First Aid whilst reffing

[Scarlet Al]

Completed a First Aid course Monday for work... Just been thinking about this... If a situation was to arise (God forbid) where urgent first aid attention was needed on the field, and say, all present first aiders were dealing with something else... Would you, as a referee and trained first aider get involved?

 

[ckuxmann]

You should never give 1st aid to a player if there is a medical person as qualified or more qualified, unless this person is in need of assistance. Also only do this if it is a life threatening situation.

 

[Toby Warren]

Common sense must prevail. 99.9 times out of a 100 you will not provide the care.

However If you are in the best postion to provide the emergency care you describe then you shouild, but in most cases there will be someone in a better postion to provide the care than you. (By positon I mean by way of training etc etc)

Your role is to ensure that they receive the care (stopping the game, briefing physios before the game etc etc. )

Thankfully whilst minor and moderate injuries are reasonably common serious ones aren't.

 

[FlipFlop]

As some Dr's I know who ref would say (and some have done), and as Spreaders has shown in games:

If you know how - then do it.

99% of first aid is common sense (having done the 1st Aid in work place course as well) and ignoring myths. So a little knowledge goes a long way. BUT the course teaches you your boundaries.

On a rugby pitch, in the situation you describe, I would get involved, and manage the situation - delegate someone to call the ambulance, someone to get the other players away, some one to direct ambulance etc. And I would ensure that I did the minimum necessary to the injured player until the experts got there. (i.e. Breathing? If yes, I would just reassure, and ensure they aren't moved. If not, then I would take charge of the necessary steps until a more qualified person arrived - as per training)

But if you are not trained, then it is probably just best to leave it, and let someone else deal. Although you can still manage the non-medical bits if necessary - perhaps offer this. Phone call, ambulance direction, players away etc.

 

[Dixie]

I have given limited emergency first aid in the past, and would do so again without hesitation. The referee's first priority is player safety. It is hard to agree with this, and simultaneously watch an unconscious player choke on his tongue while you frantically blow your whistle to attract the attention of the female physio who is being chatted up by the opposition subs.

 

[Phil E]

I have found that quite often, even when there is a fully qualified medical person present, the rest of the players look to the ref for some guidance.

So take charge of the "situation", not the casualty.

I would only intervene medically if there was no first aider or physio and it was a life threatening situation (DRAB).

 

[Davet]

If there is a trained 1st aider in attendance then give them the opportunity to do their job. Even if you are a qualified doctor then you may find their training in 1st aid is better than your own.

If you are yourself a qualified 1st aider, and no one else around is then - if it were me (and it has been) I would take the role of providing 1st aid.

The main principle of 1st aid is that you must not make the situation worse. You must ensure that there is no additional danger around and that they have a pulse (best one to use is in the neck, under the jawbone and beside the adams apple -practice finding it on yourself and significant other) and are at the very least breathing and with clear airways. In rugby injuries you must always be aware of neck and spinal issues, if ANY doubt then DO NOT move the casualty; you can carefully cover them to keep them warm.

Luckily it is unusual to see a deep a heavily bleeding cut o a rugby pitch, even a laceration from a broken stud probably won't result in a really serious loss of blood. Pads, Pressure, and Elevation should suffice. If it is bleeding heavily and a pad gets blood soaked put another one on top, don't remove the first one.

Breaks are more common. Pain, swelling and loss of mobility may be the indicators (though not always). If its a limb try to ensure it's kept as immobile as possible. If it's ribs don't try to immobilise the upper body, and don't apply any pressure. Remove casualty from the pitch if "walking wounded".

In all cases make sure someone calls an ambulance. Make sure that person knows where they are, addess, ideally post code (for ambulance satnav) and how to get to the site. Don't let the casualty drink and certainly don't provide food - if they later need an anasthetic this may delay the time when that can be given. (Dr Stu may care to comment)

The only situation in which you may be forced into taking some definite activity beyond making them comfortable is if their airway is blocked or they have stopped breathing. If the airway is blocked, mud, false teeth, oppo hookers ear, whatever - try to get it out, be very careful not to push further in.

If pulse/breathing has stopped then the only thing to do is to give CPR.

Frankly I think this should be taught in schools and everybody should know how to do it, and get the opportunity to practice on a model (plastic, not super). If you nor anyone else can do that then they are going to be in bit of a hole. No pun intended.

I have heard the dire warning about being sued - frankly, so long as you interfere at the minimum level you can then I think, in the UK at least this is most unlikly to happen, and even less likely to succeed. I think our courts are far more sensible than, for example, US ones.

This post is not intended as authoritative guidance, nor is it in any way Hampshire Society policy - it is a purely personal view based on my own first aid experience and training in the Army, and later in civilian life.

 

[Toby Warren]

Good to see that there is a genric theme devloping here.

 

[spmilligan]

As Davet said

"I have heard the dire warning about being sued - frankly, so long as you interfere at the minimum level you can then I think, in the UK at least this is most unlikly to happen, and even less likely to succeed. I think our courts are far more sensible than, for example, US ones"

I believe by doing the DRABC and keeping someone alive until medical intervention you are covered by the Good Samaritan Act and the courts would look favourably upon you, but someone more learned than me can confirm this.
Surely, worse case scenario, if trained to do so it would be better to start CPR than not, you wont make the matter any worse for the person.

 

[Adam]

If there is a trained 1st aider in attendance then give them the opportunity to do their job. Even if you are a qualified doctor then you may find their training in 1st aid is better than your own.

If you are yourself a qualified 1st aider, and no one else around is then - if it were me (and it has been) I would take the role of providing 1st aid.

The main principle of 1st aid is that you must not make the situation worse. You must ensure that there is no additional danger around and that they have a pulse (best one to use is in the neck, under the jawbone and beside the adams apple -practice finding it on yourself and significant other) and are at the very least breathing and with clear airways. In rugby injuries you must always be aware of neck and spinal issues, if ANY doubt then DO NOT move the casualty; you can carefully cover them to keep them warm.

Luckily it is unusual to see a deep a heavily bleeding cut o a rugby pitch, even a laceration from a broken stud probably won't result in a really serious loss of blood. Pads, Pressure, and Elevation should suffice. If it is bleeding heavily and a pad gets blood soaked put another one on top, don't remove the first one.

Breaks are more common. Pain, swelling and loss of mobility may be the indicators (though not always). If its a limb try to ensure it's kept as immobile as possible. If it's ribs don't try to immobilise the upper body, and don't apply any pressure. Remove casualty from the pitch if "walking wounded".

In all cases make sure someone calls an ambulance. Make sure that person knows where they are, addess, ideally post code (for ambulance satnav) and how to get to the site. Don't let the casualty drink and certainly don't provide food - if they later need an anasthetic this may delay the time when that can be given. (Dr Stu may care to comment)

The only situation in which you may be forced into taking some definite activity beyond making them comfortable is if their airway is blocked or they have stopped breathing. If the airway is blocked, mud, false teeth, oppo hookers ear, whatever - try to get it out, be very careful not to push further in.

If pulse/breathing has stopped then the only thing to do is to give CPR.

Frankly I think this should be taught in schools and everybody should know how to do it, and get the opportunity to practice on a model (plastic, not super). If you nor anyone else can do that then they are going to be in bit of a hole. No pun intended.

I have heard the dire warning about being sued - frankly, so long as you interfere at the minimum level you can then I think, in the UK at least this is most unlikly to happen, and even less likely to succeed. I think our courts are far more sensible than, for example, US ones.

This post is not intended as authoritative guidance, nor is it in any way Hampshire Society policy - it is a purely personal view based on my own first aid experience and training in the Army, and later in civilian life.

Wrt checking pulse, I've always been told that checking for pulse has been taken out of the basic first aid course. This is because many people couldn't find it, and that if someone isn't breathing normally the best thing to do is to start chest compressions.

However, apparently this is likely to change due to a recent court case, with pulse checking reintroduced and the 2 rescue breaths (30:2) taken out.

 

[barker14610]

Take charge of the situation. Captain, with your player, keep him calm. Send someone to go and get the trainer if need be. Coach, get on the phone, call 911 (if needed). Everyone else, get back, take a knee and relax. Keep family members calm as well if they come out. I had a young player suffer a bad break last spring. All was well until Mommy looked and saw his foot pointing the wrong direction. The only reason I even think of intervening is a head/ neck injury or something life threatening.

 

[Phil E]

The main principle of 1st aid is that you must not make the situation worse. You must ensure that there is no additional danger around and that they have a pulse (best one to use is in the neck, under the jawbone and beside the adams apple -practice finding it on yourself and significant other) and are at the very least breathing and with clear airways. In rugby injuries you must always be aware of neck and spinal issues, if ANY doubt then DO NOT move the casualty; you can carefully cover them to keep them warm.

Luckily it is unusual to see a deep a heavily bleeding cut o a rugby pitch, even a laceration from a broken stud probably won't result in a really serious loss of blood. Pads, Pressure, and Elevation should suffice. If it is bleeding heavily and a pad gets blood soaked put another one on top, don't remove the first one.

Breaks are more common. Pain, swelling and loss of mobility may be the indicators (though not always). If its a limb try to ensure it's kept as immobile as possible. If it's ribs don't try to immobilise the upper body, and don't apply any pressure. Remove casualty from the pitch if "walking wounded".

In all cases make sure someone calls an ambulance. Make sure that person knows where they are, addess, ideally post code (for ambulance satnav) and how to get to the site. Don't let the casualty drink and certainly don't provide food - if they later need an anasthetic this may delay the time when that can be given. (Dr Stu may care to comment)

The only situation in which you may be forced into taking some definite activity beyond making them comfortable is if their airway is blocked or they have stopped breathing. If the airway is blocked, mud, false teeth, oppo hookers ear, whatever - try to get it out, be very careful not to push further in.

If pulse/breathing has stopped then the only thing to do is to give CPR.

Frankly I think this should be taught in schools and everybody should know how to do it, and get the opportunity to practice on a model (plastic, not super). If you nor anyone else can do that then they are going to be in bit of a hole. No pun intended.

I have heard the dire warning about being sued - frankly, so long as you interfere at the minimum level you can then I think, in the UK at least this is most unlikly to happen, and even less likely to succeed. I think our courts are far more sensible than, for example, US ones.

This post is not intended as authoritative guidance, nor is it in any way Hampshire Society policy - it is a purely personal view based on my own first aid experience and training in the Army, and later in civilian life.

DaveT

Sounds like it has been a long time since you did a 1st aid course. Quite a lot of the above is no longer standard practise.

Just to repeat what I wrote earleir, you can't be sued for giving 1st aid.

 

[Davet]

Finding a pulse can be hard. That's partly why I suggest practise on someone who likes you touching their neck. There is also a strong pulse in the groin...

 

[Adam]

I seem to remember DRABC being replaced in the past few years with DRBAS.

Danger
Response (call for help)
Breathing
Ambulance (call for)
Start compressions

 

[Adam]

Finding a pulse can be hard. That's partly why I suggest practise on someone who likes you touching their neck. There is also a strong pulse in the groin...

Recommended practice is not to check for pulse, as it's so difficult, and differs so much between people.

Much better to start compressions immediately after checking for breathing, and continue until they start breathing normally again.

 

[Davet]

Phil E

which bits are out of date?

Ensuring a clear airway?
Pads Pressure Elevation for bleeding?
Keeping Broken limbs immobile?
Not binding broken ribs?
Not moving suspected spinal injuries?
Not giving food/drink

I hear the bit about pulse checking currently being not recommended, but surely the rest is pretty standard?

 

[Phil E]

Phil E which bits are out of date?

that they have a pulse

No longer done (as pointed out and accepted) check for breathing only. If they are breathing they will have a pulse and its easier to check.

be aware of neck and spinal issues; if ANY doubt then DO NOT move the casualty;

Only to a point, if they are not breathing, not moving them wont really help. You should still roll them into the recovery position if they start to vomit, making sure to keep their head and neck in line with the spine.

Pads, Pressure, and Elevation should suffice.

Agreed, but not in that order.

Breaks are more common. Remove casualty from the pitch if "walking wounded".

Never move a casualty with a broken limb (I assume we are not talking about just a finger) immobilise and wait for the ambulance, broken ribs can puncture lungs, etc

If the airway is blocked, mud, false teeth, oppo hookers ear, whatever - try to get it out,

This is no longer done. Don't put your hand in their mouth (or anything else for that matter) open airway with head tilt and do chest compressions the gag reflex will move any obstruction when they start breathing

If pulse/breathing has stopped then the only thing to do is to give CPR.

It's not called that anymore. Chest compressions and rescue breaths and even the rescue breaths are not compulsory (not recommended either unless its a family member). Note that the compressions are only to keep the heart pumping blood to the brain. They wont stop someone dying, only a defibrillator will do that.

I think Seattle (might have got the city wrong) is the best place in the world to have a heart attack because every public premises has to have a defibrillator by law. 70% chance of surviving, as opposed to less than 10% in the UK

 

[dave_clark]

90% of heart attacks in this country are fatal? sounds like my mate who survived two was a one in a hundred shot...

 

[Mat 04]

Being a current lifeguard I can confirm everything Phil has said. Apparently they conducted surveys and only around 50% of the doctors and nurses they tested could find a pulse within an acceptable time, so presumably for us lesser first aiders there was an even greater chance of finding one.

Alun already knows my opinion on first aid as a referee. Let someone else handle it unless it is an emergency.

 

[Toby Warren]

Phil is right when he says that people look to you to take charge, lost count of the times people have said have you called 999 what did teh 999 people say.

(Let me just check for missed calls on my score card... )

As always what yuo do before the game is key, chatting to physio / capataon re first aid and so one really helps