Does your dojo/club/school have a procedure to follow in case of a serious injury occurence? Do you have certified or qualified individuals that train with you should an emergency occur? How important do you feel that your instructor should be qualified to administer to serious injury? Dojo Emergency Procedures Is the individual conscious? If not: 1. Check Airway/Breathing/Circulation 2. Dial appropriate 3-digit emergency phone#... 3. CPR if necessary 4. Check for MedicAlert info 5. Head/Neck injury: immobilize BLEEDING: 1. Universal Precautions (Gloves/Padding) 2. Direct Pressure 3. Elevation SHOCK: Pale, dizzy, sweating, weak, confused: lie flat, elevate feet INJURY: 1. Fracture/Dislocation: immobilize/stabilize 2. Closed soft tissue: RICE 3. Open wound: Universal precautions, cleanse, cover WHEN DO I CALL 911? No breathing or pulse; loss of consciousness that does not resolve right away, or leads to confusion or amnesia (all loss of consciousness DOES require prompt medical attention!); shock symptoms that do not resolve quickly with rest and fluids; major injury such as unstable fracture or rapid bleeding; seizures that don't stop. In cases of: HEAD INJURY concussion grade 1: confusion, no amnesia, no loss of consciousness: Evaluate, rest and observe at least 20 minutes for being 100% symptom-free before return to activity. concussion grade 2: confusion with amnesia, no loss of consciousness: Evaluate, rest and observe 24 hours (medical attention required), return to activity after one week symptom-free. concussion grade 3: any loss of consciousness: Immediate medical attention required, return to activity after 2--4 weeks symptom-free depending upon medical advice. DIABETES It may be difficult to differentiate too high blood sugar from too low blood sugar in some people. In the dojo it is safe to assume that the rapid onset of symptoms that may include pallor, sweating, weakness or confusion associated with exercising is causing too low blood sugar. Position as for shock and administer sugar, either in the form of glucose tablets from the first aid kit, or by fortifying any liquid with a lot of sugar. If the person cannot take oral sugar due to weakness or loss of consciousness, call emergency phone # FRACTURES Evaluate all injuries for deformity, inability to bear weight, decreased range of motion, and pain (swelling and bruising may not be severe initially). Complex splinting and transport issues should not arise in the middle of a city with 911 functioning. Provide immobilization to the affected area and keep the person quietly resting until paramedics arise or, as may be done in the case of smaller bones such as wrists or feet, other transport is arranged. NECK INJURY If a neck injury is suspected due to the type of accident, the angle of the head, or any symptoms such as numbness of the extremities or difficulty with movement, do not move the person unless it is mandated by another emergency such as fire or falling debris. Provide reassurance, and immobilize the person's head and neck exactly as they are by sandbagging with anything available until the paramedics arrive. If a disaster necessitates moving the person, the head and neck must be supported/maintained exactly as they are to avoid risk of further injury to the spinal cord. SHOCK Shock symptoms may be caused by diabetes or other low blood sugar situations (see above), by illness, by blood loss, by dehydration, by overexertion, by massive allergy reaction or by heat. Pallor, with or without sweating; weakness, dizziness, confusion would be primary things to look for; sometimes there may be flushing instead of pallor. Lying down and then elevating the feet to above heart level is the key; provide fluids if the person is awake enough to swallow safely. If shortness of breath or labored breathing predominate, the person may only feel relief if supported sitting up, leaning somewhat forward. Any shock-like symptoms that do not resolve within a few minutes should be considered an emergency. SEIZURE The mat or carpeted floor is a safe place. Prevent harm during the seizure by removing objects from the vicinity but do not attempt to restrain the person except if needed to prevent harm; i.e. from banging into something. Do not attempt to force anything between the teeth. Sleepiness or confusion afterwards may be normal for some people. Basic life support for Instructors ,,, Every MA Instructor must have some knowledge of how to handle a medical emergency that may develop during a normal training class What will you do if you are suddenly confronted with the following situations? …during class a student suddenly fall to the ground with no breathing and is pulseless ? ….. during a fight a student is knocked out cold?, or is struck on the throat and his trachea is compressed obstructing his airway ? …... a student comes running towards you grabbing his throat and point to you that there is something obstructing his airway ? Airway obstruction inevitably leads to loss of consciousness followed by heart arrest and once the heart stops beating, irreversible brain damage and death will follow within 4 to 6 minutes unless effective cardiopulmonary resuscitation (CPR) is given.. There is no situation which requires more immediate attention and appropriate action than a cardiac arrest. Airway obstruction is a emergency situation that must be recognized and treated immediately. A student's life may depend on your ability to perform immediate and adequate resuscitation. Basic Adult CPR: Whenever you are confronted with a medical emergency situation, always remember the following algorithm: " H-H-H-A-B-C-D " Hazards - Hallo - Help - Airway - Breathing - Circulation - Defibrillation Hazards? Move the person to a save place and or remove hazardous material that can be dangerous to you or the person . Hallo? Assess the persons responsiveness by tapping on his shoulder and asking " What is your name or can you hear me ?" If he responds, treat his basic needs like a nose bleeding from a blow or a cut and keep him comfortable till help arrives. Help? If the person is unresponsive, SHOUT for help or ask a bystander to wait while you proceed to open his airway and determine if he is breathing. Airway? Open the airway by placing the palm of your one hand on the person's forehead to tilt the head backwards, while lifting the bony part of his chin forward with the fingers of your other hand. - If you suspect a neck injury, do not tilt the head backwards, but just lift or pull the chin forward. Breathing? Keeping the airway open, determine if he is breathing by placing your ear over his mouth facing his chest and feel, listen and look for any breathing or chest movement. Take up to 10 seconds for this important procedure. * Breathing present: If an unconscious person is breathing, turn him on his side and hold his chin up to prevent his tongue from falling back and obstructing his airway again and also to allow for blood or secretions to drain from his mouth. Turning him is done as a unit by placing the hand closest to you under his face, place his opposite hand and leg across his body, grab him by the hip with one hand and roll him gently towards you as your other hand support his chin and face. This is called the "Recovery position". Cover the person with a blanket and stay with him till help arrives and continuously checking his breathing. * Breathing not present: 1/ With the hand holding the jaw, just open the mouth and look inside for any visible foreign objects, if nothing is visible, keep the mouth open and with the other hand sweep a finger across the inside of the mouth very careful not to push any objects down the airway. Remove mouth guards and put dentures back in place since they help in providing a proper seal for mouth-to-mouth (MTM) breathing. 2/ At this stage you have a unconscious person that is not breathing and he is going to need CPR: Ask your helper to call the Paramedics immediately - tell them what your emergency is, give details about location and a telephone number. - If there is no helper, call the Paramedics yourself, because the sooner trained staff with a defibrillator arrive at the scene, the better is your chance for a successful resuscitation. - If you are alone or the person is a child (or a drowning victim), give CPR for one minute, before activating the emergency personnel. Return immediately to your victim and start rescue breathing by placing the person on his back on a firm surface .Mouth -to-mouth-breathing is done while tilting the forehead backwards with the one hand and with the same hand pinch the soft part of the nostrils close with the thump and index fingers. Take a deep breath and place your mouth as a seal over the persons partially opened mouth that is hold in this position by your other hand. Administrate a slow full breath into the persons airway over approximately 1,5 seconds making sure the chest moves as you breath. (If no movement of the chest is seen, tilt the head more and hold the chin more upwards.) Lift your mouth and keeping the airway open turn your head towards the persons chest in order to feel the exhaled air against your cheek while you inhale another full breath for the next administration. Give 2 effective breaths while giving proper time for exhalation. Now is the time to check for evidence of circulation - movement, swallowing or the presence of a pulse. Circulation? Feel for the presence of the carotid artery pulsation at the side of the neck. Keep the head tilted backwards and place the fingertips of the other hand on the front of the persons neck at the level of the Adams apple - gently slide the fingers back till they slide into the groove between the trachea and the strap muscles of the neck. Take up to 10 seconds to perform this very important procedure. * Circulation present : If signs of circulation is present, continue with MTM breathing at a rate of 1 breath every 5 seconds checking circulation after one minute ( 10 -12 rescue breaths) If breathing returns place the person on his side and monitor until the Paramedics arrive. * Circulation not present: If there is no evidence of a circulation within 10 seconds, start chest compressions. Place the person on a firm horizontal surface. Locate the lower end of the sternum with your one hand, then place the heel of your other hand on the lower end in the mid line of the sternum. Your hand nearest to the persons legs can now be put on top of the hand already on the sternum so that your fingers point away from you - keep them of the chest wall. With your arms straight compress the chest 15 times to a depth of 4 -5 cm at a rate of 100 per minute. No pressure must be exerted between compressions on the sternum, but do not remove your hands from the sternum so that you do not wasted time for repositioning of your hands. Count out load every compression and keep them as rhythmically and smooth as possible. After 15 compressions, immediately return to opening the airway, administering 2 effective breaths (MTM), followed by checking hand positioning on the sternum and 15 compressions ( A-B-C ) After one minute of CPR check for a pulse. Continue with A-B-C until movement and spontaneous breathing starts or until the Paramedics arrive. When can you stop with CPR: If any sign of life is detected, check for a pulse .If a pulse is detected but the person is not breathing, continue with rescue breathing at 12 breaths per minute. Once he starts breathing spontaneously, turn him as a unit on his side and monitor his pulse and breathing till the Paramedics arrive. Defibrillation? This is the procedure where the Paramedics "shock" the person's heart back to a normal rhythm. Most cardiac arrests or sudden deaths are due to fibrillation ( an abnormal ineffective contraction of the heart.). The only way to get these persons back to life is to defibrillate them. We can save lives if we can keep a persons circulation and respiration going until help arrives. A victim's life, whether a student, a family member or a foreigner, may depend on your ability to perform effective and adequate CPR at any time. Remember : Most persons will start breathing by just opening their airway, and or removing objects from their mouth, followed by 2 effective breaths. With proper compression of the chest only 30 % of blood circulation is possible - so do not waste time between rescue breathing and compressions - (15/2). The ultimate goal is to get the person back to life again - if his heart is fibrillating only the Paramedics will save him - keep him alive till help arrives with the defibrillator. It becomes futile to keep on doing CPR after 10 minutes, but there are no ethical justification on a slow ineffective, inefficient resuscitation. The latest information from the American Heart Association on sudden death is as follows: Just do heart compression at 15 per minute and no rescue breathing !! - Only if you definitely know that the emergency personnel is on their way with a defibrillator and oxygen, and normally they will reach you within 2 to 3 minutes. Airway Obstruction: Any object that obstructs the flow of air into the lungs may result respiratory distress or death - rapid removal of such an obstruction is absolute. Numerous objects may be the reason for such an obstruction - running or laughing with sweets in the mouth, broken dentures, teeth or mouth guards. Any swelling of soft tissues in and around the upper airway or the tongue may cause obstruction by falling backwards in the throat of an unconscious person lying on his back or side. Obstruction may be partial when the person can still get some air into his lungs or complete with a total obstruction. Partial Obstruction: Swelling of the soft tissue in and around the neck or compression of the trachea usually causes this type of obstruction. A foreign object may also be responsible. The person will be in distress with a stridor or wheezing and with strong efforts to breath. Allow the person to sit up if he wants to. Encourage him to cough forcefully in an attempt to dislodge the object and give oxygen if available. Have him transported as soon as possible to a hospital for more immediate and definitive treatment. Complete Obstruction: With this type of obstruction the person usually grasps his throat with his fingers and thumps. He can not breath, talk or cough. Soon he will loose consciousness and die. What do you do when you are confronted with this situation? Ask him " ARE YOU CHOKING " If he can not answer you it means that he can not talk or cough - get behind him, place your arms around his waist. Form a fist with your one hand so that its thumb comes to rest in his abdomen just above his navel, but well below his ribcage. Grab your fist with your other hand and perform a sudden inward and upward abdominal thrust. If the obstruction is not immediately relieved, perform up to five such thrusts Until the obstruction is relieved or the person become unconscious. (This is known as the Heimlich Maneuver). The Unconscious Obstructed Airway Person: An unconscious person lying on his back can not control his neck position and most of the time his neck is flexed and by so doing his tongue is falling back thereby blocking his throat. Therefore the very first thing to do when attending to an unconscious-unresponsive-person ( H-H-H ) is to tilt his head backwards. Make 5 attempts at rescue breathing to ventilate the person. If unsuccessful, kneel astride (straddle position) the persons thighs and place the palm of one hand in the midline of his abdomen just above the navel, well below the ribcage, place your other hands palm on top of the other hand and administrate a quick inward and upward thrust. These thrusts must be rapid and distinct, with the purpose of dislodging the obstruction. Repeat these thrusts up to 5 times before you open his mouth to check for dislodgment of an object and then lifting of the chin to check for breathing. Once the obstruction is relieved, start rescue breathing and chest compressions if no pulse is present. If you are alone, go for help if the obstruction has not been relieved after one minute. Points to remember: Never put your finger blindly into a throat for you may push the obstructing object deeper down. First open the mouth and look inside. A general reaction to a choking person is to slap him on his back. This technique can be used and up to 5 slabs on the back between the shoulder blades may be given - only when the person can bend his head lower than his chest Slapping a person on the back in a upright position causes the head to extend backwards opening the airway and this may cause the obstructing object to be sucked deeper down as the person attempts to inhale. If the victim happens to be yourself: You can try a modified Heimlich on yourself and if unsuccessful, throw yourself against a firm edge as the side of a table or the back of a chair so that the edge stuck you just above the navel or belt level.