Emergency Assessment and Management
Primary survey
Approach every collapsed athlete with a primary survey: airway, breathing, circulation, disability, and exposure, with cervical spine precautions when the mechanism suggests trauma. Assume sudden cardiac arrest in any athlete who collapses and is unresponsive, especially if there was no protective response or if seizure-like activity occurred. Agonal gasping is not normal breathing.
Cardiac arrest and commotio cordis
Start high-quality CPR immediately: rate 100–120 per minute, depth about 5–6 cm, full recoil, minimal interruptions. Apply an AED as soon as available and follow its prompts. Commotio cordis results from a blow to the precordial area during ventricular repolarization; survival depends on immediate CPR and defibrillation. Seizure-like movements after a blow to the chest should never be treated as a seizure.
Environmental emergencies
Exertional heat stroke is defined by hyperthermia with central nervous system dysfunction. Cool first and transport second - cold-water immersion is the standard. Do not rely on oral temperature. Exertional hyponatremia presents with confusion, vomiting, and headache in a fluid-overloaded athlete; restrict fluids and use hypertonic saline in severe cases.
Trauma and planning
Do not remove a helmet or shoulder pads unless there is airway compromise or the equipment prevents assessment. Control hemorrhage with direct pressure and tourniquets when needed. Every program needs a written emergency action plan, rehearsed with all staff, including venue access, equipment location, and transport routes.
Traps
Do not delay cooling for transport. Do not give oral fluids to an athlete with altered consciousness. Do not assume a normal pulse means the athlete is stable.
Worked example: a hockey player takes a puck to the chest and collapses with brief seizure-like activity. Treat as cardiac arrest: start CPR, apply the AED, and continue until advanced care arrives.