"When there is any concern of a spinal cord injury with a football player of any age, the removal of football helmets and/or shoulder pads is not recommended. Due to the risks related to excess movement of the spinal cord, the removal of this protective gear, unless deemed absolutely necessary by a trained medical specialist, is strongly discouraged." Mike Ryan, PT,ATC,PES Head Athletic Trainer/Physical Therapist, Jacksonville Jaguars
Adjuncts to the Response to an
Unconscious Athlete Kristian B. Goulet, MD and William P. Meehan III, MD When an athlete loses consciousness, it often causes panic and anxiety for the medical and coaching staff. If trained medical personnel are available, they should be allowed to tend to the athlete. If medical personnel are unavailable, EMS should be called immediately. If you are in a situation where you may be required to respond to an unconscious athlete, you should undergo proper training. At minimum, you should take a course in cardiopulmonary resuscitation (CPR) and the response to trauma. The following advice is to draw your attention to some important facts. It alone will not prepare nor qualify you to respond to the unconscious athlete. You will learn in your training that the most emergent medical needs must be evaluated first. This is as simple as remembering “ABC”: Airway, Breathing, and Circulation. Your course will describe how to evaluate and manage each of these. In athletes, especially those wearing bulky protective equipment, the protocols change from the response to non-athletes. Some of these changes are discussed below. Airway - The airway refers to the mouth, nose, throat, and windpipe. Mouth guards, loose teeth, or other objects obstructing the athlete’s airway must be removed. This must be accomplished with as little movement of the head and neck as possible. Unconscious athletes may have neck injuries, cervical spine fractures and injuries to the spinal cord. Unnecessary movement of the head and neck may lead to further injury of the spinal cord. Therefore, if a facemask prevents access to the airway, removing the facemask is preferable to removing the helmet. Multiple medical studies have shown that removing the facemask causes less movement of the neck than removing the helmet. In addition, most sports that require helmets also require shoulder pads. When athletes are lying on the ground wearing both their helmets and their shoulder pads, the bones of the neck are well-aligned. In most situations, leaving both the helmet and shoulder pads on the athlete is best. If the helmet is removed, but the shoulder pads are left in place, the athlete’s neck arches backwards, placing the athlete at risk for further injury. Thus, if the only way to help an unconscious athlete breathe is by removing the helmet, the shoulder pads should be removed as well. There are specific protocols for removing the helmet and shoulder pads of an injured athlete, while minimizing the movement of the neck. Any reader who might find themselves in this situation should familiarize themselves with these techniques, should undergo proper training, and should practice these techniques regularly. Breathing - Once you are able clear the airway from obstructions, you need to determine whether or not the athlete is breathing. If the athlete is not breathing, you need to assist with breathing. Certain techniques to ensure the tongue and other structures do not interfere with an athlete’s breathing will be taught during your CPR class. Two common techniques are the chin-lift maneuver and jaw-thrust maneuver. In an athlete who is unconscious after a head trauma, the jaw thrust is preferred as it results in less movement of the neck than the chin-lift. Circulation - Although it is uncommon after trauma, the athlete may not have a pulse. If this is the case, you may need to perform chest compressions as learned in your CPR class. Occasionally, shoulder pads may interfere with your ability to perform chest compressions. If the shoulder pads need to be removed from an unconscious athlete after trauma, the helmet should be removed as well, in order to preserve proper alignment of the bones of the neck. Again, proper techniques must be used in order to minimize movement of the neck. If the athlete is unconscious, but breathing well and has a pulse, simply kneel behind the top of the head and hold the head and neck in place with your two hands until medical help arrives. Suggested Readings: 1. Ghiselli G, Schaadt G and D. R. McAllister. 2003. On-the-field evaluation of an athlete with a head or neck injury. Clin Sports Med (22); 445– 465.
5. Banerjee R,
Palumbo MA, Fadale PD.
Catastrophic cervical spine injuries in
the collision sport athlete, part 1:
epidemiology, functional anatomy, and
diagnosis.
Am
J Sports Med. Jun
2004;32(4):1077-1087. |
|
|
|
Copyright © 2010
SportsConcussions.org. All Rights Reserved.
SportsConcussions.org does not provide medical advice, diagnosis or
treatment. Additional
Information
Phone: | 360-775-8197 |
Editor: Jean Rickerson: |
SportsConcussions.org |
Main Email: | SportsConcussions@yahoo.com |
Connecticut Office: | SportsConcussionsCT@yahoo.com |
Rhode Island Office: | SportsConcussionsRI@yahoo.com |
Facebook: | SportsConcussions@yahoo.com |
More: | Contact Information |