This week I participated in a revision session on emergency trauma, managed the hockey game acting as the first aider and provided pre and post treatment to the players.
Before going on to pitch side, I participated in an emergency trauma session where we practiced different scenarios, specifically the primary survey (ABCDE). The primary survey is made up of five components; Airways (A) with cervical spine protection, Breathing (B) with adequate ventilation, Circulation (C) with haemorrhage control, Disability (D)/neurological status and Everything else (E). To check the airways the therapist puts their arm down the casualty’s sternum, while holding the chin. With the other hand they hold the players head. As part of C spine protection, the second therapist performs manual-in-lie-stabilisation (MILS), to ensure that the head remains in a neutral position. However, airways take priority over the spine; you may have to use a jaw thrust to open the airways. While the player is in MILS, palpate the cervical and upper thoracic spine and get the player to actively perform side rotation to 45 degrees. If they resist the movement or cannot get to 45 degrees, it implies that there is an underlying issue. With breathing there is two areas you should check for pain, rate and expansion; under the ribs and over the pectorals. Circulation is checked at the wrist but if a pulse cannot be found find it at the neck. It is important to consider the rhythm, rate and strength to ensure there is no abnormalities. At this point you should also check if there is any obvious bleeding. With disability we are checking neurological status using the acronym AVPU. A=alertness, V= voice, P= pain and U=unresponsive. The final thing we need to check is everything else. As part of this there are five things to check: thoracic, abdomen (push down on four points, if tender could be an internal bleed), kidney, pelvis by adding compression and long bones to check for fractures and breaks.
Once the session had finished, I checked to ensure that the medical bag had the correct equipment inside as well as the right amount. This is to minimise equipment failure and mistakes. After this I provided pre-game treatment to the players of the girl’s hockey team. This included rigid taping two ankles using the figure of 8 ankle support. I chose this method of taping as it increases proprioception, relieves pain and supports the joint (Podolsky & Kalichman, 2015). I also applied kinesiology (k) tape to another players knee, using the PFPS taping technique to enhance functional performance, control pain and increase muscle activity (Poon et al., 2014). During the game no first aid was needed, however at the end of the game some people required ice as bruising had developed from being hit in the arms/legs by the stick. The final thing I did was post-game treatment on a player with possible patellofemoral pain syndrome (PFPS). I used the game ready machine to do this as it combines cryotherapy that minimises inflammation, decreases pain and reduce muscle spasms with compression (Lubkowska, 2012).
Areas for further improvement
My first area for further improvement would be to revise the primary survey (ABCDE). I currently know the basics of the survey but struggle with the in-depth knowledge, such as the five things that need to be tested as part of everything else (E). Another thing I need to do to further my learning would be to research and look around the literature surrounding PFPS, including the mechanism of injury (MOI), subjective and objective assessment, differential diagnosis and treatment. Currently there is a player in the team who could have PFPS. I want to research this pathology so I can see if her assessment matches that of what you would expect from PTFS, therefore I can provide the most effective treatment. Finally, I need to ensure that the other therapists are aware of their roles within the emergency action plan (EAP). This should minimise errors and therefore improve the effectiveness of player care. You may have to give members of the team (that are competent) roles within the EAP such as helping with a log roll or calling 999.
Things to Remember:
Lubkowska, A. (2012). Cryotherapy: physiological considerations and applications to physical therapy. In Physical Therapy Perspectives in the 21st Century-Challenges and Possibilities. IntechOpen.
Podolsky, R., & Kalichman, L. (2015). Taping for plantar fasciitis. Journal of Back and Musculoskeletal Rehabilitation, 28(1), 1–6.
Poon, K. Y., Li, S. M., Roper, M. G., Wong, M. K. M., Wong, O., & Cheung, R. T. H. (2014). Kinesiology tape does not facilitate muscle performance : A deceptive controlled trial. Manual Therapy,20(1), 1–4.