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“Fortunes favour the prepared mind.” Being prepared for sporting emergencies ~ Shane Brun

Fortunes favour the prepared mind” and making assumptions can sometimes help…

Emergencies in the sporting context are something we hope will never happen; unfortunately they do and are happening more frequently. In healthcare we are constantly reminded never to assume and always confirm our clinical suspicions. Managing emergencies in sports is no different, or is it?

Unfortunately, too many people die unnecessarily because those around them are ill prepared or ill equipped to deal with the emergency in front of them. Sadly, this situation occurs far too often in the sporting context as well. In some cases, when managing the severely injured athlete making some assumptions may be lifesaving. Here are a few:

Situation Assumption Response
If an athlete collapses and becomes unconscious during training or competition and the cause of the collapse did not result from contact or a collision. The cause of the collapse is a cardiac arrest unless proven otherwise. Commence Basic Life Support (BLS) and obtain an AED immediately. (http://www.resus.org.au/public/arc_basic_life_support.pdf)
If an athlete collapses and becomes unconscious during training or competition and the cause of the collapse did result from contact or a collision. The athlete has sustained a spinal injury as well as a head injury. Whilst assessing and managing Airway, Breathing and Circulation, ensure inline spinal immobilisation. This involves the entire spine and not just the neck; immobilising only the neck may worsen the problem.
Someone is unconscious. Their airway is blocked and the most likely cause is their tongue and soft tissues at the back of the throat. Head tilt and chin lift is the most effective immediate way of clearing an airway(1).
Someone who is unconscious and not breathing normally. This person is in cardiac arrest. Whilst applying BLS principles, apply and use an AED as soon as possible. For every one minute delay in defibrillation there is a 10% reduction in survival(2). Extrapolation of conservative data suggests that in a population the size of Australia anywhere from 125-5,000(3-7) people per year will have a Sudden Cardiac Arrest. An AED will save many of them, (road traffic incidents account for about 1,500 deaths per year).
You are confronted by an emergency situation. Chances are you may be the only one with the skills to manage the situation. Ensure you and your support team practice your emergency drills regularly.
An explosion, fire or stadium collapse occurs. The nearest emergency exit is blocked. Ensure you and your team are aware of all emergency exits and the best way to get to them. You should be familiar with the contents of chapter 47 of CSM4(8).
An athlete is experiencing an itch and lip and facial swelling, redness, you hear them wheezing and they are finding it difficult to breathe shortly after taking some anti-inflammatory medication. This person is having an anaphylactic reaction and they will become much worse very quickly. Administer adrenaline intramuscularly immediately(9); this person will die of an airway blockage, shock or both unless they are treated immediately.

Shane Brun is Associate Professor of Musculoskeletal and Sports Medicine at James Cook University Queensland Australia. He is also Visiting Professor to the Sports Medicine unit of the University Malaya and an elite medical officer with the Asian Football Confederation (AFC) and Fédération Internationale de Football Association (FIFA).

References:

  1. Koster RW, Sayre MR, Botha M, Cave DM, Cudnik MT, Handley AJ, et al. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2010 Oct;81 Suppl 1:e48-70. PubMed PMID: 20956035.
  2. Sunde K, Jacobs I, Deakin CD, Hazinski MF, Kerber RE, Koster RW, et al. Part 6: Defibrillation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2010 Oct;81 Suppl 1:e71-85. PubMed PMID: 20956034.
  3. Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olson HG. Nontraumatic sports death in high school and college athletes. Medicine and science in sports and exercise. 1995 May;27(5):641-7. PubMed PMID: 7674867.
  4. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol. 1998 Dec;32(7):1881-4. PubMed PMID: 9857867.
  5. Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation. 2009 Mar 24;119(11):1484-91. PubMed PMID: 19273724. Pubmed Central PMCID: 2679169.
  6. Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in national collegiate athletic association athletes. Circulation. 2011 Apr 19;123(15):1594-600. PubMed PMID: 21464047.
  7. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009 Mar 3;119(8):1085-92. PubMed PMID: 19221222.
  8. Brun S. Medical Emergencies in the Sporting Context. In: Peter Brukner KK, editor. Clinical Sports Medicine. 4 ed. Sydney: The McGraw-Hill Companies; 2012. p. 972-95.
  9. Brown SG, Mullins RJ, Gold MS. Anaphylaxis: diagnosis and management. Med J Aust. 2006 Sep 4;185(5):283-9. PubMed PMID: 16948628.

 

 

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