Chapter Six Principles of injury management

Learning outcomes

Identify the context and operations of a sports trainer in accordance with accepted principles of injury management.

1. Define and apply the DRSABCD principle for crisis management.

2. Define and apply the STOP principle.

3. Define and apply the TOTAPS principle.

4. Detail how to question injured athletes.

5. Describe the basic principles underlying assessment of an injury.

Assessment of outcomes

Underpinning knowledge

Oral or written questions may be asked relating to the principles and practices of injury management in a sporting context. You may also be asked to complete an online learning task related to the principles of injury management and submit copies of completed online tasks.

Practical demonstration

You may be asked to show the treatment of your athletes or manage medical documentation. You may be required to identify specific sporting injuries and use sports medicine equipment in the treatment of these injuries.

Scenario

You may be asked to perform one or more treatments of a range of sports-related injuries. You may also be asked to complete all necessary documents and complete a handover to other medical personnel.

Introduction

The primary role of the sports trainer is to prevent injury and improve safety in sport. However, the risk of injury always exists in the sporting environment so, in the absence of more qualified medical personnel, it is the responsibility of the sports trainer to appropriately assess and manage the situation, at least until more qualified help arrives. The sports trainer should calmly approach the situation and apply established procedures based on up-to-date medical knowledge. This chapter describes a set of injury management principles that can guide the sports trainer in the management of sports-related injuries. These principles can be applied regardless of the type or severity of the injury. It is assumed that the sports trainer has a high degree of first-aid proficiency, which is a prerequisite for all sports trainers.

The basic principles of injury management that sports trainers should be guided by are:

Before acting, check for potential danger to yourself as well as to other athletes and bystanders. Continue to reassess the situation and ensure your continued safety as well as that of other athletes and bystanders.

Rapidly assess the situation, including noting what has happened, how many athletes are involved and their general condition.

Call for help as soon as it is possible and safe to do so.

Assess the response of each athlete – unconscious athletes have priority of care.

Unless the condition is minor, or there is imminent danger, do not move the athlete. If an athlete must be moved, immobilise suspected fractures beforehand if it is possible.

If the accident was not witnessed, treat the athlete as if they have sustained a spinal injury and immobilise them appropriately.

An unconscious person who is breathing should be placed on their side (lateral position) to avoid choking and should be moved, if necessary, in this same position.

When carrying an athlete on a stretcher, ensure all movements are as smooth as possible and that the stretcher remains horizontal.

Explain to the athlete everything that is being done and continue to reassure them to minimise fear and improve cooperation.

Chain of survival

The assessment and management of a collapsed or apparently unresponsive person is based on the concept of the ‘chain of survival’. This is a series of linked actions that greatly increase a person’s chance of survival and are usually defined as:

Early access – call emergency services for help as soon as possible and get to the athlete to provide immediate assistance. This is sometimes referred to instead as early recognition.

Early cardiopulmonary resuscitation (CPR) – effective CPR can maintain cardiac output and provide oxygen to the brain.

Early defibrillation – defibrillation to restore normal heart function is applied as soon as possible.

Early advanced life support – trained personnel, such as doctors or paramedics, apply interventions such as medication, artificial airways or ventilation.

Figure 6.1 The chain of survival

For an athlete to have the best chance of survival, sports trainers must act quickly to assess the athlete’s condition, seek medical assistance and begin resuscitation until more qualified help arrives. CPR greatly increases the chance of survival.

All athletes who have collapsed or require crisis management for any reason must be sent to hospital, even if they appear to have fully recovered.

DRSABCD principles

Basic life support (BLS) is emergency treatment to maintain life with little or no equipment. The guidelines for BLS in Australia are continually monitored and regularly updated by the Australian Resuscitation Council in line with the latest available medical research and scientific opinion. The current BLS guidelines are commonly referred to by the acronym DRSABCD. They are also often referred to as the CPR guidelines.

Regardless of the reason or circumstances leading to a person collapsing or becoming apparently unresponsive, the principles of DRSABCD apply to all first aid cases. They provide the starting point for sports trainers in their assessment and management of an athlete.

DRSABCD principles

D	Dangers?
R	Responsive?
S	Send for help
A	Open Airway
B	Normal Breathing?
C	Start CPR
D	Attach Defibrillator

Figure 6.2 The Basic Life Support flow chart

Dangers?

Before attempting any further assessment or treatment, first check the area for danger to yourself, the athlete(s) and bystanders. As the rescuer, you should not put yourself in a situation where there is a risk of personal injury or death. You cannot help others if you add yourself to the casualty list by exposing yourself to danger.

Check the area around the site of the incident for anything that may cause further injury to the athlete or prevent you from helping them (e.g. electrical cables, sharp objects, dangerous wildlife etc). In a sporting situation, danger may be present in the form of other players, moving vehicles or other equipment. Always remember to check in all directions – ‘look up, look down, look around’ is a good principle to remember.

Move the athlete only if it is necessary to do so because of emerging danger that cannot be avoided or eliminated. If danger is present and the athlete cannot be attended to or removed safely, seek expert assistance, such as paramedics, and wait for them to arrive.

Figure 6.3 Check for danger

Responsive?

It is necessary to determine if the athlete is conscious or apparently unconscious. Gently squeeze the athlete’s shoulders and use the COWS phrases to assess the athlete’s response.

COWS phrases

C	Can you hear me?
O	Open your eyes
W	What is your name?
S	Squeeze my hand

While assessing whether they are responsive, be careful not to move the athlete’s neck.

If the athlete is responsive, place them in the lateral position and continue to monitor them until help arrives. If they are not responsive, continue with the DRSABCD principles.

Figure 6.4 Check for responsiveness

Send for help

If there is no response, the person must be regarded as unconscious, so immediately send for help. Call 000 for an ambulance or instruct someone else to call while you prepare to initiate CPR. If calling from a mobile phone that is locked or does not connect to 000, call 112, which will redirect to 000.

Figure 6.5 If unresponsive, send for help

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