Emergency Procedures PDF

Emergency Procedures Learning Goals Success Criteria Identify and react 4 – Demonstrates Safety appropriately to various and Infection Control emergency situations 5 – Manage acute care emergency and non-...

Emergency Procedures Learning Goals Success Criteria Identify and react 4 – Demonstrates Safety appropriately to various and Infection Control emergency situations 5 – Manage acute care emergency and non- emergency situations Emergency Action Plan (EAP) ▪ An emergency action plan (EAP) is a written document required by particular OSHA standards. [29 CFR 1910.38(a)] The purpose of an EAP is to facilitate and organize employer and employee actions during workplace emergencies. Well developed emergency plans and proper employee training (such that employees understand their roles and responsibilities within the plan) will result in fewer and less severe employee injuries and less structural damage to the facility during emergencies. A poorly prepared plan, likely will lead to a disorganized evacuation or emergency response, resulting in confusion, injury, and property damage. Emergency Action Plan (EAP) ▪ Primary concern is to maintain the functioning of cardiovascular and central nervous systems ▪ Key to emergency aid is the initial evaluation of the injured athlete ▪ All sports programs must have a prearranged emergency action plan (EAP) Emergency Action Plan (EAP) ▪ Issues to address while developing an EAP ▫ Develop separate plans for the fields of each sport ▫ Determine the number of personnel required and their responsibilities ▫ All involved personnel should know the location of the AED ▫ Identify emergency equipment required for each sport Emergency Action Plan (EAP) ▪ Establish policies and procedures regarding the removal of protective equipment ▪ Ensure that phones that provide access to 911 assistance are readily available ▫ Wireless phones may pose connectivity issues in some areas; landline phones must be used instead ▪ All staff should be familiar with community- based emergency health care delivery plan ▫ Includes awareness on policies regarding treatment of minors Emergency Action Plan (EAP)- What does it include? ▪ Chain of command (who does what) ▪ Address of venue ▪ Access route for EMS within that venue (emergency medical services) ▪ IT WILL BE DIFFERENT FOR DIFFERENT FIELDS/VENUES. Emergency Action Plan (EAP) ▪ The person making the phone call must provide the following information to the medical personnel: ▫ Type of emergency ▫ Type of suspected injury ▫ Present condition of the athlete ▫ Current Assistance being given (ex. CPR) ▫ Location of telephone being used ▫ Exact location of the emergency and how to enter facility ▫ Any limitations of the building (no elevator to the third floor) ▪ Keys to gates or locks must be easily accessible Emergency Action Plan (EAP) ▪ Key facility and school administrators must be aware of emergency action plans and their roles in each plan ▫ Meetings on awareness and responsibilities of personnel must be held annually before the beginning of the school year Emergency Action Plan (EAP) ▪ One member of personnel has to accompany an injured athlete to the hospital (depending on school/state regulations) ▪ Personnel must carry contact information of all athletes at all times ▫ When traveling with minors, consent forms for medical treatment must be available Emergency Action Plan (EAP) ▪ In secondary schools and colleges, personnel must be able to provide emergency care to individuals other than athletes during the course of an athletic event ▫ Coaches, referees, parents of athletes, and spectators ▪ Time out: Routine activity held at the beginning of an athletic event ▫ All individuals involved in health care go over a checklist to ensure that all parties are ready to handle emergencies Discuss with the people nearby: ▫ Why is having an EAP necessary? ▫ Who should practice the EAP? And why? You are creating an EAP for a field/court at CCHS- Pick 3 locations Include: 1. What sport are you picking, practice/game? 2. A map of your location- where is EMS entering, where should they park, etc 3. Who is in command/Who is doing what? 4. What phone system are you using 5. What information are you relaying to 911 6. Address for venue (either coordinates or regular address) Principles of On-the-Field Injury Assessment Appropriate medical care cannot be provided prior to a systematic assessment of the situation On-the-field assessment ▪ Determines the nature of injury ▪ Provides information regarding direction of treatment ▪ Divided into primary and secondary survey Primary Survey ▪ Assessment of potentially life- threatening conditions: ▫ Airway obstruction ▫ No Breathing ▫ No circulation ▫ Profuse bleeding ▫ Shock ▪ Assess Level of Consciousness ▫ With an unconscious victim, the athletic trainer should call 911 immediately AEDs Primary Survey Life-threatening injuries take precedence over other injuries sustained ▪ Life-threatening injuries include: ▫ Injuries requiring cardiopulmonary resuscitation ▫ Profuse bleeding ▫ Shock Rescue squad should always be contacted The Unconscious Athlete Unconsciousness: State of insensibility characterized by a lack of conscious (being alert/awake) awareness ▪ One of the greatest dilemmas in sports The rescue squad must always be called for treatment Always to be considered to have a life-threatening injury that requires an immediate primary survey The Unconscious Athlete Guidelines to be considered while attending to an unconscious athlete: ▪ Note body position and level of consciousness ▪ Check and establish circulation, airway, and breathing (CAB) ▪ Always consider the possibility of injuries to the neck and spine ▪ Protective equipment such as helmets, face masks, and shoulder pads should be removed to expose the airway as soon as possible The Unconscious Athlete Guidelines to be considered while attending to an unconscious athlete: ▪ Nothing is to be done if the athlete is supine and breathing ▪ In the absence of breathing, the athlete should be carefully set in a supine position and administered CPR ▪ If the athlete is prone and breathing, they are to be logrolled onto a spine board ▪ Maintain and monitor life support until emergency personnel arrive ▪ Once the athlete’s condition is stabilized, the secondary survey can begin Emergency Cardiopulmonary Resuscitation (CPR) Individuals associated with competitive or recreational sports program should be certified in CPR, AED, and first aid by the American Heart Association, the American Red Cross, or the National Safety Council All individuals who provide emergency medical care need to be aware of the Good Samaritan Laws ▪ Provide legal protection to individuals voluntarily providing emergency care Emergency Cardiopulmonary Resuscitation (CPR) In 2008, the American Heart Association simplified CPR for those who are not certified ▪ Hands-only CPR ▫ Requires rescuer to call 911 and then perform 100 to 120 uninterrupted chest compressions per minute until paramedics take over or arrives or an AED is available Emergency Cardiopulmonary Resuscitation (CPR) Should be used for adults who unexpectedly collapse and stop breathing or are unresponsive In 2010, the American Heart Association changed its acronym of ABC to CAB ▪ Circulation, airway, and breathing ▪ Change emphasizes the importance of chest compressions in creating circulation Shock Potential increases with occurrences of severe bleeding, fracture, or internal injuries Shock occurs when a diminished amount of blood is available to the circulatory system Results in a lack of oxygen-carrying blood cells, which causes widespread tissue death ▪ May lead to death of the individual if left untreated Predisposing factors ▪ Extreme fatigue, extreme heat or cold, extreme dehydration and mineral loss, or illness Shock Signs and symptoms ▪ Moist, pale, and clammy skin ▪ Weak and rapid pulse ▪ Increased and shallow respiratory rate ▪ Decreased blood pressure ▪ Urinary retention and fecal incontinence in severe cases ▪ Disinterest in surroundings, irritability, restlessness, or excitement ▫ Manifested among those who are conscious ▪ Extreme thirst Shock Management ▪ Dial 911 to access emergency care ▪ Maintain core body temperature ▪ Elevate feet and legs 8 to 12 inches above heart ▪ Positioning may need to be modified based on the injury ▪ Keep athlete calm as psychological factors could lead to or compound reaction to life-threatening condition ▪ Keep spectators away from the injured athlete ▪ Reassure the athlete ▪ Do not administer anything by mouth until instructed by physician Secondary Survey ▪ Detailed examination of injuries sustained ▪ Includes assessment of vital signs and symptoms ▪ Uncovers additional problems that may become serious if left untreated ▪ Athletic Trainer or Physician must be aware of: ▫ Level of ▫ Skin color Consciousness ▫ Pupils ▫ Pulse* ▫ Movement ▫ Respiration* ▫ Abnormal nerve ▫ Blood pressure* response ▫ Temperature Vital Signs ▪ Definition: ▫ Various determinations that provide information about the patient's basic body condition ▫ Often the first sign that there is a problem ▪ The Big Three: ▫ Pulse ▫ Respiration ▫ Blood pressure Athletic Trainer’s Kit ▪ What would you think you would find in an athletic trainer’s kit? ▪ Make a list with the people around you On-Field Injury Inspection Initial on-field injury inspection ▪ Determine injury severity and transportation of injured athlete from playing field ▪ Use a logical process to adequately evaluate extent of a musculoskeletal injury ▪ Knowledge of the mechanism of the injury is important in determining the most affected area of the body ▫ Obtain a brief history of the injury from the athlete, if possible ▫ Conduct a visual observation and an initial assessment ▫ Palpate the region of injury gently On-Field Injury Inspection Once inspection is complete, decisions can be made with regard to: ▪ Seriousness of injury ▪ Type of first aid required ▪ Whether condition requires immediate referral to physician for further assessment ▪ Manner of transportation required It is important to document in written form the findings of the on-the-field exam Off-Field Assessment Performed by athletic trainer, physical therapist, or physician once athlete has been removed from site of injury Components (HOPS) ▪ History ▪ Observation ▪ Palpation ▪ Special tests Off-Field Assessment History ▪ Obtain as much information about injury as possible ▪ Listen to athlete and how he or she answers questions pertaining to injuries Observation ▪ Look for visual signs such as deformity, swelling, and skin discoloration Off-Field Assessment Palpation ▪ Assess bony and soft tissue structures ▪ Systematic evaluation beginning with light pressure and progressing to deeper palpation (touching) ▫ Begin away from injured area Special test ▪ Designed for every body region to detect specific pathologies ▪ Used to substantiate findings of other testing procedures Controlling Bleeding Hemorrhage: Abnormal discharge of blood ▪ May be arterial, venous, or capillary, and internal or external ▫ Venous: Dark red with continuous flow ▫ Capillary: Exudes from tissue and is reddish in color ▫ Arterial: Flows in spurts and is bright red ▪ Universal precautions must be taken to reduce risk of exposure to bloodborne pathogens Blood and Wound Care ▪ Universal Precautions: Treating all bodily fluids as though they could be infected ▪ Use the appropriate Personal Protective Equipment (PPE) when providing blood and wound care ▪ Examples of PPE: ▫ Gloves ▫ Gown ▫ Goggles ▫ Mask ▫ Face shield Controlling External Bleeding Direct pressure ▪ Recommended technique ▪ Firm pressure, by hand and using a sterile gauze, is placed directly over site of injury against the resistance of a bone ▫ Exception: Fracture Elevation ▪ Reduces blood pressure and facilitates venous and lymphatic drainage Controlling External Bleeding Pressure Points ▪ Eleven points on either side of body where direct pressure is applied to slow bleeding ▫ Examples: Brachial artery and femoral artery ▪ Add more gauze if blood seeps through (DO NOT REMOVE WHAT YOU HAVE ALREADY APPLIED, it could remove the clot that developed) ▪ After bleeding has slowed or stopped, clean the area ▪ Apply appropriate dressings (bandaid, gauze, wrap, etc.) Blood and Wound Care ▪ PPE and supplies should always be disposed of properly ▪ Anything that is contaminated with blood or bodily fluids should be disposed of in the biohazard bin or sharps container ▪ The biohazard bin and sharps containers are both RED ▫ Used syringes or other “sharp” contaminated objects like a disposable scalpel should be disposed of in the sharps Internal Hemorrhage Invisible unless manifested through body opening, X-ray, or other diagnostic techniques Athletes can be moved without serious consequences if the hemorrhage is subcutaneous or intramuscular Bleeding within body cavity such as the skull, thorax, or abdomen may be a life-threatening condition Difficult to detect as symptoms are obscure ▪ Hospitalization and observation by medical staff is recommended Severe cases may lead to shock if not treated immediately Immediate Treatment Following Acute Musculoskeletal Injury Primary goal is to limit swelling and extent of hemorrhaging If controlled initially, rehabilitation time will be greatly reduced Control via PRICE ▪ Protection ▪ Rest ▪ Ice ▪ Compression ▪ Elevation Immediate Treatment Following Acute Musculoskeletal Injury Protection from further injury ▪ Occurs immediately following an injury ▪ Involves immobilizing the area of injury and determining an appropriate method of transportation Immediate Treatment Following Acute Musculoskeletal Injury Ice (cold application) ▪ Widely accepted initial form of treatment of acute injuries ▪ Used immediately after injury to decrease pain ▪ Lowers cell metabolism, tissue demand for oxygen, and hypoxia ▪ Ice should be applied at least for 20 minutes ▫ Prolonged application may result in tissue damage Immediate Treatment Following Acute Musculoskeletal Injury Compression ▪ As essential as cold and elevation, and at times more important than them ▪ Helps in decreasing hemorrhage and edema ▪ A number of means can be utilized ▫ Elastic wraps, tape, and commercial pneumatic compression devices ▪ Maintained for at least 72 hours ▫ Initially, pain may be felt due to pressure buildup in the tissues Immediate Treatment Following Acute Musculoskeletal Injury Elevation ▪ Reduces internal bleeding by eliminating the effect of gravity on blood pooling in the extremities ▪ Aids in drainage ▪ Greater the degree of elevation, more effective the reduction in swelling Splinting ▪ Splinting should be done if there is a suspected fracture or dislocation ▪ Splinting can be done with a variety of objects, but there are specific types of splints that can be purchased ▫ Cardboard splints ▫ SAM splints ▫ Vacuum splints Splinting ▪ When splinting, you are trying to reduce the amount of movement in an area to reduce further damage ▪ Before splinting, you should always check for distal pulse, motor (movement), and sensory (sensation/feeling); Absence of a pulse is a medical emergency (911)! ▪ Splinting should cover the joint ABOVE and joint BELOW the injured area ▫ So if someone fractured their forearm, the splint should cross both the wrist and the elbow! Splinting ▪ After you have completed splinting the area, you should always check distal pulse, motor (movement), and sensory (sensation/feeling) to make sure they still have blood supply ▪ Also, consider a sling, spine board, crutches, or a wheelchair for extrication (transport) to reduce the stress on the area. ▪ If there is an open wound around the area needed to be splinted, you should always control bleeding FIRST. Extrication Extrication: ▪ Removing an injured athlete from a playing field or court 50 Check, Call, Care ▪ Check to make sure scene is safe ▪ Check victim ▫ Life-threatening conditions (primary survey) ▪ Call 911, if necessary ▪ Care for victim ▫ Extrication ▫ Secondary survey 51 Extrication Precautions ▪ Use proper lifting technique ▪ Use proper bending technique INCORRECT CORRECT 52 Guidelines for Lifting ▪ Squat close to the load ▪ Maintain the natural curves in your back ▪ Grip the object firmly Guidelines Continued ▪ Hold the load close to your body ▪ Keep your arms fixed and close to your sides ▪ Lifting by pushing up with your strong legs Ambulatory Athlete: ▪ When there are no life-threatening conditions: ▫ Athlete can be moved without further injury ▫ Ambulatory: can walk or move with minimal support ▫ Make sure a serious lower extremity injury is immobilized prior to extrication 55 One-person Carry ▪ Athlete places arm around shoulders of assistant ▪ Assistant stands on the injured side ▪ Assistant can support athlete by placing arm around waist 56 Terminology ▪ Proper body mechanics- special ways of standing and moving to make the best use of strength and to avoid fatigue or injury. ▪ Ambulate- to walk or move about ▪ Three-point gait- Walking with crutches and one weight bearing leg. ▪ Four-point gait- Walking with crutches and both legs weight bearing. 57 Two-person Assist ▪ Two assistants stand on each side of athlete. Athlete’s arms around assistants’ shoulders. Assistants support athlete around waist. Two-person Carry ▪ Two assistants face each other and lock their arms together (grasp forearms). Athlete sits on one set of arms. Other set of arms provides backrest. Athlete places arms around assistants’ shoulders. Crutches and Crutch Walking ▪ Make sure crutches fit properly: ▫ Stand with good posture, in low-heeled shoes ▫ Crutches should be placed 6 inches from outer margin of shoe and 2 inches in front of the shoe (about 2-4 inches diagonal to feet) ▫ Crutch base should fall 1 inch below anterior fold of axilla (about 2-3 fingers between axilla and tops) ▫ Hand brace should be positioned to place elbow at 30 degrees of flexion ▫ Cane measurement should be taken from height of greater trochanter Three-point (tripod) gait ▪ Athlete swings through crutches without injured limb contacting ground ▪ Athlete stands on one foot, with the affected foot completely elevated or partially bearing weight ▪ Placing the crutch tips 12 to 15 inches ahead of the feet, the athlete leans forward, straightens the elbows, pulls the upper crosspiece firmly against the side of the chest, and swings or steps between the stationary crutches ▪ After moving through, the athlete Four-point Gait ▪ Athlete stands on both feet ▪ One crutch is moved forward, and the opposite foot is stepped forward ▪ The crutch on the same side as the foot that moved forward moves just ahead of the foot ▪ The opposite foot steps forward, followed by the Stretchers ▪ Used to move athletes that do not have a possible spinal cord injury/back injury ▪ Secure athlete as needed ▪ All 6-plus rescuers place themselves in a position to stand ▫ On the command of the person stabilizing the cervical spine, they collectively lift and carry the patient to the emergency vehicle ▪ When transporting a person with a limb injury, be certain Scoop stretcher ▪ Metal, can be separated into halves ▪ Athlete does not need to be rolled or lifted Spine boarding Spine boarding ▪ Do you think we should spine board? ▪ Or who do you think should spine board? ▪ It is the standard of care in athletic training ▪ Stabilize until EMS arrives, they use the technique more frequently and will re- do anything already done anyway Spine boarding ▪ Must be executed with techniques that will not result in additional injury ▪ No excuse for poor handling ▪ Planning is necessary ▪ Additional equipment may be required General Spineboard Rules ▪ When do you spine board? ▫ If you suspected any spinal or back injury ▫ When you are not sure of victim's status ▫ When there is not enough time to splint obvious serious fractures Spine boarding how to’s: ▪ One person is in-charge (head-man) ▪ Need at least 4 helpers ▪ Control/stabilize head Spine boarding how to’s: ▪ Call 911 immediately! ▪ Apply neck stabilization ▫ Head-squeeze technique ▫ Trap-squeeze technique ▪ Prepare backboard ▫ Undo straps ▫ Match straps ▫ Remove head block Spine boarding how to’s: Equipment considerations ▪ Protective equipment may complicate lifesaving procedures ▪ Prior to transporting the injured athlete: ▫ Remove the helmet and shoulder pads ▫ Apply a rigid cervical collar at the earliest Spine boarding how to’s: ▪ Roll athlete 90 degrees and position board by sliding it behind victim ▪ Roll athlete onto board ▪ Carefully lower board ▪ Secure athlete with straps and pads. Bloodborne Pathogens, Universal Precautions, and Wound Care Bloodborne Pathogens Pathogenic microorganisms that can potentially cause disease May be present in: ▪ Human blood ▪ Other bodily fluids including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, and any other fluid contaminated with blood Bloodborne Pathogens Most significant bloodborne pathogens ▪ Hepatitis B virus (HBV) ▪ Hepatitis C virus (HCV) ▪ Human immunodeficiency virus (HIV) Other bloodborne diseases that exist are hepatitis A, hepatitis D, hepatitis E, and syphilis Hepatitis B Virus (HBV) Major cause of viral infection that results in swelling, soreness, and loss of normal function in the liver Signs ▪ Flu-like symptoms such as fatigue, weakness, nausea, abdominal pain, headache, fever, and possibly jaundice ▪ It is possible that the individual will not exhibit signs and symptoms ▪ Approximately 85 percent of those infected recover within 6 to Prevention of HBV ▪ Good personal hygiene and avoiding high-risk activities ▪ Being cautious as HBV can survive for at least one week in dried blood or on contaminated surfaces and may be transmitted through contact with these surfaces Management of HBV ▪ According to Occupational Safety and Health Administration (OSHA), vaccination against HBV should be provided by an employer at no cost to an individual who may be exposed ▫ Three inoculations over 6 months ▪ Any individual working in an allied health care profession who may potentially come in contact with blood should receive HBV immunization Hepatitis C ▪ Acute and chronic form of liver disease caused by HCV ▪ The most common chronic bloodborne infection in the United States ▪ Leading indication for liver transplant ▪ Signs and symptoms ▫ 80% of those infected have no signs or symptoms ▫ Symptoms include jaundice, mild abdominal pain, loss of appetite, nausea, fatigue, muscle or joint pain, and/or Hepatitis C Mainly spread by contact with blood of infected person ▪ Sharing needles or syringes ▪ Sharing personal care items that may have blood on them ▫ Examples: Razors and toothbrushes Getting a tattoo or body piercing is risky Athletic trainers should always follow routine barrier precautions Management of Hepatitis C ▪ No vaccination exists for preventing HCV transmission ▪ Several blood tests can be done to determine whether a person has been infected with HCV ▪ Single positive test indicates infection with HCV ▫ Single negative test does not prove that a person is not infected ▫ When hepatitis C is suspected, even though an initial test is negative, the test should be repeated ▪ Peginterferon and ribavirin are two drugs used in combination to be the most effective for Human Immunodeficiency Virus (HIV) ▪ Family of complex viruses that invade normal healthy cells, thus decreasing the effectiveness of the host cell in preventing disease ▪ Viral infection that has the potential to eventually destroy the immune system ▪ According to World Health Organization, 35 million people were living with HIV/AIDS as of 2013 Human Immunodeficiency Virus (HIV) Symptoms and signs ▪ Transmitted by exposure to infected blood or other bodily fluids or by intimate sexual contact ▪ Fatigue, weight loss, muscle or joint pain, painful or swollen glands, night sweats, and fever ▪ Antibodies can be detected in blood tests within a year of exposure ▪ People with HIV may go as long as 8 to 10 years before developing any signs or symptoms ▪ Most individuals who test positive for HIV will eventually develop acquired immunodeficiency syndrome (AIDS) Acquired Immunodeficiency Syndrome (AIDS) ▪ Syndrome: Collection of signs and symptoms that are recognized as the effects of an infection ▪ Person infected with AIDS has no protection against the most minor infections ▪ Positive test for HIV cannot predict when the individual might show symptoms of AIDS ▪ Those who develop AIDS generally die within three years after the symptoms appear Management of HIV ▪ No vaccine for HIV ▪ Much research is being done to find preventive vaccine and an effective treatment ▪ Certain combinations of various antiviral drugs, which have been labeled “cocktails,” can slow replication of the virus and improve prospects for survival Prevention of HIV ▪ Best means for prevention is through education ▪ Greatest risk is through intimate sexual contact with infected partner ▫ Practicing safe sex is of major importance Dealing with Bloodborne Pathogens in Athletics Chances of transmitting HIV among athletes is low Minimal risk of on-field transmission of HIV Sports with potentially higher risk for transmission are those that involve close physical contact and possible direct contact with the blood of another person ▪ Martial arts, wrestling, and boxing HIV and Athletic Participation ▪ Contact with others' bodily fluids should be avoided ▪ Participant should also avoid engaging in exhaustive exercise that may lead to an increased susceptibility to infection ▪ According to the Americans with Disabilities Act of 1991, infected athletes cannot be discriminated against and may be excluded from participation on a medically sound basis Testing Athletes for HIV ▪ HIV testing should not be used as screening tool to determine if an athlete can participate in sports ▪ Mandatory testing may not be allowed for legal reasons related to the Americans with Disabilities Act ▪ Mandatory testing should be secondary to education to prevent transmission of HIV ▪ Athletes engaging in risky behavior should be encouraged to seek voluntary anonymous testing for HIV Testing Athletes for HIV ▪ A blood test may detect the presence of the HIV virus within three months to one year following exposure ▫ Testing should occur at six weeks, at three months, and at one year after exposure ▪ Many states have enacted laws that protect confidentiality of an HIV-infected person ▪ Athletic trainers should be familiar with state laws and guard the confidentiality and anonymity of HIV testing for their athletes Universal Precautions in an Athletic Environment ▪ All sports programs should develop and carry out a bloodborne pathogen exposure control plan ▫ Plan should include counseling, education, volunteer testing, and management of bodily fluids ▪ OSHA's guidelines should be followed by anyone coming in contact with blood or other bodily fluids Universal Precautions in an Athletic Environment Preparing an athlete ▪ All open wounds and lesions should be covered with dressing that does not allow for transmission to or from an athlete ▪ Occlusive dressing lessens the chances of cross- contamination ▫ Reduces chances of the wound reopening by keeping it moist and pliable Universal Precautions in an Athletic Environment When bleeding occurs ▪ Athletes must be removed from participation and returned when it is deemed safe by the medical staff ▪ When blood is present on a uniform, it can sometimes be removed with hydrogen peroxide, without having to remove the entire uniform Personal Precautions Health care personnel working directly with bodily fluids on the field should use appropriate protective equipment in all cases in which there is potential contact with bloodborne ▪ Protectivepathogens equipment: Disposable nonlatex gloves, gowns or aprons, masks and shields, eye protection, nonabsorbent gowns, and disposable mouthpieces for resuscitation devices ▪ Double gloving is suggested when there is severe bleeding or when Personal Precautions ▪ Hands and skin surfaces coming in contact with blood and fluids should be washed immediately with soap and water or other germicidal agents ▪ First-aid kits must have protection for hands, face, and eyes as well as resuscitation mouthpieces Availability of Supplies and Equipment A sports program must have the following: ▪ Chlorine bleach, antiseptics, and proper receptacles for soiled equipment and uniforms ▪ Wound care bandages and a designated container for disposal of sharps such as needles, syringes, or scalpels Availability of Supplies and Equipment Biohazard warning labels should be fixed to: ▪ Containers for regulated waste ▪ Refrigerators containing blood ▪ Containers used to store or ship potentially infectious materials Gloves and bandages should be placed in sealed white bags prior to disposal in regular trash containers Availability of Supplies and Equipment Disinfectants ▪ Contaminated surfaces should be cleaned immediately with a solution of one part bleach to ten parts water or with a disinfectant approved by the Environmental Protection Agency ▪ Contaminated towels or other linens should be bagged and separated from other laundry ▪ Soiled linen is to be transported in red or orange containers or bags that prevent soaking or leaking and are labeled with the biohazard warning labels Availability of Supplies and Equipment Sharps ▪ Objects such as needles, razor blades, and scalpels ▪ OSHA mandates that sharps be disposed of in a leakproof and puncture-resistant container ▫ Container should be red or orange and labeled as a biohazard Post-exposure Procedures ▪ An exposed individual should have confidential medical evaluation that documents the exposure route, identification of the source individual, a blood test, counseling, and an evaluation of reported illness ▪ Laws that pertain to reporting and notification of results relative to confidentiality vary from state to state Caring for Skin Wounds ▪ Skin wounds are extremely common in sports ▪ Soft and pliable nature of skin makes it highly susceptible to injury ▪ Numerous mechanical forces can injure soft tissue ▫ These forces produce friction, scraping, compression or pressure, tearing, cutting, and penetration Types of Wounds Abrasions ▪ Skin scraped against a rough surface ▪ Top layer of skin wears away, exposing numerous blood capillaries ▫ Increases the probability for infection Types of Wounds Lacerations ▪ Occur when a blunt force is delivered over a sharp bone or a bone that is poorly padded, giving a wound the appearance of a jagged-edge cavity ▫ May also result in skin avulsion Types of Wounds Incisions ▪ Wounds with smooth edges Types of Wounds Puncture wounds ▪ Can easily occur during physical activities and can be fatal ▪ Direct penetration of tissues can introduce the tetanus bacillus into the bloodstream, possibly making the athlete a victim of lockjaw ▪ All severe lacerations and puncture wounds should be referred immediately to a Types of Wounds Avulsion wounds ▪ Skin is torn from the body ▪ Associated with major bleeding ▪ To reattach the torn tissue, the avulsed tissue should be placed on moist gauze, preferably saturated with saline solution ▫ Should be taken along with the athlete to the Avulsion Immediate Care Open wounds should be cared for immediately All wounds should be treated as though they have been contaminated with microorganisms ▪ Must be cleaned, medicated (when called for), and dressed as soon as possible To minimize the chances of infection, the wound should be cleaned with copious amounts of soap and water or sterile solution ▪ Avoid using hydrogen peroxide and bacterial solutions initially Immediate Care Dressing ▪ Sterile dressing should be applied to keep fresh wounds clean ▪ Occlusive dressings provide a complete barrier around and over a wound and are air-tight and water-tight ▪ Antibacterial ointments are effective in limiting surface bacterial growth and prevent the dressing from sticking to the wound ▪ Saline solution is recommended for cleaning wounds repeatedly Are Sutures Necessary? ▪ Deep lacerations, incisions, or occasionally puncture wounds may require some sort of manual closure using sutures ▪ Physician determines the severity of the wound and whether sutures are needed to close the wound ▪ Sutures should be put in within 12 hours following injury ▪ Fine suture material and minimal tightening limit any additional tissue damage, inflammation, and scarring ▪ Physician may decide that the torn tissues may be approximated using steri-strips, butterfly bandages, or skin glue Signs of Wound Infection ▪ Same as those for inflammation ▫ Pain, heat, redness, swelling, and disordered function ▪ Pus may form due to accumulation of white blood cells ▪ Fever may occur as immune system fights bacterial infection Signs of Wound Infection Most wound infections can be treated with antibiotics Some strains of Staphylococcus aureus have become resistant to some antibiotics ▪ Bacteria is known as methicillin- resistant Staphylococcus aureus (MRSA) and is more difficult to treat ▪ Infections tend to become more severe than they may otherwise have been if the cause of the infection is not diagnosed early, and antibiotics that are given at first may not work Tetanus ▪ Bacterial infection that may cause fever and convulsions ▫ Occurs most often with a puncture wound ▪ Tonic spasm of skeletal muscles is always a possibility for any non- immunized athlete ▪ Tetanus bacillus enters wound as spore and acts on the motor end Tetanus ▪ After initial childhood immunization with a tetanus vaccine, boosters should be given every 10 years ▫ Athletes who are not immunized should receive tetanus immune globulin (Hyper-Tet) immediately following a skin wound