Emergency Care Basics

Every athletic program should have a written Emergency Action Plan (EAP) for each venue it uses. A usable EAP names who calls 911, where the AED is stored, the exact street address and gate the ambulance should use, who meets and directs them, and who is responsible for crowd and teammate control.

An EAP that lives in a filing cabinet is not a plan. It has to be rehearsed before a season, with the coaching staff, because in a real emergency people default to what they have practiced rather than what they have read.

Before evaluating the ankle, evaluate the athlete. Check responsiveness, then airway, breathing, and circulation. Look for severe bleeding. If the mechanism suggests a head or neck injury, protect the spine and do not move the athlete.

For sudden cardiac arrest — an athlete collapses, is unresponsive, and is not breathing normally — the response is immediate CPR and the fastest possible AED application. Survival falls sharply with every minute of delay, and gasping (agonal breathing) is not normal breathing. Treat it as arrest.

A concussion is a mild traumatic brain injury caused by a direct blow to the head, face, or neck, or by a force transmitted to the head from elsewhere in the body. You do not have to hit your head to get one, and most concussions do not involve loss of consciousness.

Signs someone else can observe include a dazed look, confusion about the score or opponent, clumsy movement, slow answers, and a personality change. Symptoms the athlete reports include headache, pressure in the head, nausea, dizziness, sensitivity to light or noise, and feeling "foggy" or "not right."

The rule athletic trainers repeat for a reason: when in doubt, sit them out. An athlete removed for evaluation who turns out to be fine has lost part of one game. An athlete returned to play with an unrecognized brain injury is exposed to a far worse outcome.

Heat cramps and heat exhaustion — heavy sweating, weakness, nausea, dizziness, pale skin — are handled by moving to shade, removing equipment, cooling, and rehydrating.

Exertional heat stroke is the emergency. It combines a dangerously high core temperature with central nervous system dysfunction: confusion, aggression, staggering, collapse. The instruction that saves lives is cool first, transport second. Rapid whole-body cold-water immersion on site is the recognized standard of care, because outcomes track how quickly core temperature comes down, not how quickly the ambulance leaves.

For ordinary acute soft-tissue injuries, the long-taught protocol was RICE — rest, ice, compression, elevation. Current guidance has shifted toward an approach that avoids prolonged rest, encourages early protected movement, and progressively reloads the tissue, because complete rest for days tends to slow recovery rather than speed it.

The practical version for a student: protect it early, control swelling, then start moving it under guidance as soon as it is safe. Extended immobilization is now the exception, not the default.