Injury Management


ATTENTION, the information presented here is in no way a substitute for a course in C.P.R. or first aid offered by various recognized organizations. It is simply intended to be complimentary information.


Principles of management

General principles

  • Act to the extent of your knowledge
  • Know your athletes
  • Remain calm at all times
  • Act quickly, but safely
  • Recognize an exceptional injury (see below)
  • Distance people from the injured person
  • Let the injured person guide you in your actions

Stages of evaluation

  • Look
    By witnessing an accident, you immediately obtain the essential information needed to take charge of the situation..
  • Think
    While you are approaching the injured person, you should already be able to predict if there is an exceptional injury that will require immediate emergency transportation. Mentally prepare your intervention.
  • Observe
    Observe the injured person and in particular the injured area. This should provide you with the rest of the information needed to make a decision. Establish their state of consciousness and/or talk to the injured person. Check how they are feeling and ask them to execute a couple of movements of the injured area.
  • Touch
    As a general rule, you will not need to touch the injured area at this stage, with the exception of certain specific or exceptional injuries.


Common injuries

The vast majority of sports injuries that we encounter are soft tissue injuries, very often of muscles or ligaments and with signs and symptoms that are always quite similar. The role of the first aid person on the team is not to identify the exact structure, type of lesion or the degree of injury but rather to adequately manage the injury in its’ critical early stages. The application of Ice (15 min.-90 min.), Compression (an elastic bandage relatively tight) and Elevation of the affected region is still the recommended way to react (ICE). Don’t forget that the first aid applied during the first 6-12 hours post-injury is very important.

If there is an obvious fracture, a deformity at the level of the injured area, do not apply this method (ICE) of first aid. For all injuries, a medical follow-up and often an x-ray are necessary to eliminate the possibility of a fracture.

As far as bleeding is concerned, it is important to differentiate between minor, moderate and major cases. Minor bleeding is frequent and without risk. Nobody would concede to the necessity of sutures here and so this is an obvious situation. In this case, clean the area with soap and water, rinse well and apply a band-aid. Major bleeding is also very easy to recognize and its’ management is described below.

Moderate bleeding, therefore, is that which leads us to have doubts as to whether or not sutures are necessary. This is not for us to decide. Treat this case as a major bleeding and ensure that a medical consultation is done as early as possible, within at least 4 hours.

Other types of interventions are indicated in the following sections.


Specific injuries

Arrested breathing

It happens to most people at one point or another: breathing is cut off following a blow to the abdomen. It is a very stressful situation. We really have the impression that we will stay like this. This feeling of ‘’having the wind knocked out of you’’ is a result of an involuntary spasm of the diaphragm, the principal breathing muscle. What should we do when faced with this situation?

Firstly, one must realize that the worst-case scenario in this situation is that the person could go unconscious due to a lack of oxygen. It is necessary, therefore, to ensure that she does not hurt herself while falling. Once unconscious, as a general rule, a state of normal breathing will return without any intervention on our part. Before the person loses consciousness, you must maintain eye contact with them, attempt to calm them and ask them to try to take small quick breaths while keeping the lips pinched shut. Rarely do these cases fall fully unconscious.

Hits to the testicles

Evidently this problem occurs in only approximately 50% of the population. For those who have experienced it, it seems the pain is considerable. Women will certainly say that from their perspective child delivery is worse. Evidently, management of the situation is not the same!

A sudden blow to the testicles can provoke a sharp pain, accompanied by vomiting. The fetal position is automatically adopted. The first aid person intervening must initially attempt to gently stretch the legs of the individual while calming him. If unable to perform this gesture, the first-aider could place himself behind him, seize the injured person by the thorax, raise him up about 5-10 centimeters and let him fall back on his buttocks to the ground.

The impact has the same effect as jumping on one’s heels and has the tendency to diminish the cremasteric spasm which is in large part responsible for the pain. When the pain has diminished, proceed with the extension of the legs.

Broken tooth

It is possible for a dentist to re-attach a broken tooth or to re-implant a whole tooth. You must get to the dentist as quickly as possible, bringing the tooth either in a small container of milk or easier still, place it in a damp compress inside the cheek of the injured person.

It is very important to try to find the piece or pieces of the tooth because upon impact the injured person may have inhaled some of them. A pulmonary x-ray would be necessary to eliminate this possibility.

Nosebleeds

One frequently has to intervene for nosebleeds. At one time, it was recommended that the injured party keep his head back and pinch the nose. Today, it is still recommended to pinch the nose, but to instead bend the head slightly forward. Keep the nose pinched until the bleeding ceases totally. Do not allow the person to blow their nose for a significant lapse of time. If there is an obvious fracture, the injured person will not likely let you pinch the nose. In this case, ensure that they are safely transferred to the nearest hospital.


Exceptional injuries

Loss of consciousness

Nobody can adequately evaluate an unconscious person since they cannot respond to our questions and demands nor can they demonstrate their physical or mental capacities. We must all therefore, until proof of the contrary, presume a major cervical injury exists which requires the utmost caution. Faced with this situation, it is necessary that the injured person be able to breathe, that a pulse be present and that emergency transportation be initiated. We never move an unconscious person. Ambulance services are the only ones equipped to execute this safely.

Spinal column

A neck or back injury must be handled very cautiously. Generally, the person will feel some pain at the site of the injury, possibly accompanied by one or several of the following symptoms: swelling, loss of sensation, weakness (feeling of heaviness) and radiating pain to the upper or lower limb depending on the injury. As long as the injured person is able to breathe and they have a pulse, they should never be moved. Wait for the emergency transport team to arrive. If unable to confirm a pulse and breathing, proceed with artificial resuscitation.

Concussion

A concussion is an injury to the brain. Therefore, it is quite normal that it generates particular concern and care. Concussions are generally light but some of them can be quite serious.

A concussion is characterized by a change in the person’s mental state. He may experience a state of confusion, dizziness, loss of consciousness and/or memory, nausea, vomiting, headaches, fatigue, an absent look, spatial and/or temporal disorientation, lack of coordination, etc.

In all cases, a concussion requires immediate removal from play and a visit to a health professional is necessary. Never administer aspirin or similar medication, even if there is a headache. Consult a doctor before taking anything. Only ice may be used safely. As with any injury, but especially with concussions, a gradual return to play with specific training is necessary. The brain needs time to heal and only a gradual return to training will guide us as to its’ stage of readiness. If the athlete is ready (healed), none of the above mentioned symptoms should reappear with intense effort.

Major bleeding

Regardless of his size, the human adult contains only four to five liters of blood. We cannot afford to lose a lot of it. Consequently, it is necessary to control blood loss immediately and to get the victim to a hospital center without delay.

The best way to contain bleeding is with direct pressure on the wound. Wearing gloves is strongly recommended. One must attempt to bring the sides of the laceration together, apply sterile compresses and firmly compress the area. Never take away the first layers of bandages that have already been applied. Add layers on as necessary. Do not use a tourniquet.


Accident report

Any injury that requires that a player stop playing during a match or practice should be documented. It does not have to be elaborate nor do you have to indicate a diagnosis but it is important to relate the facts as they happened. A standardized form should be utilized and attached to the athlete’s medical information form (see medical history). We have taken care to provide you with a standardized form that you may use if you wish. Click here to see it and print it out.


Return to play

We all ask ourselves the same question eventually. Is he/she ready to return to play? Sometimes we have the impression that people take out their crystal ball to find the answer. And yet, this decision is very straightforward and the person responsible for health and safety has an important role to play here.

Firstly, after an injury and an absence from competition, it is essential to obtain the opinion of a health professional (doctor and/or physiotherapist). Next, the athletes’ capacities to perform technical skills required for the practice of his sport must be verified progressively. Using practices, he can be put into game-like situations that are increasingly difficult until he demonstrates abilities that correspond to his initial skill performance level or that we judge acceptable and not representing a risk.

 


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