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Medical Emergencies: How to Anticipate and Prepare for Injuries

by Albert Tyldesley, ISI Safety Committee Chair

Skating rinks offer activities that can lead to personal injuries. The characteristics of hockey, figure skating, even general public skating are such that the prudent person would expect some injuries to occur. How rink staff handles these medical emergencies is increasingly important as increasing numbers of customers consider litigation a natural extension of personal injury.

The types of injuries caused from skating accidents vary. However, there are patterns that rink managers should be aware of. Wrist injuries are common in all categories of skating. Hockey players get hit across the wrist with sticks, and skaters attempt to break a fall by putting their hands out in front of them. Sprained and broken wrists are a common injury in skating rinks. Shoulder and elbow injuries are also common for the same reasons and are more difficult to deal with than a wrist injury.

Head and spine injuries might not occur with great frequency, but when they do this type of injury requires skilled medical evaluation and cautious handling. The knee joint suffers injury in all categories of skating and is very difficult to evaluate. Lacerations that cause bleeding occur on a daily basis in most skating rinks. Emergency medical personnel refer to all of these injuries as trauma injuries. The significance of these injuries is the possibility of additional medical problems caused by the injury that may not be seen or understood by untrained rink staff. Shock is a common problem associated with trauma injuries.

Having a staff member trained in first aid on duty at all times should be a goal of all rink managers. What constitutes a "trained" staff member? Because the law varies from state to state, it is difficult to give a single answer to this question. The medical community and local public safety officials have established an Emergency Medical Services (EMS) system that is accepted by every state. Emergency medical care within this system is provided by Emergency Medical Technicians. EMTs are rated by letters which designate the level of care to which they are trained. An EMT-P is a paramedic, the highest level.

EMTs are found in every community and have become the standard first aid provider in many athletic venues. EMTs are covered by the "good Samaritan law," which protects care givers from lawsuits.

First aid training and certification offered by organizations such as the Red Cross may be useful for minor cuts and bruises but are of questionable value for serious injuries. While it’s nice to have a doctor in the house, it’s also important to remember that many doctors and nurses are not trained in emergency procedures. Other titles such as athletic trainer may or may not cover you from a legal standpoint. If you are providing emergency medical coverage with anyone other than an EMT you might want to check state law or with you legal counsel to see if they meet state requirements. You should also establish ground rules for medical staff who enter your rink with visiting teams.

In most communities across the U.S., emergency medical services are provided by the local fire department. Off-duty firefighters make excellent part-time employees in skating rinks. You have the benefit of employees who work with mechanical equipment every day and are easy to train, plus you have an EMT on duty at the rink.

Sending rink employees to be trained as EMTs is possible. However, the course can run for more than six months and EMT training is usually provided by local community colleges, hospitals, or fire departments in conjunction with the area Emergency Medical Services system.

Many rinks hire EMTs to provide medical coverage at high profile events such as college and high school hockey games. Should you find that most of the injuries in your rink occur during public skating sessions or perhaps during senior hockey games, you might consider retaining EMTs at those times.

EMTs are also capable of providing first aid training to your staff. Basic first aid courses should be provided to all skating rink employees. Understanding what not to do in case of injury can be as important as knowing what to do.

Every skating rink should have several employees trained in CPR. This life saving skill can be taught at the rink by local instructors. A basic first aid course should be presented to your entire staff, especially skate guards, once per year by a qualified teacher.

Documentation on how an injury occurred and the services provided the victim by rink staff can be very important, should litigation follow. All employees need to know how to handle an injury from patient care to filling out an injury report. Check with your insurance company for information on incident reports, or see the 2000 edition of the ISI Instructor Manual for guidelines for a safe skating environment, rink liability information, a sample incident report, a skate at your own risk waiver, and emergency first aid information.

Every skating rink should have a room dedicated to providing care to people with injuries. The first aid room must be clean, stocked with the correct medical supplies, be accessible to the ice and should have an outside door for patient removal to an ambulance. Walking into a dirty, dust-covered first aid room filled with unrelated equipment and rink supplies does not convey a good image. Empty supply cabinets or absence of first aid supplies will not only embarrass you but can delay patient care. What medical supplies you keep on hand will be determined by the level of care your staff is qualified to provide. Unqualified employees using medical equipment they are not trained or certified in may result in a lawsuit.

Listing medical supplies that should be kept in the first aid room is difficult and may legally differ from community to community. You might check with your local EMS authorities on appropriate medical supplies and equipment. Standard items such as adhesive bandages, slings, medical tape, latex gloves, gauze bandages, sterile water, etc. are usually safe and acceptable at all levels of patient care.

Any staff member dealing with an open cut or wound MUST wear latex gloves. This is for their protection as well as the patient’s. Aspirin is commonly found in first aid rooms but cannot (by law) in most states be dispensed to children. You can sell aspirin in the snack bar, but you cannot offer it to a child who is hurt.

Skating rink first aid rooms may have advanced medical equipment that can only be used by certified personnel. Backboards, oxygen, splints, pen lights, slings and other such equipment can be on hand for qualified people to use in an emergency. Should you have an injury on the ice and qualified employees present, it’s possible to remove the injured person from the ice prior to the arrival of the fire department. Correct patient removal by qualified personnel allows superior patient care and saves the rink time but must be acceptable to your local EMS provider.

Training rink employees in first aid procedures must always include how to call for help. Access to telephones to call the fire department must be available when the rink is open. Emergency numbers should be posted at the phone. Did you know that every pay phone must accept a 911 call without a coin?

Emergency procedures should be anticipated in your facility. Hiring independent medical experts, training employees, and providing a first aid room are the responsibility of the rink manager.

* Editor’s Note: To order a copy of the 2000 edition of ISI’s Instructor Manual, call 972-735-8800, extension 213. This 74-page book contains a wealth of essential information.