BUCs Placement – 13th November 2019 for 4 hours

This week I was the first aider for both the women’s volleyball and hockey team. The main incident that occurred was just after half time in the hockey match; a player from the opposing team was knocked unconscious as they received a ball to the face.

Reflective Summary

My first role of the day was to be the first aider for the BUCs volleyball game. The first incident was that a player ran into a bench as they tried to keep the ball in play. I checked if they were ok to carry on and they seemed fine. At the end of the game I applied ice to the player as some bruising had become apparent on the anterior surface of the lower leg. The clinical application of cryotherapy is recommended for inflammatory conditions, such as swelling and acute localised pain, which the player had (Lubkowska, 2012). Another player came off during the game as they complained of a dull pain in the muscle belly of the triceps brachii. As I was on still pitch side, watching the rest of the game, I conducted a brief clinical assessment to understand where the pain was coming from (localised or referred). I focused on resisted movements at the elbow (mainly flexion and extension) to try to identify if there was an underlying pathology. They only experienced a dull pain during extension and on the oxford strength scale they scored a 5. From this I concluded that is was most probably muscle tightness and recommended stretches specific for the triceps brachii including the overhead triceps stretch and horizontal stretch. The aim of these stretches is to improve musculoskeletal function, pain relief and increase range of motion (ROM), therefore reducing injury (Dhinkaran, Sareen, & Arora, 2011). I advised the player to stretch to a degree that is comfortable for them, without going beyond their limits however, once flexibility has improved it is important for them to go as far as their max ROM.

Once I arrived at the girl’s hockey game, the second half had just begun. Not long after this, a player from the opposing team got hit in the face (jaw area) by the ball, which was going at some speed. Immediately she dropped to the floor and was knocked unconscious for a few seconds. The other first aider and I ran over to her straight away and checked to see if she was responding. By this time, she was awake and aware of what was happening. To start with our maim aim was to stop the bleeding; I used the spray to remove the blood and then applied a bandage to compress the wound (which was reasonably deep). Our next priority was to cheek the presence of any neurological, head or neck related symptoms. If it was neurological you would expect tingling sensation/pins and needles, pain in the neck could indicate a spinal issue and a head injury could lead to concussion. The player was negative for all these things however, it is possible that the player may experience clinical symptoms, physical signs, cognitive impairment, neurobehavioral features and sleep disturbance of concussion a few days later (Mccrory et al., 2013). For this reason, we gave her part of the SCAT5 test showing the symptoms that would be positive for concussion, as well as information advising her on what to do if this happens. We then sat her up and took her off the field of play, supporting her bodyweight in case she felt faint etc. The bleeding had now stopped so we taped a bandage over the wound to prevent any dirt entering it. It was also advised that she should go to hospital as soon as possible so she could be checked out.

Areas for further improvement 

My first area for further improvement would be to familiarise myself with the Emergency Action Plan (EAP). An EAP is so important as it ensures that all members of the medical team are aware of their roles, therefore if an incident arises it can be dealt with efficiently, minimising errors. It is vital to check that there is enough equipment in the physio bag before going on to the field of play. I personally could have worn two pairs of gloves (rather than one pair) in case there were multiple blood injuries. If this did occur the management of the bleed will be more effective as you would have reduced the time that is needed to put on gloves. Finally, it is important to find out from the umpires/referees when is it legal for the first aider to go onto the pitch, if an injury occurs. For this reason, it is important to research the rules and regulation of different sports as it may be varied.

Things to Remember:

  1. Always check the physio bag before a game to ensure all necessary equipment is present
  2. Keep an EAP with step by step information for different scenarios such as a cardiac arrest, fracture, catastrophic bleed or concussion
  3. You can change a taping technique to ensure that the appropriate structure is being supported
  4. Always be very cautious with head injuries – check presence of neurological, head and neck symptoms

References 

Dhinkaran, M., Sareen, A., & Arora, T. (2011). Comparative analysis of muscle energy technique and conventional physiotherapy in treatment of sacroiliac joint dysfunction. Indian J Physiother Occup Ther5, 127-30.

Lubkowska, A. (2012). Cryotherapy: physiological considerations and applications to physical therapy. In Physical Therapy Perspectives in the 21st Century-Challenges and Possibilities. IntechOpen.

Mccrory, P., Meeuwisse, W. H., Aubry, M., Cantu, R. C., Echemendia, R. J., Engebretsen, L., … Turner, M. (2013). Consensus Statement on Concussion in Sport — The 4th International Conference on Concussion in Sport Held in Zurich. British Journal of Sports Medicine, 5(4), 255–279.

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