First Aid Guidelines for Coaches

The Goal

For participants to have a general understanding of the prevention and management of injuries of the softball or baseball player.

P.R.I.C.E.S.

One of the most important things to remember today is the term: P.R.I.C.E.S.

Remembering the term P.R.I.C.E.S. can get you through the majority of the steps needed to prevent or treat an injury on and off the field:

P: Prevention, Preparation and Protection

R: Rest

I: Ice

C: Compression

E: Elevate

S: Support

P: Prevention, Preparation and Protection

Encourage all players to have a pre-participation sports physical. Most physicians or clinics will make sure that the players are up to date on their vaccines (tetanus, pertussis, meningococcemia, etc). This simple step may prevent a lot of illness or injury to the player, their teammates, and you.

Prepare by knowing what is in your first aid kit. Handle and touch everything in there. You may elect to keep additional things in a separate container. Just make sure to know what you have and how to use it. Make sure to have quick access to every players medical release form so you know how to get in touch with the parent(s) at a moment's notice.

Protection includes not only the individual player but also their teammates, coaches, etc. Keep in mind that all times that field is your domain. Take ownership of the potential for injury or illness that others (including parents) may not recognize. Pay attention to your instincts about your players and their general well being. Act on your instincts even if it means upsetting the parents, team, other coaches, etc. That child, no matter how old, is depending on you. Protect yourself and your players by making sure every player has their parent fill out the medical release form (attached). When the situation warrants, make sure all injured players have clearance from their physician to return to play. Make sure it is a signed document.

R: Rest

Rest is just as important in preventing an injury as it is in rehabbing on.

I: Ice

Ice is important in reducing the inflammation resulting from strains and sprains but is completely ineffective in the presence of fractures so use appropriately.

C: Compression

Compression is also an important aspect of strain and sprain rehab. It can help to keep swelling down which increased blood flow to the affected area.

E: Elevate

Elevation is to used to keep pressure and swelling of the affected joint down and increase blood flow.

S: Support

Support is the second most important part of PRICES. The prevention of injuries is our primary goal and, as the "experts", are required to share with the players and their parents our knowledge, wisdom and diligence to attain that goal. Players may not know that they should or may be afraid to tell you when they are experiencing pain so it is vitally important that we express to them the need for them to do just that. And should a player experience an injury it is our requirement as the "experts" that we ensure that a player's injury is sufficiently healed prior to allowing them to resume play.

Typical Injuries to Expect with Baseball & Softball

1. Insect Stings & Bites

Typically, insect stings and bites are not much more than a temporary annoyance. However, if one of your players is allergic to the bite or sting it can be a life threatening situation that can progress quickly. Be aware of the players on your team that have known allergies to bee stings. They should have immediate access to an Epi­ Pen or "special insect bite kit". You should be familiar with how to use it and it should be available at all times. Go over the proper use of the kit before the season begins. You should know how to handle the situation should it arise.

LOOK at the site of the bite or sting. At the same time, LOOK at the player's response. Listen for the worrisome signs or complaints:

• Sudden weakness all over
• Child looks pale and/or is confused
• Sudden headache
• Breathing difficulties (wheezing or shortness of breath)
• Sudden stomach cramps or vomiting
• Pulse is rapid or weak

If worrisome signs are present:

• Stay with the child.
• Direct an adult present to call 911.
• Follow instructions of the special insect bite kit.
• Act immediately.
• Begin CPR if needed.
• Send two adults to the nearest intersection to direct emergency personnel to the correct field/location.
• Inform 911 where you have sent the adults so EMS can arrive to the appropriate location in a timely manner.
• Contact parents and inform them of the situation.
• If parents are not present, stay with the child and ride to the ER with them.
• Make sure to have the child's medical release form with you.
• Stay with the child until parents or guardians arrive.

2. Contusions

This is basically a bruise or abrasion. The area becomes black and blue and there may be associated "road rash". Swelling is typically present. The most likely sources for the injury would be:

• the ball itself
• the bat
• a player falling, sliding, or running into another player or base
• the player running into a hard object (fence, pole, etc)

LOOK at the player and the location of the injury. Try to assess the player's response to the injury and whether the response is in proportion to the injury or not.

Location and appearance: Try to first assess if the injury is mild, moderate or severe.

Ask yourself: Is the injury a simple injury that requires simple cleansing, and a bandage? Or, is it associated with a joint where they may be additional structures injured? Even if the injury looks mild, consider if the injury involves the structures of the face (mouth, eyes, nose, and ears), head, chest (cardiac), abdomen (spleen, kidney), and genitalia (testicles); special considerations need to be taken. Remember to apply P.R.I.C.E.S. as necessary.

Be mindful anytime the pain experienced by the player is disproportionate to the mechanism of injury.

R: Rest the player

I: Apply ice to the area of bruising

C: Compression wrap or apply pressure if necessary

E: Elevate

Notify parents and encourage physician evaluation if you feel uneasy about the injury.

3. Sprains

Ligaments attach bone to bone across a joint. Tendons attach muscle to bone. A sprain is an injury to a ligament. Ligaments make the joint strong and stable. Thus, an injury to the ligament may cause pain, swelling and instability of the joint. Typically involves a twisting injury to the ankle. Be aware of worrisome comments:

• A popping sound at the time of the injury
• The joint felt as though it slipped out of place at the time of the injury
• The pain experienced by the player is disproportionate to the appearance of the injury.

Apply P.R.I.C.E.S. as indicated:

R: Rest the player

I: Apply ice to the area of injury

C: Compression wrap or apply pressure if necessary

E: Elevate

S: Player may need support/assistance with walking.

Notify parents and encourage physician evaluation, especially if gross deformity was ever present.

4. Injuries to Small Joints

An injury to a small joint is not a small thing. Fingers and toes are important to daily functioning now and in the future. Take these injuries seriously. Worrisome signs or comments:

• A direct blow or extreme of flexion/extension
• Gross deformity is present - compare with the uninjured extremity
• A story that the joint was knocked out of place, even if it is now back in place
• Severe tenderness and/or swelling
• Inability to fully straighten or bend the injured joint

Apply P.R.I.C.E.S. as indicated. Consider "buddy taping" (e.g., taping injured finger to the finger next to it) as a method of temporary splinting. Notify parents and encourage physician evaluation, especially if gross deformity was ever present, or if the joint will not move fully.

5. Fractures

A fracture is a broken bone. In the case of a closed fracture, the skin overlying the injury is intact. In an open fracture, the skin is cut or broken, exposing the broken bone to you and all of God's creatures. A fracture can be caused by any imaginable force or injury such as a twist, wrong tum or direct blow. Be mindful of worrisome signs or complaints:

• History of a violent twisting injury
• History of a direct blow (bat, line drive)
• The player or you heard a snap or pop
• There is an obvious deformity
• Marked tenderness over the injury
• The pain experienced by the player is disproportionate to the appearance of the injury
• Bone ends are staring at you.

If the injury is not stable, leave the child where they are and await the arrival of EMS. If there is an open fracture, call 911 and follow the steps as outlined above. Immediately apply a sterile dressing (if you have one), and again, await the arrival of EMS. Be aware of the potential for blood loss. Make sure to stay with the child if the parents are not available.

For suspected, but stable fractures, splint and apply P.R.I.C.E.S. Contact the parents immediately and encourage ER evaluation ASAP.

6. Facial Injuries

A blow to the face could result in more than one injury, all possibly serious. A nosebleed might not be minor at all. There are multiple fragile bones of the face that can sustain significant long lasting damage with what seems like a mild injury. Be mindful of the eyes and the bones surrounding the eye sockets. Concussions frequently occur with significant facial injuries. You may have to deal with more than one problem. Worrisome signs or findings:

• History of a direct blow to the face
• Bleeding from the nose, eye or eyelids
• Change in the appearance of the face (crooked nose, compressed eye socket)
• Swelling (mild, moderate or severe)
• Marked tenderness over the injury site or surrounding structures
• Blurred or double vision
• Loss of part or all of the visual field
• Your inability to fully assess the injury; • Signs or symptoms of a concussion.

Apply P.R.I.C.E.S. as indicated:

R: Rest the player

I: Apply ice to the area of injury

C: Compression. Apply pressure if necessary with nose bleeds and closed nasal bone fractures. DO NOT APPLY PRESSURE TO AN INJURED EYE!!!

E: Elevate. NO! With nose bleeds and most facial traumas, you would want them to lie flat on their back.

S: Player may need support/assistance with walking.

If a concussion is suspected, call 911 and follow the steps as outlined. Contact parents immediately and encourage ER or physician evaluation if symptoms are mild or comfortably moderate. As a reminder:

• If worrisome signs are present: stay with the child
• Direct an adult present to call 911
• Begin CPR if needed
• Send an adult to the nearest intersection to direct emergency personnel to the correct field/location
• Contact parents and inform them of the situation
• If parents are not present stay with the child if transport is needed to the ER. Make sure to have the child's medical release form with you. Stay with the child until parents or guardians arrive.

7. Heat Illness

Heat illness can be divided into three categories depending on its severity: heat cramps, heat exhaustion, and heat stroke. Pre-adolescents acclimate to exercise in the heat more slowly than adults or older adolescents. For instance, the degree of acclimatization achieved in 6 days in young men requires 12 days for 8- to 10-year-old boys. So, the coach will acclimate to the heat better and faster than the younger players. Prevention involves water, water, water, and the care of an alert coach.

a. Heat Cramps

Usually present as painful muscles cramps with exercise and possible muscle fatigue. Cramping is probably the result of dehydration and electrolyte imbalance. Such cramps are usually brief and most often affect the legs, arms and abdomen. Cramps may occur during or after exercise. The body temperature remains normal. Treatment involves stopping the exercise, massaging and stretching the involved muscle, and rehydrating by drinking water or an appropriate carbohydrate-electrolyte drink.

b. Heat Exhaustion

Heat exhaustion occurs in athletes who sweat profusely and experience mild to moderate volume depletion. Core body temperature ranges 100.4- 104. Symptoms include nausea, vomiting, headache, dizziness, fainting, confusion, and inattention.

For treatment, stop the exercise and immediately move the athlete to a cool, shaded area. On-site cooling with fans, ice bags, etc should be initiated. Unnecessary equipment should be removed. If the athlete is cooperative and alert enough, begin rehydration by having him/her drink water or an appropriate carbohydrate-electrolyte drink.

Heat exhaustion progresses quickly to heatstroke and thus, if there is any doubt on the child's condition, contact 911 and arrange for transport. Make sure to contact the parents as above and follow the guidelines as outlined above.

c. Heatstroke

BAD NEWS. This is a life-threatening medical emergency with a mortality of 10% when good medical management occurs. Heatstroke is defined as a core temperature of greater than 104 and is accompanied by hot, dry skin (they stopped sweating) and central nervous system abnormalities (confusion, seizures, or coma).

If the youth has collapsed or is unconscious, call 911 immediately and follow the guidelines above. Until 911 arrives, immediately move the athlete to a cool, shaded area. On-site cooling with fans, ice bags, etc should be initiated. Unnecessary equipment should be removed.

8. Head Injuries (Concussions)

A concussion is a transient, traumatic disruption of neural function. The signs and symptoms reported in athletes who have experienced a concussion are varied. Even a minor concussion can result in symptoms that last for several days. Loss of consciousness and amnesia are symptoms that have formed the basis for most concussion grading scales. Most athletes who experience a concussion do not lose consciousness.

If the athlete is unconscious, the neck must be immobilized to prevent catastrophic damage to the cervical spine. Next, the airway must be established and adequate ventilation ensured. DO NOT MOVE THE ATHLETE FROM THE FIELD UNTIL CLEARED BY MEDICAL PERSONNEL. If the athlete regains consciousness on the field, stand firm in your stance to not allow him/her to be moved. Stay with the athlete.

Signs and symptoms of concussion:

• Headache
• Dizziness
• Confusion
• Nausea
• Unsteadiness
• Concentration difficulties
• Disorientation
• Amnesia
• Loss of consciousness
• Irritability
• Vomiting
• Visual disturbance
• Ringing in the ears
• Performance impairment
• Sleep disturbance
• Seizure

Be sure all injured players with a suspected concussion have clearance from their physician to return to play. Make sure it is a signed document.

9. Blunt Force Chest Trauma

This occurs when a player takes a sharp blow to the chest from another object. It can be a ball, bat, helmet or even a fist. The result can be a condition called Commotio Cordis which is an interruption of the normal heart rhythm resulting in ventricular fibrillation. Statistically the chances of this happening are very small but you need to be aware of it and watch for signs and symptoms.

Anytime a player experiences blunt force to the chest, keep an eye on them for a moment as they won't show signs immediately. Should a player collapse after such an event, immediately have another adult alert EMS.

Check the player to see if they are breathing. If they are not, check for a carotid pulse as this will be the easiest to palpate. If no pulse is present begin chest compressions until EMS arrives. Be ready to tell EMS what happened, how long ago it happened and how long compressions have been in progress. The only effective cure for V-fib is defibrillation so do not delay in alerting EMS.

Final Thoughts

1. Do no harm

2. Always trust your instincts

3. P.R.I.C.E.S.