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WHAT COACHES SHOULD KNOW

There are two general types of cardiac emergencies-when the heart doesn't function properly, depriving the heart muscle of much needed oxygen and causing chest pain or discomfort (heart attack), and when the heart doesn't function effectively as a pump resulting from an abnormal rhythm or no rhythm at all (cardiac arrest). In a cardiac emergency, activate the Emergency Action Plan and follow the emergency action steps, Check-Call- Care. The greatest chance of survival from cardiac arrest occurs when the following sequence of events happens as rapidly as possible: Early recognition and early access to advanced life support Early CPR Early defibrillation Early advanced life support

Any player can have a heart attack or suffer sudden abnormal rhythm or stoppage of his heart because of existing medical conditions. If a coach has an automated external defibrillator on site and is trained in lifesaving CPR and defibrillation skills, he may be able to save a player's life.

There are two general types of cardiac emergencies-emergencies where the heart doesn't function properly, depriving the heart muscle of much needed oxygen and causing chest pain or discomfort (heart attack), and emergencies where the heart doesn't function effectively as a pump resulting from an abnormal rhythm or no rhythm at all (cardiac arrest).

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HEART ATTACK

Most people who die of heart attacks die within two hours after the first signals appear. Many lives are lost because people deny they are having a heart attack and delay calling for help. Recognizing the signals of a heart attack and calling 9-1-1 or the local emergency number before the heart stops are critical steps to saving lives.

Signals

Chest pain or discomfort lasting more than 3-5 minutes or that goes away and comes back. The pain is not relieved by rest, changing position, or medication. The pain may spread to shoulder, arm, back, neck, or jaw. Trouble breathing. Breathing is often faster than normal. The person feels short of breath. Nausea Sweating or changes in skin appearance Dizziness or unconsciousness Ache, heartburn, or indigestion. These signals are more likely to occur in women, the elderly, and diabetics.

To provide immediate care for a heart attack:

Have the athlete stop activity and rest Help the athlete rest in a comfortable position. A sitting position may make breathing easier. Loosen restrictive clothing Assist with prescribed medication Monitor breathing and movement closely Be prepared to give cardiopulmonary resuscitation (CPR) and use an automated external defibrillator (AED), if available, if the athlete loses consciousness, shows no movement, or shows no evidence of breathing or the presence of a pulse.

HEART FUNCTION ARREST

This can be caused by underlying heart disease, severe injuries, or abnormalities of electrical conduction of the heart.

Signals

Loss of consciousness as defined by lack of response to verbal questions or commands. No breathing and no pulse noted. When responding to a cardiac emergency, a coach or responder should activate the Emergency Action Plan and follow the emergency action steps, Check- Call-Care.

To provide immediate care for heart function arrest:

Initiate CPR. Use AED, if available.

AED AND SUDDEN CARDIAC ARREST

AED and sudden cardiac arrest An AED is a small, portable device that automatically analyzes a heart rhythm, and, if necessary, prompts a trained responder to deliver a life-saving shock to restore a heart's normal rhythm. To use an AED, the responder attaches an electrode pad on the upper right side and another on the lower left side of the injured player's chest. If the device identifies a rhythm that should be defibrillated, the responder is prompted with either an on-screen message or by voice message. The AED will analyze the heart rhythm, charge to the appropriate energy level, and advise when the shock is needed. Any time an AED is analyzing the rhythm, charging to a specific energy level, or administering a shock, the responder and others must not be in contact with the injured player.

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CARDIAC CHAIN OF SURVIVAL The greatest chance of survival from inadequate cardiac function or arrest occurs when the following sequence of events happens as rapidly as possible:

Early recognition and early access. The sooner 9-1-1 or the local emergency number is called, the sooner early advanced life support arrives. Early CPR. Early CPR helps circulate blood that contains oxygen to the vital organs until an AED, if available, is ready to use or emergency personnel arrive. Early defibrillation. Most injured players who sustain sudden cardiac arrest need an electric shock to the heart called defibrillation. Each minute that defibrillation is delayed reduces chances of survival by about 10 percent. Early advanced life support. This is given by trained medical personnel who provide further care and transport to hospital facilities. It is a necessary addition to CPR and is the reason for an immediate call to EMS.

CPR To administer CPR, first follow the emergency action steps, Check-Call-Care. Call, or have someone call 9-1-1 or the local emergency number immediately.

If the player does not have normal breathing, or you cannot tell, remove the facemask. If you do not suspect an injury to the head, neck, or back, open the airway by tilting the head back and recheck for breathing for approximately 5 seconds. Using a breathing barrier, make a seal over the player's mouth and nose, then give 2 slow breaths. Each breath should make the player's chest gently rise and fall. Check for signs of circulation for no more than 10 seconds. Signs of circulation include coughing or movement in response to rescue breaths. If there are signs of circulation, continue rescue breathing as needed by giving 1 breath every 5 seconds. If there are no signs of circulation, begin CPR: Find your hand position in the center of the chest, over the breastbone; Position your shoulders directly over your hands. While keeping your arms straight, compress the player's chest to a depth of about 2 inches 15 times in about 10 seconds; Give 2 slow breaths; Do 3 more steps of 15 compressions and 2 breaths; Recheck for signs of circulation for no more than 10 seconds; If there are no signs of circulation, continue giving sets of 15 compressions and 2 breaths, rechecking every few minutes. Repeat this cycle until EMS personnel arrive and take over or an AED arrives and is ready to be used. The only instance in which an athlete's helmet should be removed is when a medical authority believes it is necessary for the care of the athlete or if the equipment interferes with the rescuer's ability to provide required CPR. Remove the helmet by opening the straps and pulling them directly backward. Obtain available assistance to minimize neck movement and maintain the neck in a neutral position (level with the height of the shoulders). After the helmet is removed, keep the neck in a neutral position by manual support or by placing towels or clothing under the head. If the shoulder pads must be manipulated to provide chest compressions, do so with the minimal required movement. Maintain maximum control of the neck and open and move the shoulder pads only as much as is required to provide effective chest compressions.

Note: This information is not intended to replace formal first aid and CPR training given in a course such as the American Red Cross Sport Safety Training course. Coaches are encouraged to contact their local chapter of the American Red Cross to enroll in a Sport Safety Training, First Aid, CPR, or AED course.

The evaluation of any athlete, whether as a part of health evaluations prior to activity or as a diagnosis of an injury as the consequence of sports activities, is specific to that individual and the history and current state of the individual presented. Advice, diagnosis and treatment is individualized according to numerous factors, including patient health and age information, medical history and symptoms. All athletes should be cleared by a physician or other appropriate medical professional before engaging in physical activities and, after injury, diagnosis and treatment, for return to play.