Serious injuries and emergencies

An emergency might involve unconsciousness, the suspicion of a neck injury, a broken bone, persistent bleeding, chest pain or even cardiac arrest. You will be able to deal with these situations if you have acquired the necessary skills on a basic first aid course (see Useful addresses on page 94).

Practice under expert guidance is the key to confidence in dealing effectively with emergencies. If you do have to do so, it is essential that you or someone else controls any spectators who may hamper attempts at treatment by giving all kinds of advice.
If you really know what to do, you will not have to listen to them.

Head injuries

Any bump on the head that is associated with loss of memory or loss of consciousness should be regarded as potentially serious. Other warning signs include nausea and vomiting or drowsiness. If in doubt, the victim should be taken to the accident and emergency department.

Why head injuries are different

Unlike many other sports injuries, they can be life-threatening, usually as a result of the development of secondary complications rather than the severity of the initial impact. Complications include bleeding inside the brain, brain swelling and infection.
Many of the problems associated with these complications are preventable and people involved in sport should know what to do. In contact or combat sports such as football, rugby or boxing, someone who suffers a head injury that affects their level of consciousness is likely to sustain another – possibly even more serious – injury.

Concussion

This is a knockout or a period of loss of memory after a bump on the head (known as post-traumatic amnesia – PTA). In a knockout there is sudden loss of consciousness which may last a few minutes or hours. Alternatively, after a bump on the head the person may have no immediate recall of what has happened even though he or she may appear to be talking normally. In such instances you need to ask some specific questions (see below).
Concussion is dangerous because, even in a minor injury that is associated with loss of consciousness or memory, complications can set in.
The person may be knocked out for several seconds or minutes, then appear to recover completely, but may also sustain loss of memory (post-traumatic amnesia) for events after the injury.

Treatment:

• Even if the person seems to have made a full recovery after a minute or two, they may be functioning automatically without really being aware of what is happening.

• To avoid the risk of a second injury (especially if you’re playing a contact sport) get the injured player to sit on the sidelines for a while.

• Take your time to assess the person and if there is any doubt obtain medical advice. Ask:

1 Do you know where you are and what happened?

2 Do you know who you are?

3 What’s your address?

4 What’s your job?

5 Do you have a headache or feel sick?

• Then check whether they are moving in a coordinated way – can they hop and touch their nose with their index finger? Can they obey simple commands? Do their eyes follow your fingers as you move them and are their pupils of equal size?

Unconsciousness

Treatment:

• Unless you suspect a neck injury, an unconscious and breathing person should be placed carefully in the coma position

• Check that the airway is clear and that the person is breathing
• Check their pulse

• Cover any wounds and keep them warm

• GET MEDICAL HELP IMMEDIATELY.

Neck injury

This is potentially very serious. There may be damage to the spinal cord which can lead to paralysis or death. High-risk sports are diving, rugby, gymnastics, American football, motor racing, winter sports and horse riding.
Possible causes include head-on tackles, collapsed scrums, dives into a shallow pool, falling off a horse or a rock, falling badly on to a trampoline.

Symptoms and signs

• Numbness or tingling of the arms or legs

• Paralysis – check whether the person can move his or her arms or legs.

Treatment:

• Stay cool

• Look and listen

• Do not attempt to move the person without expert help.

Less serious injuries

Acute cervical sprain

This is an injury that occurs frequently in contact and high-velocity activities including motor sport and parachuting. After a twisting movement, the person may develop pain in the neck and be unable to move it normally. They may also feel pain or even tingling in their arms. Although they should go to hospital for an X-ray, no damage may show up because this type of injury is often a result of stretching the supporting ligaments or joints. A person who repeatedly suffers this type of injury – from heading a football, for example – may eventually develop neck changes visible on X-ray.

Treatment:

• Anti-inflammatory drugs are usually given for seven days or until neck movements return.

• Persistent pain will require further investigation and possibly physiotherapy and neck traction.

Chest injury

This may be caused by direct blows, muscle strains, broken ribs, punctured lung or a heart attack. Possible symptoms include persistent pain in the chest, or pain on breathing, sneezing or laughing; a heart attack is a possible cause of sweating, coldness, clamminess, shivering, nausea and vomiting.

Minor chest injuries

For direct blows, muscle strains, broken ribs and bruised cartilages, you should first apply an ice pack to the injury, then sit the person down and arrange to have them checked by a doctor.
A punch or a blow to the midriff will lead to difficulty in breathing, usually for about 30 to 60 seconds. Don’t move or touch the injured person, except to loosen any tight clothing. Do not apply pressure of any sort to the injured area in case there is internal damage. If the player is slow to recover, or is in continued difficulties, get urgent medical help.

The first aid kit

Make sure that you buy a well-equipped first aid bag suitable for your sport. It should contain at least the following:

• Dressings including sticking plasters, crêpe bandages, sterile wound pads, adhesive strapping, eye pads

• Pen torch

• Antiseptic cream or lotion, povidone–iodine solution or spray (or some other antiseptic solution or spray)

• Custom-made ice packs (unless ice is always readily available from a freezer or the freezing compartment of a refrigerator)

• Cotton wool, gauze swabs, surgical tape

• Scissors, tweezers and safety pins.

In addition the following are recommended for contact sports events and should be used only by someone trained to do so:

• Airways – small, medium and large

• Stretcher (scoop or foldable)

• Cervical collars – small, medium and large

• Inflatable and rigid splints.

[The Laerdal First Aid Kit is an excellent one.]

KEY POINTS

♦  Any bump on the head associated with memory loss or loss of consciousness should be regarded as serious and medical advice sought

♦  Learn basic life support techniques and principles because it could save someone’s life

♦  Get medical help immediately whenever serious injury is suspected