Risk Management the Coach's Responsibility

Many coaches find it difficult to come up with a complete risk management plan for their team.  For some it may be that they don't understand the importance of one or not feel it is their responsibility, for others it is not knowing where to start or what all comprises of a complete plan.  As a coach you are the decision maker for your team, you need to make safety and risk management a priority as it can be the difference between success and failure or life and death. 

Risk management is an ongoing process that must begin prior to the season beginning and does not end until after the season is over. 

So what all does a coach need to do? We will discuss the basics of a risk management program for sport teams. 

Emergency Action Plan (EAP) - the EAP is designed to make sure all the proper steps are taken when an injury occurs and that specific people have a designated roles/jobs so that all are prepared.  Basic EAPs consist of 3 roles, the charge person who is attending to the injured athlete, the call person who contacts EMS and the control person who maintains order among the crowd, opposing team and liaises with the facility.  

Have First Aid and CPR - it is all great that you have an EAP but if you don't have basic injury management skills such as first aid and CPR, what are you going to do if something occurs?  You can not rely on always having a trainer, athletic therapist on your staff or that each year you will have parents who are doctors, nurses or paramedics.  These are added bonuses not sure things.  

Take an Injury Management Seminar - First aid and CPR only get you so far in the world of sports.  You need to understand the types of injuries that will occur in sports and how to apply the knowledge you gained in first aid and CPR to those situations.  A good seminar will not only discuss sports injuries but go in-depth on risk management, injury prevention and return to activity. 

Carry a First Aid Kit - each team should carry an individualized first aid kit for their sport and the knowledge of those who will be using it.  Sports require more than just few pieces of gauze and band-aids but unless you are trained to do so you don't need a stitch kit. 

Do Risk Assessments - at practices and games.  Know what the areas of risk are in your sport and at each facility you are at.  By doing so you can implement prevention strategies and be more prepared for situations that are specific to each activity. 

By no means is this a complete list of everything that comprises a risk management program.  After each practice, game or competition you will tweek your plan based on what occurred.  Rely on past experiences as well to help form your full plan.  Risk management is about creating a safe environment for your athletes, your staff as well as the other team and spectators.  Though when you first start working on your plan it is a lot of work, the benefits pay off throughout the seasons.  When injuries do occur, because you were prepared they will take less energy and focus at that time than if you did not have an effective risk management plan. 

For more information on risk management, EAPs and the coaches role please visit our website at www.eliteinjury.com  and follow us on Twitter @EliteInjuryMgmt 

SCORE - Saving & Creating Better Athletes

Today is the official launch of our SCORE - Saving and Creating Better Athletes - program.   This program has been designed to give all school athletes tools to help them succeed in all areas of their lives.  The goal of the SCORE program is to create athletes who are not only better prepared to participate in sport and excel but also create athletes who are able to reduce the risk of injury and deal with injury and emergency situations if they do occur.

The SCORE program consists of the following. 

First Aid & CPR Certification 

In the case of any emergency having someone present who is able to perform CPR and       administer life saving first aid can be the difference between life and death.  Having these skills is not only applicable to those in sport but is a great life skill.  Student athletes will be certified in CPR, AED and First Aid.

Injury Recognition 

The importance of having first aid and CPR is great, however without the knowledge of how to recognize common sports injuries those skills are not useful.  We offer numerous injury recognition seminars including concussion recognition. musculoskeletal injuries, anaphylactic    reactions, spinal injuries, heat illness and medical episodes such as cardiac arrest, diabetes, and asthma.  

Sport Taping & Strapping

If you want to learn unique and practical taping techniques for most common sports injuries.  Participants learn proper taping procedures, when to tape and when not to, taping versus bracing, as well as have the opportunity to practice different taping techniques for all parts of the body.

Education Seminars 

Seminars will increase athletes awareness of health and safety topics. Participants will gain knowledge on how to perform at peak levels as well as knowledge to use in everyday life.  Topics include nutrition, injury prevention, drugs in sport and mental training skills such as goal setting.

Student Trainer Course

For those students who wish to expand their knowledge of sports medicine or who are wanting to pursue a career in sports medicine this is the place to start.  This course is comprised of three parts: First Aid and CPR certification, Sport Taping and Strapping and our Managing Injuries—A Trainer’s  Responsibility.

 By creating an athlete that not only has the skills to compete on the playing field or gym, but who now has the knowledge as to how injury prevention and management plays a role in athletic success.  The SCORE program truly makes athletes - student athletes as it gives direct education applicable to sport that they can carry over into every day life.

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

First Aid supplies

Every team needs to have a fully stocked first aid kit on site during all team, club or sport activities.  Having these supplies at hand, knowing what is available and knowing how to use them are all part of a well organized risk management plan and emergency action plan for your group. 

Not all first aid kits are created equal.  A kit used at home, work or in the car will not meet the needs of an athletic event.  Depending on your expertise you may expand the supplies you keep on hand, but it is very important to only have supplies you are trained to use.  When being given a first aid kit by your organization or club it is very important to go through it.  Knowing what supplies you have on hand or not can mean change how prepared you are for the injury situation. 

Basic supplies that everyone should carry are:

• Barrier protective gloves - non latex is best, but if you have not latex allergies in your athletes latex is fine.
• CPR mask or shield 
• Bandaids - I always recommend butterfly or knuckle as they have more coverage and stay on better.  You may need to pay attention to adhesive allergies. 
• Triangle Bandages - They aren't just for slinging shoulders, in my world the more the better.
• Tensor Bandages - 3" and 4" are best, depending on your knowledge adding a double 6" is beneficial.
• Saline Solution - Used to clean wounds.
• Antibiotic Cream - Keep wounds clean 
• Gauze - Sterile and non-sterile to dress wounds, 3" is sufficient
• Alcohol Sanitizer - You can not always make it to a sink to wash.
• Hypafix or similar product - Keeps gauze on great
• Prowrap - Even if you don't know how to tape this comes in handy for many things
• White Athletic Tape - Zinc Oxide tape is the basic tape used in athletics.  If you have a taping and strapping course carry enough to tape.  If you do not know how to tape still carry some as you can use it to hold on bandaids or gauze. 
• Scissors - Rescue Shears or Utility Scissors can cut through shoulder pads, great to have on hand for emergency or everyday issues.
• Helmet Removal Tool - Depending on your sport having something to properly remove the face mask can be life saving.  An pair of angled pruners or the Trainer Angel work well, a Utility Knife is not safe for either the athlete or person using it. 
• I do not recommend chemical ice packs as they can break and tear.  Leaving the athlete prone to chemical burns or the ice pack has already been activated prior to needing to be used.

A well packed and organized first aid kit can make a huge difference when managing injuries.  By knowing what supplies you have on hand and how to use them will save you time when an injury does occur. Nothing is worse than trying to find gloves and gauze when dealing with a wound.  Always keep your first aid kit stocked and check for expiration dates on any supplies.   Check with your sport governing body or organization as to if there are any restrictions as to what you can carry in your kit. Some sport governing bodies do not allow you to carry anything that has a drug identification number (DIN).  The final step to having an effective first aid kit is making sure you take it to all sport events. Practices, games, training and competitions all require having your first aid kit on site. 

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

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 

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

Why Ice?

As you can gather from the name of this blog, I fully believe in icing injuries.  Any athlete or patient will tell you that I don't believe in heat only ice when it comes to treatment of musculoskeletal injuries.  There has been a lot of new information coming out saying that icing an acute injury is detrimental to healing.

When dealing with an acute injury the use of cryotherapy (application of cold) to the area is important for the first 24-48 hours.  The use of ice decreases pain and muscle spasm as well as blood flow, inflammation and edema.  This is due to the stop of tissue hypoxia and additional tissue injury.  When managing an acute injury the reduction of all of these aids in recovery and rehabilitation.

Reviews of research done on cryotherapy shows that more detailed studies need to be completed.  The research has proven that the application of ice on acute injuries does decrease pain, which will decrease spasm caused by the pain-spasm cycle.  Since muscle spasm decreases range of motion, this decrease in pain will lead to earlier improvement in range of motion and subsequent earlier start to rehabilitation.

The principle of RICE is still the standard when dealing with acute injuries.  Rest, ice, compress and elevate the injured area for the first 24-48 hours.  When icing on average for topical application the ice should be applied for around 20 minutes depending upon the size of the area needing treatment and the depth of soft tissue.  Topical application will reduce tissue temperature to a depth between 2 - 4 cm.

When applying ice, no matter the mode there are 4 sensations that you will experience.  Starting with cold, progressing to burning, achy/dull and finally numb.  When determining how often to apply the ice, the area needs to come back to normal body temperature before reapplying.

No matter the type of soft tissue injury, be it sprain, strain, contusion or post operative the application of ice is the still the best way to decrease pain and inflammation without the use of medications after an acute injury.

Articles used
Hubbard, T.J & Denegar, C.R. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training. 2004 Jul-Sep; 39(3): 278-279
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

Nadler, S.F, Weingand, K, Kruse, R.J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner Pain Physician.  2004;7:395-399, ISSN 1533-3159
http://www.painphysicianjournal.com/2004/july/2004;7;395-399.pdf

Fighting the Cold

As the temperature keeps dropping, we all need to be aware of cold injury.  Cold injury falls under two categories, localized and systemic.

Localized cold injury involves two main types, frost nip and frost bite as well as chilblains.  Frost nip is the most mild form and typically happens to the nose, ears, hands and feet.  This is most common when outside with out protection.  Frost bite also occurs from exposure to freezing temperatures but is more severe than frost nip.  The area effected will at first be painful and progress to numbness.  The skin will appear white and waxy.  Chilblains are caused by exposure to non freezing temperatures and dampness.  The person will have lesions that are red and raised, they may reoccur over time.

Hypothermia is when the body temperature drops below 35 degrees Celsius and is also called systemic cold injury.  There are two categories, primary caused by exposure to severe cold temperatures and inadequate clothing and secondary which is predisposed by illness.  Someone with mild hypothermia will display the following symptoms; shivering, fast breathing, trouble speaking, confusion, lack of coordination, fatigue, increased heart rate and increased blood pressure.  Severe systemic cold injury displays as follows; shivering, lack of coordination, slurred speech, stumbling and lack of coordination, confusion and poor decision making, drowsiness, apathy towards their situation, progressive loss of consciousnesses, weak pulse and slow, shallow breathing.

As with most injuries prevention is the first step of treatment.  Pay attention to weather forecasts,  especially if it involves a wind chill.  The chance of frost bite increases as the windchill drops below -27 Celsius.  Wear warm layers, keep dry and keep moving, but avoid overexertion.

If a localized cold injury occurs you should do the following treatments for frost nip, gentle rewarming by putting the effected area under the armpits is most successful.  For frost bite removal from the cold is critical, place the person in warmth and have them transported to a hospital.  Never rub the effected area as this can cause further tissue damage.  For chilblains should be rewarmed and the skin needs to be kept lubricated.

If someone is suffering from hypothermia be gentle when moving or touching them.  Remove the person out of the cold and remove any wet clothing.  Gently warm with person with blankets, shared body heat or dry warm compresses. Do NOT apply direct heat such as water, heat packs or heat lamps.  Monitor breathing and contact emergency medical services.

Staying warm and dry is the key preventing cold injuries.  Monitor the conditions and the time that you are outside.