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Primary assessment of athletic injuries

This is an excerpt from Fundamentals of Athletic Training, Third Edition, by Lorin A. Cartwright, MS, ATC, and William A. Pitney, EdD, ATC, FNATA.


The assessment of each injury is divided into two categories: primary and secondary. The primary assessment deals with injuries that are life threatening, or injuries involving the ABCsairway, breathing, and circulation. The secondary assessment involves all non-life- threatening injuries. Luckily, most athletic injuries are not life threatening.

The order in which the assessment is done is crucial to ensuring that life-threatening injuries will be cared for first. Current American Heart Association guidelines stress that Compressions come first, and then you focus on the Airway and Breathing (CAB). The primary assessment is done in the following order: (1) Check the scene to determine that it is all right to approach the athlete safely, (2) assess responsiveness by lightly tapping or shaking (not so hard that the neck gets twisted or jostled) and talking to the athlete, (3) recognize that lack of responsiveness, no breathing, or abnormal breathing indicates a cardiac emergency, (4) call 911 and obtain an AED if available, (5) start CPR by initiating chest compressions, (6) open the airway and provide two breaths, and (7) check for severe bleeding. Conducting 30 compressions should take 18 seconds. The student assistant should become certified in first aid and cardiopulmonary resuscitation (CPR) so that when an emergency happens, she will be better prepared to help.

Checking the Scene

The first step is to prevent any more injuries than already exist, which includes making sure you do not get hurt. Approach an athlete only when the scene appears safe. If, for example, an athlete goes down during a football play, you will need to make sure the play has stopped so you do not step onto the field and accidentally get hit by a player.

Determining Responsiveness

The first step is to determine whether an athlete is conscious and able to respond. To check responsiveness, the AT will gently talk to and tap the athlete.

An unconscious athlete may be able to hear the AT and may be able to respond to a voice if she does not have a severe head injury. The response may be no more than a squeeze of a hand, but even such a feeble sign is an indication that the athlete is hearing and reacting. No one near the athlete should speak negatively about the athlete when she is unconscious because she may be able to hear. Reasons for unconsciousness include poisoning, respiratory arrest, cardiac arrest, hemorrhaging, diabetic illness, heat-related illness, cold-related illness, and head injury.

If an athlete is able to respond clearly and logically to the responsiveness check, the AT will know that the airway, breathing, and circulation are OK. At that point in the primary assessment the AT can skip the CABs (steps 3-7 in the primary assessment) and proceed to check for severe bleeding. It is important to recognize that if the athlete does not respond, however, the AT must check the CABs. If other rescuers are present they should be directed to call 911 and obtain an AED if one is available.

Initializing the CAB Sequence

If the respiratory or circulation system is impaired, the athlete’s life is in danger, and the AT must respond quickly to give the athlete the best chance for survival. Quick action and early chest compressions without interruptions are recommended.

  • Circulation. Based on the response and recognition of cardiac arrest, rescuers should start CPR immediately. It is no longer recommended that pulse or breathing detection be performed first, as early chest compressions are critical for survival. There may be spurting blood; a steady, heavy flow of blood; or blood pooling. This type of bleeding is severe and is an emergency that requires immediate attention from the AT.
  • Airway. An untrained or solo rescuer should provide hands-only CPR, and not interrupt compressions to check the airway or breathing. A trained rescuer, or second rescuer who is able, should make sure the airway is open. To do so, the AT will place one hand on the athlete’s forehead and two fingers of the other hand under the athlete’s chin. Simultaneously lifting the chin while controlling the head will open the airway by pulling the tongue away from the back of the throat. This is called the head-tilt chin-lift procedure.
  • Breathing. To check breathing, the AT will use a technique called look, listen, and feel. The AT will look at the chest and watch for the chest to rise and fall, listen for breathing by placing an ear close to the mouth, and feel for hot breath on his cheek. Checking for breathing should take about 10 seconds, and should be done by a trained rescurer. The look, listen, and feel step has been removed for lay rescurers.



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