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The Game Bag

Matt Baird, MD and Matthew DeLaney, MD
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There is a lot of variability in terms of practice patterns when it comes to providing medical care for an out of hospital event. Keys to preparation include having a good understanding of the particular event logistics and anticipating potential injuries and medical complications.

Pearls:

  • Mental preparation is critical for identifying the possible equipment needed when staffing a sporting event.
  • Inquire about what additional staff and supplies will be available prior to the event. 
  • Know where the nearest AED is and what services are available at the nearest hospital. 

  • Use a checklist to ensure you have supplies for handling both life-threatening situations as well as the minor, but more common first aid needs. 

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  • The skill set of UC providers is generally well-suited for serving as a sideline clinician at sporting events.
  • When preparing to staff an event, understanding the nature of the event in advance will help to determine what to expect and, therefore, what you should have in your “game bag.”
  • Important pre-event considerations include:
    • Indoor vs. outdoor? If outdoors, what is the weather going to be?
    • How many people are you responsible for? Just players or attendees as well?
    • Will there be EMS, trainers, or other healthcare providers there? 
    • What supplies will be provided? 
  • It’s best to avoid volunteering on short notice because it doesn’t allow time to mentally prepare for all these logistical considerations. 
  • Consider worst case scenarios and know where the nearest AED is located. 
    • Other serious emergencies to consider include: asthma exacerbations, anaphylaxis, hypoglycemia, and serious head and neck trauma. 
  • Consider common problems likely to arise and supplies needed to provide immediate relief.
    • These include blisters, cramps, sprains, vomiting, lacerations and abrasions.
  • Using an A,B,C… approach can be helpful in providing a checklist for needed items:
    • Airway preparation should include a bag-valve mask (BVM), oral and nasal airways, and several sizes of laryngeal mask airway (LMA). 
      • Consider carrying a scalpel and/or basic cricothyrotomy kit. 
      • An EpiPen™ is essential for cases of anaphylaxis.
    • Breathing emergency supplies:
      • Albuterol inhaler for asthma
      • 14 gauge angiocatheter for suspected tension pneumothorax
    • Circulatory emergency supplies:
      • Location of nearest AED is critical information.
      • Consider carrying aspirin for chest pain and IV fluids for severe hypotension, however, these are most practical for events held in remote locations. 
      • A combat design type tourniquet can be lifesaving in cases of extremity hemorrhage.
    • For “D,” think disability (ie: a rigid c-collar) and dextrose (ie: glucometer and glucose gel and/or D50).
    • Environmental considerations include mainly hyper- and hypothermia. 
      • While it can be awkward to check, using a thermometer that can check a core (ie: rectal) temperature is critical for excluding hyperthermia.
      • In warm weather, having access to an ice bath is critical. 
      • In cold weather, blankets and a heater are necessary equipment. 
    • For fractures, carrying moldable splint materials (e.g. SAM™ splints) is helpful for immediate immobilization before the patient can get to definitive care. 
      • Material for a sling and crutches are also commonly useful. 
    • “G” is general, which includes everything else:
      • Other staff and physical facilities (e.g. tent, locker room, etc.) 
      • Cots, lights, chairs, drapes, blankets
      • Ziplock plastic baggies
      • Ice
      • Location of the nearest hospital and its capabilities
      • Vital sign monitoring equipment (e.g. pulse oximeter, blood pressure cuff)
      • Gloves
      • Scissors
      • Symptomatic medications (e.g. antiemetics, NSAID, acetaminophen, antihistamines)
  • Consider supplies for laceration and wound care:
    • Alcohol swabs, gauze, hemostats, sutures, skin glue and stapler
  • For eye injuries, think about carrying an ophthalmic topical anesthetic +/- fluorescein and a black light. 
  • All of the above equipment won’t be necessary for every event, so consider the specific location and details of each event and modify the bag’s contents accordingly. 

 

References: 

  1. Herring S, Kibler W, et al. Sideline preparedness for the team physician: a consensus statement-2012 update. Med Sci Sports Exerc. 2012 Dec;44(12):2442-5.
  2. Hutchinson M, Briner W. Be prepared: what's in your game bag? Curr Sports Med Rep. 2007 Jan;6(1):5-10.
  3. Everline C. Application of an online team physician survey to the consensus statement on sideline preparedness: the medical bag's highly desired items. Br J Sports Med. 2011 Jun;45(7):559-62.

Ian L., Dr -

Great List .
A portable oxygen cylinder to drive a nebuliser with salbutamol (albuterol) at 6L /min of O2 for acute asthma is also useful .
You need a shaver to remove hair from the chest for the AED .
OLAES modular bandage allows direct pressure wound care (from TAC MED Australia .)

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