Download File - Huff Hills Ski Patrol

Chapter 32
Outdoor Adaptive
Athletes
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
32.1 Define and contrast the following terms:
a. disability
b. handicap
c. impairment
32.2 List and describe two disorders that
cause intellectual disabilities.
32.3 List two disorders that cause
progressive physical disabilities.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
32.4 Describe four elements of effective
communication with a person who has
an intellectual disability.
32.5 Describe how to assess and care for
physically disabled athletes.
32.6 List the signs and symptoms of
autonomic dysreflexia.
32.7 Describe and demonstrate how to
assess an adaptive athlete.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
32.8 Describe and demonstrate how to care
for an adaptive athlete who is injured or
ill.
32.9 Describe and demonstrate how to
manage an above-the-knee amputee
with a femur fracture of the same leg.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Common
Disabilities
 Adaptive Equipment
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
At a racing event for disabled athletes, one of the
chaperones waves you over.
The chaperone explains that the 14 year-old girl had
a “few falls” during the day, and has not been acting
right for the past 10 minutes.
As you lean down to assess the patient, you notice
that she does not make eye contact and is staring off
to the side. She is unresponsive and does not follow
verbal instructions.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Disabilities
 Americans
with Disabilities (ADA)
overview
 Terminology matters
◦ Handicap – substantial limitations of one
or more ADL.
◦ Disability
• Physical or intellectual
• May be situational
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Disabilities
 Terminology
matters
◦ Impairment
• Physical, physiological, or psychological
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Intellectual/Physical
Disabilities
 May
have one or both disabilities
 Intellectual may be learning,
cognitive, or psychological/personality
related
◦ Communication may be difficult
 Most
common physical are
neurological, amputees, and muscular
disease
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Intellectual/Physical
Disabilities
 Some
have severe disability
 Some need modified sport with
supervision
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Intellectual Disabilities
 Learning
disorders
◦ ADD, dyslexia
◦ Communication may be impaired
 Autism
spectrum disorders
◦ Autism, Asperger’s, and Atypical
◦ Limits to effective communication
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Intellectual Disabilities
 Cognitive
◦ TBI or loss of brain function
◦ Seizures, physical impairments,
coordination issues
◦ Autonomic dysfunction, Mental illnesses
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Intellectual Disabilities
 Intellectual
difficulties
◦ Genetic conditions, fetal alcohol
syndrome, and other pre-natal causes
◦ Asphyxia, brain trauma, poisoning,
meningitis among other causes
◦ Exhibit anxiety, hyperactivity/apathy, bad
judgment, impulsiveness
◦ Kindness and caregiver help are vital
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Spinal
cord injuries
 Adjunct devices may be used
 AD: Result from:
◦ Dangerous increase in BP
◦ Medical emergency
• Determine source
• Patient may assist
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Cerebral
Palsy
◦ Anoxic brain injury – Three patterns:
Spastic, athetoid, dsytonic
◦ Extremity injuries likely: Patient’s cannot
control during a fall
◦ Many sit to ski
◦ Treat in position of comfort:
Spasms/rigidity are concerns in splinting
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Multiple
sclerosis: Progressive
degeneration of central and peripheral
nerves
◦ Intermittent progression
◦ Impairments vary
 Function
at high mental capacity
◦ Affect may change as disease
progresses
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Spinal
bifida
◦ Malformation often at lumbar spine
◦ Sensory or motor deficits below
◦ Abnormal CSF circulation
• Shunt may be implanted
• Blockage may cause pressure/life threat
◦ May be allergic to latex
◦ Some have abnormal circulation of the
continued
CSF
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Muscular
dystrophy
◦ Affects skeletal muscles
◦ Spinal curvature, lax joints, weak/wasted
muscles
◦ Easily fatigues
◦ Normal mental status
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Amputations
◦ Largest group of adaptive athletes
◦ Can be congenital, traumatic, or surgical
◦ Relative impairment based on amount of
extremity lost
◦ Use adaptive equipment and prosthetics
◦ Type/location of lower extremity
amputation determine equipment needs
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Disabilities
 Visually/Hearing
Impaired
◦ Blind skier:
• Higher incidence of injury; explain in detail
when providing care
◦ Hearing impaired skier:
• Be sure they can see your mouth
• May sign or be able to speak
• May prefer written communication
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Combined Physical
and Intellectual Disabilities
 Down
syndrome
◦ Physical and intellectual impairments
vary widely.
◦ May be highly competitive, not complain
about injury or illness
◦ Chance of musculoskeletal injuries
increases due to laxity of ligaments
◦ May have upper c-spine ligament
injuries (C1/C2 area)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Adaptive Equipment
 Available
for many sports
 Prosthetics
 Scale from no assistance required to
complete control by helpers
 Some ‘generic’, some customized
 Understand “ins” and “outs”
 Chair evac modifications maybe
needed
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Adaptive Equipment
Copyright Dorling Kindersley Media Library
Copyright Image Source/PunchStock
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Snow Sports Equipment
4
◦
◦
◦
◦
major classes
Sit Down (Mono, Bi, or Sit Ski/Board)
4 track (3 track)
Blind Guiding
2 track (Stand up)
 Snow
slider or bike
 Tethers and outriggers
 Treat equipment with care
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Snow Sports Equipment
Copyright David Johe
BRADY
Copyright Craig Brown
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
You’ve established that her ABCDs appear to be
intact. The chaperone listed the patient’s
medications and described her known seizure
disorder. As another patroller arrives with a fully
loaded toboggan, the patient begins to have a tonicclonic seizure.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
assessment procedures –
ABCDs, SAMPLE, and vitals
 Be aware of communication issues
 Standard
◦ Speak to the athlete
◦ Use input from the companion/guide
◦ Pain/stress may impact ability to
communicate
 If
sensation is absent, do not prolong
exposure to cold/heat
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessing Athletes
with Intellectual Disabilities
 Anticipate
behavior anomalies
 Remain calm, manage distractions
 Ask direct, clear questions - give
simple explanations/directions
 Be aware of minimized complaints
 Be aware of autonomic dysfunction
(AD)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessing Athletes
with Physical Disabilities
 Modify
communication style with
sensory impairments
◦ Lip reading/written
◦ Verbal cues/explanations
 If
stroke or TBI, muscle wasting or
flexor tendon contractures may be
present and risk for injury
 Equipment, prosthetics, ostomy
bags/tubing may be involved
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Notify
base, request help
 Demo/explain what you will do to
reduce anxiety
 Anticipate unusual reactions
 Stabilize in position of comfort, modify
splints/strapping when splinting
 Pad areas without sensation
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
continued
Copyright Greg Bala
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Ensure
adequate help when removing
adaptive equipment
◦ Care for and transport with patient
 Keep
service animals with patients
 Be aware of wheelchair needs
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Give
priority in lift evacuation
◦ Evacuate first – athletes & companion
◦ Give extra coaching as needed
◦ Know how sit skis attach to evac
equipment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
Because you suspect that trauma is a factor in this
case, you apply a cervical collar while the patient is
still on the ski slope. Because she has remained
confused and unresponsive to questioning, you and
your partner elect to transport her in the toboggan on
a long spine board with the cervical collar in place.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
You maintain high-flow oxygen during transport to
the clinic, checked alertness and radioed ahead
about the seizure. A family member and the
chaperone meet the patient at the clinic and describe
the patient’s gradual return to baseline mental
status. X-rays of the patient’s cervical spine show no
evidence of injury, but a CAT scan of her brain
shows a small subdural hematoma.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Assume that altered mental status is the
result of a new injury or illness.
 Adaptive athletes with sensory and
movement disorders are
 at higher risk for cold-weather injuries.
 Ask adaptive athletes how you can assist
them.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Ask the athlete’s skiing guide or
chaperone for information and assistance.
 Describe and demonstrate how you will
help an adaptive athlete before doing a
procedure.
 Ask about medications and medical history.
Look for medical alert jewelry or other
alerts to help identify preexisting
conditions.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Request additional rescuers when caring
for athletes with disabilities.
 Collect an adaptive athlete’s equipment,
and transport it with the athlete.
 Paraplegics are at an increased risk for
hypothermia and frostbite.
 Patients with spina bifida are allergic to
latex. Always use latex-free gloves when
treating these patients to avoid an
anaphylactic reaction.

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ