Preventing Common Sports Emergencies

And knowing how to treat them

Organized sports are supposed to be fun with minimal risks, but occasionally athletes, coaches, and even bystanders experience a medical emergency. It’s important to know when an event is considered an emergency and what to do if one occurs. Coaches and other staff members frequently find themselves acting as first responders, and the actions they take can be critical to the outcome.

 Below are the top six medical emergencies most frequently seen in sports, listed in no particular order:

•     Head and Neck Injuries
•     Heat Illness
•     Asthma
•     Allergic Reaction/Anaphylaxis
•     Sickle Cell Trait/Exertional Sickling
•     Sudden Cardiac Death

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Head & Neck Injuries

Brain and spinal cord injuries can occur when athletes are participating in full-contact, limited-contact, or no-contact sports.  Any of the following scenarios require standard cervical spine precautions:

• A head injury results in a change in the level of consciousness
• An injured athlete complains of severe pain in his/her neck or back
• The injured athlete complains of weakness, numbness, or paralysis
• A loss of control of limbs, bowel, or bladder
• Observable odd positioning of head, neck, or back

Head injuries can range from a routine concussion to serious trauma. A concussion, while an injury to be taken seriously, is not necessarily an emergency. Sports organizations should adopt and implement a brain injury / concussion risk management program which explains the types of brain injuries which require immediate medical attention as follows:

Danger signs which require immediate medical attention: one pupil larger than the other; drowsiness or inability to wake up; headache that gets worse and does not go away; weakness, numbness, or decreased coordination; repeated vomiting or nausea; slurred speech; convulsions or seizures; inability to recognize people or places; increasing confusion, restlessness, or agitation; unusual behavior, loss of consciousness (even brief). If one or more of these danger signs occur after a bump, blow, or jolt to the head or body: call 9-1-1 or transport the athlete immediately to the emergency room.

If an athlete sustains what is suspected to be a serious head or spinal cord injury (the signs of which are listed above), call 911 and activate your emergency action plan. Do not move anyone with a suspected cervical or spinal injury  unless he/she is in immediate danger (and do not allow them to move). This includes leaving any protective gear (pads, helmet) in place until EMTs arrive. Hold the head and neck to prevent movement and keep stabilized until help arrives.

 If the injured party is unresponsive, check for a pulse. CPR should be performed while maintaining spinal immobilization.

In the event vomiting occurs, roll the injured person on their side with the assistance from at least one other person, working in unison and keeping the spine, neck and head in line.

Heat Illness

While quite preventable, heat illness is one of the top three causes of death in athletes. Please see our guidelines for preventing heat illness.

The most minor symptom of heat illnesses is cramping. More serious forms of heat illness are heat exhaustion and heat stroke. Cramps from overheating are a result of dehydration and exhibit as involuntary muscle spasms, usually in the legs, abdomen or arms. Rest, rehydration, and stretching of the muscles will ease the cramps. Heat cramps are not a medical emergency, but can be one of the first signs of heat exhaustion.

Heat Exhaustion exhibits in the symptoms listed below.

• Heavy sweating
• Dizziness or fainting
• Cold, pale, and clammy skin
• Rapid, weak pulse
• Headache  
• Nausea or vomiting
• Persistent heat cramps
• Tiredness or weakness
• Loss of coordination

Release anyone experiencing any of these symptoms from activity, move them to a shaded or air-conditioned area, and monitor closely. Have the athlete remove any extra clothing and equipment and lie down with legs elevated. Use fans, cold towels, or water to cool the person. Have the athlete drink cold water or a sports beverage. If the athlete is vomiting or nauseated, offer ice chips.

The athlete should not return to activity unless and until all symptoms have subsided. If vomiting or symptoms do not improve after one hour, call for emergency medical assistance.

Heat Stroke occurs when the body is unable to cool itself properly to maintain a normal body temperature. This can lead to death if not treated properly. Heat stroke can occur even when it is not hot outside; players who are unable to sweat enough to cool their body are at a higher risk for heat stroke. The signs and symptoms are:

•     Body temperature of 103ºF or higher
•     Dizziness
•     Confusion or combativeness
•     Hot, red, dry or damp skin
•     Headache
•     Rapid, strong pulse
•     Nausea/vomiting
•     Loss of consciousness/fainting

Call for emergency medical assistance immediately if heat stroke is suspected. Remove athlete’s extra clothing and equipment before cooling with a fan, cold towel, cold water, or ice packs. The best treatment for heat stroke is cold water immersion. Water temperature should be between 35º and 59º F and stirred to maximize cooling. Do not put the athlete at risk by leaving him/her alone in water. He/she could lose lose consciousness or become dizzy, and unintentionally be submerged.

Asthma

People with asthma risk swollen, narrowed airways, which restrict their ability to breathe. Severe asthma attacks can lead to death. Symptoms of respiratory distress are: 

•     Wheezing or chest tightness
•     Uncontrolled cough
•     Inability to speak in full sentences
•     Difficulty exhaling during breathing
•     Abnormal abdominal movements attempting to help breathing

Require athletes with asthma to have an asthma action plan developed by their physician, which should be communicated to coaches and trainers.

Allergic Reactions or Anaphylaxis

A whole-body allergic reaction causing airways to tighten and restrict breathing is an anaphylactic reaction to an allergen. It is a potentially life-threatening medical emergency requiring immediate treatment. 

Avoiding known allergens is the best way to prevent a severe allergic reaction. Parents of children with severe allergies should make all coaches and caregivers aware of allergens to avoid, and have an emergency plan in place for treatment should a reaction occur.

Signs of anaphylaxis are:

•     Swelling and or tingling of the tongue, lips, eyes and/or face
•     Anxiety
•     Difficulty breathing; coughing
•     Chest pain/ tightness
•     Abnormal breathing sounds; wheezing
•     Difficulty swallowing
•     Hives, itchiness, red skin
•     Dizziness or feeling lightheaded
•     Nasal congestion
•     Nausea, vomiting
•     Rapid, pounding heartbeat or fluttering heart
•     Slurred speech
•     Loss of consciousness

 Call 911 immediately If anaphylaxis is suspected. Check that the airway is clear. Check pulse and begin CPR if necessary. If emergency allergy medicine or an EpiPen is available, administer it immediately. Never administer oral medication or fluids when a person is having difficulty breathing.

Sickle Cell Trait

Athletes with sickle cell trait are typically healthy in other respects. In rare instances sickle cell can lead to exertional sickling, which is a medical emergency that requires immediate treatment. 

Exertional sickling is sometimes confused with heat cramps.  A combination of intense exertion and low blood oxygen causes exertional sickling. The oxygen-starved muscles may cause pain, injury, organ failure, and even death.

Allow athletes with sickle cell trait to set their own pace, rest, and hydrate at any sign of symptoms. Pain in the lower legs is typically the first symptom. Symptoms that do not quickly resolve or include collapse, severe pain, or breathing problems should be considered a medical emergency requiring a call to 911.

Sudden Cardiac Distress

Fortunately, instances of sudden cardiac death are rare, but it is one of the leading causes of death in athletes. Most events are due to abnormalities of the heart such as Marfan syndrome, hypertrophic cardiomyopathy, and Wolf-Parkinson-White syndrome. These conditions typically have no obvious symptoms before the actual incident occurs. Cardiac-related deaths can also be caused by a concussion of the heart known as Commotio cordis, which results from a blow to the chest by a blunt object, which we see most often in baseball and softball.

Regardless of why sudden cardiac events occur, treatment is the same. Check the athlete’s responsiveness, breath, and pulse and call 911. If an AED is on hand, have someone trained in its use administer treatment; early defibrillation drastically improves chances of survival. If no AED is available, begin CPR immediately, which also significantly increases the chances of survival.