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Thursday, 27 March 2014

Emergency Action Plan Part 2

As a continuation from last week we will continue with Emergency Action Plans to continue showing the importance of why all teams, clubs and organizations need to have an effective EAP.  I would like to thank Dr. David Geier, Mike Hopper, ATC and Stop Sports Injuries blog for their posts on EAPs as well in the last couple of weeks as some of the basis for this post will come from them.

Last week we discussed the three major roles that are needed to have an effective EAP, these make up the personnel portion based on Dr. Geier's components.  The second component is communication, both with each member of the EAP, parents, other teams and administrators.  We covered communication within the EAP last week so we will discuss communicating with parents and administrators.

Parent communication is so critical prior to competition, once an injury occurs and after an injury occurs.
Prior to the season starting or competitions inform your parents that you have an EAP, they do not need to know the details, just make them aware that if an injury does occur you have a detailed plan.  It is very important to let them know that the plan includes injury care and contacting EMS as it will help avoid multiple calls to dispatch.  During injury care, it becomes the job of the control person or additional members of the team staff to help calm the parents of the athlete.  Inform them of the degree of the injury, that they are being cared for and that EMS is on route.  This would be the same if you are travelling and the parents are not there, you need to contact them as soon as possible to advise them of the situation.  Post injury stay in contact with the parents to ensure that everyone is on the same page as to severity and rehabilitation of the injury.

When acting as the host for events, you should let the other team know of your EAP as there may be differences as to activating EMS and access to the facility compared to their home venue. When visiting ask the other team or facility these questions, you can not always be reliant on them having an EAP and there maybe the same differences as if they were the visiting team.

Whenever a major injury occurs especially in a school based setting, letting the administrators know can be vital.  In school settings the athletic director, principal and at times the school board must be made aware of the situation.  For minor sports, the club or organizing body will need to know the details of the incident.  In both cases it primarily will be about liability and insurance.  Depending on the insurance plan, there can be time frames for starting a claim and retrieving the information needed.  Usually it will involve paper work from the hospital which can take time to receive and insurance companies usually don't budge on their deadlines.

The third component is ensuring you have proper equipment to deal with emergency situations.  That equipment will vary depending on whether you are a coach, parent, or Athletic Therapist.  The most basic things that everyone in sport should have on the sidelines are:


  • Up to date medical information on all participants in your care including coaches
  • Face mask removal tool - football 
  • Rescue shears for removal of equipment
  • CPR mask & other Personal Protective Equipment such as gloves
  • Wound supplies - gauze and towels to stop flow of blood
  • ICE 
  • Triangle bandages
  • Splints 
  • AED - you may not have a portable one but knowing where it is located at the venue is extremely important

An AED can mean the difference between life and death in emergent situations involving the heart.  The rate of survival increases by 75% when and AED is used.  For every minute that an AED is not used the rate of survival drops by 7-10% and by 12 minutes without defibrillation the rate of survival is only 5%.  Having one on site during any sporting event is a major step towards proper injury management.

You never know what each day at the rink, field or gym will bring.  Hopefully everything goes off fine and no injuries occur, but at some point an injury will happen.  Emergent situations can range from a spinal injury, head injury or an open fracture.  You may have a medical situations such as heat stroke, allergic reactions or an athlete with diabetes who is either hypo or hypoglycemic.  Be it in a school setting, a club or team sport having a detailed documented EAP that fully defines the roles and actions of everyone involved is the critical step in ensuring athlete safety.  Having someone on hand as a first responder, be it a coach with first aid and CPR, an Athletic Therapist or an EMT, without the prior planning of what to do in that emergent situation, no matter what their skills are, the athlete's well being and safety has been put in jeopardy.

For more information on EAP's please contact us at info@eliteinjury.com or visit our website at www.eliteinjury.com.

Resources used

Dr. David Geier - Why are Emergency Action Plans Critical for sports teams?
Mike Hopper, ATC - Sports Emergencies
Heart and Stroke Foundation - Public access to AEDs
Stop Sports Injuries - Why all sports teams should have an Emergency Action Plan



Monday, 24 March 2014

Athletic Therapist as Coach Educator

As much as we all would like to live in a perfect world where every team, school, and club carried or hired an Athletic Therapist, we haven't reached that point and unfortunately never will.  After participating in the #sportssafety chat this past week, it came to my attention that no matter how hard we try to have ATs at all levels of sport it seems that there are obstacles that will never be removed.  So what do we do?  We need to work on educating the coaches on injury prevention, recognition and basic management.

When working with a team or not one of the roles an AT takes on is educating coaches on the above topics.  Injury prevention must be something that all participants buy into.  The coaching staff are the ones that run practices, make tactical plans for competitions and are the overall guardian of what goes on with the athletes. Coaches need to learn about topics such as proper warm up, nutrition, hydration, rest and equipment as they can be a major influence if not the key influence as to athlete safety.

When it comes to injury recognition and management, by no means do I think coaches should know the difference between the laxity of a grade 1 sprain vs a grade 2 nor should they learn how to place players on spine boards.  What coaches do need to know though are basic first aid, CPR and have an understanding of basic injuries.  ATs need to share some of their knowledge with coaches.  Coaches do need to understand the difference between sprains and strains and understand the severity of each.  This knowledge will help them become a better coach, as they will understand why their athletes are out of sport while injured.  Everyone involved in sport should have first aid and CPR, so they can deal with emergent situations and have basic splinting skills.  Where ATs come into the education role is to help coaches take that first aid knowledge and apply it to sport.  

We know that at some point in their coaching career a coach will have to deal with an injured athlete, by educating them as to how to prevent injuries, we can help them decrease the number they will see.  By expanding their skill set when it comes to injury recognition and management, they will feel more comfortable when an injury does occur.  Athletic Therapists have a wide knowledge base, and by no means should coaches be expected to have the same one.  What we as ATs need to do is help the coaches expand their knowledge base, take the fear and uncertainty away when it comes to injuries.  Give coaches the ability to handle an injury until the athlete can receive more advanced care and ensure that the injury is not made worse.  If we as ATs work to empower coaches then coaches will learn that we are an integral part of the sporting community.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 


Thursday, 20 March 2014

Emergency Action Plan

An athlete goes down, they are hurt and not getting back up.  What do you do?

Well no matter if you are an Athletic Therapist/Trainer or coach the most important thing that you have already done is have your Emergency Action Plan (EAP).  The EAP is simply the plan that you as an association, club or team have set out in case an emergent situation may occur.  It is important to remember that not all emergent situations may be an injury.  An athlete may have a medical episode as well as someone in the stands.

It is really simple to think that if an emergency does occur everything will fall into place and there will be no complications.  However during an emergent situation, there is chaos.  No matter the level, no matter the expertise of the medical staff or coaching staff, everything going on is chaos.  If you check back to any of the videos from the post Athletic Therapists/Trainers in Action  even though all the ATs are working in the professional ranks, what goes on around them is chaos.  The biggest thing to notice is that it is organized chaos.  Each person knew their role and that by completing their role, that was what would guarantee the athlete getting the best, quickest care possible.

It is very important to note that if as a coach you are unable to have an Athletic Therapist on staff you still need to have an EAP and may find it more important as you will be taking control and charge of the situation.  You as a coach need to have this written plan that you share with your coaching staff and inform your parent group that you have one.  This will help with efficiency in care and will ease any concerns that your parent group will have in case something were to happen to their child.

So what makes up a good EAP.  There are three major roles.  Charge Person, Call Person, Control Person.  The focus will be on if you do not have an AT on staff and will be managing the emergency as a member of the coaching staff.  Time is of the essence during an emergency, so making sure that everyone knows what to do is very important.

The Charge Person's only concern is the care of the injured athlete.  They are to decide whether or not further care is needed beyond what they are trained to do.  This can include finding someone more qualified in the stands and activating EMS.  It is recommended that this person does possess some level of first aid and CPR training that way they have the knowledge base to know if more care is needed and can do some basic interventions.

The Call Person has at times the most simple job, they need to discuss with the charge person what the extent of the players injury is and if they want EMS contacted.  Never rely on a cell phone during this time as depending on the location service may be intermittent.  The call person should know the location of a land line or pay phone at the venue and have the address for each.  They should also know the best location for the ambulance to come to to ensure adequate access, the closer the ambulance can get to the playing field can at times be critical.

The Control Person can be likened to the bouncer.  They must ensure only the people needed to help with the emergency have access to the athlete.  As much as spectators and parents feel they will be of assistance, the more bodies in the way can impede the care of the injured athlete.

So how does all this start.  Once the charge person enters either the competitive surface, both the call and control person need to be at the ready.  A simple set of easily identifiable signals can get the ball rolling.  You can choose which signals work best for you and your EAP team, but some standard rules should apply.  The signal for activating EMS should be one handed, as your other hand could be stabilizing the head and neck.  All signals should be large ie. arm straight up in the air, hand on the head ect.  That way someone on the sidelines or stands can easily distinguish what is going on.  You can have a signal not only to activate EMS, but to ask for assistance from the sidelines.

Depending on the EAP sample you look at, it can be either the call person or control persons job to talk to the facility staff.  The facility staff are a huge asset during this time.  They know the layout of the venue and will assist in ensuring the ambulance can get to the athlete quickly and uninhibited.  You can also decide who will retrieve the Automated External Defibrillator (AED), it can be the call or control person or you can designate someone who's job is solely to do that.  As soon as the charge person shows the need to activate EMS the AED needs to be retrieved.

Use the officials of the game or event, they can help greatly in dealing with crowd control including the other team.  Once they charge person has decided that EMS needs to be activated they can assist the control person and facility staff in ensuring quick access to the athlete.

Time is of the essence during an emergency, be it your athlete or a spectator or even an athlete from another team, you want to ensure they get the quickest access to advanced medical care.  In rural areas your average time for an ambulance to arrive can be upwards of half an hour, even in the city you may be looking at a wait of ten minutes or more.  The sooner that you as the charge person decide that is what is needed, the sooner that ambulance is on its way.  Never assume that someone else more qualified will be there to make that determination and know that unlike professional sports Paramedics are not waiting in the wings to take over.  A well organized EAP runs smoothly like a well choreographed dance, each person moves independently of each other but all working towards the same goal.  This goal is the safety of the athletes and having an EAP is one of the first steps in ensuring that for them.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com




Monday, 17 March 2014

The Life of an Athletic Therapist in Junior A Hockey

Thank you to Mat Bonneau, CAT(C) for sharing what it is like to work with in the AJHL. 

I’ve had the pleasure of working this past year for a Junior A hockey team as their athletic therapist/equipment manager. It’s been a lot of fun and I love being able to go to the rink every day and get paid to be there. I have a variety of different tasks but all focusing on keeping our guys on the ice and in the best condition to play that I safely can. On the equipment side, my major duties include ordering and picking up equipment, keeping inventory and sharpening/repairing skates. There’s a lot of long days and a many hours logged on bus trips but nothing beats the feeling of being at the rink on game day. Typically I’m at the rink six days a week, training camp was 2-3 weeks of being there every day so it’s nice to get that out of the way and get a bit of a break once the season starts.

Our boys practice from 2:45-4:00pm each day, so I typically arrive at the arena around 1:00pm. From there I may have a few pairs of skates to sharpen or put rivets in if I didn’t get to it the night before. I try and get water bottles filled and put out sock and stick tape for the guys. I do any brief treating and assessing before practice to see where injured guys are at and to help determine what they are doing at practice that day. This is also usually the time that guys find broken sticks or any other repairs that need to be done before they head out on the ice.

During practice I usually try and keep the water bottles filled and assess anyone that gets injured during practice. Also if we have guys that are out, I try and get them to do some exercises while they are at the rink. This is usually a good time to assess anyone that may be out with a concussion because everyone is out of the room so they can focus on their SCAT without any distractions. We have some bikes in the room as well so guys can ride when they reach that part of their return to play.  After practice I typically get ice ready for anyone that needs it. Also I usually try and the guys to put their skates out and I’ll finish them that night.

Game days run a little different. I’m usually at the rink pretty early. I’ll hang all the boy’s jerseys in their stalls to start. Then usually I’ll fill water bottles for our bench and the penalty boxes. I have to make sure the game day pucks are on ice so that they don’t bounce around too much during the game. Again I’ll set out sock and stick tape for the game and make sure that guys that are playing have their game socks in their stalls. There’s usually a couple guys that need skates done because they didn’t check them or didn’t put them out the night before so I try and get those done while the players are having their pre-game meeting. I also mix the Gatorade and make sure that the visiting team has the game sheet. It’s also a good time to check in with the other therapist and see if they need help with anything or forgot something. After the meeting the guys go for their run and after the run I’ll do any extra stretching or taping/supportive techniques that need to be done. After that’s done I set up the bench with the water bottles, towels, my medical bag and set up the pucks for warm-up as well as make sure the nets are on for both sides. After warm-up I try and help pick up pucks and do any last minute things that need to get done before the game.

The routine for road games looks fairly similar but I also have to make sure that the bus is packed and ready to go. This means making sure we have all our jerseys, socks, extra equipment, tape, skate sharpener,  medical equipment and extra sticks all packed and ready to go the night before so when I get the rink the next day its ready for the guys to load.

During the games I like to run one of the doors to keep me involved and it’s fun to do. I try and look after myself but I’ve still been hit with the odd puck or stick during games. I’ll look after any injuries that happen and deal with equipment issues like broken sticks or skates that lose their edges. Between the periods I’ll refill the water bottles and put nets on if I have time to do it. The odd time I’ll have to sharpen a pair of skates or two if someone stepped on something or slid into a post.

After games I’ll get ice ready and I’m responsible for getting the game socks and jerseys washed. If I’m at a home game I’ll usually do it the same night. After getting back from the road it’s usually pretty late by the time we get back and unpack the bus so I’ll do them the next day we have practice.


It’s been a great year so far and I really hope that I get to continue and maybe move up someday to a major junior or professional team. We have a great staff and team so it’s fun to go to work each day. Like I said there are a lot of long days and weeks but it’s still great to be able to do it at the rink.

Thursday, 13 March 2014

Athletic Therapists/Trainers in Action

With the events of Monday March 10, this post will show either Athletic Therapists or Athletic Trainers at work.

Richard Zednik, throat laceration on February 10, 2008.  Assistant Athletic Trainer Dave Zenobi


Rich Peverley suffers a cardiac event on March 10, 2014.  Athletic Trainers Dave Zeis and Craig Lowry.  This article form Bleacher Report describes the emergency treatment he received.


Freddy Meyer collapses at centre ice on February 3, 2011.  Athletic Trainer Tommy Alva was first on the ice.


Alex Cobb, pitcher for the Tampa Bay Rays is hit by a pitch.  Head Athletic Trainer Ron Porterfield does an amazing job of dealing with Cobb and keeping the scene clear.  Shout out to the Kansas City staff for assisting on the field.

As you can see having an Athletic Therapist or Athletic Trainer on your bench or sidelines can save a life.  ATs are not just for professional athletes.  To ensure the safety of all athletes please push your organizations, leagues and teams to have Athletic Therapists and Athletic Trainers there.  Not all teams can have team physicians and as you have seen the physicians are not the first on site.  It does not matter the sport or the level injuries happen and someone needs to be prepared and trained to deal with minor muscle injuries to severe ones such as a spinal cord injuries.

For more information on Athletic Therapists please visit www.athletictherapy.org and for Athletic Trainers www.nata.org

Please follow us on Twitter @EliteInjuryMgmt and for more information on Elite Injury Management and the services we offer including on site coverage at www.eliteinjury.com 

Monday, 10 March 2014

So Your the One who Runs Onto the Ice?

First of all I don't run onto the ice, that isn't safe, I walk quickly.  You may be thinking that all our concentration is on not falling, even though that may be part of what is going on in our head, we are already starting assessing the scene.

When you are working on the bench or the sideline as an Athletic Therapist you are always at the ready.  I have heard coaches say it is like we have eyes in the back of our heads we can know something is wrong even if we are not looking at the playing surface.  Adam Oates commented that when he started as a coach in the NHL he noticed one of his players was hurt and turned to Athletic Trainer Greg Smith to point it out and Smith was already moving down towards the end of the bench the player was coming off at.  This is a typical reaction for any AT working with a team.

I have been asked what we do while on the bench.  When working lacrosse and hockey I did work the gate but for me that just helped me see the ice and floor better, it also helped me get to know my athletes.  You could tell what they were like coming off from each shift, what was normal and what wasn't.  You would also be amazed at what they will tell you while you are both standing there.

So a player goes down.  You get an initial shot of adrenaline, I have told coaches who do not have access to ATs on their bench that the first thing you need to do when entering the playing surface is to take a deep breath and calm down, it is because that is what I do. As I am on my way to the injured athlete, many things are running through my head.  I am assessing what position they are in, are they lying still or rolling around in apparent agony?  I am going over what I saw the last few seconds of the play, based on this I already have an idea of what body part might be injured.  I quickly run through their medical history, was that the same knee that they had surgery on two seasons ago?  I may talk to another player or official to see if the noticed anything.

Once I arrive at the athletes side, the hands on work begins.  Always start with A, B, C - Airway, Breathing, Circulation.  Hopefully the athlete is talking to you and that solves A & B, you still need to check their heart rate.  Have them take some deep breaths before you start to assess, what is wrong, what hurts, what happened?  What I saw might not be what they are complaining of, however when I start my physical assessment I am going to make sure we both aren't right.  As long as it is not a suspected spinal injury, a quick physical assessment occurs and once the athlete is ready we move the athlete safely.

The pressure that is on during the on field assessment is huge.  Deciding if it is safe to move the athlete and how to do so.  Officials, other players are over your shoulder trying to help and wanting to get the game moving.  The coaches are wanting you to find out what is wrong so they know if they have lost a player or not.  Then there is the fans.  Parents, grandparents, family, friends, scouts, everyone is watching your every move, at times if feels like they are waiting for you to mess up.

I may not have eyes in the back of my head, but I do use my senses during injury assessment.  Initial injury assessment begins on the sideline, by watching and listening to the game or sport.  Once the physical assessment begins we add the sense of touch but always continue with my eyes and ears.  The use of the 6th sense is almost the most important, however that is a whole other post in itself.

So yes I am the one that goes onto the ice or field, but my job doesn't start or end there.  I've been watching to make sure if anything happens, making sure any of the prevention techniques used are doing their job, checking in with athletes as to their status of a healing injury.  When an athlete does get hurt, getting them off to the sidelines safely is just the start, a further assessment and decision about care must occur prior to anything else.  No matter what the safety of the athlete is key.  Getting them back to play is the goal, that is why we do what we do.

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com

Thursday, 6 March 2014

Females and ACL Sprains

In a continuation of our female athlete series we will focus on their predisposition to of suffering ACL sprains.
To start a quick overview of the role of the anterior cruciate ligament (ACL) in the body and why it is important to athletes.  The cruciate ligaments in the knee form an X the ACL starts in the front of the knee while the PCL starts in the back, together they prevent back and forth movement of the knee.   ACL sprains can typically without contact.  A quick deceleration, hyper-extension and typically with a change of direction.
So if we all have ACL why are female athletes more prone to suffer an injury. There are both intrinsic and extrinsic factors.

Intrinsic factors include:

Alignment
Large Q Angle
Q angle is the angle formed by a line drawn from the ASIS to the central patella and a second line drawn from the central patella to the tibial tubercle. In females the average angle is 17 degrees compared to males at 14 degrees.  The increase in this angle puts more stress on the structures of the knee and comes from females typically having wider hips.

Hyper-extension
The alignment of the femur onto the tibia can predispose females to hyper-extension of the knee putting them in a position that is already causing stress on the ACL.  Any further extension pushes the ligament beyond its tensile strength.

Hormones
There are studies showing that joint laxity increases during the pre-ovulatory phase of the menstrual cycle.  The sex hormones estradiol, estriol, and progesterone all rise in this stage causing an increased laxity in the joint.

Extrinsic Factors:

Strength
Females have a tendancy to have a low hamstring to quad strength ratio, meaning their quadriceps are stronger than their hamstrings.

Shoes
The type of shoes and surface playing on can increase the likely hood of an ACL injury.  The proper type of footing is required.  Wearing outdoor soccer cleats during indoor season will more than likely place a female in danger of suffering an ACL sprain.  This is caused by the cleat getting caught on the playing surface causing torsion of the knee.

Combined Factors:

Propioception
This is the body knowing where it is in space.  An example of this is being able to touch your finger to your nose.

Sport Specific Skills
Having the appropriate skills needed to compete at the given level of competition goes along way towards injury prevention.

Prevention:

The use of ACL prevention programs has shown to decrease injuries up to 88%.  These programs typically are around 15-20 minutes long.  They will consist of a dynamic warm up, the use of plyometrics and propioceptive exercises.  These programs can be used as your teams warm up.  The strength portion focuses not only on the lower leg but strengthening the core as well.

Females are 2 - 10 times more likely to suffer an ACL injury compared to their male counterparts.  Intrinsic factors can not be changed, however extrinsic factors such as strength, propioception, and the type of shoes being worn can be dealt with either by implementing an ACL prevention program or by being aware what shoes are appropriate to the surface that participation is occurring on.

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com

References used for this post:

William Romani, Jim Patrie, Leigh Ann Curl, and Jodi Anne Flaws. Journal of Women's Health. April 2003, 12(3): 287-298. doi:10.1089/154099903321667627

 2009 Jan;19(1):3-8. doi: 10.1097/JSM.0b013e318190bddb.

http://www.aaos.org/news/aaosnow/nov10/research3.asp

Dr. Connie Lebrun, Considerations for the Female Child Athlete

Monday, 3 March 2014

Where do Athletic Therapists Work?

In honor of National Athletic Training Month in the States this entry will be an overview of all the different areas that an Athletic Therapist works in.

Sport:
All the major professional sports in North America have associations for their Athletic Therapists/Trainers (ATs), the NFL, NHL, NBA, MLB and MLS all have highly qualified personal on their sidelines to ensure the safety of their athletes.  Many of the national sport programs in Canada and the United States carry ATs to help lead their medical teams.

It is not just mainstream sports that employ ATs.  There are ATs working with major dance and performing arts groups such as Cirque du Soleil, Radio City Music Hall Rockettes, Disneyland and Disney World.  Many ballet companies employ ATs to keep their dancers in top form through rehearsals and performances.  In both Canada and the US you will find ATs working and supporting pro rodeo athletes, working in the NLL, and the PGA.  You will find that ATs work with cheerleaders, gymnasts and figure skaters.  No sport is immune to us being there to help the athletes, coaches and parents be safe.

From secondary schools to major universities and colleges ATs are the driving force for player safety.  Many are required to teach classes or do research during the day and then start treating and preparing athletes for practices and games.  For those in secondary schools they are the sole person in charge of all their schools athletes which can range in the hundreds.  Those working at major post secondary institutions might be lucky enough to have a group of assistant therapists/trainers as well as a group of student trainers/therapists.  They become administrators and teachers on top of their normal AT tasks.

Occupational:
As discussed in our post So You Only Work with Athletes Right? ATs do not only work with athletes.  Though many work in a clinical setting where they help rehab athletes from injuries, they also will treat the general public.  ATs are employed in hospitals, as occupational health and safety experts and with the military.  Many private companies are using the skill sets of ATs to help reduce on the job injuries and improve the overall health of their employees.  One of the motos of the Canadian Athletic Therapist Association is Rapid Return to Work and Play.

General Public:
The skill sets of prevention and rehabilitative care are not only for those in the areas of sport and work settings.  Anybody who suffers from a musculoskeletal injury can benefit for seeing an AT.  If you have been in a motor vehicle accident, fell on the ice and broke your ankle, strained your back shoveling snow or hurt your shoulder doing yard work, ATs will get you back on track quickly and safely.

All Athletic Therapists/Trainers are trained in the areas of injury prevention, rehabilitation and emergency care.  We work with all levels of athletes, different types of occupations, and all ages of the general public.  Our goal no matter what our occupational setting is to help you get back to either work or play safely and quickly.  We truly are AT4All.

Please follow us on Twitter @EliteInjuryMgmt and check out or website at www.eliteinjury.com