On-field management of emergent and urgent extremity conditions

On-field Emergencies and Emergency Action Plans

Sideline coverage can be an enjoyable experience and provide the opportunity to witness and evaluate an athlete's pathology at the time of injury. While the majority of on-field injury will likely be of low acuity, it is essential to develop an Emergency Action Plan (EAP) to deliver excellent medical care efficiently. The EAP should provide a written, standardized multidisciplinary approach involving key personnel. The EAP should be rehearsed on at least an annual basis and should highlight the initial assessment of the patient while also accounting for the various types of trauma that may occur on the field and appropriate field extrication procedures. As most players who have a true on-field emergency will not return to same-day play, a thorough understanding of how to deliver emergency care and transfer the player to a higher level of care is essential.

Reduction of Acute Shoulder Dislocations in a Remote Environment: A Prospective Multicenter Observational Study

OBJECTIVE

Acute dislocations of the glenohumeral joint are common in wilderness activities. Emergent reduction should take place at the site of trauma to reduce the patient's pain and the risk of vascular and neurological complications. A limited number of reduction methods are applicable in remote areas. The aim of this study is to present our method of reduction of anterior shoulder luxation that is easily applicable in remote areas without medication, adjuncts, and assistants and is well tolerated by patients.

METHODS

A prospective observational study was conducted during a 5-year period. The patients included underwent closed manual reduction with our technique. After each reduction, the physician who performed the reduction completed a standardized detailed history, and reexamined the patient (for acute complications). The patients were contacted 6 months after the trauma to investigate long-term postreduction complications.

RESULTS

Reduction was achieved with our method in 39 (100.0%) of 39 patients. The mean pain felt during our reduction procedure was rated 1.7 ± 1.4 (on a scale of 10) using the visual analog scale scoring system. No complications were noted before or after the reduction attempts. We did not find any long-term complications.

CONCLUSIONS

The reduction method presented in the present study is an effective method for the reduction of acute shoulder luxations in remote places. Our data suggest that this method could be applied for safe and effective reduction of shoulder dislocation.

Safety and efficacy of attempts to reduce shoulder dislocations by non-medical personnel in the wilderness setting

OBJECTIVE

The objectives of this study were to explore the success rate and the complication rate for shoulder reduction attempts by non-medical personnel in the wilderness setting, and to compare the average time to reduction for those done on scene versus those that waited for reduction at a medical facility.

METHODS

In this study we solicited online survey responses from users of wilderness sports forums between October 2008 and April 2009. These surveys asked respondents to describe previous wilderness sports injuries they experienced. Descriptive statistics were calculated, and the Mann-Whitney U test was used to compare average reduction times, with an alpha of .05 selected as the significance threshold.

RESULTS

Overall, there were 112 responses with 56 describing shoulder dislocations that were reduced either on scene or at a medical facility. Reduction on scene, in the absence of a medically trained person, was attempted in 39 of these 56 cases with a success rate of 71.8% (28/39). The median time to reduction on scene was 5 minutes, compared to 135 minutes from the time of injury for those that were reduced at a medical facility (P <.001). Other than pain during the reduction, there were no reports of serious complications associated with the reduction attempts.

CONCLUSIONS

These data suggest that reduction of dislocations in the wilderness setting by non-medical personnel may be safe and effective, and significantly decreases the time to reduction. These findings may help guide future instruction of participants in high-risk wilderness sports.