Triage
True or false? According to NATA’s position statement on preventing sudden death in athletes, if you are unsure whether an unresponsive athlete has a pulse, you should withhold CPR until a pulse check can be confirmed by EMS.
False
What is the athletic trainer's FIRST priority when arriving at the scene of an emergency?
A) Begin treatment immediately. B) Activate EMS. C) Ensure scene safety D) Obtain a medical history
C. Ensure scene safety
An athletic trainer arrives at a football athlete who collapsed during practice. Before making patient contact, which piece of information should be identified first?
A) Athlete's medical history. B) Potential hazards to rescuers. C) Athlete's pain level. D) Previous injury history.
B. Potential hazards to rescuers.
During preseason planning, the athletic trainer is reviewing the Emergency Action Plan (EAP) for a high school football venue. According to NATA position statements, which component is MOST critical for ensuring an effective emergency response?
A) Posting team schedules at all venues. B) Annual review and rehearsal of the EAP by all the emergency personnel. C) Providing copies of insurance information to all athletes. D) Having coaches develop independent emergency procedures.
B) Annual review and rehearsal of the EAP by all emergency personnel
It is a hot, humid afternoon at a high school wrestling tournament held in a poorly ventilated gym (no air conditioning). A 17-year-old wrestler with a known history of type 1 diabetes and exercise-induced asthma is in his third match of the day. During a takedown, he lands hard on his right shoulder, which now sits in an obviously abnormal position; he is in significant pain but alert, oriented, and able to answer questions appropriately. He tells the athletic trainer he feels "shaky and sweaty" and mentions he hasn't eaten since this morning. He also says his chest feels "a little tight," though he is currently able to speak in full sentences without difficulty.
The wrestler's right shoulder appears grossly deformed after the takedown, but he is alert, breathing normally, and has a palpable distal pulse. Per NATA's position statement on the immediate management of appendicular joint dislocations, what should guide the athletic trainer's decision about whether to attempt an on-site reduction?
A) On-site reduction should never be attempted by an athletic trainer under any circumstances, regardless of training. B) The decision should weigh factors such as the AT's training/experience, an established physician-supported protocol, the specific joint involved, whether it's a first-time dislocation, and the presence of associated injuries. C) Reduction should always be attempted immediately on-site for any shoulder dislocation, since delay always worsens outcomes. D) The decision belongs solely to the athlete, who can simply choose whether or not they want it reduced on the mat
B) The decision should weigh factors such as the AT's training/experience, an established physician-supported protocol, the specific joint involved, whether it's a first-time dislocation, and the presence of associated injuries.
The two diagnostic criteria that together confirm exertional heat stroke are:
A): Sweating heavily & rapid heart rate. B): Core (rectal) temperature above 105 F & profound CNS dysfunction. C): Skin that is hot and dry & dizziness. D): History of exercising in hot weather & muscle cramping
B. Core (rectal) temperature above 105 F & profound CNS dysfunction
An athlete collapses during conditioning and is unresponsive. After confirming the scene is safe, what should the athletic trainer do NEXT?
A) Check for fractures. B) Assess responsiveness, breathing, and pulse. C) Move the athlete to a shaded area. D) Obtain vital signs.
During a swimming meet, a diver strikes the board during a failed dive and remains floating face down in the water. Several spectators immediately jump into the pool to help. What issue should the athletic trainer address first?
A) Potential cervical spine injury. B) The diver's level of consciousness. C) Uncontrolled responders entering the environment. D) The diver's breathing status.
C) Uncontrolled responders entering the environment
A newly hired athletic trainer has been tasked with updating the Emergency Action Plan (EAP) for a high school athletic department. According to NATA position statements, which group should be involved in the development, review, and revision of the EAP?
A) The athletic trainer, team physician, coaches, administrators, and local EMS personnel who may respond during an emergency. B) The athletic trainer and team physician only, because they have the highest level of medical training. C) The athletic trainer, coaches, administrators, and parents of all participating athletes. D) The athletic trainer, coaches, and school administrators only, because EMS personnel should not be involved until an emergency occurs
A) The athletic trainer, team physician, coaches, administrators, and local EMS personnel who may respond during an emergency.
It is a hot, humid afternoon at a high school wrestling tournament held in a poorly ventilated gym (no air conditioning). A 17-year-old wrestler with a known history of type 1 diabetes and exercise-induced asthma is in his third match of the day. During a takedown, he lands hard on his right shoulder, which now sits in an obviously abnormal position; he is in significant pain but alert, oriented, and able to answer questions appropriately. He tells the athletic trainer he feels "shaky and sweaty" and mentions he hasn't eaten since this morning. He also says his chest feels "a little tight," though he is currently able to speak in full sentences without difficulty.
True or False? The wrestler's report of feeling "shaky and sweaty" with no food since morning is consistent with hypoglycemia, which NATA's position statement identifies as typically occurring at blood glucose levels below 70 mg/dL.
True
A football player goes down hard and is unresponsive with a suspected cervical spine injury. The face mask is interfering with airway access. Select ALL actions consistent with NATA’s guidance for managing this athlete’s equipment.
A) Completely remove the face mask using a tool such as a cordless screwdriver with a backup cutting tool, leaving the rest of the helmet in place. B) Strip off the helmet and shoulder pads immediately so the spine board can be applied faster. C) Keep the helmet and shoulder pads in place unless they prevent airway access, CPR, or proper spinal alignment. D) Pad under the head if the helmet is removed but the shoulder pads remain, to preserve neutral spinal alignment. E) Wait for EMS to arrive before touching any equipment. F) Remove only the shoulder pads first in every case, since they are easier to take off than the helmet.
A) Completely remove the face mask using a tool such as a cordless screwdriver with a backup cutting tool, leaving the rest of the helmet in place.
C) Keep the helmet and shoulder pads in place unless they prevent airway access, CPR, or proper spinal alignment.
D) Pad under the head if the helmet is removed but the shoulder pads remain, to preserve neutral spinal alignment.
During a football game, an athlete sustains a suspected cervical spine injury and remains motionless on the field. The athletic trainer is the first healthcare provider to reach the athlete. According to NATA recommendations, which of the following actions are appropriate?
A) Manually stabilize the head and cervical spine in the position found. B) Instruct teammates to help the athlete sit up. C) Assess airway, breathing, and circulation while maintaining spinal stabilization. D) Remove the helmet immediately upon arrival. E) Roll the athlete onto their side to evaluate the injury.
A) Manually stabilize the head and cervical spine in the position found.
C) Assess airway, breathing, and circulation while maintaining spinal stabilization.
A tennis player collapses during an outdoor tournament. Before patient contact, the athletic trainer notices dark clouds approaching and hears thunder. The athlete appears unconscious. Which principle should guide the athletic trainer's decision-making?
A) Life-threatening conditions supersede environmental concerns. B) Scene safety takes precedence over patient assessment. C) Emergency equipment should be retrieved before care begins. D) EMS activation should occur before scene assessment.
B. Scene safety takes precedence over patient assessment.
An athletic trainer is responsible for developing Emergency Action Plans (EAPs) for a university's athletic facilities, including the football stadium, baseball field, aquatic center, and indoor arena. According to NATA position statements, why should each venue have its own EAP?
A) Different sports have different injury rates that require unique medical protocols. B) Emergency equipment, communication methods, and EMS access points may vary between venues. C) State practice acts require separate athletic trainers for each venue. D) Athletes participating at different venues have different legal rights during emergencies.
B) Emergency equipment, communication methods, and EMS access points may vary between venues.
It is a hot, humid afternoon at a high school wrestling tournament held in a poorly ventilated gym (no air conditioning). A 17-year-old wrestler with a known history of type 1 diabetes and exercise-induced asthma is in his third match of the day. During a takedown, he lands hard on his right shoulder, which now sits in an obviously abnormal position; he is in significant pain but alert, oriented, and able to answer questions appropriately. He tells the athletic trainer he feels "shaky and sweaty" and mentions he hasn't eaten since this morning. He also says his chest feels "a little tight," though he is currently able to speak in full sentences without difficulty.
A blood glucose check confirms a reading of 58 mg/dL. The athlete remains alert, oriented, and able to swallow and follow directions, and he is still able to speak in full sentences despite the chest tightness. Select ALL actions consistent with NATA guidance for this combination of findings:
A) Administer 10–15 grams of fast-acting carbohydrate (such as glucose tablets or regular soda) since the athlete is conscious and able to swallow. B) Recheck blood glucose approximately 15 minutes after the initial carbohydrate treatment. C) Activate EMS immediately for the glucose reading alone, regardless of the athlete's ability to swallow or follow directions. D) Administer a glucagon injection immediately, since any blood glucose under 70 mg/dL requires glucagon rather than oral carbohydrates. E) Continue to monitor his breathing closely, since chest tightness in an athlete with asthma can signal an evolving respiratory issue even though he can currently speak in full sentences. F) Allow him to return to the mat immediately after the carbohydrate dose without rechecking glucose, since he reports already feeling better.
A) Administer 10–15 grams of fast-acting carbohydrate (such as glucose tablets or regular soda) since the athlete is conscious and able to swallow.
B) Recheck blood glucose approximately 15 minutes after the initial carbohydrate treatment.
E) Continue to monitor his breathing closely, since chest tightness in an athlete with asthma can signal an evolving respiratory issue even though he can currently speak in full sentences.
An athlete with known asthma is using a rescue inhaler but is now unable to speak in full sentences, has a respiratory rate of 30 breaths per minute, and shows paradoxic abdominal movement. Per NATA’s position statement on asthma management, what should the athletic trainer do?
A) Have the athlete rest and recheck symptoms in 15 minutes before deciding on EMS. B) Activate EMS immediately, since these are signs of impending respiratory failure and symptoms have not improved with rescue medication. C) Give a second inhaler treatment and send the athlete home to rest. D) Document the episode and reassess at the next practice
B) Activate EMS immediately, since these are signs of impending respiratory failure and symptoms have not improved with rescue medication.
An athlete collapses during preseason conditioning in hot, humid weather. The athlete is confused, combative, and has a rectal temperature of 105.8°F (41°C). According to NATA's Exertional Heat Illness Position Statement, which of the following interventions are appropriate?
A) Activate the emergency action plan and EMS. B) Begin cold-water immersion immediately. C) Wait for EMS to arrive before initiating cooling. D) Continuously monitor rectal temperature during treatment. E) Provide oral fluids while preparing for transport. F) Place the athlete in an air-conditioned room and observe for improvement. G) Transport the athlete immediately without cooling.
A) Activate the emergency action plan and EMS. B) Begin cold-water immersion immediately. D) Continuously monitor rectal temperature during treatment.
An athletic trainer is developing a new Emergency Action Plan for a university soccer complex. According to NATA position statements, which components should be included in the EAP? Select ALL that apply.
A) Specific emergency personnel roles and responsibilities. B) Venue-specific directions and access routes for EMS. C) Emergency communication procedures. D) Names of the team’s coaching staff. E) Location of practice equipment. F) Seasonal participation statistics. G) Location of emergency equipment. H) List of player’s names.
A) Specific emergency personnel roles and responsibilities.
B) Venue-specific directions and access routes for EMS.
C) Emergency communication procedures.
G) Location of emergency equipment.
It is a hot, humid afternoon at a high school wrestling tournament held in a poorly ventilated gym (no air conditioning). A 17-year-old wrestler with a known history of type 1 diabetes and exercise-induced asthma is in his third match of the day. During a takedown, he lands hard on his right shoulder, which now sits in an obviously abnormal position; he is in significant pain but alert, oriented, and able to answer questions appropriately. He tells the athletic trainer he feels "shaky and sweaty" and mentions he hasn't eaten since this morning. He also says his chest feels "a little tight," though he is currently able to speak in full sentences without difficulty.
While treating the shoulder, the athletic trainer also wants to rule out a cervical spine injury from the takedown, since the athlete landed with significant force. Which finding would be MOST reassuring against a cervical spine emergency, consistent with NATA's position statement on the cervical spine-injured athlete?
A) The athlete reports mild neck stiffness that resolves within a few seconds and has full, pain-free cervical range of motion with no midline tenderness or neurological symptoms. B) The athlete was wearing a properly fitted helmet during the match. C) The athlete was able to walk off the mat under his own power immediately after the takedown. D) The athlete denies any history of prior neck injury.
A) The athlete reports mild neck stiffness that resolves within a few seconds and has full, pain-free cervical range of motion with no midline tenderness or neurological symptoms.
A football player collapses during a preseason practice in August. He is confused, combative, and his skin is hot. Rectal temperature on-site reads 106 F. The athletic trainer has a cold water immersion tub set up, and EMS has just arrived. The nearest hospital is only 4 minutes away. Select the statements that are consistent with NATA’s exertional heat illness position statement.
A) Cold water immersion should continue until core temperature drops below 102.5°F, even though EMS has already arrived on scene. B) Because the hospital is so close, transport should happen immediately and cooling can be initiated after arrival in the emergency department. C) Combativeness is an expected CNS symptom of heat stroke itself and is not a reason to withhold or delay cold water immersion. D) Ice packs placed on the major arteries during transport are an equally effective substitute for completing the full cold water immersion treatment. E) Cooling should be capped at a fixed 10 minutes regardless of the athlete's temperature response, then transport should begin. F) Cooling should stop as soon as EMS takes over care on scene, since ambulance personnel assume responsibility for treatment decisions at that point.
A) Cold water immersion should continue until core temperature drops below 102.5°F, even though EMS has already arrived on scene.
C) Combativeness is an expected CNS symptom of heat stroke itself and is not a reason to withhold or delay cold water immersion.
During the first conditioning session of preseason football practice, an athlete with known sickle cell trait suddenly falls behind during repeated sprint drills. He reports severe leg weakness, difficulty catching his breath, and low back pain before collapsing to the ground. The athlete is conscious but appears distressed. According to NATA recommendations regarding the recognition and emergency management of exertional sickling in athletes with sickle cell trait, which of the following actions are appropriate?
A) Check vital signs. B) Administer high-flow oxygen (15 L/min) with a non-rebreather mask if available. C) Encourage the athlete to continue walking to prevent muscle stiffness. D) Cool the athlete if clinically indicated. E) Wait until the athlete becomes unresponsive before activating EMS. F) Attach an AED and prepare for advanced emergency care if vital signs decline. G) Perform aggressive stretching of the affected muscles. H) Assume the athlete is experiencing heat cramps and provide oral fluids as the primary treatment.
A) Check vital signs.
B) Administer high-flow oxygen (15 L/min) with a non-rebreather mask if available.
D) Cool the athlete if clinically indicated.
F) Attach an AED and prepare for advanced emergency care if vital signs decline.
An athletic trainer is educating coaches and game administrators about the Recognition and Activation of an Emergency Action Plan (RAP) Medical Time-Out, as recommended by NATA. Which of the following statements accurately describe the purpose and appropriate use of a RAP Medical Time-Out? Select ALL that apply.
A) It should be initiated when medical personnel identify a potentially serious injury or medical condition requiring immediate assessment or intervention. B) It allows medical personnel unrestricted access to the athlete without interference from game activities. C) It is intended to provide time for coaches to discuss strategy while the athlete is being evaluated. D) It should be used when an athlete may require activation of the Emergency Action Plan or emergency medical services. E) It is only appropriate when an athlete has lost consciousness. F) It facilitates communication and coordination among healthcare providers, officials, and emergency responders. G) It is designed to replace the Emergency Action Plan and eliminate the need for EMS activation. H) It allows additional time for athletes to recover from fatigue or improve performance before returning to play.
A) It should be initiated when medical personnel identify a potentially serious injury or medical condition requiring immediate assessment or intervention.
B) It allows medical personnel unrestricted access to the athlete without interference from game activities.
D) It should be used when an athlete may require activation of the Emergency Action Plan or emergency medical services.
F) It facilitates communication and coordination among healthcare providers, officials, and emergency responders.
It is a hot, humid afternoon at a high school wrestling tournament held in a poorly ventilated gym (no air conditioning). A 17-year-old wrestler with a known history of type 1 diabetes and exercise-induced asthma is in his third match of the day. During a takedown, he lands hard on his right shoulder, which now sits in an obviously abnormal position; he is in significant pain but alert, oriented, and able to answer questions appropriately. He tells the athletic trainer he feels "shaky and sweaty" and mentions he hasn't eaten since this morning. He also says his chest feels "a little tight," though he is currently able to speak in full sentences without difficulty.
Twenty minutes later, after his glucose has stabilized and his shoulder has been splinted for transport, the athlete becomes increasingly confused and combative, and his skin feels hot to the touch. The gym remains hot and poorly ventilated. A rectal temperature is obtained and reads 105.8°F. Select the TWO statements that are consistent with NATA's exertional heat illness position statement for this new presentation:
A) Because his confusion could be from low blood glucose again rather than heat, no cooling should begin until a repeat glucose check rules out hypoglycemia as the sole cause. B) The combination of profound CNS dysfunction and a rectal temperature above 105°F meets NATA's diagnostic criteria for exertional heat stroke, and cold water immersion should begin immediately. C) Because the athlete already has a confirmed orthopedic injury (the dislocated shoulder), heat illness protocols are suspended until the shoulder is fully immobilized. D) The athletic trainer should continue cold water immersion until core temperature drops below 102.5°F before transport, per the "cool first, transport second" principle. E) Since his blood glucose was already treated once today, any further confusion should be assumed to be glucose-related rather than heat-related. F) Oral or tympanic temperature should be rechecked to confirm the rectal reading before initiating any cooling.
B) The combination of profound CNS dysfunction and a rectal temperature above 105°F meets NATA's diagnostic criteria for exertional heat stroke, and cold water immersion should begin immediately.
D) The athletic trainer should continue cold water immersion until core temperature drops below 102.5°F before transport, per the "cool first, transport second" principle.