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Care of the injured athlete

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Gymnastics Pit extraction. Ada County Paramedics ... Gem State Gymnastics at 5420 West State Street ... Uses a standard 4' gymnastics mat to access the patient ... – PowerPoint PPT presentation

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Title: Care of the injured athlete


1
Care of the injured athlete
  • Gymnastics Pit extraction

2
Ada County Paramedics
  • Steve Cole
  • Cool Dude

3
Disclaimer
  • Although the information presented here is
    developed from practice , and published
    guidelines, it is in no way meant to replace or
    supercede local protocols.
  • It is intended for educational and conceptual use
    only.
  • Ada County Paramedics accepts no responsibility
    for the use/misuse of the information provided
    here.
  • When in doubt, consult with your local medical
    guidance.

4
Objectives
  • Adapt and refine standard immobilization skills
    to the unstable gymnastics pit environment.
  • Gain knowledge on the Ladder approach and Mat
    approach to accessing the injured patient with
    spinal injury.
  • Lean the pros and cons of rapid entry and
    delayed entry techniques.

5
Background
  • 33 of fatal and catastrophic injuries that
    occur in college level winter athletics
    occurred with Gymnastics (in 1998).
  • The majority of these were related to spinal
    cord/cervical injury.
  • A unique factor in these injuries is that safety
    equipment, like many professional sports, while
    designed to protect the athlete, become a
    hindrance to care in the event the athlete is
    seriously injured.
  • As a result of this , new guidelines have been
    published on the care of injured gymnast,
    including spinal immobilization techniques.

6
Background
  • The greatest hindrance in gymnastics to prompt
    emergency care is the gymnastics pit. These
    pits are either filled with foam chunks/squares
    or a large foam mat.
  • The greatest number of lawsuits against gymnastic
    centers currently from injuries sustained by
    visitors (parents) involved in horseplay.

7
Gymnastics Pit
8
The Gymnastics Pit
  • A Typical pit will be 10 by 20 feet and approx.
    6-8 feet deep. This produces a very safe crash
    landing area for the routine mishaps in
    gymnastics.
  •  This also creates a very unstable platform to
    access the patient on. Any movement by occupants
    entering the pit will often transfer to the
    patient. The debris in the pit will hinder any
    attempts at immobilization.
  • Thus special methods of accessing the patient
    have been developed.
  • Some rest on a trampoline style frame and
    suspension system. These are called self
    fluffing
  • Some are simply Pits filled with foam chunks

9
Local Information
  • There are two known pits in Ada County
  • BSU- by the pavilion
  • Gem State Gymnastics at 5420 West State Street
  • When discovering that there is a Gymnastics Pit
    Extraction, please notify other incoming units.

10
SPECIAL NOTE
  • All of these methods assume that the patient
    does not have any immediate airway, respiratory,
    or cardiac compromise.
  • In case of need of life saving interventions
    (like CPR) then rapid extrication by staff on
    hand while maintaining alignment as best as
    possible is recommended.

11
Pre- EMS Actions
12
The S.T.O.P. ProcedureTaught to trainers
  • S Stop all activity around the section
  • T Talk to the injured athlete
  • O Observe the injured Athlete from outside the
    pit for breathing, movement, etc
  • P prevent further injury. Proceed carefully into
    the pit based on perceived need
  • Again If an immediate threat to the ABCs is
    perceived then direct entry is indicated.

13
S.T.O.P.
14
C- Spine Immobilization
  • The Jaw thrust is preferred for opening the
    airway in trauma.
  • The decision to provide more advanced care in the
    pit is made on a case by case basis
  • While most areas have back boards available,
    these will generally only be used before EMS
    arrival if a life threat exists.

15
Moving in the pit
  • May be over your head
  • Will be deeper than it looks
  • Sudden movement stir up dust, may cause the
    athlete to move
  • We found that taking off boots helped

16
Pit extraction Steps
  • S.T.O.P. (already discussed)
  • Pt. Access
  • Pit Entry
  • PT immobilization
  • PT removal

17
Pt. Access
  • Three Methods
  • Direct entry
  • Ladder Access
  • Mat Access

18
Pt. Access Direct Entry
  • Quickest
  • No Special Equipment
  • The most potential movement to the patient
  • Should be done slow
  • moving foam as you go

19
Pt. Access- Direct Entry
20
Pt. Access- Ladder Access
  • Uses a standard FD roof ladder (16 feet ) to span
    the pit
  • The ladder is placed just above the patients
    head.
  • Provides a stable platform for assessment and
    securing c spine.
  • FD always has a ladder
  • What we found the easiest to do after trying all
    methods

21
Pt. Access- Ladder Access
22
Pt. Access- Ladder Access
23
Pt. Access- MAT Access
  • Uses a standard 4 gymnastics mat to access the
    patient
  • The Mat distributes the weight of the person
    across the pit
  • Some movement may be transferred to the pt
  • Must spider crawl
  • Always available.

24
Pt. Access- MAT Access
25
Pt. Access- MAT Access
26
Pt. Access- MAT Access
  • Though not illustrated in the photos, in larger
    pits, the same technique is used to move mats in
    to each side and provide access to the patient as
    well.
  • In the smaller pits, we discovered it to be a
    hindrance.

27
Pit Entry/Pt Access- foam removal
  • Often the pt. is buried by the foam.
  • Foam is moved only when it covers the patient or
    interferes with the ABCs
  • The foam beneath the patient provides the support
    for the patient
  • Removing foam beneath the patient will cause the
    pt. to sink lower in the pit.

28
Pt. Immobilization
  • The pt. is often found in a pseudo seating
    position when supine
  • However pt may be prone, sideways, or even head
    lowest.
  • In our experience 4-5 people were required to
    safely immobilize and remove the pt. from the
    pit.
  • 1 on C-Spine, 2 on each side of the pt.

29
Pt. Immobilization
  • The back board seemed to work best, as when the
    pt. was on the board the board distributed the
    pt.s weight across the foam.
  • Other devices may be indicated (KED, Vacuum
    mattress)

30
Pt. Immobilization
31
Pt. Immobilization
32
Pt. Immobilization
33
Pt removal
  • Once the patient is packaged, we found it easiest
    to remove the pt. by the means we made first
    entry.
  • The ladder was by far the easiest in our
    training.
  • The mat works well too.
  • Wading through the debris, lifting over our head
    was pretty hazardous.

34
Pt removal using a Mat
35
Pt removal using a ladder
36
Pt removal using a ladder
37
Summary
  • This practice session brought to light a whole
    set of issues not normally encountered
  • The most important lesson was to stop and
    carefully assess the situation, just like any
    other rescue
  • Utilization of proper resources is the issue

38
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