o   broad field of medical practice related to physical activity and sport

-Defined as multi-disciplinary and including the physiological, biomechanical, psychological, and pathological phenomena associated with exercise and sports 

o   exercise physiologists

o   biomechanics

o   strength & conditioning coaches

o   sports nutritionists

o   sports psychology

o   personal fitness training

o   coaching

o   physical education

o   primary care physicians

o   orthopedic surgeons

o   athletic trainers

o   sports physical therapists

o   sports massage therapy

o   sports dentistry

o   osteopathic medicine

o   orthotists/prosthetists

o   sports chiropractic

o   sport podiatry

 An individual that organizes, plans and oversees leisure

activities and athletic programs in local recreation, camp

and park areas, playgrounds, health clubs, and fitness

centers, in the workplace and theme parks, and other

tourist attractions.

-Coaches

-Team Physicians 

-Certified Athletic Trainer

-Non-traditional settings may involve fitness/health care professionals with a family physician and/or parents

-Other related health care practitioners that may asisst:

o   strength & conditioning coaches

o   nurses

o   physical therapists

o   massage therapists

o   exercise physiologists

o   parents

1) Coordinating pre-participation physical exams or medical screening

2) Identifying pre-existing conditions or limiting factors (illness, biomechanics, etc.)

3)Providing medical management of injuries and illnesses on and off field

4)Coordinating rehabilitation and a safe return to participation after illness or injury

5)Providing education and counseling for coaches, athletes, and parents

6) Providing proper documentation and medical record keeping (certification exam, continuing education)

-Proper selection 

-Proper fit

-Mass production

-Equipment testing methods

-Requirements for wearing

-Maintenance 

-Potential risks inherent in using or misusing equipment 

-If an athlete is injured and it is determined that defective or inadequate equipment was responsible the manufacturer is responsible

-If an athletic trainer, coach or athlete modifies the equipment and is injured the liability on the part of the manufacturer is void and whoever modified the equipment absorbs the liability for those changes

Off-the-shelf: immediately available

Customized: sizing problems or individual fit

National Operating Committee on Standards of Athletic Equipment 

-They establish testing standards 

-Not a warrant but a statement indicating the equipment met standards 

-Place warnings in football helmets so they are visible (No helmet can prevent all injuries)

-Purpose is to disperse impact over a large surface and/or decelerate forces

-Helmets should be routinely checked for proper fit

1) Helmet should fit snug around all parts of the player's head (no gaps, not right enough to leave marks, credit card check between head and liner) 

2) The chin strap should be centered and fastened (prevents helmet from tilting forward and back)

3) Jaw pads keep helmet from tilting forward and backward

4) The base of the skull should be covered, occipital protuberance

5) The helmet should sit 3/4-1 inch above the eyebrows (1/4 front edge)

6) The ear holes should match

7) Face mask should be securely attached, allowing complete field of vision and positioned 3 finger widths from nose 

-Helmet should not shift when pressure is applied

-It should not recoil on impact

-Motions: Pull down on face mask (no rocking)

Turn helmet on head (no twisting)

Push down on helmet (no recoil)

-Hockey helmets

-Baseball helmets

-Bike helmets

-Fencing 

-Skate board

-Rodeo 

-Must withstand high velocity impact of stick or puck but also high mass low velocity forces produced by running into the boards or falling on the ice

-Face mask must be narrow enough not to let a hockey stick through

-1-1.5" between nose and face mask 

-Face guards

-Mouth guards

-Ear guards

-Eye protection

-Reduce the number of mouth and face injuries 

-Should not interfere with vision or head/neck motion

-Protects teetch

-Absorbs shock from chin blows and helps with concussions

-Minimize lacerations to the lips, cheeks, and fractures to the mandible

-Should hace a tight fit, be comfortable, not restrict breathing or impede speech

-Do not modify a mouth guard! (should cover last molar) 

-Measure the width of the shoulders, AC joint to AC joint or use chest size

-Split clavicle shoulder pad must align with the clavicle 

-Inside shoulder pad should cover the tip of the shoulder (acromion)

-Cups should cover deltoid muscle (anterior and posterior)

-Neck opening must allow the athlete to raise their arms above their head

-Posterior coverage of lateral border of scapula and inferior angle 

-The straps underneath must be snug to hold the pads in place

-Uniforms that are tucked in help hold the shoulder pads in the proper position

-Sports bras are designed to hold the breasts to the chest wall

-Prevent excessive vertical and horizontal movement and prevent stretching of the Cooper's ligament

-Wide shoulder straps

-No metal fasteners next to skin

-Body suits for football and hockey

-Padded bunners for volleyball and spine protection for rolling

-Rib belt

-Chest padding for children playing baseball or hockey to prevent cardiac contusions

-Hockey goalies are required to wear throat protection

-Athletic cups and jock straps 

(adolescent boys as soon as the testes drop)

-Sole

-Uppers

-Heel Counter

-Toe box

-Arch support

-Longest toe should be a nails width (or 1/2 to 3/4") from the end of the shoe

-Heel counter should not slip (should be firm when pinching sides together)

-Widest part of the foot matches up with the shoe, bend or break should be at that point and straight across (arch fits, laces 1" in width and doesn't create "tucks" in the toe box, toes should be able to extend w/o being cramped, toes should not be able to spread)

-Straight last shoe for excessive pronation

-Shoe should not "twist" through the arch

-Medial heel should not compress with hand force

-Used to try and place the foot in a neutral position and eliminate one area of stress, or repeated stresses

-A second trend is to move away from orthotics and use exercises to increase muscular support of the foot

-Ankle braces

-Shin and lower leg protection

-Thigh and upper leg

-Knee pads and bracing (rehabilitative, functional)

-Elbow, wrist and hand protection

A. Buy from "reputable" manufacturers

B. Buy safest, best equipment the budget can afford

C. Make sure all equipment is assembled correctly

D. Maintain all equipment

E. Use equipment for only the purpose it was designed for

F. Warn athletes of possible risks that using the equipment may entail

G. Use caution in the constructing or customizing any piece of equipment 

H. Do not use defective equipment

I. Routinely inspect equipment 

-Proper planning is essential to ensure appropriate initial first aid management of an injury 

-Anything done ahead of time to improve athletes' health should be a priority

-Failure to have an emergency action plan is grounds for negligence 

-Primary concern is maintaining cardiovascular and CNS functioning

-Key to emergency aid is the initial evaluation of the injured athlete

-Identifies personnel directly involved in carrying out the plan (identifies required training and roles)

-Specifies necessary equipment (AED, splints, etc. and location of them)

-Establishes a mechanism for communication (phones, numbers, medical records, who makes the call & info required)

-Identifies mode of transportation (routes, keys)

-Is specific to individual venues

-Incorporates local emergency care facilities 

-Specifies documentation needed to support plan implementation and evaluation

-Is reviewed and rehearsed at least annually, and the results of these efforts are documented

-Is reviewed by the administration and legal counsel of the sponsoring organization or institution 

-Athletic trainer generally first to arrive on scene of emergency, and has more training and experience transporting the athlete than physician

-EMT has final say in transportation, athletic trainer then assumes assistive role

-To avoid problems, all individuals involved in the plan should practice to familiarize themselves with all procedures (including equipment management)

-When athlete is a minor, ATC should try to obtain consent from parent prior to emergency treatment (based on HIPAA)

-Consent indicates that parent is aware of situation, is aware of what the ATC wats to do, and parental permission is granted to treat specific condition

-predetermined wishes of parent (provided at start of school year) are enacted

-With no informed consent, consent implied on part of athlete to save athlete's life

-Appropriate acute care cannot be provided without a systematic assessment occurring on the playing field first 

-On-field assessment

-Primary survey

-Secondary survey

-Performed initially to establish presence of life-threatening condition

-Airway, breathing, circulation, shock and severe bleeding

-Used to correct life-threatening conditions

-Assess vital signs and perform more detailed evaluation of conditions that do not pose life-threatening consequences 

-Used to identify additional problems in other parts of the body not necessarily associated with the injury

Ø  Life threatening injuries take precedents

Ø  Life threatening injuries include

–      Those injuries requiring cardiopulmonary resuscitation

–      Profuse bleeding

–      Shock

Ø  Rescue squad should always be contacted in these situations

Ø  Keep your CPR credentials current

Ø  Equipment Considerations

–      Equipment may compromise lifesaving efforts but removal may compromised situation further

–      Facemask should be removed  with appropriate clip cutters (Anvil Pruner, Trainer’s Angel, FM Extractor)

–      Recent recommendations suggest using a combination of electric screwdrivers and clip cutters 

–      Use of pocket mask/barrier mandated by OSHA during CPR to avoid exposure to blood-borne pathogens

-Automatic External Defibrillator 

Ø Device that evaluates heart rhythms of victims experiencing cardiac arrest

Ø  Can deliver electrical charge to the heart

Ø  Fully automated - minimal training required

Ø  Electrodes are placed at the left apex and right base of chest - when turned on, machine indicates if and when defibrillation or additional compressions necessary

Ø Maintenance is minimal for unit

-Bleeding: The abnormal discharge of blood

-Arterial (flows and spurts and is bright red)

-Venous (dark red with continuous flow)

-Capillary (exudes from tissue and is reddish)

-Internal or External bleeding

**Universal precautions must be taken to reduce risk of blood-borne pathogens exposure 

-Stems from skin wounds, abrasions, incisions, lacerations, punctures, or avulsions

-Direct pressure: firm pressure (hand and sterile gauze) placed directly over site of injury against bone

-Elevation: reduces hydrostatic pressure and facilitates venous and lymphatic drainage- slows bleeding

-Pressure points: Eleven points on either side of body where direct pressure is applied to slow bleeding

Ø  Invisible unless manifested through body opening, X-ray or other diagnostic techniques

Ø  Can occur beneath skin (bruise) or contusion, intramuscularly or in joint with little danger

Ø  Bleeding within body cavity could result in life and death situation

Ø  Difficult to detect and must be hospitalized for treatment

Ø  Could lead to shock if not treated accordingly

Ø  Generally occurs with severe bleeding, fracture, or internal injuries

Ø  Result of decrease in blood available in circulatory system

–      Vascular system loses capacity to maintain fluid portion of blood due to vessel dilation, and disruption of osmotic balance

Ø  Movement of blood cells slows, decreasing oxygen transport to the body

Ø  Extreme fatigue, dehydration, exposure to heat or cold and illness could predispose athlete to shock

–      Moist, pale, cold, clammy skin

–      Weak rapid pulse

–      Increasing shallow respiration

–      Decreased blood pressure

–      Irritability or excitement, and potentially thirst

–      Dial 911 to access emergency care

–      Maintain core body temperature

–      Elevate feet and legs 8-12” above heart

–      Positioning may need to be modified due to injury

–      Keep athlete calm as psychological factors could lead to or compound reaction to life threatening condition

–      Limit onlookers and spectators

–      Reassure the athlete

–      Do not give anything by mouth until instructed by physician

- Once an athlete is deemed stable a secondary survey can begin recognizing Vital Signs:

–      Heart rate and breathing rate

–      Blood pressure

–      Temperature

–      Skin color

–      Pupils

–      Movement

–      Presence of pain

–      Level of consciousness

Ø  Initial on-field injury inspection

–      Determine injury severity and transportation from field

Ø  Must use logical process to adequately evaluate extent of trauma

Ø  Knowledge of mechanisms of injury (MOI) and major signs and symptoms are critical

Ø  Once the MOI has been determined, specific information can be gathered concerning the affected area

–      Brief history

–      Visual observations           

Ø  Gently palpate to aid in determining nature of injury

–      Determine extent of point tenderness, irritation and deformity

Ø  Decisions can be made with regard to:

–      Seriousness of injury

–      Type of first aid and immobilization

–      Whether condition require immediate referral to physician for further assessment

–      Manner of transportation from injury site to sidelines, training room or hospital

Ø  Individual performing initial assessments should document findings of exam and actions taken

Ø  Performed by athletic trainer, physical therapist or physician once athlete has been removed from site of injury

Ø  Divided into 4 segments

–      History

–      Observation

–      Palpation

–      Special tests

Ø  continue to monitor breathing and circulation

Ø  note athlete’s body position and behavior as you approach

Ø  Note willingness to move, bear weight

Ø  assess gait

Ø  note signs and symptoms relating to the injury

–      sign is an objective finding

–      symptom is a subjective descriptor

Physical Exam-Palpation

Ø  must know anatomy & surface landmarks

Ø  communicate what you are doing

Ø  is a useful skill to find deformity, spasm, swelling, etc.

Ø  begin by palpating away from areas of injury

Ø  begin with the uninjured limb, if the injury is to an extremity

–         compare bilaterally

Ø  watch the athletes face 

Ø  Injuries requiring evaluation by medical personnel to return, resume participation

·      neurologic injury (head, neck, spine or tingling, numbness to a limb)

·      heat-related problems

·      functional loss

–      lower extremity (hops, cuts, runs)

–      upper extremity (full ROM & push up strength)