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Pre-Hospital Immediate Care in Sport (PHICIS) course ...

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PHICIS COURSE Demonstrate the ability to apply the principles of initial assessment in Pre-Hospital Immediate Care in Sport to the injured/ill athlete.        

Identify the need to ensure the safety of the medical team before approaching and assessing an injured/ill athlete Identify the correct sequence of priorities for assessment of an injured/ill athlete Apply the principles in the primary and secondary evaluation surveys to the assessment of an injured/ill athlete Apply guidelines and approved techniques in the initial resuscitation of the injured/ill athlete Explain how the athlete’s medical history and the mechanism of injury contribute to the identification of conditions Understand the importance of re-evaluation of the injured/ill athlete Identify the role of the secondary survey understanding when this is applicable and the process Identify how to correctly prepare an injured/ill athlete for transfer to definitive care understanding the importance of documentation and communication with the receiving hospital

Rapid assessment and initiation of the appropriate life or limb saving care in a safe environment. Time is of the essence. A systematic approach is required to ensure injuries or the consequence of illness, are identified and treated in the correct order. This process is termed the initial assessment and the following template should be used for the assessment of all emergencies      

SAFE approach Primary survey with Resuscitation as required Re-evaluation Secondary survey Definitive care

The SAFE approach and primary survey applies to all emergencies. A full secondary survey requiring the removal of the patent’s clothing and definitive care are only really carried out in an appropriate environment. A limited secondary survey may be carried out pitch side to identify issues that may restrict the movement of the injured athlete e.g. open ankle fracture but this more likely to occur in the medical room or the ambulance. There should be no delay in patient transfer to hospital to allow a secondary survey when there are life threatening problems or time critical injuries. Safe approach:    

Shout for help Assess the scene Free from danger Evaluate the athlete

Injured or critically ill athletes should be assessed and their treatment priorities established based from their injuries, vital signs and the mechanism of injury. The athlete’s vital signs must be assessed quickly and efficiently with management consisting of a rapid primary survey including resuscitation of identified problems and rapid re-evaluation.

Process constitutes of the ABCDEs of immediate care and identifies life threatening conditions by adhering to the following sequence. 1. 2. 3. 4. 5. 6.

Catastrophic bleeding management Airway maintenance with C- spine protection Breathing with adequate ventilation Circulation with haemorrhage control Disability: neurological status Exposure & environment control

1. Pressure dressing should be considered in attempt to arrest the bleeding before moving to assess and maintain the athlete’s airway. 2. Check the verbal response to verb commands- Essential to identify airway compromise early and manage this appropriately to minimise hypoxia and hypercarbia. Furthermore it is important the airway is regularly re-evaluated since some airway problems are progressive in nature and may not be apparent during the first primary survey. 3. Determine the respiratory rate and to check for equal expansion of the chest wall. A cursory palpation of the chest wall at this time will reveal any areas of crepitus or tenderness. More detailed inspection in medical room or ambulance: inspection of the thorax, respiratory rate, expansion, percussion, auscultation, and examination for tracheal deviation and cyanosis are undertaken. All athletes with critical injury or illness should be provided with oxygen in the pre hospital environment via a non-rebreathe (trauma) mask with high flow oxygen. 4. Asses the athletes’ circulatory status by: assessing the presence of radial pulse (indicates probable end organ perfusion- if received blunt thoracic or abdominal trauma), check the pulse rate, volume and character, colour of the athlete, conscious level, agitation and external and internal bleeding. External haemorrhage should be managed by direct pressure to the wound and the application of dressings to stem the bleeding. If a athlete has clinical evidence of shock, it is important that all major areas of occult bleeding are assessed namely the chest, abdomen, retroperitoneum, pelvis and long bones. 5. AVPU, gsc, head or spinal cord injury suspicion: peripheral neurology! 6. For the initial on pitch assessment there should be limited exposure and the athlete protected from the environment...