A Reflection on Pitch-side Trauma in Sport - Guest Blog

Thank you to Catrin Hawthorn who has the honour of becoming our first guest blogger! We hope you enjoy/learn from her following experience.

As “Physioroute” Catrin has worked extensively within elite sport for the last 11 years, primarily with the AAW (athletics), FAW (women’s), cycling, golf and swimming. Currently, she works as the Consultant Physiotherapist within the Welsh Rugby Union for Builth Wells and Gwernyfed RFC’s, managing a team of professional and highly skilled Physiotherapists offering pitch side trauma management.

I first came across the Lubas Sports Trauma Management course about 9 years ago when I took over the care of a rugby club. Just on the basic confidence front of knowing I was right (and I so do like to be right!) in managing an injury, and having that backup support if needed (love twitter for that).

I’ve been working within club level rugby for nearly 10 years, and I’m thankful that I’ve only had cause for concern about using a spinal board twice.  During the most recent incident, the player was ok, but there were key areas that I’d have lacked confidence in had I not attended the Sports Trauma Management course.

During the second half of a match, one of our players went in for a tackle. Reviewing the situation the player did not tackle low enough and instead made contact directly through the top of his head. The game continued on but the player stayed down. At the time he was lying partially face down with his right arm outstretched and under his head over to the left side. He was alert when I reached him.  I advised him to stay still but he then began to fit. So that’s when the brain whirls, “Cr!p! Airway, Breathing, Circulation, please nowhere’s the rest of play?” (ABCD—see what I did there?)

The initial fit occurred for 5-10 seconds, breathing became stridor and very intermittent, before the player became semi-alert. I yelled for support stabilising his head. He then fitted again in a similar fashion. I had yelled for my bag as I was unsure whether we would have to stabilise his airways. He then became alert again. That may be through my incessant calling of his name with plenty of expletives! I supported the head and managed the team of players and a physiotherapist (from another team). We rolled and stabilised him on his back so I could keep his airway manageable if necessary and check his C spine. He complained of a C2 pain on palpation, no PN and could wiggle his fingers/toes. We immobilised him as best we could with a collar, log rolled him onto a board and waited for medical support. He stayed alert and responsive, complaining of a groggy head, and painful neck, RR returned normal (12 RPM). He did have one other episode of unconsciousness but that was fleeting and his vitals returned to normal.

Now, this is where the Lubas course was invaluable. I always approach each game with the knowledge that a major injury could occur. My kit is checked weekly and I discuss at each away venue, their policy and kit for major trauma. I was advised they had a board for spinal injuries. The local A+E was a major trauma centre and their pitch-side support was a chartered physiotherapist. Sadly the head blocks and straps for the spinal board had been stolen/vanished into thin air. Again some naughty words were uttered (it is rugby!), and an improvised approach was needed.  We managed to make blocks from tape boxes, not ideal but it allowed a better stability to the head with the collar than hands-free alone.

Knowing that players had spinal boarded before and that the opposition team had physiotherapy cover did make the situation easier. The confidence of improvisation can only come from a foundation of good knowledge and this is what the course offers you. Needless to say, the player had a nasty concussion but a clear C spine. He spent 5 hours on a spinal board (thanks to me!) but his mam was grateful so that’s all that matters (he’s 21 but he plays Welsh rugby so you always call the mam first).

Anyway I guess this post is about how I feel all club rugby at all levels should have a designated “qualified medical personnel” e.g. nurse, Paramedic, Physio, Doctor  - I don’t care (well I do as I think us Physios are blooming amazing actually!) with the skills to deal with anything the game has to throw at them.

Well done Catrin and many thanks for the blog. If you have used your Sports Trauma skills we want to hear about it. Tweet us @lubasmedical or email info@lubamedical.com and yours could be the next guest blog!

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