Resources for Athletic Trainers and Coaches

• Documentation of a known anaphylactic allergy to bee stings, foods, medications, etc., should be on file for any athlete.
• Students with a known anaphylactic allergy should have prescribed rescue medication, usually an epinephrine auto-injector, readily accessible during all sporting activities, including conditioning, practices and games.
• The athletic trainer or coach should have an extra supply of each athlete’s prescribed rescue medication as a backup.
• The medication should be examined before each activity to ensure it is functional, contains medication and is not expired.

The best way to prevent dental emergencies in sports is for each athlete to wear a mouthguard. A custom-fit mouthguard designed by a dentist offers the best protection, but store-bought “boil and bite” guards can also be effective. Here are some general tips for common dental problems:

• If a child’s baby tooth gets knocked out, apply pressure to the area if there is bleeding. Advise the child’s parents to contact the dentist as soon as possible.
• If a child’s permanent tooth gets knocked out, locate the tooth, if possible. Rinse the tooth in cold water, and try to place it back into the socket. If this can’t be done, place the tooth in a clean container with milk, saliva or water and have the child’s parents contact the dentist immediately. There is a chance the tooth can be saved with immediate treatment.
• If a child chips a tooth, rinse her mouth with cold water and use a cold compress on the area to help alleviate any swelling. If you can find the broken part of the tooth, take it to the dentist as soon as possible.
• Immediate treatment can prevent infection and limit the need for further dental work.
• If a child has a toothache, rinse her mouth with cool water and place a cool compress on her face where it hurts. Do not put heat or aspirin on the sore area. Advise the child’s parents to make an appointment with the dentist as soon as possible.

Knowing what to do for an eye emergency can save valuable time and possibly prevent vision loss.

• Do not let the athlete rub the eye. This may scratch or damage the cornea.
• Try to let the athlete’s tears wash the speck out, or use saline eyewash or room-temperature water.
• Have the athlete lift the upper eyelid outward and down over the lower lid. Using a clean finger and thumb, the athlete should gently pull the upper eyelid down over the top of the lower eyelid. This should cause tearing and flush the object out. The athlete may need to repeat this several times.
• If the athlete can see the object, try to remove it from the eye with a sterile gauze or clean cloth.
• If the speck does not wash out, keep the eye closed, bandage it lightly and have the athlete see a doctor.

Blows to the eye

• Apply a cold compress without putting pressure on the eye. Crushed ice in a plastic bag can be taped to the forehead to rest gently on the injured eye.
• Seek emergency medical care in cases of pain, reduced vision or discoloration (black eye). Any of these symptoms could mean internal eye damage.
• Check for satisfactory extraocular movement (look up, down and side to side).

Cuts and punctures of the eye or eyelid

• Have the athlete see a doctor right away.
• Do not wash out the eye with water or any other liquid.
• Do not try to remove an object that is stuck in the eye.
• Cover the eye with a rigid shield without applying pressure. The bottom half of a paper cup can be used.

Do not assume that any eye injury is harmless. When in doubt, have the athlete visit a doctor right away.

A fracture is a break or crack in a bone. Symptoms include a snapping sound as the bone breaks, bone protruding from skin, detectable deformity of bone, abnormal movement of bone, grating sensation during movement, pain and tenderness, difficulty in moving or using the affected part, swelling, and discoloration. In case of a fracture or suspected fracture:

• Seek medical attention right away. Call for an ambulance, or transport the child to the nearest emergency department after immobilizing the affected area. Wait for an ambulance, and do not attempt to transport the athlete if you suspect a head, back or neck injury; if there is a visible deformity of bone; or if the limb cannot be splinted or transported without causing more pain.
• Assume a back or neck injury if the athlete is unconscious or has a head injury, neck pain or tingling in the arms or legs. If a neck or back injury is suspected, do not move the athlete unless necessary to save her life.
• Immobilize and support affected bone in the position in which it was found. Do not try to push protruding bone back into the body or let the athlete move or use the affected area.
• Control any bleeding through direct pressure, but do not elevate the affected area.
• Cover any protruding bone with clean cloth once bleeding is controlled.
• Observe for shock or change in mental status (drowsy, sleepy, etc.). Do not give the athlete anything to eat or drink.
• Immobilize the injured area:
  • If no open wound is present, apply an ice pack wrapped in clean cloth.
  • Check for sensation, warmth and color of toes or fingers below suspected break.
  • Place a padded splint under the area of suspected break. Use a board, a rolled newspaper or magazines, a broomstick or a rolled blanket for a splint.
  • Wrap the splint in cloth or towels for padding.
  • Bind the splint to the limb using neckties, cloth, belts or rope. Do not bind directly over the break.
  • Recheck often for sensation, warmth and coloring. Loosen the binding if fingers or toes turn blue or swell.
  • For arm or shoulder injuries, place a splinted arm in a sling, with the hand above elbow level. Bind the arm to the athlete’s body by wrapping towel or cloth over the sling and around the upper arm and chest. Tie the towel or cloth under the athlete’s opposite arm.

Most minor cuts and scrapes don’t require a trip to the emergency department. Proper care immediately after the injury can help prevent infection and other complications. These guidelines from the Mayo Clinic can help you care for simple wounds. Always remember to wear protective gloves when treating cuts.

A wound may require stitches if it:

• Will not stop bleeding.
• Is more than a quarter-inch deep.
• Is gaping or jagged.
• Has fat or muscle protruding from it.

Remember to properly remove your gloves after treating a wound.

• With both hands gloved, grab the outside of one glove at the base of the wrist.
• Peel the first glove off away from your body, turning the glove inside out.
• Hold the removed glove in the gloved hand.
• With your ungloved hand, peel off the second glove by sliding your fingers inside at the top of the wrist.
• Turn the second glove inside out while peeling away from your body.
• Dispose of the gloves, and wash your hands thoroughly.

Caring for shock

• Have the athlete lie down.
• Help the athlete maintain normal body temperature (cover with blanket if cold).
• Elevate the athlete’s legs about 12 inches, unless you suspect a head, neck, back or lower-extremity injury.
• Do not give the athlete anything to eat or drink, even though he is likely to be thirsty.

Caring for burns

• Stop the burning.
• Cool the burn (use cool water only—no ice or ice water).
• Cover the burn (use sterile dressings or clean cloth).

Caring for sprains and strains
Follow the steps laid out in the acronym PRICEMM:

• Protection: Remove athlete from game or activity.
• Rest: Limit use of injured body part for 24 hours.
• Ice: Apply ice for 15 to 20 minutes every one to four hours to reduce pain and control swelling.
• Compression: Apply an elastic bandage to control swelling.
• Elevation: Raise injured limb above the level of the heart to help reduce swelling.
• Motion: Begin mild range-of-motion exercises 24 hours after injury.
• Medicine: Can be taken up to 72 hours after injury.

A concussion is a short-term impairment of neurologic or brain function caused by a direct blow to the head, face or neck or an indirect blow to another part of the body that transmits an acceleration or deceleration force to the brain. Any athlete with signs or symptoms of a concussion should be removed from competition and not allowed to return until evaluated and cleared by a medical professional trained in the management of concussion.

Call an ambulance or go to the nearest emergency department immediately if the child:

• Can’t be awakened.
• Has one pupil that is larger than the other.
• Has a convulsion or seizure.
• Has slurred speech.
• Appears to be getting more confused, restless or agitated.

Call 404-785-KIDS (5437) for more information.

Remain calm.

If athlete is unconscious and positioned face up:

• Call 911.
• Assume serious neck injury.
• Give CPR if needed.
• Place hands on both sides of the head for stabilization.
• If necessary to maintain airway, remove face mask (if applicable) with screwdriver or face mask clip cutting tool.
• Do not:
  • Move athlete.
  • Remove helmet.
  • Use smelling salts.
  • Give water.
  • Rush evaluation.
  • Worry about delaying the game.

If athlete is positioned face down, conscious or unconscious:

• Team-roll the athlete to the face-up position:
  • Use three to four people.
  • Let the person at the head lead.
  • Roll the athlete as a unit.
• Leave helmet and shoulder pads on.

If athlete is conscious and positioned face up:

• Do not move athlete.
• Check orientation and memory of play.
• Ask if it is painful to move the neck.
• Ask about pain, headache, dizziness, nausea, blurry vision, numbness, tingling or electric shock sensation in arms or legs.
• Do not let the athlete sit up, unless he has:
  • No neck pain or tenderness
  • No pain, numbness or tingling in arms or legs
  • Normal sensation to touch in chest, arms, hands, legs and feet
  • Normal motor function (make a fist, bend elbow, lift arm, curl toes, move ankle up and down, bend knee, lift legs, etc.)
• Let the athlete sit up on his own if safe to do so. Provide only minimal help.

Once sitting:

• Reassess for pain, dizziness or nausea.
• Look for areas of deformity, bleeding or swelling.
• If no evidence of head, neck or spine injury, carefully help athlete off field.
• If symptoms recur or change, carefully lay athlete back down and call 911.

When in doubt, call 911.

A stinger is a traction or compression injury to the nerves in the neck and shoulder. Symptoms rarely last longer than one to two minutes and include:

• Sudden burning and numbness of lateral arm, thumb and/or index finger
• Weakness of shoulder, arm and wrist muscles

Stinger management steps:

• Ask about localized neck pain or stiffness.
• Ask if the athlete is afraid to move his head.
• Check if there is numbness in both arms.
• If any of the above occur or there is any doubt, immobilize the athlete and call 911.

If this is the athlete’s first stinger of the season, she can return to play if she meets the criteria below. If this is her second stinger of the season, or third or more in separate seasons, she should sit out until she is cleared by a sports medicine physician. For recurrent stingers, athletes should consider a neck roll, or “cowboy collar.”

To be cleared to play, the athlete:

• Must have no pain.
• Must have no numbness.
• Must have no weakness.
• Must have full, active range of motion in neck.

Children and teens who show these early warning signs could be at risk for sudden cardiac arrest and should be evaluated by their primary care providers and referred as needed:

• Fainting or near-fainting during or right after exercise
• Extreme shortness of breath with exercise
• Extreme fatigue with exercise
• Chest, shoulder or back pain or discomfort with exercise
• Family history of sudden, unexpected, unexplained death before age 50

After further evaluation, these conditions can usually be treated, and activity may or may not be restricted.

Treating sudden cardiac arrest

• Activate your emergency action plan.
• Call 911 and get the automated external defibrillator (AED), if one is available.
• Have someone stand outside to direct emergency medical services (EMS) to the scene.
• Begin CPR immediately. Remember CAB:
  • Begin chest compressions—push hard and fast, give 30 compressions, then give two breaths.
  • Open the airway.
  • Check for breathing and give two breaths.
• When the AED arrives, open it and turn it on.
• Follow directions given by the AED.
• If no shock is advised, continue CPR; if athlete is still unresponsive, check for other medical conditions.

Learn more about our Project S.A.V.E. Program.

Sudden cardiac arrest and other life-threatening emergencies can happen anywhere. Giving CPR and using an AED can greatly increase the chance of survival. Make sure you know the location of the AED and have access to it. Keep a maintenance checklist updated to ensure it will be working if you need it.

Get to know your athletes:

• Ask if anyone has asthma, and then discuss with any affected athletes privately. Learn about their asthma action plan and medicine needs.
• Always have quick access to asthma medicines on the field during any activity (conditioning, practice, game, etc.). Athletic trainers and coaches should have an extra inhaler prescribed individually for each athlete as a backup. The inhaler should be tested before each activity to ensure it is functional, contains medication and is not expired.
• Make sure the athlete uses the quick-relief inhaler with a spacer 15 to 20 minutes before exercise.
• Have the athlete do a 10-minute warmup and cooldown before and after exercise.
• Make sure the athlete drinks plenty of water before and during exercise.

Early warning signs of an attack:

• Chest pain or tightness
• Coughing
• Difficulty doing physical activity
• Weak voice or difficulty completing a sentence
• Wheezing

When to take a break:

• Stop the activity if you see, or the athlete reports, any early warning signs.
• The athlete should use a quick-relief inhaler as soon as she shows any signs of distress.
• The athlete can return to activity once asthma signs are gone.
• In the meantime, do not leave the athlete out of the activity—find alternative reduced activities for her to participate in, such as walking.

Peak trouble factors:

• Pollen counts—tree pollen (fall and spring); grass/ragweed (summer)
• Ozone and air quality
• Cold air
• Weather changes

Watch for an emergency. Call 911 if the athlete:

• Cannot finish a sentence without stopping to catch her breath.
• Cannot stop coughing or wheezing.
• Has blue lips or fingernails.
• Has sunken skin on her chest and neck.

If you feel the athlete does not have control of her asthma, you can talk to her parents about making an appointment with our allergy and immunology team. The team will design an asthma action plan that will help the athlete stay in control and active. Call 404-785-KIDS (5437) for more information.

There are three stages of heat-related illness: dehydration, heat illness/exhaustion and heat stroke. Each stage is progressively more severe. There are several steps you and your athletes can take to prevent any heat-related illness.

This is the mildest form of heat illness and occurs when athletes do not replenish lost fluids, often during or after rigorous exercise and sweating in heat.

Signs and symptoms

• Dry mouth
• Thirst
• Headache
• Dizziness
• Muscle cramps
• Excessive fatigue

Treatment

• Move the athlete to a cool environment, and give the athlete fluids to rehydrate.
• Make sure the athlete maintains normal hydration as indicated by baseline body weight.
• The athlete should begin exercise sessions properly hydrated. Any fluid deficits should be replaced within one to two hours after exercise.
• Have the athlete hydrate with a sports drink like Powerade, which contains carbohydrates and electrolytes. Doing this before and during exercise is optimal.
• Make sure the athlete hydrates throughout practice to minimize dehydration and maximize performance.
• Seek medical attention to replace fluids intravenously if the athlete is nauseated or vomiting.

This happens in extreme heat and when sweating without adequate fluid and salt replacement. Heat exhaustion occurs when the body is unable to cool itself properly. It’s characterized by the inability to sustain adequate cardiac output as the result of strenuous exercise and heat stress. If left untreated, it can lead to heat stroke.

Signs and symptoms

• Athlete finds it hard or impossible to keep playing
• Loss of coordination, dizziness or fainting
• Dehydration
• Profuse sweating or pale skin
• Headache
• Nausea, vomiting or diarrhea
• Stomach cramps or persistent muscle cramps

Treatment

• Remove the athlete from play, and move him to a shaded or air-conditioned area.
• Remove excess clothing and equipment.
• Cool the athlete until his temperature is approximately 101°F.
• Have the athlete lie comfortably with legs propped above heart level.
• If the athlete is not nauseated or vomiting, help him rehydrate orally with chilled water or a sports drink. If he is unable to take fluids orally, use I.V. infusion of normal saline.
• Monitor the athlete’s heart rate, blood pressure, respiratory rate and core temperature.
• Transport him to an emergency department if rapid improvement is not noted.

This is the most severe type of heat illness, resulting from elevated body temperatures induced by strenuous activity and increased heat. It occurs when the body’s heat-regulating system is overwhelmed. It is a serious, life-threatening emergency and requires immediate attention. Call 911.

Signs and symptoms

• Sudden collapse, usually with a loss of consciousness
• Elevated core body temperature, usually about 104°F
• Central nervous system dysfunction, including:
  • Altered consciousness
  • Seizures
  • Confusion
  • Emotional instability
  • Irrational behavior
  • Decreased mental acuity
• Nausea, vomiting or diarrhea
• Headache, dizziness or weakness
• Flushed, hot and either wet or dry skin (sweat is often absent, as the body has lost the ability to cool itself)
• Increased heart rate, decreased blood pressure or fast breathing

Treatment

Aggressive and immediate whole-body cooling is the key to treating exertional heat stroke. The duration and degree of hyperthermia may determine adverse outcomes. If untreated, fatal consequences may occur in vital organ systems like the muscles, heart or brain. It is recommended to cool first and transport second if on-site rapid cooling and adequate medical supervision are available.

• Schedule workouts and exercises during cooler times of day.
• Give children who are overweight, out of shape or not acclimated to the heat time to adjust.
• Schedule water and rest breaks every 30 minutes during activities. During these breaks, require young athletes to drink; don’t just encourage it. This also gives the coach or athletic trainer time to monitor each athlete.
• Have shade, ice and a kiddie pool filled with water and ice between 55 and 65 degrees ready for emergency treatment and rapid cooling.
• Have a cellphone with a charged battery available at all workouts in case of an emergency.
• Make sure each athlete wears sunscreen of at least SPF 15. Apply it 30 minutes before activity begins and every 20 to 30 minutes if sweating or swimming.
• Have athletes wear hats with brims and light-colored, breathable clothing.
• Modify the rules of some games or practices to allow for more breaks. For example, a soccer game can be broken into quarters instead of halves.

Hydration

• Athletes should be well-hydrated prior to participating in any athletic activity.
• Athletes should drink water or an electrolyte drink every 15 to 20 minutes during activity.
• Recommendations are based on body weight:
  • A child weighing 88 pounds should consume 5 ounces of water or an electrolyte drink every 15 to 20 minutes.
  • An adolescent weighing 132 pounds should consume 9 ounces of fluid in the same period.

• Any special tools to remove athletic equipment
• Automated external defibrillator (AED) and corresponding equipment, including:
  • Age-appropriate pads
  • Non-sterile gloves
  • Razor to shave chest, if necessary
  • Resuscitator bag and mask or face shield for rescue breathing
  • Scissors to cut clothes
  • Towel to dry chest
• Communication device (cellphone, walkie-talkie, landline)
• Ice tub prefilled during high heat-index season
• Keys for any locks you may need to open
• Splints, back board
• Stretcher/gurney/wheelchair

• Padding
• SAM splint
• Scissors
• Shark tape cutter
• Sling
• Tongue depressor

• Elastic bandage wraps
• Heel and lace pads
• Pre-wrap
• Quick-drying adhesive spray
• Stretchy tape
• Skin lube
• Tape

• Alcohol wipes
• Bandages
• Betadine
• Cotton tip applicators
• Gloves
• Hand sanitizer
• Non-sterile gauze
• Nose plugs
• Peroxide
• Saline wound wash
• Single-use triple antibiotic ointment
• Steri-Strips
• Sterile gauze
• Zinc oxide