NATA-BOC Critical Incident Management 2 — Questions and Answers
Question 1: During a football game, an athlete is found unconscious on the field with a suspected cervical spine injury. What is the first priority in the emergency action plan?
- Remove the helmet immediately
- Establish and maintain an open airway (Correct answer)
- Apply a cervical collar
- Transport the athlete to the sideline
Correct answer: Establish and maintain an open airway
Establishing and maintaining an open airway is always the first priority in emergency management. The modified jaw thrust technique should be used for suspected spinal injuries to open the airway while minimizing cervical spine movement.
The ABCs of emergency care (Airway, Breathing, Circulation) dictate that securing an airway is the immediate priority. In a helmeted athlete with a suspected cervical spine injury, the helmet should NOT be removed in the field unless the airway cannot be maintained with it in place. The modified jaw thrust (rather than head-tilt chin-lift) is used to open the airway while maintaining neutral cervical alignment. The facemask should be removed using a cordless screwdriver or FM Extractor to access the airway while the helmet remains in place. A cervical collar and spine board are applied before transport.
Question 2: An athletic trainer suspects an athlete is experiencing an exertional heat stroke. Which of the following is the most critical immediate intervention?
- Administer oral fluids
- Apply ice bags to the neck and groin
- Initiate cold water immersion (Correct answer)
- Transport to the emergency department immediately
Correct answer: Initiate cold water immersion
Cold water immersion (CWI) is the gold standard for treating exertional heat stroke. The principle of 'cool first, transport second' should be followed, as rapid cooling within 30 minutes significantly reduces morbidity and mortality.
Exertional heat stroke (EHS) is defined by a core body temperature above 104 degrees F (40 degrees C) with central nervous system dysfunction. Cold water immersion in a tub of water maintained at 35-59 degrees F (2-15 degrees C) provides the fastest cooling rate. The 'cool first, transport second' protocol is based on evidence that cooling within 30 minutes of collapse results in 100% survival. Ice bags to the neck, axillae, and groin are far less effective, with cooling rates approximately 3 times slower than CWI. Oral fluids are contraindicated in athletes with altered mental status due to aspiration risk.
Question 3: An athlete collapses on the field and is found to be pulseless and not breathing. An AED is available. What is the correct sequence of actions?
- Call 911, begin chest compressions, apply AED when ready (Correct answer)
- Apply AED first, then call 911 if no shock advised
- Begin rescue breathing, then apply AED
- Call 911, perform 2 minutes of CPR, then apply AED
Correct answer: Call 911, begin chest compressions, apply AED when ready
For a witnessed sudden cardiac arrest in an athletic setting, the correct sequence is to activate EMS (call 911), begin high-quality chest compressions immediately, and apply the AED as soon as it is available without interrupting CPR unnecessarily.
The American Heart Association guidelines emphasize early recognition, early CPR, and early defibrillation for sudden cardiac arrest. In an athletic setting where collapse is typically witnessed and an AED is nearby, the athletic trainer should activate EMS and begin chest compressions at a rate of 100-120 per minute with a depth of 2-2.4 inches. The AED should be applied as soon as it arrives, with minimal interruption to compressions. Each minute without defibrillation decreases survival by 7-10%. Athletic trainers should have a rehearsed emergency action plan that designates roles for calling 911, performing CPR, and retrieving the AED.
Question 4: An asthmatic athlete becomes severely dyspneic during practice and is not responding to their rescue inhaler. What is the appropriate next step?
- Administer a second dose of the rescue inhaler and wait 15 minutes
- Have the athlete lie supine and elevate the legs
- Activate EMS and prepare to administer epinephrine if available (Correct answer)
- Move the athlete indoors and apply a cold pack to the chest
Correct answer: Activate EMS and prepare to administer epinephrine if available
An asthmatic patient not responding to a rescue inhaler is in status asthmaticus, a life-threatening emergency. EMS should be activated immediately, and epinephrine may be necessary if respiratory failure is imminent.
Status asthmaticus is a severe, prolonged asthma attack that does not respond to standard bronchodilator therapy. It is a medical emergency that can rapidly progress to respiratory failure and death. The athletic trainer should activate EMS immediately, position the athlete upright or leaning forward to optimize breathing mechanics, monitor vital signs, and be prepared to administer epinephrine and assist ventilations if the athlete deteriorates. Having the athlete lie supine would worsen breathing difficulty. Repeating the inhaler alone while waiting wastes critical time when the initial dose has failed.
Question 5: During a wrestling match, an athlete sustains a laceration to the forehead that is bleeding profusely. After applying direct pressure, the bleeding continues. What should be done next?
- Apply a tourniquet above the wound
- Add additional dressings on top without removing the first (Correct answer)
- Remove the blood-soaked dressing and apply a pressure bandage
- Apply a hemostatic agent directly to the wound
Correct answer: Add additional dressings on top without removing the first
When initial direct pressure is not controlling bleeding, additional dressings should be placed on top of the existing ones. Removing the original dressing disrupts any clot formation that may be occurring.
Hemorrhage control follows a specific protocol: apply direct pressure with a sterile dressing first. If bleeding continues, add more dressings on top of the original without removing it, as removing the first dressing would disrupt any fibrin clot that is forming. Continue applying firm direct pressure. Tourniquets are only appropriate for extremity hemorrhage that is life-threatening and uncontrollable by other means — they are never used on the head or neck. Hemostatic agents are typically reserved for tactical/military settings or severe hemorrhage not controllable by direct pressure alone. For facial lacerations, elevation (sitting upright) can also help reduce bleeding.
Question 6: An athlete is struck in the chest by a baseball and immediately collapses. The athletic trainer suspects commotio cordis. What is the most time-sensitive intervention?
- Begin chest compressions and activate EMS
- Apply an AED as quickly as possible (Correct answer)
- Administer a precordial thump
- Position the athlete in the recovery position and monitor
Correct answer: Apply an AED as quickly as possible
Commotio cordis typically causes ventricular fibrillation, and early defibrillation with an AED is the most critical intervention. Survival rates drop dramatically with each minute of delay in defibrillation.
Commotio cordis occurs when a blunt impact to the chest occurs during a vulnerable period of the cardiac cycle (20 ms window during repolarization), triggering ventricular fibrillation. The survival rate is approximately 58% when defibrillation occurs within 3 minutes but drops significantly with each passing minute. While CPR should be initiated immediately and EMS activated, the AED is the definitive treatment because ventricular fibrillation requires electrical defibrillation to restore a normal rhythm. Precordial thump is not recommended by current guidelines. The key is having an AED immediately accessible at all sporting events.
NATA-BOC Critical Incident Management 2
During a football game, an athlete is found unconscious on the field with a suspected cervical spine injury.
What is the first priority in the emergency action plan?