Basic Life Support & First Aid in

Sports

Dr Vinay Aggarwal
MBBS,MS(orth),DNB(orth),MNAMS,MRCSEd,
FRCS(orth)
Lead Sports Doctor
Sports Authority of India
 Index

• Definition of BLS & CPR

• Cardiac Arrest & sudden death in athletes
• Understanding the chain of survival
• Components of BLS
• Sports injuries & basic first aid
• Dehydration & heat illness
 What is CPR ?
• Three basic vital functions:

 Breathing
 Circulation
 Consciousness
 What is CPR ?
• Once heart stops functioning, a healthy
human brain can survive only upto 4 minutes
without having permanent neurological
damage.
• It is during this critical time, CPR provides
oxygenated blood to vital organs(brain &
heart)
 CPR &BLS
• CPR (Cardio-pulmonary resuscitation) is an
emergency first-aid procedure that is used to
maintain respiration and blood circulation in a
person, whose breathing and heartbeats have
suddenly stopped (one or more vital functions
failed ).
• BLS : A system of training of psychomotor skills
to identify distress & deliver high quality CPR
(including training of usage of AED)
 Cardiac Arrest
• Cardiac arrest occurs when the heart unexpectedly stops beating.
o It’s triggered by an electrical malfunction in the heart that causes an
irregular heartbeat (arrhythmia) and prevents the heart from pumping
blood to the brain, lungs and vital organs.
• Death occurs within minutes if the victim does not receive treatment.
• It is not a heart attack.
o A heart attack is caused by one or more blockages in the heart’s blood
vessels, preventing proper flow, and heart muscle dies.
• A person has the best chance of survival if CPR (cardiopulmonary
resuscitation) and an AED (automated external defibrillator) are used
immediately.
Cardiac arrest & sudden death in athletes

• Cardiac arrest is an uncommon event however it’s a

cause of sudden death in an athlete, hence it’s a
catastrophic event.
• Sudden death related to sports is defined as an
unexpected death during or immediately after intense
physical activity (1-3 hours)
• Among the major causes in younger athletes(<35
years) is Hypertrophic cardiomyopathy
• In older athletes (>35 years), coronary artery disease
is most common cause
 Signs of Cardiac Arrest
1. Unconsciousness for several seconds
2.   Respiratory arrest ( apnea) or the gasps
(agonal breathing)
3.   Pulse-less on large ( major) arteries
(carotid or femoral artery)
4.   Changed general appearance
(colour changes, face changes…)
 Who is at risk?
• Cardiac arrest can impact anyone at any age or any time.
– There is no evidence that cardiac arrest is more common in
athletes than in the general population of young people (ages
12-25).
• The incidence of cardiac arrest in athletes is unknown.
• According to one study, sudden cardiac arrest in athletes is
largely a survivable event (>85%) if the event is witnessed, the
sports arena has an established emergency action plan and the
victim receives prompt cardiopulmonary resuscitation and early
defibrillation from an automated externalAmerican
defibrillator (AED).
Heart Association 2015 Statistical2Update
1

2
Drezner, Jonathan A., et al. "Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective from the National Registry
for AED Use in Sports." 
British journal of sports medicine (2013): bjsports-2013. Retrieved from
https://www.nata.org/sites/default/files/outcomessuddencardiacarrest.pdf
Exercise physiology of sudden cardiac arrest

• Discharge of catecholamines during intense

exercise interacts unfavourably with pre-
existing arrythmogenic substrate.
• Other factors responsible are :
– Dehydration
– Electrolyte imbalance
– Hyperpyrexia
– Increased platelet aggregation
– Overdose of drugs
 Concept of Survival chain & why BLS is
important?
• Survival chain is an algorithm of interrelated
steps that must be adopted by sports staff so
that the victim has maximum chances of survival
• CPR, along with defibrillation from an AED, can
double or triple a cardiac arrest victim’s chance
of survival.
• In this context, training of all sports staff in BLS
& defibrillation is fundamental to improve
prognosis of survival
The “Chain of Survival”
BLS sequence

Kneel by the side of the

victim
Shake shoulders
Ask “Are you all right?”
BLS sequence

Unresponsive

Shout for help

Open airway

Check breathing
 BLS sequence

• Look, listen and feel for

NORMAL breathing
• No breathing – apnea
• Gasps (agonal
breathing)

Occurs shortly after heart stops in up to 40% of

cardiac arrests

Described as barely, heavy, noisy or gasping

breathing

Recognised as a sign of cardiac arrest

BLS sequence
Unresponsive

Shout for help

Open airway

Check breathing

Call 102/1099

30 chest
compressions
C: Chest compression

 Place the heel of one hand in the

centre of the chest
 Place other hand on top
 Interlock fingers
 Compress the chest
 Rate 100 min-1
 Depth 4-5 cm
 Equal compression : relaxation
 When possible (2 or more
rescuers) change CPR operator
every 2 min. to prevent fatigue
A :Opening the Airway
B: Rescue breaths

Unresponsive

Shout for help

Open airway

Check breathing

30 chest
compressions

2 rescue
breaths
Rescue Breaths
Using a Debrillator
How Long to continue CPCR ?
SPORTS Injuries: Need for awareness
 Sports Injuries: classification

 BONE INJURIES
 MUSCULAR INJURIES
 LIGAMENTS INJURIES
 TENDON INJURIES
 Bone Injuries

• Bone Fracture
• Dislocation
• Shin splints
 MUSCULAR INJURIES

• Strains

• Tears

• Cramps
 On Field First Aid

• R.I.C.E.
• Alter or stop sports
activities
• Physical therapy &
medication
• Early transport to
sports medicine
doctor
On Field First Aid
• Splint
Provides support to an
injured extremity .
Dehydration & heat Illness
Factors affecting dehydration

Intrinsic Factors – Unique to the Extrinsic Factors – Outside athlete’s

individual control
Intense or prolonged exercise without
Lower fitness level
enough breaks

Lack of sleep High temperature and/or high humidity

Illness Equipment and/or heavy clothing

Taking certain medications
(antihistamines, diuretics, Direct sun exposure
antihypertensives), supplements,
and/or stimulants
Overweight or obese Not enough fluids or breaks
Not used to the heat
 Types of heat illneses

Heat Syncope • Fainting or lightheadedness episode

Heat Cramps • Involuntary muscle contraction, large

electrolyte loss, sweating, fatigue

• Inability to continue to exercise in the heat,

weakness, headaches, heavy sweating, clammy
Heat Exhaustion skin, dizziness or fainting, rapid pulse, heat cramps,
fast and shallow breathing, nausea, vomiting

• Rectal temperature above 105 degrees

Exertional • Central nervous system dysfunction
Heat Stroke • Confusion, disorientation, combative behavior,
unconsciousness, collapse, weakness
 What to do ?
• Move to cool or shaded area, sit or lie the
athlete down as soon as they begin to feel
Heat Syncope symptoms, elevate legs to promote blood
returning to heart, rehydrate with water or
sports beverage. Monitor vital signs.
• Remove from play, consume salty
Heat Cramps foods/beverages, light stretching (if
tolerable)
• Remove from play to cool or shaded area,
rehydrate, douse with cold water or rotate
Heat Exhaustion cold, wet ice towels over the body, elevate
legs to promote blood return, monitor
closely

Exertional • MEDICAL EMERGENCY – call 112

• Cold water immersion
Heat Stroke • COOL FIRST, TRANSPORT SECOND
 Dehydration?
• Dehydration occurs when a person does not
replace body fluids lost from sweating.
• Dehydration causes a person to become
hotter and have a higher heart rate, putting
them at greater risk for heat illnesses.
• Minimizing dehydration to less than 2-3% of a
person's body weight will help to optimize
health and performance
Dehydration: signs & symptoms
Signs and Symptoms of Dehydration
Thirst Heart palpitations

Lightheadedness
Dry mouth (especially when standing)

Being irritable or cranky Weakness

Headache Decreased urine output

Dizziness Dark urine color

Nausea and vomiting Exercise session weight loss > 2%

 How can hydration be monitored?

• Body Weight changes– Pre-practice to post-practice

– Most weight lost during activity is because of water loss.
– Athlete should drink approxone bottle of drink per pound weight
lost.
• Urine color check
– Check before and after practice.
– Urine that is light or like lemonade indicates proper hydration.
Urine color that is dark like apple juice would indicate dehydration.
– Encourage your athlete to maintain a urine color that looks like
“lemonade.”
– Note: Supplements or medications can alter urine color.

It’s best to try to rehydrate within 2 hours post exercise.

How to prevent heat-related illnesses and dehydration

• Heat acclimatization
• Proper hydration before, during and
after activity
• Take regular breaks throughout exercise
sessions
• Make practice adjustments to account
for the weather conditions
• Dress for the heat
• Have your athlete observe the color of
their urine
• The athlete should never be denied,
limited or discouraged from drinking
 Sports Event Safety Checklist
 Emergency action plan posted at venue
• Contains phone numbers, location for Emergency services , basic steps to follow
for an emergency
 Accessible and functioning AED within 1-2 minutes of venue

 Accessible water source for cold water immersion & hydration that
includes supplies to provide water
 All Sports science staff certified in first aid, CPR and AED use

 Policy for pre-participation screening of athletes at practices or

games
Italy : 12 lead ecg, history & physical exam
USA : Clinical questionnaire & physical examination
Heart.org/back to sports
Thank you !