CARE FOR THE SPINE-INJURED ATHLETE
ATHLETE WEARING HELMET AND SHOULDER PADS:
Recommended Face Mask Tools:
Anvil Pruning Shears
- Trainer's Angels
- FM Extractor - Most efficient
Procedure of face mask removal and when:
AT THIS TIME THE HELMET SHOULD BE LEFT IN PLACE
- Face mask should be removed as quickly as possible when you suspect player has a spinal injury and after they are stabilized on spine board.
- All four loop straps should be removed, so the face mask can be extracted.
- The helmet SHOULD ONLY BE REMOVED if the following occurs:
- If the face mask cannot be removed to gain access to the airway.
- If the helmet and chin straps do not securely immobilize the head.
- If the design of the helmet and chin strap cannot provide access to the airway after the removal of the face mask.
Procedure of helmet removal:
- Helmet and shoulder pads can be removed once the x-rays have been obtained.
- One person should stabilize the head and neck while another person cuts the chin strap.
- After the chinstrap has been cut then the ear pads need to be removed with the use of tongue depressors as well as the air bladders deflated with an inflation needle or a large hypodermic needle.
- The helmet should be slid off the athlete with some forward rotation and slight traction of the helmet.
- Be sure with the removal of the helmet to maintain neutral spinal alignment.
- Never spread the helmet apart by the ear holes due to the fact that this only serves to tighten the helmet on the forehead and occipital region.
Procedure of shoulder pad removal:
- The helmet and shoulder pads SHOULD BE REMOVED TOGETHER. If the helmet is removed then the shoulder pads should be removed as well.
- Cut jersey and all shirts from the neck to the waist and from midline to each arm.
- Cut all straps used to secure the shoulder pads to the torso and arms along with all accessories such as neck rolls and collars. Never try to unbuckle these straps due to the potential unnecessary movement. Full access to the chest, face, neck, and arms are available after all straps and shirts are cut.
- Remove shoulder pads, shirts, and jerseys at the same time the helmet is removed. This should be done with someone holding the spine in neutral position from the front or in a cephalad direction. Once that is established then the athlete will be slightly lifted with personnel strategically placed along the body. At this time the helmet will be removed along with the shoulder pads. The shoulder pads will be spread apart from the front panels and pulled around the head. Finally the patient is lowered.
Transfer of the Athlete
- Supine athlete - The six-plus person lift either to a scoop stretcher or directly onto a rigid stretcher should be used for the supine athlete rather than the log roll technique, which is used for the prone athlete.
- Prone athlete - The log roll technique should be used be for the prone athlete. There should be a minimum of four persons, with one person assigned to the head and neck. The person controlling the head CANNOT let go until the head and neck are secure.
- If the athlete is not breathing then the log roll should be performed immediately onto the playing surface, then transferred to a rigid spine board when it is available.
- If the athlete is conscious and stable, then the log roll should be delayed until the backboard is available.
- When possible athlete with no collar should be treated with a rigid cervical collar to ensure immobilization of all segmental levels before they are moved.
Chain of Command
- Most qualified individual should always be in charge, but should also respect the qualifications and expertise of his or her coworkers.
- Each healthcare provider has individual expertise and deserves the respect of the others working with this situation.
- No one discipline should have entitlement to supervision or performance of any particular aspect of the rescue. By working together, the knowledge and experience of individual team members can benefit the athlete in a critical situation.
Operator Considerations
The Virginia Tech sports medicine program utilizes the PhysioControl LifePak 500 AED. The Lifepak 500 is a semi-automatic defibrillator that uses a patented Shock Advisory System. This software algorithm analyzes the patient's electrocardiographic (ECG) rhythm and indicates whether or not it detects a shockable rhythm. The Lifepak 500 AED requires operator interaction in order to defibrillate the patient. The Lifepak 500 AED is intended for use by personnel (certified athletic trainers, student athletic trainers, and team physicians) who are authorized by a physician/medical director and have, at a minimum, the following skills and training:
CPR training (which meets the standards of American Red Cross)
AED training equivalent to that recommended by the American Red Cross
Training in the use of the Lifepak 500
Procedures for Training and Testing in Use of AED
Personnel using the AED must complete a training session each year, to include instruction in:
The proper use, maintenance, and periodic inspection of the AED.
Defibrillator safety precautions to enable the user to administer a shock without jeopardizing the safety of the patient, the user, or other persons.
Assessment of an unconscious person to determine if cardiac arrest has occurred and the appropriateness of applying an AED.
Recognizing that an electrical shock has been delivered to the patient and that the defibrillator is no longer charged.
Rapid, accurate assessment of the patient's post shock status to determine if further activation of the AED is necessary.
The operations of the local emergency medical services system, including methods of access to the emergency response system, and interaction with emergency medical services personnel.
The role of the user and coordination with other emergency medical service providers in the provision of CPR, defibrillation, basic life support, and advanced life support.
The responsibility of the user to continue care until the arrival of medically qualified
personnel.
Procedures to Ensure the Continued Competency Required for AED Use:
Personnel using the AED must complete a review session every ninety days using the AED training device and/or the AED Challenge computer simulation software for the PhysioControl LifePak 500 AED to ensure continued competency in the use of the device. A record will be maintained documenting medical staff competency training on the AED.
Medical Control Reporting and Incident Review
The Lifepak 500 AED digitally records patient data, including ECG rhythm and delivered shocks. A digital audio recording of scene activity is available. Recorded data may be transferred by direct connection to a printer or computer or by modem to a remote computer.
Following an incident of application, the data will be downloaded from the AED and reviewed by both the medical director and the attending physician(s) at the emergency facility where emergency care was provided. In addition, a report detailing the emergency scene and treatment will be documented in writing. The Lifepak 500 AED digitally records patient data, including ECG rhythm and delivered shocks. A digital audio recording of scene activity is available. Recorded data may be transferred by direct connection to a printer or computer or by modem to a remote computer.
Location and Maintenance of AED:
Virginia Tech University sports medicine program has five Lifepak 500 AED units. They will be housed at different sporting events with one maintained in the Eddie Ferrell Athletic Training Facility located at 160 Jamerson Athletic Center.
Based upon the sports covered, the AED unit may either be maintained in the athletic training facility or carried on-site to the athletic venue. The medical staff will determine the location and use of the AED unit at the athletic venues.
The Lifepak 500 AED performs an automatic self-test every 24 hours. If service is required, the AED activates an alarm. The non-rechargeable lithium batteries have a five-year life. If batteries require replacement the AED activates an alarm. Personnel using the AED on a regular basis and after each time the AED is used should inspect and clean the AED and check to make sure that all necessary supplies and accessories are readily available.