1. Form a General Impression
When determining the severity of a sports injury, you probably already have a gut feeling about what you just witnessed. Sometimes perception is reality and sometimes looks are deceiving though, so forming a general impression is important. You will first look to see the position of the victim and notice immediately whether or not an injury is suspect (such as a femur protruding from the pants and through the skin, or an arm facing the wrong way). You should also take this time to listen for moaning, snoring or gurgling respirations. This indicates a very severe injury. You also want to take note of any smells such as urine, feces or vomit. These too indicate the presence of life threatening trauma.
2. Perform Your Initial Assessment
One other way to determine that this injury is really bad is if the victim is conscious or knocked out. You determine this by his responsiveness to stimuli. A good acronym to use is AVPU (Alert, Verbal, Painful, Unresponsive). Alert is that he is sitting up talking, verbal is unconscious but responds when spoken to, painful is responsive only when given a painful stimuli such as a pinch or sternal rub and unresponsive is no response and is not good at all. You must then check that the patient has a viable airway, is breathing and has a pulse. If not, these must be corrected immediately, or nothing else matters.
3. Distal PMS
One of the most definitive tests for mobility is distal PMS. This is where you take the pulse at the feet and at the wrist. You will run your fingers up the foot from heel to toes, and across the hands as well. You will apply slight pressure to the bottoms of the feet and ask the victim to push down like they are stepping on the gas pedal, and then put pressure on top of the foot and ask them to pull back up. If they have no discernible pulse, they cannot feel your hands or they cannot respond to the gas pedal test, you have a very good indication of a spinal or neck injury.
4. Physical and Visual Inspection
You must take the time to palpitate the skullcap, head, neck, chest, arms, abdomen and legs. If you feel crepitus (bone rubbing and grinding against bone), the patient should not be moved on his own. The victim should be immobilized onto a backboard and carried out on a stretcher. You will also visually inspect for cerebral fluid leaking from the ear canal or nostrils, unevenly dilated pupils, blackened eyes or bruising behind the ears. Any of these are a good indicator of a spinal cord injury and the patient should not be moved.
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