INVITED CLINICAL SUGGESTION: “ON THE SIDELINES”- EMERGENCY CARE BASICS FOR THE SPORTS PHYSICAL THERAPIST

Abstract

An integral part of the responsibilities of the sports physical therapist is emergency care that is provided on the sidelines and courtside during athletic events. Often times, the sports physical therapist is the “most medical” individual present at athletic events, especially at high school, middle school, and club level events. The sports physical therapist is looked upon to provide appropriate care in the event of an injury to or sudden illness of an athlete, or in the event of an unexpected medical emergency that arises in members of the coaching staff, officials, and fans.

Sports physical therapy, a diverse specialty practice, requires that certified specialists be able to examine, evaluate, develop a diagnosis and prognosis, and provide appropriate interventions for a wide variety of athletes. In addition to this part of the specialty practice, sports certified specialists must be able to provide emergency care. Frequently, the sports physical therapist (PT) is the “most medical” individual present at athletic events, especially at high school, middle school, and club level athletic events. The American Red Cross Emergency Responder training course affords the sports PT the opportunity to become trained in appropriate care of acute athletic injuries as well as illnesses that may be encountered. Additionally, this course is required by the Sports Specialty Council of the American Board of Physical Therapy Specialties (ABPTS) as one of the qualifications in order to sit for the ABPTS Board Certification examination for sports specialization. The course as offered by the Sports Physical Therapy Section (SPTS) is taught by Board Certified Sports Physical Therapists and is designed specifically for the sports PT. This course covers all aspects of emergency care that may be encountered by the PT working at athletic venues as well as emergencies that may occur in clinical settings or in the community. All aspects of emergency care including initial athlete evaluation, legal and ethical issues, CPR, airway insertion, open wounds, fracture/dislocation care, bandaging, splinting, management of the concussed athlete, management of suspected spinal cord injuries, and medical emergencies are addressed. This course has ample opportunity for practice of skills that will be needed by PT's working on the sidelines/ courtside at athletic events.

“On the Sidelines” will offer readers of the International Journal of Sports Physical Therapy suggestions and current evidence regarding topics related to emergent care of athletes. Subsequent columns will include topics of interest to the sports physical therapist working in athletic venues, regardless of the sport. Contributors will include Board Certified Sports Clinical Specialists with an interest in emergency care that will provide information that is useful in emergency situations.

With participation in sport comes the possibility of injury. (Figure 1, Figure 2) Many injuries are gradual and occur over time, while others are sudden and could be classified as emergencies. Emergencies range from musculoskeletal injury to medical conditions that arise during sport participation. Granted, not all emergencies are catastrophic, however, the sports physical therapist must be equipped with specific skills and specialized equipment in order to deal with any type of injury or emergency when it occurs. Basic sideline/courtside equipment for the sports physical therapist includes (but not limited to) equipment and tools that allow the sports physical therapist to deal with most emergencies that could occur during a sporting event or contest. (Table 1)

Figure 1.

Football athletes in collision mechanism of potential injury.

Figure 2.

Basketball athletes involved in contact, a potential mechanism of injury.

Table 1.

Sideline/Courtside Required Support Supplies.

Note: Supplies vary by type of sport being covered.

• Sideline/Courtside Emergency Kit (gloves, first aid supplies and tools[tweezers, scissors, etc.], tapping/wrapping supplies)

• Splints, slings,

• Spine Board with straps and head immobilization device

• AED

• Oxygen Tank with regulator and oxygen administration device

• Set of airways

• Facemask removal tools

• Bag Valve Mask

In addition to equipment and knowledge, the sports PT must also develop rapport with the coaching staff, school or club administration, team physician, and local EMS personnel. Trust of the PT by the coaching staff (Figure 3) is an absolute must for a successful sports physical therapy program within an educational setting. Ground rules should be established between the sports physical therapist and the coaching staff especially related to return to play decisions and criteria. Should the sports physical therapist make the decision that a player is unable to return to competition, that decision should be honored by the members of the coaching staff. This relationship does not happen overnight. This is an ongoing process. When the coaching staff knows the sports physical therapist is making decisions based on what in the best interest of the players, this rapport will develop. The contrary is also true. When the sports physical therapist knows that the coach has the best interest of the players in mind during decision making regarding injury disposition, this will add to the relationship. Should the coaching staff override the decision of the sports physical therapist to hold a player from action and return the player to competition (against advice), the sports physical therapist may need to reconsider the decision to work with the team and the coaching staff. When the best interest of the player is not being considered, the liability of the sports PT increases considerably. This is especially important in the care of athletes under the age of 18 that would be encountered at the grade school, middle school, and high school levels as well as club teams with players who are minors.

Figure 3.

Coach of High School football team. It is important to build rapport between the Sports physical therapist and the coaching staff.

Caring for athletes at the time of injury and then seeing them through the rehabilitation process and return to play is one of the most rewarding aspects of sports physical therapy. (Figure 4) Rehabilitation starts at the time of injury. Prompt and accurate evaluation of the athlete's injury, efficient management emergent conditions and injuries, and appropriate early referral of the athlete to other necessary medical providers will lead to decreased lost time due to injury. Proper early management allows the sports physical therapist to participate, as part of a multi-disciplinary team, in returning the athlete to competition as quickly and as safely as possible. This should be the goal of every sports physical therapy program. When the coaches, administration, physician, parents, and fans buy into this program, the program will be successful.

Figure 4.

Sports physical therapist involved in prevention initiative in female soccer athletes.