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Introduction

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Fortune favors the prepared mind.

Louis Pasteur

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This chapter addresses emergencies—the life- or limb-threatening situations that require more advanced medical knowledge, skills, and equipment. As with many elements of sport and exercise medicine (Chapter 2) these situations are best managed using a team approach (if possible). Because athletes and their accompanying clinical teams travel widely both nationally and internationally, not all athlete emergency care occurs near high-level definitive services. We were aware of this when writing this chapter.

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Because emergencies are infrequent, it is tempting not to prepare and practice for such events because of all the other pressing demands on clinicians’ time. Unfortunately, life- and limb-threatening conditions require immediate and expert care. Are you and your clinical team well prepared and rehearsed in the skills, knowledge, and equipment required? Clinicians with the responsibility of caring for athletes at any level should undertake a recognized and accredited medical emergency care course.

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The role of the physiotherapist in emergency care

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Most sporting situations take place in the absence of a physician trained in the management of sporting emergencies. Thus, the responsibility of preparing for, and managing, an emergency may fall to other clinicians such as the physiotherapist or athletic trainer. All clinicians must be aware of the limits of their practice, as determined by their national credentialing organization. Those responsible for sporting teams or athletes are strongly encouraged to gain further training in emergency care.

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Although there are skills and procedures described in this chapter that are legally restricted to medical practitioners, the chapter is also relevant for physiotherapists. The physiotherapist performs a vital role in the management of sporting emergencies either as the team leader or team member. As a member of an emergency team, the physiotherapist assists the physician in preparing for an emergency situation, and in the overall immediate management of the patient with a life- or limb-threatening condition. If the physiotherapist is the emergency team leader, he or she has the responsibility for preparing for and managing the emergency situation.

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Emergency care principles

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When an emergency occurs, the onus is on the most senior clinician present to perform a rapid assessment of the situation and the patient and initiate life- and/or limb-saving management. Leadership and team roles must be clearly defined and outlined well in advance, and the skills related to each role rehearsed as a team. The sequence of events for emergency care is outlined in the box below.

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Sequence of events for emergency care

  1. Preparation

  2. Triage

  3. Primary survey

  4. Resuscitate and stabilize

  5. Focused history

  6. Secondary survey

  7. Continuous reassessment

  8. Definitive care

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Preparation

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The two components of preparation are:

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  • pre-situation preparation

  • situation preparation.

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Pre-situation preparation
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The clinical team must prepare and rehearse its approach to ...

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