In March, 2001, we published a sample accident report form and a sample release form, that we hope raised awareness of important issues and was of some use to dojo administrators. This month, we are pleased to offer guidelines on emergency care in the dojo. Please feel free to print them out for use in your own dojo, with special thanks and credit to Janet Rosen, RN.

The following outline of emergency medical protocol appears with the kind permission of its author, Janet Rosen, RN, and AikiWeb, http://www.aikiweb.com/misc/rosen3.html, on which site it is published. Ms. Rosen currently trains at San Francisco Aikikai (http://www.sfaikikai.com).

Dojo Emergency Protocol

The ABC's

• Conscious? If not:
• Check Airway/Breathing/Circulation
• Call 911
• CPR if necessary
• Check for MedicAlert info
• Immobilize Head/Neck injury if necessary

Bleeding

• Universal Precautions (Gloves/Padding)
• Direct Pressure
• Elevation of bleeding area

Shock

• Symptoms
  • Pale, dizzy, sweating, weak, confused
• Lie flat and elevate feet

Injury

• Fracture/Dislocation
  • Immobilize/stabilize
• Closed soft tissue
  • RICE (Rest, Ice, Compress, Elevate)
• Open wound
  • Universal precautions, cleanse, and cover

When should I call 911?

• No breathing or pulse.
• Loss of consciousness that does not resolve right away, or leads to confusion or amnesia (all loss of consciousness does require prompt medical attention!).
• Shock symptoms that do not resolve quickly with rest and fluids.
• Major injury such as unstable fracture or rapid bleeding.
• Seizures that do not stop.

Additional Information

• Head Injury (information from Cecilia Ramos, R.N., of Grass Valley Aikikai)
  • Concussion Grade 1: confusion, no amnesia, no loss of consciousness
    • Evaluate, rest and observe at least 20 minutes for being 100% symptom-free before return to activity.
  • Concussion Grade 2: confusion with amnesia, no loss of consciousness
    • Evaluate, rest and observe 24 hours (medical attention required), return to activity after one week symptom-free.
  • Concussion Grade 3: any loss of consciousness
    • Immediate medical attention required, return to activity after 2-4 weeks symptom-free depending upon medical advice.
• Diabetes
  • It may be difficult to differentiate too high blood sugar from too low blood sugar in some people. In the dojo it is safe to assume that the rapid onset of symptoms that may include pallor, sweating, weakness or confusion associated with exercising is caused by too low blood sugar. Position as for shock and administer sugar, either in the form of glucose tablets from the first aid kit, or by fortifying any liquid with a lot of sugar. If the person cannot take oral sugar due to weakness or loss of consciousness, call 911.
• Fractures
  • Evaluate all injuries for deformity, inability to bear weight, decreased range of motion, and pain (swelling and bruising may not be severe initially). Complex splinting and transport issues should not arise in the middle of a city with 911 functioning. Provide immobilization to the affected area and keep the person quietly resting until paramedics arise or, as may be done in the case of smaller bones such as wrists or feet, other transport is arranged.
• Neck Injury
  • If a neck injury is suspected due to the type of accident, the angle of the head, or any symptoms such as numbness of the extremities or difficulty with movement, do not move the person unless it is mandated by another emergency such as fire or falling debris. Provide reassurance, and immobilize the person's head and neck exactly as they are by sandbagging with anything available until the paramedics arrive. If a disaster necessitates moving the person, the head and neck must be supported/maintained exactly as they are to avoid risk of further injury to the spinal cord.
• Shock
  • Shock symptoms may be caused by diabetes or other low blood sugar situations (see above), by illness, by blood loss, by dehydration, by overexertion, by massive allergy reaction or by heat. Pallor, with or without sweating; weakness, dizziness, confusion would be primary things to look for; sometimes there may be flushing instead of pallor. Lying down and then elevating the feet to above heart level is the key; provide fluids if the person is awake enough to swallow safely. If shortness of breath or labored breathing predominate, the person may only feel relief if supported sitting up, leaning somewhat forward. Any shock-like symptoms that do not resolve within a few minutes should be considered an emergency.
• Seizure
  • The mat or carpeted floor is a safe place. Prevent harm during the seizure by removing objects from the vicinity but do not attempt to restrain the person except if needed to prevent harm; i.e. from banging into something. Do not attempt to force anything between the teeth. Sleepiness or confusion afterwards may be normal for some people.