Friday Nights, Football, Scoop Stretchers and Spineboards
AC Reynolds varsity quarterback Kyle Johnson takes a few minutes out from practice to help us demonstrate special procedures for caring for an injured football player.
A Buncombe EMS Guide to Football Injuries August, 2006
The normal procedures for immobilizing a patient cannot be followed when the patient is wearing bulky pads such as shoulder pads. We don’t want to remove a football player’s helmet unless the shoulder pads are not present or can be removed at the same time. Removing the helmet but leaving shoulder pads in place creates misalignment of the spine because the shoulder pads elevate the patient’s shoulders several inches above the surface of the spine board. The football helmet provides excellent stabilization and can be left in place and secured to the spine board along with the patient. Make sure the chin strap remains fastened and intact to keep the patient’s head secure in the helmet. To access the face for airway management we’ll remove the face mask and leave the helmet on. More about that in the next section.
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Cut Loops Here
Pruning shears will cut plastic loops
Motorcycle helmets are often removed to provide access to the patient's face to facilitate airway management. Modern football helmets have face masks which can be removed fairly easily. The face mask should be removed if the player is going to be immobilized and transported. Don't wait for the patient to rapidly deteriorate, or begin vomiting before you remove the face mask. If the player is going to be immobilized, remove the face mask.
Some sources advocate retracting the face mask instead of removing it. The problem with this is the curvature of the face mask, coupled with the curvature of the helmet makes this a difficult task which often causes lots of movement of the helmet and the patient's head and neck. Remove the face mask completely.
The face mask is attached to the helmet with plastic loops screwed to the helmet. A screwdriver can be used to unscrew the loops, but often the screws are corroded from sweat and water or the t-bolt inside the helmet might become loose and not allow the screw to be removed. The best bet is to cut the plastic with shears or knife or better yet; a set of standard garden pruning shears. The plastic is difficult to cut with standard EMT shears but if there's an athletic trainer on hand they often have a "trainer's angel" or pruning shears specifically used for cutting face mask loops. You will have to apply a lot of strength to the loops to cut them so make sure you are stabilizing the head/helmet and protecting the patient from sharp edges that might slip while trying to cut the loops! Think about where that blade is going to go if it slips!
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Patrick Hunter, certified trainer with Southeastern Sports Medicine observes practice at AC Reynolds High School. High schools usually have a certified trainer, but middle schools and youth programs might not.
Certified Athletic Trainers have completed at least a Bachelor’s program in an approved college program, completed a national exam and maintain hundreds of hours of continuing education. That’s for CERTIFIED trainers. Some smaller schools or rec league teams might have a trainer appointed, but ask if they’re certified before you depend on their skills and expertise. If you have a certified trainer on the scene, you can usually count on them to give sound advice on orthopedic and musculoskeletal injuries. They will know how to remove protective gear and can assist coaches and parents in making decisions about the need for EMS transport. Trainers are not usually familiar with our immobilization procedures or equipment, so a team approach to evaluating and caring for the patient will yield the greatest benefit.
Certified Athletic Trainer Patrick Hunter stabilizes AC Reynolds QB Kyle Johnson while Paramedic Tim Swicegood and Intermediate Phillip Roberts get the scoop in place. The scoop is used to avoid log-rolling the patient onto the lateral shoulder pads.
Rely on the trainer’s knowledge and skills to assess the patient and the trainer will rely on the skills and knowledge of EMS to immobilize and/or resuscitate and provide advanced level treatment enroute as needed.
Head Injuries are not as common as musculoskeletal injuries in football and other full contact sports, but we might be called upon to “check out” a player with an injury. Musculoskeletal injuries that present with deformity are easy to identify as needing further medical attention. Musculoskeletal injuries without frank signs of fracture can be difficult to identify even for trained specialists. The best practice is to refer all injuries to further medical attention and avoid the liability or ill-will. Some school teams will have a trainer and even a designated physician or physicians group to care for injured athletes and therefore a decision to refer to a specific physician or group may be made by the coaching staff and the player/parents/guardian. Don’t get trapped or pressured into “clearing” a player to return to the game; always refer that to a physician or others with specialized training in sports medicine. EMS personnel do not have the specific knowledge needed to make that call, just say no.
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The most common head injury we might see is a concussion. You know that a concussion is usually a mild traumatic brain injury (TBI), but initial symptoms can mimic more serious injuries.
Realize that the injured player, the coach and often the parents will want the player returned to the game right away. There is nothing more important than winning the contest at hand and in some cases, the player’s performance may be associated with anything from parental expectations to scholarship qualification or fulfillment. A serious injury to a player may precipitate strong feelings in the player, the parents, coaches, friends, etc. Don’t offer prognosis predictions good or bad and be prepared to deal with a wide range of reactions from the injured player and those counting on his/her performance. Even if it’s not important to you, the contest and the ability to perform at maximum ability is very important to the players, coaches and team supporters. Try to be sensitive to that and reassure them that your care is driven by concern for getting the player “repaired” as quickly as possible. Don’t be surprised if a player requests to be returned to play once you splint a fracture! They’re not crazy; just really dedicated! If the responsible adult (parent, guardian, player 18 and older) doesn’t desire transport, follow the usual protocol.
Click Here for a PDF of the JEMS Concussion Article
If you’re dealing with a player down on the field, immobilize them as needed but get them off the field as soon as possible. Resuscitation of cardiac arrest or severe injury should take place in the back of the truck as much as possible and not on the field or on the sidelines in front of the crowd. Load and go with immobilization done properly and quickly. Seeing a player, coach or official being resuscitated can have profound emotional impact for a long time; avoid making a public spectacle of it.
The August 2006 issue of JEMS offers a good article on concussion. Concussion is graded from Grade 1 (mild) to Grade 3 (severe). See the chart for the breakdown.
Concussion Grading Schema
Grade 1: Mild Concussion
- Transient confusion (inattentive, incoherent thoughts, no goal-directed movements)
- No loss in consciousness
- Symptoms resolve in less than 15 minutes
Grade 2: Moderate
- Same symptoms as grade 1 but symptoms persist more than 15 minutes and amnesia may be present.
Grade 3: Severe
- Any loss of consciousness, brief (seconds) to prolonged (minutes)
The Glasgow Coma Scale (GCS) can be also employed in assessing the severity of a traumatic brain injury (TBI)…
Glasgow Coma Scale Relationships
- GCS 13-15 - mild injury
- GCS 9-12 - moderate
- GCS 3-8 - severe
- A mild brain injury will produce a GCS of 13 to 15
- A moderate injury produces a GCS of 9 to 12
- A severe injury produces a GCS of 3 to 8
Always evaluate the mechanism of injury, loss of consciousness, ask about seizure activity post trauma but pre-EMS arrival and have a look at the helmet for damage. It’s not a bad idea to transport the helmet with the patient to give the trauma docs and neuro folks a first-hand look at the location of potential problems.
While many TBI’s are mild, multiple mild TBI’s can accumulate to generate a more serious outcome and long-term effects. Always get a head injury history from the patient and others as this may play into the treatment scheme down the line.
Click here to take a look at the Spinal Cord Injury protocol.
Answer this review question to move on to the next section…
An Ounce of Prevention…
Coaches should be (and most are) teaching players proper blocking and tackling techniques that prevent spinal injuries. “Head tackling” can be dangerous and is easily observable when a player lowers his head in order ram the opponent. Proper instruction has and continues to significantly decrease the incidence of axial loading injuries to the cervical spine. The “see what you hit” approach is one of several programs to teach young players proper technique.
This course has emphasized the practice of removing the face mask instead of removing the helmet. However, some older style helmets have the face mask bolted directly to the helmet, making it nearly impossible to remove the mask. Equipment should conform to the NOCSAE (National Operating Committee on Standards for Athletic Equipment) standards.
Special thanks to AC Reynolds Rockets Varsity Football Coach Steve McCurry and his star Quarterback Kyle Johnson for giving us their time for pictures. Southeastern Sports Medicine and trainer Patrick Hunter have been big EMS supporters on previous projects and helped us out with this one too.
Watch for Kyle Johnson on the MIT football team, he has a full ride scholarship there not so much for his football ability but for math!
See the “links” section below for some additional information. The “Prehospital Care of the Spine-Injured Athlete” provides excellent information and is a major source of information contained in this program.
Links
NOCSAE (National Operating Committee on Standards for Athletic Equipment): nocsae.org
AC Reynolds Athletics: acreynoldsathletics.org
National Association of Athletic Trainers: nata.org
Excellent Document: “Prehospital Care of the Spine-Injured Athlete”