Two Casualties in Five Minutes at the Summer Camp
It is the fourth day of a ten-day summer kabaddi camp at your school, and two things happen within five minutes of each other. You are the only person present with first-aid training. Player A, aged 14, lands on a rough patch and rolls her right ankle; within three minutes the outer side is visibly swollen, she can take a few limping steps, the swelling sits over the bone below the outer ankle bone, and she rates the pain 7/10. She wants to keep playing because her team has a match tomorrow. Player B, aged 13, finished a long drill in full sun, sat down and complained of headache and nausea; his skin is clammy, his shirt is soaked, he is dizzy when he stands, and he admits he had only a bottle of cold drink at breakfast. On the ground you have one ice pack, one elastic bandage, a bottle of water, one ORS sachet, and no vehicle for the next 20 minutes. The camp supervisor is at the far end of the field.
1. Rank the two players by urgency, justify the ranking, and state what you do for each in the first five minutes.
Read the worked answer
Player B first. His signs are systemic - clammy skin, dizziness on standing, headache, nausea and almost no breakfast - which fits heat exhaustion and carries a risk of progressing to heat stroke. Player A has a limb injury with stable vital signs.
First five minutes for B: move him to shade, lie him flat with legs slightly raised, loosen clothing, fan him, place cool wet cloths on the neck, armpits and groin, and give ORS in small sips (about 100 ml every 10–15 minutes) because he is fully alert. Do not give a large cold drink at once and do not leave him sitting alone. If he becomes confused, stops sweating, or does not improve in 30 minutes, treat it as an emergency and arrange transport.
At the same time, two minutes for A: sit her down, remove the shoe, apply the ice pack wrapped in cloth for 15–20 minutes, apply the elastic bandage in a figure-of-eight from toes to mid-calf (check the toes stay warm and pink), and elevate the leg. No massage, no heat rub, no "run it off". Both are managed because the ankle care takes only two minutes before you turn to B.
2. Should Player A play tomorrow? Which findings would make you suspect a fracture and refer her?
Read the worked answer
No. Standard return guidance for a sprained ankle is no sport for at least 24–48 hours, and only when she can walk normally, has no swelling, and can jog and hop without pain. Playing on a swollen ankle tomorrow risks a worse sprain and long-term instability.
Fracture red flags to check before deciding it is "only a sprain":
- Cannot bear weight for four steps immediately after the injury and cannot bear weight in the clinic.
- Point tenderness over the back edge or tip of the outer ankle bone.
- Point tenderness at the base of the fifth metatarsal (little-toe side of the foot).
- Obvious deformity, bone tenderness, numbness, or pain that wakes her at night.
If any of these are present: do not test her walking repeatedly, immobilise with a splint or a firm bandage, elevate, and refer for an X-ray. Also examine the inner side of the ankle and the lower leg, because a high ankle injury behaves differently and needs longer rest. Document the time, findings and advice given.
3. List what you would add to the ground first-aid kit and one standing rule for the camp, based on what happened today.
Read the worked answer
Additions to the kit:
- Six to ten ORS sachets and a 20-litre drinking-water drum at the field.
- Four instant cold packs and two crepe bandages (5 cm and 10 cm), plus elastic adhesive tape.
- Triangular bandages for slings, sterile gauze, antiseptic, disposable gloves, scissors.
- A thermometer, a light blanket, a torch, and a charged phone with the nearest health centre's number.
- A shaded rest area and a folding cot or mat.
Standing rule: breakfast and fluid check before the session. No player starts a session without having eaten and without a filled water bottle; a 5–10 minute water and shade break is taken every 30 minutes in the heat; a trained first-aider is always present with a vehicle on standby within 15 minutes.
Reasoning: today's two cases were both preventable - one by ground inspection and footwear, the other by food, fluid and work-to-rest control. The kit must match the risks of the actual activity, not be a general box.