During an on-field (on-site) assessment, the athletic trainer or any trained personnel with a first aid certification should assume a position close to the injured individual. The history of the injury can be obtained from the individual or, if the individual is unconscious, from bystanders who may have witnessed the injury. Questions should be open-ended to allow the person to provide as much information as possible about the injury. The athletic trainer should listen attentively for clues that may indicate the nature of the injury.
On-site history taking should be relatively brief as compared to a more comprehensive clinical evaluation. Critical areas of information include:
(1) Location of pain. The site of the injury should be identified; it is important to be aware that several areas may be injured.
(2) Presence of abnormal neurologic signs. The presence of any tingling, numbness, or loss of sensation should be noted.
(3) Mechanism of injury. The position of the injured body part at the point of impact and the direction of force should be identified.
(4) Associated sounds. A report of hearing a “snap” or a “pop” may indicate a fracture or rupture of a ligament or tendon.
(5) History of the injury. Any preexisting condition or injury may have exacerbated the current injury or may complicate the injury assessment.
To determine the history of injury and level of responsiveness, first stabilize the head and neck. Do not move the individual unnecessarily until a spinal injury is ruled out. If nonresponsive: first, call the person’s name loudly, and gently tap the sternum or touch the arm. If no response,rap the sternum more forcibly with a knuckle, or pinch the soft tissue in the armpit (axillary fold). Note if withdrawal from the painful stimulus occurs. If no response, immediately initiate the primary survey. Secondly, if airway, breathing, and circulation (ABCs) are adequate, gather a history of the injury. If you did not see what happened, question other players, supervisors, officials, and bystanders. Ask:
- What happened?
- Did you see the individual get hit, or did the individual just collapse?
- How long has the individual been unresponsive?
- Did the individual become unresponsive suddenly or deteriorate gradually?
- If it was gradual, did anyone talk to the individual before you arrived?
- What did the person say?
- Was it coherent?
- Did the person moan, groan, or mumble?
- Has this ever happened before to this individual?
If conscious, ask:
(1) What happened? Note if the individual is alert and aware of his or her surroundings or has any short- or long-term memory loss. If the individual is lying down, determine if the person was knocked down, fell, or rolled voluntarily into that position.
(2) Are you in pain? Where is the pain? Is it localized, or does it radiate into other areas?
(3) Did you hear any sounds or any unusual sensations when the injury occurred?
(4) Have you ever injured this body part before or experienced a similar injury?
(5) Do you have a headache? Are you experiencing any nausea? Are you dizzy? Can you seeclearly?
(6) Are you taking any medication (e.g., prescription, over-the-counter, or vitamins)?
The history of the evaluation will enable the athletic trainer to determine the possibility of an associated head or spinal injury, to rule out injury to other body areas, and if necessary, to calm the individual. If the individual cannot open the eyes on verbal command or does not demonstrate withdrawal from painful stimulus, a serious “red flag” injury exists. It is important to avoid leading the individual. Instead, the individual should be encouraged to describe what happened, and the examiner should listen attentively for clues to the nature of the injury.