Facial Injuries 114
David McDonagh and Mike Loosemore
FoP Management Serious Facial Injuries 114
Facial Injury - Clinical Findings/Management Serious Facial Injury 115
Fieldside Management Serious Facial Injury 115
Clinical Findings/Management Serious Facial Injury 116
Clinical Findings/Management LeFort Fracture 117
Clinical Findings/Management Mandibular Fracture 118
Clinical Findings/Management Orbital Fracture 118
Clinical Findings/Management Zygomatic Fracture 119
Clinical Findings with a Nasal Fracture 121
Clinical Findings/Management NOE Fracture 122
Clinical Findings/Management Septal Hematoma 122
Clinical Findings/Management Epistaxis 123
Bibliography 124
14 Eye Injuries and Other Ocular Emergencies 125
Sibel Kocabeyoglu, U ur Erdener and David McDonagh
Fieldside Observation and Observations on Approaching the Athlete 126
Fieldside Management Eye Injury 126
Eye Blunt Trauma 127
Clinical Findings/Management Hyphema 128
Clinical Findings/Management Lens Subluxation 128
Posterior Chamber Hemorrhage 129
Clinical Findings/Management Retinal Detachment 130
Clinical Findings/Management Blowout Fracture 130
Clinical Findings/Management Orbital Fracture 131
Clinical Findings/Management Rupture of the Globe 131
Clinical Findings/Management Retrobulbar Hemorrhage 132
Clinical Findings/Management Periocular Ecchymosis 132
Clinical Findings/Management Subconjunctival Hemorrhage 133
Eye Penetrating Injuries 134
Treatment 134
Non-traumatic Ocular Emergencies 135
Bibliography 136
15 Dental Injuries 137
Paul Piccinini and Anthony Clough
Types of Injuries 137
Management of Dental and Orofacial Injuries 138
Fractured Teeth 138
Dental Luxation 138
Intrusions 139
Avulsions 139
Trauma to the Alveolus 139
TMJ Trauma 140
Soft Tissue Trauma 140
Injury Prevention 141
16 Thoracic Injuries 142
David McDonagh and David Zideman
Fieldside Observation and Observations on Approaching the Athlete 142
FoP Management Chest Injury 143
Clinical Findings/Management Chest Injury 143
Fieldside Management Chest Injury 144
Clinical Findings Traumatic Pneumothorax 145
Clinical Findings Major Traumatic Pneumothorax 146
Clinical Findings Tension Pneumothorax 146
Pneumothorax Treatment 147
Tension Pneumothorax Immediate Treatment 147
Needle Thoracostomy of Tension Pneumothorax 148
Clinical Findings/Management Hemothorax 149
Clinical Findings/Management Flail Chest 150
Clinical Findings/Management Pulmonary Contusion 151
Clinical Findings/Management Sternal Fracture 152
Needle Pericardiocentesis 153
Primary Management of Penetrating Thoracic Injuries 155
Bibliography 156
17 Abdominal Injuries 157
David McDonagh and Dara Lundon
FoP Management of an Abdominal Injury 158
Clinical Findings/Management Abdominal Injury 158
Clinical Findings/Management Penetrating Abdominal Wound 160
Clinical Findings/Management Blunt Abdominal Injury 161
Clinical Findings Splenic Injury 162
Clinical Findings Liver Injury 163
Clinical Findings Kidney Injury 164
Clinical Findings/Management Scrotal Trauma 165
Clinical Findings/Management Testicle Torsion 166
Bibliography 167
18 Pelvic Injuries 168
Andy Smith and Jo o Grangeiro Neto
FoP Management Pelvic Injuries 169
Clinical Findings/Management Pelvic Injury 169
Fieldside Management Pelvic Injury 171
Clinical Findings Pelvic Injury at the Fieldside 171
Summary 175
Bibliography 175
19 Spinal Injuries 176
Éanna Falvey and Craig Roberts
Preparation for Onfield Management 177
FoP Management Potential Spinal Injury 177
Primary Survey Potential Spinal Injury 177
FoP Management of a Patient with Findings Indicative of a Spinal Cord Injury 178
Transfer of the Patient onto the Spinal Board/Lifting Device 179
Transfer from the FoP to the Fieldside 179
Fieldside Management Potential Spinal Injury 179
Clinical Findings with a Potential Spinal Injury 180
Return to Play After a Fieldside Evaluation of a Neck Injury 180
Clinical Findings with a Potential Cervical Spinal Fracture 181
Clinical Findings/Management Facet Joint
Injuries 182
Clinical Findings/Management Stinger Injury 183
Clinical Findings/Management Acute Prolapsed Disc 184
Clinical Findings Spondylolysis and Spondylolisthesis 185
Bibliography 185
20 Extremity Injuries 186
Michael R Carmont and David McDonagh
Fieldside Observation and Observations on Approaching the Athlete 186
FoP Management - Limb Injury 187
Clinical Findings Limb Injury 187
Onfield Management Limb Injury 188
Realignment of Fracture/Dislocations 188
Transfer from the FoP 189
Fieldside Management Limb Injury 189
Splint Selection and Application (See Chapter 30) 190
Analgesia 193
Ski Boot Removal 194
Paralympic Sport 195
Documentation 195
Bibliography 195
21 Aquatic Athlete Injuries and Emergencies 196
Margo Mountjoy and Saul Marks
Introduction 196
Swimming 196
Synchronized Swimming 198
Diving and High Diving 199
Water Polo 201
Open Water Swimming 202
Conclusion 204
Bibliography 204
22 Emergency Care of the Adolescent Athlete 205
Lisa M. Vopat and Lyle J. Micheli
Introduction 205
Primary Survey and Stabilization (See Chapter 3) 206
Differences in Injury Pattern 208
Emergency Planning and Fieldside Preparedness 211
Conclusion 211
Bibliography 211
23 Emergency Medical Care in Paralympic Sports 212
Peter Van de Vliet and Mike Wilkinson
The Paralympic Athlete 212
Injury and Illness in Paralympic Athletes 214
Impairment-Specific Considerations of Medical Care 216
Specific Paralympic Medical Concerns 218
Autonomic Dysreflexia 218
Conclusion 219
Bibliography 219
24 Cold Injuries 220
Ken Zafren, Gordon Giesbrecht and David McDonagh
The Collapsed Cold Athlete 221
Primary Survey in a Cold Athlete 221
Prehospital Treatment for a Cold But
Nonhypothermic Patient or for a Mildly Hypothermic Patient 222
Prehospital Treatment of a Patient With Moderate or Severe Hypothermia 222
CPR and Severely Hypothermic Patients 223
Frostbite 223
Clinical Findings/Management Frostbite 224
Nonfreezing Cold Injuries (NFCI) 226
Bibliography 227
25 Severe Dehydration and Exertional Heat Illness 228
Eunice M. Singletary
Introduction 228
Fieldside Observation and Observations on Approaching the Athlete 228
Primary Survey Severe Dehydration or Heat Illness 229
Blood Pressure and Pulse 230
FoP Management Dehydration, Exercise-Associated Hyponatremia and Heat-Related Illness 230
Specific Conditions 231
Bibliography 235
26 Hypo- and Hyperglycemia 236
Kathryn E. Ackerman and David McDonagh
Hypoglycemia 236
Clinical Findings Severe Hypoglycemia 237
Clinical Findings Mild Hypoglycemia 237
Hyperglycemia 238
Clinical Findings Hyperglycemia 238
Bibliography 240
27 Wound Care 241
David McDonagh and Sally Whitmore
FoP or Fieldside Management 241
Wound Location 242
Reassessment of Wounds and Dressing Changes 243
Tetanus Vaccines 245
Burns, Abrasions, and Blisters 245
Bibliography 247
28 The Role of the Paramedic on the Field of Play 248
Mike Nolan and David Whitmore
Planning and Logistics 248
Clinical Practice 249
Additional Information 251
29 The Role of the Physiotherapist on the Field of Play 253
Mark Brown, Michael Kenihan and Marie-Elaine Grant
Introduction 253
An Emergency Situation When Traveling with a Team of Athletes Either Nationally or Internationally 254
An Emergency Situation Either Nationally or Internationally Where the Physiotherapist is Covering the Event Alone and There is No Doctor or Paramedic Available 256
Onfield Assessment and Management 257
Bibliography 260
30 Emergency Medications and Equipment at the Fieldside 261
Mark Faulkner, Fionna P. Moore and David Zideman
The Bag 262
Immobilization and Carrying 263
Stretcher or Trolley Bed 263
The Spinal Board 263
The Scoop Stretcher 263
The Basket Stretcher 263
Carry Sheet 264
Semi-Rigid Cervical Collars 264
Head Blocks 264
Body Straps 264
Vacuum Mattresses 264
Limb Splints (See Chapter 20) 264
Pelvic Splints (See Chapter 18) 265
Resuscitation (See Chapter 4) 265
Dressings and Hemorrhage Control 266
Drug Administration and Intravenous Access 267
Medications 267
Intravenous Fluids 271
Bibliography 272
31 Emergency Medications and the WADA Prohibited List 272
Alan Vernec and Eduardo de Rose
Therapeutic Use Exemption 275
Strict Liability 276
Supplements 276
Possession of Prohibited Medication and Physician Responsibility 277
Summary 277
32 Retrieval and Repatriation of Injured and Ill Athletes 279
Mark Brown and Glenn Brown
Introduction 279
Preplanning 279
Team Medical Staff Skills 280
Equipment Requirements 280
Medical Transport Options 281
Specialist Medical Evacuation and Repatriation Services 281
Insurance/Repatriation Processes 282
Other Procedural Considerations 282
Bibliography 283
Appendix 1 International Olympic Committee Executive Board 284
PREAMBLE 284
Olympic Charter, July 2007 284
Chapter I: Relationships Between Athletes and Health Care Providers 285
Chapter II: Protection and Promotion of the Athlete's Health during Training and Competition 288
Chapter III: Adoption, Compliance and Monitoring 289
Chapter IV: Scope, Entry into Force and Amendments 290
Appendix 2 Sport-Specific Injury Profile and Equipment Guide 292
Winter Olympics Federations 292
Summer Olympics Federations 295
Appendix 3 Healthcare Professional Skillbase 304
Field of Play (FoP) 304
Appendix 4 Treatment Algorithms at a Glance 306
Index 315