A Coach’s Guide to First Aid
First Aid on the Field—Any field
by Amanda Menard, LPN, and Lorraine Anne Liu, RN
As a coach, you want a winning team, and every parent wants their kids to be part said team, but we also want it to be a healthy winning team. As a coach, it is your job to teach the children how to play the sports they love to the best of their ability. It is also your job to keep them safe while they are doing it, and first aid is a vital part of that.
Very few coaches have formal medical training. Most of them are caring parents who are willing to make the necessary sacrifices to help their children and their friends have a great time while learning their favorite sport.
You don’t have to be a physician or a paramedic to help to keep kids safe while playing sports, but a key component is preparation.
Preparation can be broken down into essentially two categories: Long-term preparation and immediate preparation. Long-term preparation is what happens long before a practice or a game. This includes having coaches and staff and, in the case of older teams, key players trained in first aid. It also includes regular inspection of equipment to ensure the safety of the participants and the development of proper form, techniques, and regimens to help reduce injuries due to repetitive movement associated with the sport.
Immediate preparation is what occurs the day of the practice or the game, but before any of the kids go out onto the playing area. It takes a few minutes to walk the field or court to assess for a safe sporting environment, look for damage caused by previous events, ensure that the goals and nets are secure, and check the weather for lightning or a high heat index.
Review each child’s file for completeness. The following information should be contained in each file and be available to the coach at every practice and game:
- Contact information for parents/legal guardians. Having an additional emergency contact person is always a good idea. It is also important to obtain pertinent information such as medical conditions, allergies and, pediatrician information.
- Medical consent forms allowing the coach to seek treatment for the child while awaiting the arrival of the parents or legal guardians. This can save a lot of time, particularly in non-life threatening injuries that require transportation to the hospital. Without consent, the child cannot be treated.
- Past medical history, e.g. asthma, seizures, prior heat related injuries
Make sure that you and your staff are familiar with the emergency medical services (EMS) response to your facility.
During the event
Each and every coach should be CPR and First Aid certified. This is not only so that you can treat those minor cuts and scrapes, but also so that you can assess injuries and make informed decisions regarding whether a child should continue to play or not. While serious injuries are rare during children’s sporting events, the moment they happen, they are often very catastrophic. Even relatively minor injuries like strains and sprains can be less frightening if you know what to do when they happen.
One of the most difficult jobs of a coach is deciding whether a child can or cannot return to a game following an injury or if they require evaluation by a healthcare professional. The following is not a replacement for trained evaluation of an injury by a medical professional. It is meant to be a general guideline in helping you to assess illness and injury.
When in doubt about the seriousness of any injury, you should always have the child assessed by a healthcare professional before allowing them to return to the game or even to leave the facility at the end of a game. A child with any significant injury should not be permitted to return to the activity without a medical release from a physician. It is better to miss one game than to miss an entire season or worse. Remember, a minor cannot consent to a treatment and therefore cannot refuse said treatment. When a parent or legal guardian is not present, you have (or should have) his or her medical consent. That makes you the decision maker, not the child.
Much research has surfaced over the past several years regarding the seriousness of concussions and head injuries in the sports community. They can have ramifications for many years following the injury. They can also be very difficult to assess at the time of the incident. For this reason careful evaluation is a must. When in doubt, always err on the side of caution and have the child be evaluated by a healthcare professional. Any significant blow to the head should result in the removal of the child from the activity and to be immediately evaluated by a healthcare professional.
- Immediately call for EMS services.
- Evaluate if there are signs of shock or skull fracture – look for bleeding around the eyes, nose, or ears. Observe for the length of time that unconsciousness lasts.
- Immobilize the child to prevent any further damage to the brain, spinal cord, or neck. Wait for EMS to arrive.
If the child is conscious:
- Check for alertness and orientation – assess whether or not the child knows where they are or what day it is.
- Assess for numbness, tingling or weakness of any extremity.
- Check for dizziness, or general weakness. If the child is unable to stand, allow him/her to assume a position of comfort and summon EMS.
- Check the child for slurred speech, ringing in the ears, a full feeling in his head, or memory loss.
If any of the above result in a positive finding the child must be transported to a hospital and be evaluated by a medical professional. Contact EMS and remain with the child until they arrive. If a concussion is left untreated it can lead to what is called Second-Impact Syndrome (SIS). Second-Impact Syndrome occurs when a player has sustained a second head injury before the symptoms of the first injury have subsided. This syndrome is life-threatening and causes brain swelling or herniation and death.
Bleeding from cuts and scrapes are very common injuries in any sport. Remember that blood is potentially infectious which means that the child must be removed from the practice/game until the bleeding has been stopped and the wound has been cleaned and covered. This is done to protect the other children from potentially infectious exposure. Most bleeding is not considered an emergency and can be controlled rather efficiently by the coach.
Even though most of the time they are not life threatening injuries, they can be very serious in children because they can affect the bones’ ability to grow over time. All fractures in children should be taken seriously until proven otherwise by a healthcare professional. In the case of fractures of the upper leg, they can be life threatening and require immediate attention, especially if there has been any injury to the femoral artery.
Sprains and strains
While not generally considered medical emergencies, they can be pretty painful.
Do not allow the child to bear weight on the injured limb. He/she should be assisted off of the field.
Most sprains and/or strains can be treated with rest, ice, compression, and elevation (RICE).
If there is any doubt whether or not the injury represents a sprain/strain or a fracture, then it should always be treated as a fracture until proven otherwise by an x-ray.
The player can return to play when he/she can run figure eights without pain or limp and can hop on the injured foot.
If abdominal pain is present without any injury, then the child should be evaluated for dehydration and heat exhaustion/heat stroke. Abdominal pain following injury should be evaluated with a careful assessment of the presenting symptoms.
Abdominal injuries can range in severity from simple muscle strain to internal bleeding and can potentially be as dangerous as a head injury. Signs and symptoms include tenderness, rigidity, and bruising of the abdomen. There should be medical attention for the child if conditions worsen.
Heat exhaustion and heat stroke
Both are very serious medical emergencies and can be prevented during sporting events.
An increase in body temperature and a decrease in the body’s ability to get rid of the heat are complicated by dehydration and loss of electrolytes. Heat exhaustion begins with profuse sweating, cramping of the extremities and the abdomen (sometimes referred to as heat cramps), nausea/vomiting, headache, dizziness, and cool, clammy skin. If left untreated it will quickly progress to heat stroke which is a life threatening emergency.
Heat stroke is characterized by the body’s inability to deal with its increasing temperature. The skin becomes hot and dry because the body can no longer sweat. The patient begins to have difficulty breathing, becomes agitated and confused, and sometimes loses consciousness. This can quickly lead to irreversible brain damage and even death.
Prevention of dehydration is key to preventing heat stroke and heat exhaustion. Children should always remain hydrated. They should be drinking plenty of water and taking frequent breaks on hot days. Everyone should be drinking water during non-playing times. You should remember that even on a day that doesn’t feel hot to us, if you are coaching a sport that requires protective gear such as football, body heat can be trapped and become exaggerated. If it is a hot day, players should be switched frequently to provide rest and to replenish fluids.
Treatment is aimed at cooling the child down. Interventions such as removing clothing, applying cool water to the skin, and placing ice packs to their underarms and groin should assist with reducing their temperature. Heat stroke is an extreme emergency and requires emergency medical treatment at a hospital. EMS should be summoned immediately if a heat stroke is suspected.
This article was provided by the ACLS Training Center and reprinted by permission.