Dealing with serious injuries

DEALING WITHDEALING WITH
SERIOUS INJURIESSERIOUS INJURIES

CRISIS MANAGEMENTCRISIS MANAGEMENT
DD DANGERDANGER
RR RESPONSERESPONSE
AA AIRWAYAIRWAY
BB BREATHINGBREATHING
CC CIRCULATIONCIRCULATION

DANGER –DANGER – Remove DangersRemove Dangers
 Check the surrounding area for dangers, such as biological hazards, electricalCheck the surrounding area for dangers, such as biological hazards, electrical
wiring, glass, hazardous fumes, etc. Only proceed if the area is safe. Youwiring, glass, hazardous fumes, etc. Only proceed if the area is safe. You
cannot help anyone if you are injured yourself.cannot help anyone if you are injured yourself.
 Check for and control dangers to; yourself, the injured athlete and otherCheck for and control dangers to; yourself, the injured athlete and other
peoplepeople
 Remove the danger or remove the injured athlete from the dangerRemove the danger or remove the injured athlete from the danger
 An athlete may be worsened by moving them, in most cases the game willAn athlete may be worsened by moving them, in most cases the game will
stop until they are moved.stop until they are moved.
 A collapsed or injured athlete should be moved if; ensures the safety of theA collapsed or injured athlete should be moved if; ensures the safety of the
athlete, extreme weather conditions make it essential, to care for ABC and toathlete, extreme weather conditions make it essential, to care for ABC and to
control severe bleeding.control severe bleeding.
 Biological hazards (secretions from the nose and mouth – saliva and mucus,Biological hazards (secretions from the nose and mouth – saliva and mucus,
vomit, blood and any other bodily fluids) present a risk of transmittingvomit, blood and any other bodily fluids) present a risk of transmitting
infectious disease and should be controlled before continuing furtherinfectious disease and should be controlled before continuing further
management eg wearing protective gloves.management eg wearing protective gloves.

RESPONSE –RESPONSE – “Shake and Shout”“Shake and Shout”
 Check for response using “Shake and Shout”, gently shake theCheck for response using “Shake and Shout”, gently shake the
athlete by the shoulder, give the athlete a simple command egathlete by the shoulder, give the athlete a simple command eg
“open your eyes” or “squeeze my hand, let it go”.“open your eyes” or “squeeze my hand, let it go”.
 Infants and small children should never be shaken; they should be assessedInfants and small children should never be shaken; they should be assessed
by shouting and gentle stimulation.by shouting and gentle stimulation.
 If the athlete respondsIf the athlete responds (can speak or obey a command) they(can speak or obey a command) they
are conscious and should be; assisted into a position of comfort,are conscious and should be; assisted into a position of comfort,
checked for and managed bleeding, check for and manage anychecked for and managed bleeding, check for and manage any
other injuries (STOP) and observed until an ambulance arrives.other injuries (STOP) and observed until an ambulance arrives.
 If the athlete does not respondIf the athlete does not respond or gives an abnormal responseor gives an abnormal response
(doesn’t open eyes, cannot speak, cannot obey a command or(doesn’t open eyes, cannot speak, cannot obey a command or
gives an unintelligible response) he/she is unconscious or semigives an unintelligible response) he/she is unconscious or semi
conscious and should be; gently turned on the side whilst caringconscious and should be; gently turned on the side whilst caring
for the neck and head, clear and open the airway, not be leftfor the neck and head, clear and open the airway, not be left
alone and an ambulance will need to be called.alone and an ambulance will need to be called.

AIRWAY –AIRWAY – Open and Clear airwayOpen and Clear airway
An airway obstruction is when the airway is blocked andAn airway obstruction is when the airway is blocked and
affecting the oxygen intake. It may be caused by; internalaffecting the oxygen intake. It may be caused by; internal
structures (tongue, epiglottis), foreign material (food,structures (tongue, epiglottis), foreign material (food,
mouthguard, vomit) and unconsciousness.mouthguard, vomit) and unconsciousness.
In an unconscious athlete the airway takes precedenceIn an unconscious athlete the airway takes precedence
over all other injuries including spinal.over all other injuries including spinal.
1.1. Roll the athlete into the side position to clear the airwayRoll the athlete into the side position to clear the airway
a.a. Kneel beside the athleteKneel beside the athlete
b.b. Place athletes farther arm at a right angle to the bodyPlace athletes farther arm at a right angle to the body
c.c. Place the arm nearest you across the chest with the fingers at the top ofPlace the arm nearest you across the chest with the fingers at the top of
the shoulderthe shoulder
d.d. Bend the knee closest to you to right angles at the hip and the kneeBend the knee closest to you to right angles at the hip and the knee
e.e. Place one hand on the athletes shoulder and grasp the thigh with thePlace one hand on the athletes shoulder and grasp the thigh with the
other handother hand
f.f. Gently roll the athlete away from you, ensuring head and body alignmentGently roll the athlete away from you, ensuring head and body alignment
are maintainedare maintained
g.g. Keep upper leg bent during turn and while checking airway andKeep upper leg bent during turn and while checking airway and
breathingbreathing

AIRWAY –AIRWAY – continued….continued….
Head tilt and jaw support will open the airwayHead tilt and jaw support will open the airway
in most situations and must be performed onin most situations and must be performed on
an athlete on their side.an athlete on their side.
2.2. Open the mouth and use your fingers to remove anyOpen the mouth and use your fingers to remove any
visible foreign material from the mouthvisible foreign material from the mouth
3.3. Place one hand on the athlete’s forehead and the otherPlace one hand on the athlete’s forehead and the other
on the chin and gently tilt the head backwards andon the chin and gently tilt the head backwards and
slightly down. This will allow fluid to drain from theslightly down. This will allow fluid to drain from the
mouth and for gravity to keep the tongue forward tomouth and for gravity to keep the tongue forward to
clear the airway.clear the airway.

BREATHING –BREATHING – Look, listen & feelLook, listen & feel
 With the athlete lying on their side and the head in backward tiltWith the athlete lying on their side and the head in backward tilt
and jaw supported;and jaw supported; looklook for the rise and the fall of the chest andfor the rise and the fall of the chest and
upper abdomen,upper abdomen, listenlisten for the sound of air leaving the mouthfor the sound of air leaving the mouth
and nose andand nose and feelfeel for the air and leaving the mouth and nose byfor the air and leaving the mouth and nose by
placing your cheek close to the mouth and nose ANDplacing your cheek close to the mouth and nose AND feelfeel forfor
the movement of the upper abdomen and chest by placing thethe movement of the upper abdomen and chest by placing the
palm of your hand on the lower end of the athletes ribcage.palm of your hand on the lower end of the athletes ribcage.
 If breathing is present;If breathing is present; leave in the side position, ensure theleave in the side position, ensure the
head is in a backward tilt and face is slightly downwards, observehead is in a backward tilt and face is slightly downwards, observe
ABC, check for and manage bleeding, check for and manage anyABC, check for and manage bleeding, check for and manage any
other injuries (STOP) and await the ambulance.other injuries (STOP) and await the ambulance.
 If breathing is not present;If breathing is not present; turn the athlete on their back,turn the athlete on their back,
ensure head tilt and jaw support and commence EAR (Expiredensure head tilt and jaw support and commence EAR (Expired
Air Resuscitation)Air Resuscitation)

CIRCULATION –CIRCULATION – Check pulseCheck pulse
Feel for a carotid pulse at the neck:Feel for a carotid pulse at the neck:
1.1. Maintain backward head tiltMaintain backward head tilt
2.2. Place 2 – 3 fingers of the hand that was supporting the jawPlace 2 – 3 fingers of the hand that was supporting the jaw
gently on the Adams apple and slide them into the groovegently on the Adams apple and slide them into the groove
between the large muscle of the neck and the Adams applebetween the large muscle of the neck and the Adams apple
3.3. Feel gently but firmly with the flat portions of the fingers. DOFeel gently but firmly with the flat portions of the fingers. DO
NOT use the fingertips as they are less sensitiveNOT use the fingertips as they are less sensitive
4.4. Feel the pulse for up to 10 secondsFeel the pulse for up to 10 seconds
 If the pulse is present and the athlete is not breathingIf the pulse is present and the athlete is not breathing;;
continue EAR at 15 inflations/minute (1 breath every 3 – 4continue EAR at 15 inflations/minute (1 breath every 3 – 4
seconds), check for breathing and pulse at 1 minute and thenseconds), check for breathing and pulse at 1 minute and then
every 2 minutes, continue EAR until breathing returns orevery 2 minutes, continue EAR until breathing returns or
ambulance arrivesambulance arrives
 If there is no breathing and no pulse and the athlete isIf there is no breathing and no pulse and the athlete is
unconscious commence CPR immediately.unconscious commence CPR immediately.

DRABC FLOWCHARTDRABC FLOWCHART
 Make comfortable
 Observe ABC
 Check & manage
bleeding
 Check & manage othe
injuries
 Send for medical assistance
 Roll into side position
 Tilt head backwards
and slightly down
 Open mouth and clear
objects
 Open airway
 Stabilise side position
 Observe ABC
 Check for and manage
bleeding
 Check for & manage
other injuries
 Turn athlete onto back
 Commence EAR
 Give 5 full inflations in 10 seconds
 Continue EAR
15 per minute
 Check BC after
1min and then
every 2
 Commence CPR
 1 rescuer 2:15, 2 rescuers 1:5
 Check BC after 1 minute and then every 2
 Continue until an ambulance arrives or pulse/breathing returns
AIRWAY
Check airway is clear and open
DANGER
Control dangers to self and others
RESPONSE
“Shake and Shout”
BREATHING
“Look, Listen and Feel”
CIRCULATION
Check pulse
NO
NO
YES
NO
YES
NO
YES
YES
NO

EXPIRED AIR RESUSITATIONEXPIRED AIR RESUSITATION
(EAR)(EAR)
EE EXPIREDEXPIRED
AA AIRAIR
RR RESUSCITATIONRESUSCITATION
Keeping the airway open – head tilt and jaw support:Keeping the airway open – head tilt and jaw support:
1.1. If not breathing, roll the athlete onto the backIf not breathing, roll the athlete onto the back
2.2. Kneel alongside the head and neckKneel alongside the head and neck
3.3. Place one hand on the athlete’s foreheadPlace one hand on the athlete’s forehead
4.4. Place the other hand on the chin using the pistol gripPlace the other hand on the chin using the pistol grip
• Knuckle of bent middle finger underneath point of chinKnuckle of bent middle finger underneath point of chin
• Index finger extended along the line of the jawIndex finger extended along the line of the jaw
• Thumb along the front of the jaw (in groove between lip and chin)Thumb along the front of the jaw (in groove between lip and chin)
• Ensure there is no pressure from fingers on the soft tissue of the neckEnsure there is no pressure from fingers on the soft tissue of the neck
1.1. Gently tilt the head back while supporting the jaw forward atGently tilt the head back while supporting the jaw forward at
the point of the jawthe point of the jaw

MOUTH TO MOUTH - EARMOUTH TO MOUTH - EAR
Having checked for dangers, opened the airway and checked thatHaving checked for dangers, opened the airway and checked that
there is no response or breathing:there is no response or breathing:
1.1. Kneel alongside the athlete’s head and neckKneel alongside the athlete’s head and neck
2.2. Turn the athlete on their backTurn the athlete on their back
3.3. Ensure head tilt and jaw supportEnsure head tilt and jaw support
4.4. Use the hand on the chin to maintain jaw support and ensure the athlete’sUse the hand on the chin to maintain jaw support and ensure the athlete’s
mouth is slightly open. Do not open the athletes mouth too wide as thismouth is slightly open. Do not open the athletes mouth too wide as this
may cause further airway obstructionmay cause further airway obstruction
5.5. Pinch the athletes nostrils with your thumb and first finger (keep the heelPinch the athletes nostrils with your thumb and first finger (keep the heel
of the hand on the forehead to maintain head tilt) or seal the nostrils withof the hand on the forehead to maintain head tilt) or seal the nostrils with
your cheek when you breathe into the athletes mouthyour cheek when you breathe into the athletes mouth
6.6. Take a deep breath and open your mouth widelyTake a deep breath and open your mouth widely
7.7. place your mouth over the athletes mouth ensuring a tight sealplace your mouth over the athletes mouth ensuring a tight seal
8.8. Blow firmly into the athlete’s mouth, until the athletes chest rises. LookBlow firmly into the athlete’s mouth, until the athletes chest rises. Look
for the rise of the athletes chest after each breathfor the rise of the athletes chest after each breath
9.9. Remove your mouth from the athletes mouth and turn head to look forRemove your mouth from the athletes mouth and turn head to look for
the fall of the chest: listen and feel for the escape of air from the athletesthe fall of the chest: listen and feel for the escape of air from the athletes
mouthmouth
10.10. Give five full inflations in ten secondsGive five full inflations in ten seconds

MOUTH TO MOUTH – EAR cont..MOUTH TO MOUTH – EAR cont..
If the chest does not rise, check for:If the chest does not rise, check for:
 Airway obstructionAirway obstruction
 head tilthead tilt
 jaw supportjaw support
 tongue or foreign object obstructing the airway (if there is a foreigntongue or foreign object obstructing the airway (if there is a foreign
object, roll them onto their side and remove, then roll onto back andobject, roll them onto their side and remove, then roll onto back and
commence CPR)commence CPR)
 Insufficient air being blown into the lungsInsufficient air being blown into the lungs
 Inadequate air seal, causing leaks at the nose or the mouthInadequate air seal, causing leaks at the nose or the mouth
Reassess, give another breath and check for the rise ofReassess, give another breath and check for the rise of
the chest. If there is still no rise there may be anthe chest. If there is still no rise there may be an
obstruction which will need to be clearedobstruction which will need to be cleared
If the chest does rise:If the chest does rise:
 Give 5 full inflations in 10 secondsGive 5 full inflations in 10 seconds
 Feel for a carotid pulseFeel for a carotid pulse

CARDIO PULMONARYCARDIO PULMONARY
RESUSCITATION (CPR)RESUSCITATION (CPR)
CC CARDIOCARDIO
PP PULMONARYPULMONARY
RR RESUSCITATIONRESUSCITATION
‘‘Any CPR, even if the technique is not perfect, isAny CPR, even if the technique is not perfect, is
better than none!!’better than none!!’
CPR is a combination of inflating the lungs (EAR) andCPR is a combination of inflating the lungs (EAR) and
compressing the heart (ECC) to revive an athlete. Thecompressing the heart (ECC) to revive an athlete. The
aim is to ensure that oxygen is delivered to the brain soaim is to ensure that oxygen is delivered to the brain so
as to prevent irreversible damage. By performing CPRas to prevent irreversible damage. By performing CPR
you give the individual a chance of survival, no CPR –you give the individual a chance of survival, no CPR –
no chance.no chance.

PERFORMING CPR – EXTERNALPERFORMING CPR – EXTERNAL
CARDIAC COMPRESSIONS (ECC)CARDIAC COMPRESSIONS (ECC)
1.1. Kneel alongside the athletes chest, knees close to the side ofKneel alongside the athletes chest, knees close to the side of
the athletethe athlete
2.2. Locate the compression point (lower half of the sternum)Locate the compression point (lower half of the sternum)
 Find the bottom of the sternum (where it joins the ribs) by feelingFind the bottom of the sternum (where it joins the ribs) by feeling
along the lowest rib on both sides, moving from the outside until theyalong the lowest rib on both sides, moving from the outside until they
meet with the sternum, leave one index finger on this pointmeet with the sternum, leave one index finger on this point
 Find the top of the sternum by feeling the groove between theFind the top of the sternum by feeling the groove between the
clavicles, leave the other index finger on this pointclavicles, leave the other index finger on this point
 Find the mid point of the sternum by extending the thumbs of bothFind the mid point of the sternum by extending the thumbs of both
hands equal distances until they meet in the middle.hands equal distances until they meet in the middle.
1.1. Keep the thumb of the upper hand on the mid point of theKeep the thumb of the upper hand on the mid point of the
sternum and place the heel of the other hand on the lower halfsternum and place the heel of the other hand on the lower half
of the sternum. Keep the fingers relaxed, parallel to the ribsof the sternum. Keep the fingers relaxed, parallel to the ribs
and slightly raised so pressure will not be applied to the ribs.and slightly raised so pressure will not be applied to the ribs.

CARDIAC COMPRESSIONS (ECC) cont…CARDIAC COMPRESSIONS (ECC) cont…
4.4. Place the other hand securely on top of the first by:Place the other hand securely on top of the first by:
 grasping the wrist or,grasping the wrist or,
 placing the heel of the second hand on the back of the first hand andplacing the heel of the second hand on the back of the first hand and
interlocking the fingersinterlocking the fingers
4.4.
Apply compression through the heel of the bottom hand usingApply compression through the heel of the bottom hand using
your body weight to depress the lower half of the sternumyour body weight to depress the lower half of the sternum
approximately 4 – 5 cm. You should exert pressure fromapproximately 4 – 5 cm. You should exert pressure from
directly above the sternum and keep your compressing armdirectly above the sternum and keep your compressing arm
straight. Generate the compression by pivoting at the hips tostraight. Generate the compression by pivoting at the hips to
produce a rhythmical cycle with equal time for compressionsproduce a rhythmical cycle with equal time for compressions
and relaxation.and relaxation.
5.5. Apply 15 compressions in 10 – 12 seconds, then give 2 breathsApply 15 compressions in 10 – 12 seconds, then give 2 breaths
in 3 – 5 seconds. Continue CPR at minimum of 4 cycles perin 3 – 5 seconds. Continue CPR at minimum of 4 cycles per
minute.minute.

When performing ECC it is possible that ribs mayWhen performing ECC it is possible that ribs may
break, reassess compression site and depth and thenbreak, reassess compression site and depth and then
continue – it is better to break ribs than stopcontinue – it is better to break ribs than stop
performing CPR.performing CPR.
When performing CPR avoid:When performing CPR avoid:
 Rocking backwards and forwardRocking backwards and forward
 Bending the armsBending the arms
 Using quick jabs of depressive forceUsing quick jabs of depressive force
 Allowing the lower hand to slip from its correctAllowing the lower hand to slip from its correct
position on the lower half of the sternumposition on the lower half of the sternum
 Keeping pressure on the chest eg allow the chest to riseKeeping pressure on the chest eg allow the chest to rise
fullyfully

 1 person rescuer1 person rescuer
 15 compressions and 2 inflations (in approximately15 compressions and 2 inflations (in approximately
15 seconds)15 seconds)
 4 cycles per minute (minimum)4 cycles per minute (minimum)
 check breathing and pulse after 1 minute and thencheck breathing and pulse after 1 minute and then
every 2 minutesevery 2 minutes
1 minute1 minute
1 cycle1 cycle 1 cycle1 cycle 1 cycle1 cycle 1 cycle1 cycle
10 – 12 seconds10 – 12 seconds
15 compressions15 compressions
3 – 5 seconds3 – 5 seconds
2 inflations2 inflations

 2 person rescue team2 person rescue team
 5 compressions and 1 inflation (in approximately 5 seconds)5 compressions and 1 inflation (in approximately 5 seconds)
 12 cycles per minute12 cycles per minute
 The rescuer performing CPR should check for effective compressionsThe rescuer performing CPR should check for effective compressions
and return of pulse after 1 minute and then every 2and return of pulse after 1 minute and then every 2
 With 2 rescuers there should be no pause in compressions to allow forWith 2 rescuers there should be no pause in compressions to allow for
inflations. The rescuer performing ECC should count out loud so theinflations. The rescuer performing ECC should count out loud so the
inflations are performed without pausing.inflations are performed without pausing.
1 minute1 minute
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
11
cyclecycle
5 compressions5 compressions 1 inflation1 inflation

Recovery checks during CPR:Recovery checks during CPR:
Check for breathing and pulse after 1 minute and then every 2 minutesCheck for breathing and pulse after 1 minute and then every 2 minutes
1.1. Check the effectiveness of CPRCheck the effectiveness of CPR – When performing CPR the assistant– When performing CPR the assistant
should be able to feel the carotid pulse as chest compressions areshould be able to feel the carotid pulse as chest compressions are
occurring. With 2 person CPR the person performing EAR should feeloccurring. With 2 person CPR the person performing EAR should feel
for the pulse.for the pulse.
2.2. If the pulse is not felt during compressionsIf the pulse is not felt during compressions – advice the rescuer– advice the rescuer
performing ECC and check the position of the hands and the force andperforming ECC and check the position of the hands and the force and
depth of compressionsdepth of compressions
3.3. If a pulse is felt with each compressionIf a pulse is felt with each compression – immediately following an– immediately following an
inflation stop CPR and check for a spontaneous pulse for 5 seconds andinflation stop CPR and check for a spontaneous pulse for 5 seconds and
if there is no pulse continue CPRif there is no pulse continue CPR
4.4. If a spontaneous pulse is felt during a recovery checkIf a spontaneous pulse is felt during a recovery check – stop ECC,– stop ECC,
check for breathing, continue EAR until breathing occurs and check forcheck for breathing, continue EAR until breathing occurs and check for
the return of breathing and pulse every 2 minutes.the return of breathing and pulse every 2 minutes.
If the athlete regains and maintains a pulse and breathing – placeIf the athlete regains and maintains a pulse and breathing – place
the athlete into the side position and constantly observe ABCthe athlete into the side position and constantly observe ABC
until the ambulance arrives.until the ambulance arrives.

 Continue CPR until:Continue CPR until:
 Pulse returns and then continue EAR until breathing resumesPulse returns and then continue EAR until breathing resumes
 Athlete recoversAthlete recovers
 A doctor pronounces the athlete deadA doctor pronounces the athlete dead
 Expert assistance arrivesExpert assistance arrives
 It is physically impossible to continueIt is physically impossible to continue
It is important to call an ambulance as soon asIt is important to call an ambulance as soon as
possible. In most parts of Australia it is ‘000’,possible. In most parts of Australia it is ‘000’,
mobile phones are either ‘000’ or ‘112’ and can bemobile phones are either ‘000’ or ‘112’ and can be
used even if the keypad is locked or the sim card isused even if the keypad is locked or the sim card is
missing.missing.

 Resuscitating children (aged 1 – 8 years):Resuscitating children (aged 1 – 8 years):
1.1. When checking for breathing the child’s head should be in aWhen checking for breathing the child’s head should be in a
neutral position or slight tilt – depending on the age of theneutral position or slight tilt – depending on the age of the
childchild
2.2. When resuscitating a child use jaw support and slight headWhen resuscitating a child use jaw support and slight head
tilttilt
3.3. The rate of breathing is slightly quicker – 1 inflation every 3The rate of breathing is slightly quicker – 1 inflation every 3
seconds or 20 per minute and puff gently do not blowseconds or 20 per minute and puff gently do not blow
4.4. only one heel of the hand is used during compressions to aonly one heel of the hand is used during compressions to a
depth of 2 – 3 cms using the following ratiosdepth of 2 – 3 cms using the following ratios
 1 rescuer: Ratio 2:15 (in 10 seconds) at 6 cycles / minute1 rescuer: Ratio 2:15 (in 10 seconds) at 6 cycles / minute
 2 rescuers: Ratio 1:5 (in 3 seconds) at 20 cycles / minute2 rescuers: Ratio 1:5 (in 3 seconds) at 20 cycles / minute

 Comparison of children and adultComparison of children and adult
Resuscitation:Resuscitation:
Expired Air Resuscitation
Adult Child
15 breaths/minute
(1 every 4 seconds)
20 breaths /minute
( 1 every 3 seconds)
Cardiopulmonary Resuscitation
Adult Child
1 person
rescuer
2 person
rescuer
1 person
rescuer
2 person
rescuer
Ratio 2:15 1:5 2:15 1:5
Time / cycle 15 seconds 5 seconds 10 seconds 3 seconds
Min. cycles /
minute
4 12 12 20
Inflations /
minute
8 12 12 20
Compressions
/ minute
60 60 100 100
Compression
point
Lower half
of sternum
Lower half
of sternum
Lower half
of sternum
Lower half
of sternum
Depth of
compression
4 – 5 cm 4 – 5 cm 2 – 3 cm 2 – 3 cm

AIRWAY OBSTRUCTIONAIRWAY OBSTRUCTION
Choking athlete:Choking athlete:
 Signs:Signs:
 Athlete is unconsciousAthlete is unconscious
 Noisy, laboured breathingNoisy, laboured breathing
 WheezingWheezing
 Depending on the severity the athleteDepending on the severity the athlete
may be distressed and appear to bemay be distressed and appear to be
chokingchoking
 Management:Management:
 DO NOT interveneDO NOT intervene
 Encourage athlete to relax and coughEncourage athlete to relax and cough
 Allow athlete to adopt the mostAllow athlete to adopt the most
comfortable positioncomfortable position
 Refer to a hospital or doctorRefer to a hospital or doctor
Non Breathing athlete:Non Breathing athlete:
 When managing an unconscious athleteWhen managing an unconscious athlete
at may not be apparent that the airwayat may not be apparent that the airway
is obstructed until EAR is commenced,is obstructed until EAR is commenced,
thenthen
 The chest will fail to rise despiteThe chest will fail to rise despite
correct techniquecorrect technique
 Resistance is felt during inflationResistance is felt during inflation
 Management:Management:
 If finger sweeps do not clear theIf finger sweeps do not clear the
airway, position the head in a lowairway, position the head in a low
position to utilise the effects of gravity,position to utilise the effects of gravity,
then apply 4 rapid back blows with thethen apply 4 rapid back blows with the
heel of the hand between the shoulderheel of the hand between the shoulder
blades of the athlete.blades of the athlete.
 If back blows and gravity do notIf back blows and gravity do not
dislodge the obstruction then applydislodge the obstruction then apply
lateral chest thrusts (with the athlete onlateral chest thrusts (with the athlete on
their side, place the palms of 2 handstheir side, place the palms of 2 hands
on the side of the athletes chest closeon the side of the athletes chest close
to the arm pit and well clear of the ribs,to the arm pit and well clear of the ribs,
apply four firm lateral chest thrusts).apply four firm lateral chest thrusts).
 Lateral chest thrusts should only beLateral chest thrusts should only be
applied for aapplied for a COMPLETECOMPLETE airwayairway
obstruction.obstruction. DO NOTDO NOT apply if theapply if the
athlete is coughing and spluttering.athlete is coughing and spluttering.

SPINAL AND HEAD INJURIESSPINAL AND HEAD INJURIES
Spinal injuriesSpinal injuries are very serious and must be considered:are very serious and must be considered:
 In any incident where the athlete has been unconscious or had a period ofIn any incident where the athlete has been unconscious or had a period of
unconsciousnessunconsciousness
 In any athlete who has:In any athlete who has:
 pain or tenderness in the back or neckpain or tenderness in the back or neck
 an altered range of movement in the back or neck eg weakness or inability toan altered range of movement in the back or neck eg weakness or inability to
movemove
 altered sensation in any body part eg pins and needlesaltered sensation in any body part eg pins and needles
If a spinal injury is suspected or indicated:If a spinal injury is suspected or indicated:
 Conscious athleteConscious athlete – tell them not to move, DO NOT move the athlete– tell them not to move, DO NOT move the athlete
unless danger is present (if an athlete has to be moved take extreme care tounless danger is present (if an athlete has to be moved take extreme care to
ensure the head and neck are kept in alignment with the body and that theensure the head and neck are kept in alignment with the body and that the
injured athlete is fully supported) and call an ambulance.injured athlete is fully supported) and call an ambulance.
 Unconscious athleteUnconscious athlete – ABC takes priority over the injury, follow DRABC– ABC takes priority over the injury, follow DRABC
maintaining care with ensuring that there is no twisting or movement of themaintaining care with ensuring that there is no twisting or movement of the
head or the neck (especially if having to turn the athlete onto their side).head or the neck (especially if having to turn the athlete onto their side).
Techniques that are least likely to cause movement should be used eg jawTechniques that are least likely to cause movement should be used eg jaw
thrust rather than head tilt.thrust rather than head tilt.

SPINAL AND HEAD INJURIESSPINAL AND HEAD INJURIES
cont…cont… Head injuriesHead injuries must be associated with:must be associated with:
 Spinal injurySpinal injury
 Damage to the airwayDamage to the airway
 BleedingBleeding
 Altered consciousnessAltered consciousness
 Any athlete who has lost consciousness for any period of time:Any athlete who has lost consciousness for any period of time:
 ShouldShould NOTNOT be allowed to resume playbe allowed to resume play
 SHOULDSHOULD be referred to a doctor or hospital for assessmentbe referred to a doctor or hospital for assessment
 Any athlete who has sustained a head injury but not lost consciousness:Any athlete who has sustained a head injury but not lost consciousness:
 Should NOT be allowed to return to playShould NOT be allowed to return to play
 SHOULD have their parent notified and told to observe the athleteSHOULD have their parent notified and told to observe the athlete
 If any of the following are noticed by the parent, the athlete requires urgent medical attention:If any of the following are noticed by the parent, the athlete requires urgent medical attention:
 Persistent or worsening headachesPersistent or worsening headaches
 Excessive drowsinessExcessive drowsiness
 Unusual behaviour, such as confusionUnusual behaviour, such as confusion
 Weakness in the limbs or uncoordinated movementWeakness in the limbs or uncoordinated movement
 Slurred speechSlurred speech
 Vomiting or nauseaVomiting or nausea
 Seizure or obvious loss of consciousnessSeizure or obvious loss of consciousness
 Bleeding or discharge from ears, nose or mouthBleeding or discharge from ears, nose or mouth

BLEEDING AND SHOCKBLEEDING AND SHOCK
BleedingBleeding is the escape of blood from the blood vessels. Severeis the escape of blood from the blood vessels. Severe
bleeding is very serious and must be controlled very quickly.bleeding is very serious and must be controlled very quickly.
There are two types of bleeding; internal and external.There are two types of bleeding; internal and external.
External bleedingExternal bleeding
 RecognitionRecognition – is obvious and visible on the surface of the body– is obvious and visible on the surface of the body
 Hygiene infection controlHygiene infection control – is extremely important when dealing with– is extremely important when dealing with
blood. All precautions must be taken to reduce the risk of transmittingblood. All precautions must be taken to reduce the risk of transmitting
infectious disease. Strategies include:infectious disease. Strategies include:
 avoid contact between blood and your skin and eyesavoid contact between blood and your skin and eyes
 wear protective gloves, though do not delay management in obtaining gloveswear protective gloves, though do not delay management in obtaining gloves
 encourage the athlete to apply pressure themselvesencourage the athlete to apply pressure themselves
 cover your own open cuts with moisture proof dressingcover your own open cuts with moisture proof dressing
 ManagementManagement – the aim is to minimise the amount of blood lost, prevent– the aim is to minimise the amount of blood lost, prevent
further infection and prevent further damage.further infection and prevent further damage.
 If bleeding is not stoppingIf bleeding is not stopping – leave the dressing in place, relocate or– leave the dressing in place, relocate or
replace the first pad until adequate pressure is achieved and check that thereplace the first pad until adequate pressure is achieved and check that the
bleeding is controlled.bleeding is controlled.

MANAGEMENT OF EXTERNALMANAGEMENT OF EXTERNAL
BLEEDINGBLEEDING

INTERNAL BLEEDINGINTERNAL BLEEDING
Is usually invisible to the eye and very difficult to detect. The bleeding mayIs usually invisible to the eye and very difficult to detect. The bleeding may
be into an organ, tissue or body cavity.be into an organ, tissue or body cavity.
 Recognition –Recognition – may be accompanied by the signs and symptoms of shock asmay be accompanied by the signs and symptoms of shock as
well as:well as:
 pain or tenderness over or around the affected areapain or tenderness over or around the affected area
 swellingswelling
 coughing bloodcoughing blood
 vomiting bloodvomiting blood
 blood in the urine or faecesblood in the urine or faeces
 blood discharging from the ear or nose (head injury)blood discharging from the ear or nose (head injury)
 Management –Management –
 lay athlete downlay athlete down
 if the athlete is vomiting, place in side positionif the athlete is vomiting, place in side position
 raise the legs above the level of the heart (if injuries allow)raise the legs above the level of the heart (if injuries allow)
 seek medical assistance urgentlyseek medical assistance urgently
 monitor ABCmonitor ABC
 Do not allow the athlete to eat or drinkDo not allow the athlete to eat or drink
 Loosen tight clothingLoosen tight clothing
 Reassure the athleteReassure the athlete

SHOCKSHOCKShock is the condition when thereShock is the condition when there
is a gradual collapse of theis a gradual collapse of the
circulatory system. Shock maycirculatory system. Shock may
occur with severe bleeding, majoroccur with severe bleeding, major
fractures, severe diarrhoea andfractures, severe diarrhoea and
vomiting, severe sweating andvomiting, severe sweating and
dehydration or any traumaticdehydration or any traumatic
injury. It is important that theinjury. It is important that the
potential for shock is recognised aspotential for shock is recognised as
early as possible and managedearly as possible and managed
appropriately, if not shock can leadappropriately, if not shock can lead
to death.to death.
 Recognition:Recognition:
 Pale, cool, clammy skinPale, cool, clammy skin
 Weak and rapid pulseWeak and rapid pulse
 Rapid and shallow breathingRapid and shallow breathing
 Dizziness or feeling faintDizziness or feeling faint
 Anxiety and restlessnessAnxiety and restlessness
 ThirstThirst
 Nausea and vomitingNausea and vomiting
 ManagementManagement
 DRABCDRABC
 Control external bleedingControl external bleeding
 Seek medical assistanceSeek medical assistance
immediatelyimmediately
 Position athlete depending on thePosition athlete depending on the
cause of the shock (in sidecause of the shock (in side
position where comfortable, or inposition where comfortable, or in
position of greatest comfort)position of greatest comfort)
 Place a conscious athlete who feelsPlace a conscious athlete who feels
faint on their back and raise theirfaint on their back and raise their
legs above the level of the heartlegs above the level of the heart
 Manage any injuries presentManage any injuries present
 Maintain body temperature (DOMaintain body temperature (DO
NOT overheat the athlete)NOT overheat the athlete)
 Loosen any tight clothingLoosen any tight clothing
 Reassure and keep the athlete calmReassure and keep the athlete calm
and at restand at rest
 Do not allow the athlete to eat orDo not allow the athlete to eat or
drinkdrink

CHEST, ABDOMEN AND LIMBSCHEST, ABDOMEN AND LIMBS
Chest injuriesChest injuries are common in contactare common in contact
sports. Ask the athletesports. Ask the athlete
 Do you have any pain in the chest?Do you have any pain in the chest?
 Does it hurt if you take a deep breath?Does it hurt if you take a deep breath?
 If yes refer to health professionalsIf yes refer to health professionals
 Common injuries to the chest include -Common injuries to the chest include -
Nipple chaffing (apply Vaseline,Nipple chaffing (apply Vaseline,
protective tape and wear appropriateprotective tape and wear appropriate
clothing), soft tissue injury to the breastclothing), soft tissue injury to the breast
(RICER no HARM, wear firm(RICER no HARM, wear firm
support), bruising of chest wallsupport), bruising of chest wall
(RICER no HARM, look for signs of(RICER no HARM, look for signs of
internal bleeding and refer), fracturedinternal bleeding and refer), fractured
rib (fracture management, refer),rib (fracture management, refer),
collapsed lung (refer).collapsed lung (refer).
Major abdominal injuries are most uncommon
in sport.
 Injuries include – winding (rest until normal
breathing resumes), stitch (‘running through’ the
stitch or rest), internal bleeding (refer
immediately), contusion/bruise (RICER no
HARM, look for signs of internal bleeding, refer),
strained abdominal muscle (RICER no HARM,
look for signs of internal bleeding, refer)
Factors to consider withFactors to consider with limb injurieslimb injuries
include:include:
 Is there any injury to soft tissues?Is there any injury to soft tissues?
 Is there any injury to hard tissues?Is there any injury to hard tissues?
 Is there any skin injuries?Is there any skin injuries?
 Use TOTAPS to assess these factors.Use TOTAPS to assess these factors.

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