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Appendix C
Essential Emergency Procedures
Note: These are not comprehensive emergency procedures. The WSFL, to
protect its players, feels these are things all teams need to know to
assess players for return to play eligibility, and aid teams in knowing
when to activate EMS. WHEN IN DOUBT, ACTIVATE EMS. At times it may be
acceptable for an individual on the team to drive the player to the
hospital, however, in the event of unforeseen circumstances it is likely
that the drive will be unable to assist.
* Any time EMS is activated team captain should see a written release
from health practitioner
Heat Related Problems
Heat Cramps = Muscle spasms and cramps due
to loss of salt from profuse sweating and too much is taken without
replacing salts.
Heat Exhaustion = Heat emergency causing pooling of blood in
capillaries just below the skin, and away from vital organs. Skin may be
normal to cool, pale or gray in color and sweaty, altered mental status
unlikely.
Heat Stroke = Heat regulating mechanisms breakdown
- Body Overheats
- 50% will continue to sweat, 50% stop sweating
- Skin will be hot and red
- Moist or dry
- Probably altered mental status
Signs and Symptoms of Heat Emergency
Muscle cramps
Weakness and exhaustion
Dizziness or faintness
Rapid heart beat which grows more rapid and weak
Deep, rapid breathing which becomes shallow and weak
Headache
Seizures
Nausea/vomiting
Pale or red skin
Cool or hot skin
Altered mental status (possible unresponsive)
Hot skin whether dry or moist is dire medical emergency
Care and Return Policy
Heat Cramps = loosen pads, move to cool
place, introduce fluids with electrolytes (Electrolyte powders,
Gatorade, etc.). Return to play on cessation of symptons.
Heat Exhaustion = Transport via EMS if:
- Unresponsive, altered mental status
- Vomiting
- Temp over 101 F
- Poor medical history
- Does not respond to therapy
Therapy
- Move player to cool place
- Remove pads and clothing
- Apply cold compresses, fan player (especially areas at folded
skin, i.e. neck, armpits, groin).
- Lie on back with legs elevated 8-12"
- Water if alert and not nauseous
- NO water if unresponsive and nauseous/vomiting or altered mental
state.
If player does not respond after 15 minutes of therapy must
contact EMS. PLAYER WILL NOT RETURN TO COMPETITION
Heat Stroke
- Activate EMS immediately
- Maintain Airway
- Move to coolest area possible (air conditioned car if possible)
- Remove clothing
- Utilize same therapies as with heat exhaustion
* PLAYER WILL NOT RETURN TO COMPETITION
Concussions
Grade I
- No loss of consciousness
- Transient confusion (inattentive, poor stream of thought)
- Symptoms resolve in less than 15 minutes.
Grade II
- No loss of consciousness
- Transient confusion
- Amnesia = anterograde (before incident) or retrograde (after
incident)
- Symptoms last longer than 15 minutes
Grade III
- Any loss of consciousness
Management
Grade I
- Remove from play
- Examine at 5 minute intervals
- May return if symptoms clear in 15 minutes
Grade II
- Remove from play for rest of day
- Instruct player to be professionally examined within 24 hours
- Return to play after 1 asymptotic week (rest from exertion)
Grade III
- CALL FOR EMS IMMEDIATELY
- Maintain airway
- May return after 2 asymptotic weeks
What Constitutes an Asymptotic Week
All signs of concussion and post-concussive syndrome alleviated
- Vacant stare
- Delayed verbal/motor responses
- Confusion, problems with focus
- Disorientation
- Slurred speech
- Gross uncoordination
- Disproportionate emotional responses
- Memory deficits
Post Concussive Syndrome
Headache after exertion
Personality changes
Dizziness
Fatigue
Irritability
Impaired memory and concentration
Must Perform These Without Symptoms
Orientation: aware of time, place, situation, etc.
Concentration: remember 3-5 digits backward and forward, months of
year, forward and backward.
Memory: recall lists of 3 items/objects, recall recent newsworthy
events, details of contest.
Physical Performance: 40 yd sprint, 5 push ups, 5 sit ups, 5 deep
knee bends, upper extremity strength tests.
* Neurological test should be performed by professional if used to
assess player.
Neck and Spinal Cord Injuries
Erroneously returning player to participation can cause significant
morbidity/mortality, even paralysis and death. When in doubt, activate
EMS.
If you suspect a spinal injury, do not attempt to move or lift
player.
Players may not wear dark or reflective shields because it will
prevent visualization of pupils.
Activate EMS if player does not get up on their own in 2-3 minutes,
or suffers paralysis or numbness/tingling of extremities.
Return to play only if:
- Free of pain and spasm.
- Free of arm and leg symptoms at rest during range of motion tests.
- Pain free on active and passive neck range of motion.
- Athlete shows normal strength on neck and arm range of motion.
- Athlete shows no sign of concussion.
Appendix B
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