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There’s no harm in hoping for the best as long as you’ve prepared for the worst.

Stephen King

Highly publicised incidents of concussion, sudden cardiac death and heat-related illness have moved the topic of emergency medicine to the forefront of sports medicine discussions. Situations threatening life or limb require advanced medical knowledge, skills and appropriate equipment to ensure immediate and expert care for the best possible patient outcomes. Clinicians responsible for athlete care at any level, from grassroots to elite, should undertake a recognised and accredited medical emergency care course.

Knowledge of emergency care should not be limited to sport and exercise medicine physicians. Every potential member of the emergency care team must be well prepared for the acute management of the athlete who is injured or unexpectedly becomes ill. As athletes and accompanying clinical teams travel widely both nationally and internationally, not all athlete emergency care occurs near high-level definitive services, so all members of the emergency care team must also be prepared to deal with the unpredictable in diverse settings.

In this chapter we will discuss:

  • the role of the physiotherapist in emergency care

  • the sequence of events in emergency care

  • the primary survey in detail

  • equipment needed for emergencies

  • appropriate use of analgesia in emergencies.


Although there are skills and procedures described in this chapter that are legally restricted to physicians, this chapter is also relevant for other clinicians, such as physiotherapists. Given the countless number of people who participate in community sports, most sporting situations take place in the absence of a clinician who is trained in the management of sporting emergencies. Consequently, the responsibility of preparing for and managing an emergency may fall to other clinicians.


All clinicians must be aware of the limits of their practice, as determined by their national credentialing organisation. All those responsible for sporting teams or athletes are strongly encouraged to gain further training in emergency care.

The physiotherapist has a central role in the management of sporting emergencies either as the team leader or team member. If the physiotherapist is the emergency team leader, he or she has the responsibility for preparing for and managing the emergency situation. If the physiotherapist is a member of the emergency team, they can assist the physician in preparing for an emergency situation and in the immediate management of the patient with a life- or limb-threatening condition.


When an emergency occurs, the onus is on the most senior clinician present to assume leadership, delegate or personally perform a rapid assessment of the situation and the patient, and initiate management. Leadership and team roles must be clearly defined and outlined well in advance, ...

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