Critical incident management, the emergency domain

A soccer player lies prone and unresponsive after a head-to-head collision, and a cervical spine injury is suspected. The athletic trainer must turn the player supine onto a long board to assess breathing. Which technique is MOST appropriate?

1. Log-roll pull
   The log-roll pull produces more spinal motion than the push when turning a prone athlete.
2. Log-roll push
   A prone athlete is turned supine with a log-roll push, which keeps the head, trunk and pelvis moving as one unit with the least spinal motion.
3. Lift-and-slide
   The lift-and-slide moves a supine athlete onto a board; it cannot turn a prone one.
4. Leave prone until EMS arrives
   An unresponsive athlete needs airway and breathing assessment now, which is impossible while prone.

During a baseball game, a lightning strike knocks down an outfielder. The athlete is unresponsive, and lightning is still striking nearby. What should the athletic trainer do FIRST?

1. Avoid touching the victim, who holds a charge
   Lightning victims carry no electrical charge and are safe to touch.
2. Begin CPR where the athlete lies
   Starting CPR in the open exposes the rescuer and victim to further strikes.
3. Move to a safer location, then assess
   With lightning still striking, rescuers move the victim to a safer place first, then assess and start care.
4. Wait 30 minutes until the storm passes
   Waiting for the storm to pass denies care to someone who may be in cardiac arrest.

A hockey player was checked into the boards and now has worsening shortness of breath. Breath sounds are absent on the left side, the neck veins are distended, and blood pressure is falling. What is the MOST likely condition?

1. Rib fracture
   A simple rib fracture causes pain and splinting, not absent breath sounds with shock.
2. Pericardial tamponade
   Pericardial tamponade distends the neck veins, but breath sounds stay present on both sides.
3. Massive hemothorax
   A massive hemothorax drops blood pressure, but blood loss leaves the neck veins flat rather than distended.
4. Tension pneumothorax
   Absent breath sounds on one side with distended neck veins and falling blood pressure is the picture of a tension pneumothorax.

During EAP activation for an unresponsive football player, which task is MOST appropriate for the athletic trainer to delegate to the head coach?

1. Call EMS and meet the ambulance
   Calling EMS and meeting the ambulance is a nonclinical role a coach can do, freeing the athletic trainer for care.
2. Hold manual cervical stabilization
   Manual cervical stabilization requires trained hands and stays with medical staff.
3. Decide whether to remove equipment
   Equipment-removal decisions need trained medical judgment and are not handed to a coach.
4. Perform the primary survey
   The primary survey is a clinical assessment that the athletic trainer performs.

During a lift-and-slide transfer of an athlete with a suspected cervical spine injury, which rescuer should give the commands to move?

1. Senior EMS provider
   A senior EMS provider who is not holding the head does not call the moves; the rescuer at the head does.
2. Team physician on scene
   Even with a team physician on scene, the commands for each move come from the rescuer holding the head.
3. Rescuer at the head
   The rescuer holding the head controls the cervical spine and calls every move.
4. Rescuer at the hips
   The rescuer at the hips does not control the head and neck, so this rescuer does not call the commands.

A marathon runner collapses just after crossing the finish line. The runner is alert, talking, and has a rectal temperature of 101 degrees F (38.3 degrees C). What is the MOST appropriate action?

1. Supine with legs elevated
   Alert with a near-normal rectal temperature after finishing fits exercise-associated postural hypotension, treated supine with the legs elevated.
2. Sit with the head between the knees
   Sitting with the head between the knees keeps the runner upright and does less to restore venous return than lying with the legs up.
3. Cold-water immersion
   Cold-water immersion is for exertional heat stroke, and this runner is alert with a rectal temperature of 101 °F.
4. Keep walking to prevent pooling
   Walking forces the runner upright and repeats the collapse.

A hurdler collapses during practice and is unresponsive and not breathing normally. The scene is safe, and only the athletic trainer and a student manager are present. What should the athletic trainer do FIRST?

1. Leave the athlete to call EMS yourself
   Leaving to call EMS yourself delays compressions when someone else can make the call.
2. Send the manager for EMS and the AED
   Sending the manager to call EMS and bring the AED lets the athletic trainer start compressions at once.
3. Begin CPR for two minutes before calling
   Delaying the call for two minutes of CPR is the lone-rescuer sequence; with a helper available, the call goes out immediately.
4. Retrieve the AED yourself first
   Fetching the AED yourself delays compressions when the manager can bring it.

During a mass-casualty incident at a track meet, a patient cannot walk, is breathing 20 times per minute, has a radial pulse, and cannot follow simple commands. In which START category should this patient be placed?

1. Minor (green)
   Minor (green) is for patients who can walk.
2. Delayed (yellow)
   Delayed (yellow) fits a non-ambulatory patient who has normal breathing, perfusion and mental status.
3. Expectant (black)
   Expectant (black) is for patients who stay apneic after the airway is opened.
4. Immediate (red)
   Under START, a patient who cannot follow simple commands is tagged Immediate (red), even with normal breathing and a radial pulse.

During the primary survey of a conscious rugby player after a pile-up, which finding requires immediate intervention before the survey continues?

1. Obvious wrist deformity
   A deformed wrist is a secondary-survey problem once life threats are managed.
2. Oozing eyebrow laceration
   An oozing eyebrow cut is minor bleeding that waits until after the primary survey.
3. Spurting thigh bleeding
   Spurting bleeding from the thigh is life-threatening hemorrhage and must be controlled during the primary survey.
4. Swollen, tender ankle
   A swollen, tender ankle is a secondary-survey finding.

During a cross-country meet, a runner collapses on a remote wooded part of the course. What information is MOST important to give when activating EMS?

1. Number of runners in the race
   The number of runners in the race does not help EMS find or treat the patient.
2. Vital signs from 10 minutes ago
   Vital signs from 10 minutes ago are out of date and are not the priority for dispatch.
3. Complete medical history
   A complete medical history is not needed to dispatch help and delays the call.
4. Exact location and access route
   The exact location and access route let EMS reach a patient on a remote wooded course without delay.

A football player in full equipment collapses without contact and is in cardiac arrest. How should the athletic trainer expose the chest for CPR and AED pads?

1. Slide the pads off over the head
   Sliding the pads over the head takes time and moves the neck.
2. Cut the jersey and open the pads
   Cutting the jersey and opening the shoulder pads exposes the chest quickly for compressions and AED pads.
3. Place AED pads over the equipment
   AED pads must touch bare skin, so they cannot go over equipment.
4. Remove the helmet before any CPR
   The helmet stays on during CPR; removing it first delays compressions.

A football lineman collapses during an August practice and is confused and combative. Which method should the athletic trainer use to assess core body temperature?

1. Rectal thermometry
   Rectal thermometry is the only field method accurate enough to diagnose exertional heat stroke.
2. Tympanic thermometry
   Tympanic readings are unreliable after exercise in the heat.
3. Oral thermometry
   Oral temperature is falsely low after exercise because of rapid breathing and fluid intake.
4. Temporal artery thermometry
   Temporal artery readings underestimate core temperature in exercising athletes.

An unconscious athlete opens the eyes only to painful stimulus, makes incomprehensible sounds, and withdraws the arm from a pinch. What is the Glasgow Coma Scale score?

1. 10
   10 adds points the patient did not earn in eye or verbal response.
2. 7
   7 scores the motor response as abnormal flexion (3), but withdrawal from a pinch is 4.
3. 8
   Eyes to pain = 2, incomprehensible sounds = 2, withdrawal = 4; the total is 8.
4. 9
   9 overcounts one component; eyes to pain is 2 and incomprehensible sounds is 2.

A soccer player collapses during a hot, humid afternoon practice. What should the athletic trainer do FIRST?

1. Measure rectal temperature right away
   Rectal temperature guides heat stroke care, but only after responsiveness and breathing are checked.
2. Check responsiveness and breathing
   A collapsed athlete is first checked for responsiveness and breathing, because cardiac arrest must be ruled out before anything else.
3. Move the athlete to a shaded area
   Moving to shade comes after the initial check and is not a substitute for on-site cooling.
4. Begin cold-water immersion immediately
   Cold-water immersion follows the initial check; it is wrong for a cardiac arrest.

Three hours after a kick to the shin, a soccer player has severe pain out of proportion to the injury, pain with passive toe flexion and a tense anterior compartment. The dorsalis pedis pulse is present. What is the MOST appropriate action?

1. Refer immediately for emergency evaluation
   Pain out of proportion and pain on passive stretch with a tense compartment signal acute compartment syndrome, a surgical emergency.
2. Recheck tomorrow since a pulse is present
   A palpable pulse does not rule out compartment syndrome, and waiting 24 hours risks muscle death.
3. Elevate the leg well above heart level
   Elevating well above the heart lowers arterial inflow and worsens compartment perfusion.
4. Apply ice and a compression wrap
   Ice and a compression wrap raise compartment pressure and delay definitive care.

A 6-year-old collapses at a youth soccer game and is unresponsive and pulseless. The AED has arrived, but it has only adult pads. What should the athletic trainer do?

1. Wait for pediatric pads to shock
   Waiting for pediatric pads delays defibrillation of a shockable rhythm.
2. Continue CPR without using the AED
   CPR without the AED withholds a shock that the rhythm may need.
3. Cut the adult pads to fit the chest
   Cutting pads damages them and they will not deliver a proper shock.
4. Use adult pads placed front and back
   Without pediatric pads, adult pads are used, placed front and back so they do not touch.

During sprints, a 17-year-old basketball player reports chest pain and nearly faints. He says his uncle died suddenly at age 35. The symptoms resolve after 10 minutes of rest. What is the MOST appropriate action?

1. Resume practice since symptoms resolved
   Symptom resolution does not exclude an inherited cardiac condition, so returning to practice is unsafe.
2. Hold out and refer for cardiac evaluation
   Exertional chest pain, near-fainting and a relative's sudden death at a young age call for removal from play and cardiac evaluation.
3. Hydrate and allow practice tomorrow
   Hydration does not address possible structural heart disease, and play tomorrow is unsafe.
4. Treat as asthma with a rescue inhaler
   Treating this as asthma ignores warning signs of a cardiac cause.

A pole vaulter lands on a broken standard and has an abdominal wound with loops of bowel protruding. What should the athletic trainer do while EMS is on the way?

1. Cover with a dry gauze pad
   A dry gauze pad sticks to the bowel and lets it dry out.
2. Apply an ice pack over the wound
   An ice pack can damage exposed tissue and does not protect the wound.
3. Cover with a moist sterile dressing
   Exposed bowel is covered with a moist sterile dressing, with an occlusive layer if available, to keep it from drying.
4. Push the bowel back into the abdomen
   Pushing the bowel back adds contamination and injury risk.