Injuries or conditions that impair—or that have the potential to impair—vital function of the CNS and cardiorespiratory system are considered to be emergency situations. In responding to an on-field or on-site injury, the initial assessment performed by the athletic trainer is intended to rule out any life-threatening conditions. The primary survey determines level of responsiveness and assesses airway, breathing, and circulation. If at any time during the assessment conditions exist that are an immediate threat to life, or if “red flags” are noted, the assessment process should be terminated and the emergency medical plan activated.
Once it has determined that a life-threatening condition does not exist, a secondary survey is performed to identify the type and extent of any injury and the immediate disposition of the condition. The following are some of the on-site testing done to the casualty by a paramedic or any clinician with first aid training.
First is on-site functional testing. When not contraindicated, the athletic trainer should identify the individual’s willingness to move the injured body part. For a lower extremity injury, this should be expanded to include the willingness to bear weight. Movement is contraindicated, however, in the presence of a possible head or spinal injury, fracture, dislocation, or muscle/tendon rupture. Functional testing includes: (1) Active range of motion. The individual is asked to move the injured body part through the
available ROM. The quantity and quality of movement in the absence of pain should be noted. (2) Passive range of motion. The examiner moves the injured extremity through the available painfree ROM, noting any painful arc of motion. (3) Resisted range of motion. An overpressure (break pressure) should be applied to the involved muscle or muscle group to determine the ability to sustain a forceful contraction. (4) Weight bearing. If the individual successfully completes active, passive, and resisted motion, walking may be permitted. If the individual is unable to perform these tests, however, or if critical signs and symptoms are apparent, removal from the area should be performed in a non–weight bearing manner.
Second is on-site stress testing. Testing for ligamentous integrity is performed before any muscle guarding or swelling occurs to prevent the extent of injury from being obscured. Typically, only single-plane tests are performed, the results of which are then compared with the noninjured limb.
And last is on-site neurologic testing. Neurologic testing is critical to prevent a catastrophic injury. Although listed as a separate testing phase, neurologic testing, if warranted, may be performed earlier in the evaluation. Critical areas to include are: (1) Cutaneous sensation. This can be done by running the fingernails along both sides of the injured individual’s arms and legs to determine if the same feeling is experienced on both sides of the body part. Pain perception also can be tested by applying a sharp and a dull point to the skin; the ability of the individual to distinguish the difference should be noted. (2) Motor function. A cranial nerve assessment should be completed. In addition, the ability of the individual to wiggle the fingers and toes on both hands and feet should be assessed, and a bilateral comparison of grip strength should be performed.