CRITICAL CARE PITCHSIDE

You'll have seen physios such as Stuart or Stephen on the pitch when rugby players collapse after heavy challenges, or when there are potentially critical injuries to the spine. How do we train for these potentially dangerous situations, and ensure a players optimal safety on the field, and possibly safe transfer off the field on a board or buggy?

The answer is an annual course run in Scotland called 'SCRUMCAPS', currently running in Edinburgh under the leadership of  course co-ordinator Dr Johnathon Hanson. Sports physicians & pitchside physios are not trauma or critical illness specialists. The initial medical care that a critically injured or an athlete who has suffered a cardiac arrest will receive is most likely from these individuals who do not deal with critical care situations on a regular basis, and the SCRUMCAPS course has been designed to improve the immediate care skills. 

 The skills generally covered in this course include basic airway management, airway adjuncts up to laryngeal mask insertion, needle cricothyroidotomy, management of the unconscious casualty, management of potential cervical spinal injury on the field of play, oxygen therapy, recognition of life threatening injuries such as chest injuries or occult abdominal bleeding, basic life support, the advisory external defibrillator (AED), logrolling, scoop and spine board extrication and management of open and closed long bone fractures. Other areas can include anaphylaxis, choking or medical emergencies.

Athlete in vaccuum mattress

Athlete space once out of vaccuum mattress

These courses also teach planning, and promote leadership and teamwork. Favourable outcomes in stressful situations need strong leaders and efficient team working and this is seen as being a crucial skill. These courses are a massive part of ensuring athlete safety in the Northern Hemisphere, and warrant a close look by sporting authorities world-wide to promote continuing high standards of care under often exacting conditions, not just in rugby but court/field/pool sports too.


We will post some videos demonstrating some of these injuries and how they have been managed-they are already available on the internet, but we'll package them into one blogspace-the EdinburghPhysioBlogSPACE!

MRI:'Might Reveal Injury' fancy test, or key diagnostic tool?

Be careful what you wish for! 
We've all had patients arrive at clinic requesting a scan for an injury, or heard of the athlete who has been injured and 'sent for a scan' as if that itself will both diagnose & cure the problem!

An article in the New York Times health section reveals that some medics in sports' medicine may be relying on MRI scans instead of taking full and proper histories & examinations. You can feel content that SPACE ensures that we all have plenty of time to listen & look, and then only request scans if we feel it may really aid with the diagnosis or change the plan for the patient. Some patients & athletes however may wish for what they perceive as 'fancy tests', and almost will their practitioners to 'place an order' for a scan!


"MRIs can be extremely useful in sports medicine" Dr Andrew Green is quoted as saying. He is Head of shoulder and elbow surgery at Brown University, but cautions that there is a fine line between appropriate use and overuse.

Dr James Andrews

Is there a risk they may identify issues in healthy & painfree bodies? 


Dr James Andrews, a widely known sports medicine othopaedist in Gulf Breeze, Florida scanned the shoulders of 31 perfectly healthy professional baseball pitchers. The M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.


"If you want an excuse to operate on a pitcher's throwing shoulder, just get an M.R.I" Dr Andrews remarks.

Note that Magnetic Resonance Imaging (the M.R.I.) is a very sensitive, but it is not very specific, therefore scans may almost always find something abnormal, although most abnormalities are of no consequence. 

Ensure you discuss the options and the results with your health or sports' medicine professionals.

NY Times article on MRI