If you are an experienced physician, paramedic, nurse, or other medical personnel, then this section is probably not for you. The truth is that most coaches have no formal medical training, and yet, it is often the coach who is on the 'front line' for handling injuries in any sports activity. A youth coach should be prepared to deal with simple injuries, recognize more serious injuries, and work with the child following return from injury. This may entail taking first aid classes and basic CPR classes (an excellent idea for all youth sports). In addition, coaches should always have copies of the medical release forms that most clubs use with them at all times. Besides insurance information and emergency numbers, these forms should have information on any medical conditions that the child has such as medication allergies, asthma, cardiac conditions, etc.
The following information is meant to provide guidelines for the youth soccer coach in dealing with some of the problems that may arise during the course of a season.
By far the most useful item in your coaching bag of tricks will be commonsense. If you are uncertain about the severity of an injury, CALL FOR HELP! Remember that this is a game, not life or death. If the player is not responsive or is not in control of themselves, don't play around -- get help immediately! Your best bet is to have someone get to a phone and call your local emergency number.
Unless the injury is obviously severe, walk to the player. Younger children may dramatize the amount of pain they are feeling and the sight of an adult in full flight rushing to their side, may inadvertently send a signal that, by golly, they really are badly hurt. Remember that no one may enter the field without the referee's permission, including the coach, assistants, and parents. Wait until the referee's signal before coming out to check on the player. Be aware that most parents do not know this nicety and want you out there NOW. (A little parental education early in the season may save you a lot of aggravation down the road.) On your way out, instruct everyone to get 10 yards away from the injured - this is a fairly common request in soccer and it's a command most can respond to automatically. On the way out, calm yourself and avoid feelings of panic - now is the time to be cool and in control; afterwards, you can 'go to pieces' but now your players need you to be coldly analytical. Just because you're not a medical professional does not mean that you can't ACT like one. The "pros" first talk, look and listen -- you should never grab an injured person and move them right away. NEVER try to assist or move an injured player unless they are moving themselves and have demonstrated that they are doing so without crippling pain. Make this apply to everyone else without parental or emergency medical personnel involvement. Pain is a real blessing in injury cases since it will tell the injured when they are going too far. Let the injured person get themselves up on their own -- a serious injury will usually cause enough pain to keep the person from doing themselves anymore harm. If the player is responsive, talk calmly to them and ask them where it hurts or what happened. Getting the player calm enough to talk to and examine is one of the most important (and hardest) things you must accomplish. If the injury is a cut or scrape, you usually know the site and severity by inspection. However, if there is no visible injury, ask where it hurts. With younger children, be prepared for a vague waving of the hand covering anywhere from a quarter to half of the body. Ask them to point with one finger where it hurts the most. This should narrow the search down to a reasonable area.
Things to look for are:
If you see any of these signs, you need to involve the parent(s)/guardian(s) and call for 911 for help - but you are still not done. If bleeding is continuing freely (particularly if it is actually spurting), you'll have to take some basic steps to stop or control the bleeding. As you put on plastic gloves, tell the player that you are putting them on for the player's protection, and then apply clean gauze or bandages over the wound, applying gentle but firm pressure on the wound. If the eyes look abnormal, then shock is a possibility; if possible, gently elevate the legs and cover the player with coats/blankets/etc to keep them warm. If the neck looks 'odd', do not move the player but try to keep them warm. If an arm or leg looks 'odd' this is a sign of a possible serious broken bone, so movement should be minimal, but you can start with "RICE".
"RICE" is an acronym that is easy to remember but helps one recall what to do for most injuries:
"Rest" means keeping the injured relaxed and warm, usually lying down, and keeping the injured area still. If the weather is nasty, take steps to shelter the player, and if possible, get a coat or tarp tucked gently underneath them. "Ice" is straight forward - apply an ice pack (or ice inside a cloth) to the injury to minimize swelling. "Compression" means to apply gentle pressure to keep bleeding under control - note that internal bleeding is what causes swelling, so the same idea works for both. In the case where there is no external bleeding, a gentle but firm wrap with an elastic bandage will help control the swelling. "Elevation" is also straightforward - the usual rule of thumb is to get the injured area higher than the heart. Remember to let the player do most of the moving; in most cases, folding a coat or blanket a couple of times and sliding that underneath is all you want to do.
Even in the 'scrape' cases, you want to use "RICE". Make it a point to talk to the parents - ask them to watch for any complications. If the effects of the injury are not completely gone by the end of the game, recommend that they call their family physician. As a coach, there are only a few people to whom you can transfer responsibility for injury care - duly authorized medical personnel and the injured player's parent or guardian. The duly authorized medical personnel are a dispatched emergency care unit or hospital/treatment center, and not another parent or spectator even if they happen to be a doctor. Get parents involved early.
We often neglect to teach our players what to do in case of an injury to themselves, their teammates, or their opponents. Often the referee may not see the incident or know that a player is injured. Even if they do witness the event, they may decide that it is not severe enough to warrant immediate stoppage of the game. Typically they will allow play to continue until advantage is lost. Injured players should be instructed to sit, kneel, or lie down. Teammates should call "player down" to inform the referee. If the injury appears significant (and this is completely a judgment call) the team in possession should kick the ball out of bounds, point to the injured player, and tell the referee, "player down". Good sportsmanship suggests that the ball be returned to the team that intentionally kicked it out by throwing in to their end and allowing them to receive the ball.
A child who is injured and complains of pain should NOT be pushed back into playing. By the same token, if you are concerned regarding an injury, don't let the players 'talk' you into playing them. A general rule of thumb for an injured player to return to competition is: 1) the player wants to continue; 2) they must demonstrate a full, active range of motion of the affected part on the sideline; and 3) the player must demonstrate the ability to perform age appropriate skills at competition speed on the sideline prior to returning to play. In the case of significant injury (including illness), you should require both parental and medical approval before allowing the child to resume practice. This is not meant to protect you from possible litigation but to ensure that the player has received proper, qualified attention to the injury. (It's also important to remember that referees have discretion on allowing kids to play with limb casts and braces so you should check in advance if at all possible to avoid any surprises.)
Every coach has his or her own opinion on what is essential in a First Aid Kit. The essentials would certainly include disposable gloves, Band-Aids, gauze, tape and antiseptic. Additional items may be included according to your personal preference. A bag or container to keep things organized is very helpful. A plastic school lunch box makes an excellent container and is very affordable. In general it is cheaper in the long term to buy items individually rather that pre-made kits available in stores.
Any bleeding wound requires that the player be removed from the field and the injury be covered prior to returning to play. The coach should put on disposable gloves prior to examining the wound, for protection of him/herself and the player (there are many diseases, such as hepatitis and HIV/AIDS, which can be transmitted via blood-to-blood contact). The wound should be cleaned with gauze and clean water so the severity can be determined. Large cuts or gaping wounds that likely require stitches should be covered and the player sent to an appropriate medical facility. Minor cuts or scrapes can be cleaned and bandaged and the player may be permitted to return to play.
If there is active bleeding, apply a dressing to the site and put firm pressure on the dressing. If possible, elevate the site of bleeding. If the dressing becomes saturated, apply another ON TOP of the first dressing and continue to apply pressure. Any wound that will not stop bleeding or has bright red, pulsating blood requires prompt medical treatment. Never use a tourniquet.
Technically, sprains deal with joints while strains deal with muscles. Treatment for each injury, however, is similar in the acute phase. Use the "RICE" principles. Remove the player from the field and have them relax. Apply "ice" either in the form of an ice bag or using one of the disposable, chemical ice packs that will conform to the surface they are applied to. Ice should not be placed directly on the skin. Use a towel or a t-shirt for protection and remove the ice after 10 to 15 minutes for 5 minutes before reapplying. Use some form of wrap to apply "compression" (and to hold the ice in place) but don't apply too tightly. As swelling occurs, this can cause a tourniquet effect and inhibit blood flow past the compression site. If possible, "elevate" the injured part. If there is no significant pain or swelling and the player feels able to play, they may return to the game. They should be observed, however, for any limitation of movement or obvious pain and removed from the game at first opportunity.
In the event of an obvious fracture or dislocation, the player should immediately be sent to an appropriate medical facility. DO NOT attempt to re-set a fracture (realign the bones) or relocate a dislocation. You may make the injury worse. Try to stabilize the injured limb as best as possible. If the player cannot move or is in too much pain, call for help. Emergency technicians are trained in the proper way to transport and stabilize patients.
Nature has a number of nasty tricks to play on soccer players and spectators. In the fall and winter, it can be cold and wet. The temptation is to bundle up and wear sweat pants and sweatshirts under the uniform. As the player sweats, however, these clothes become saturated. As the sweat evaporates, it can actually increase the cooling effect on the skin by the cold air. If it is not too cold, it is better to eliminate the heavy undergarments and dry the skin with towels when the player comes off the field to minimize the evaporative, cooling effect. Mild hypothermia can be recognized by involuntary shivering, cold hands or cold feet. This is treated by drying the skin, adding layers of dry clothing, and finding shelter.
Moderate hypothermia is characterized by violent shivering, loss of fine motor coordination (can't tie shoes or zip coat), and mild confusion. This can be treated the same way as mild hypothermia. Be sure to keep the player (or spectator!) hydrated. Hot liquids provide internal heat as well as a "fuel source" in the sugar or fats they might contain.
In severe hypothermia shivering stops. Movements are uncoordinated, and there may be loss of consciousness. This is a medical emergency and you should call for help immediately.
Frost nip refers to freezing of the top layers of skin and is generally reversible. The top layers are waxy, white and hard but the deeper tissues are still soft. This is mostly seen on cheeks, earlobes, fingers, and toes. Re-warm the area by blowing warm air on it or placing it against a warm body part (stomach or armpits). Frostbite means the skin is frozen all the way through. Skin is white and "wooden" feeling with numbness. To re-warm, place the body part in a water bath of 105 to 110 degrees F. Do not add replacement warm water directly to injury. Immerse for 25 to 40 minutes. Thawing is complete when sensation and color have returned and skin is pliable. There can be significant pain when the area is re-warmed. Do not rub the area. Any ice crystals that have formed in the cells can tear the walls and worsen the injury! Do not use alcohol (increases heat loss), caffeine (it causes water loss), or tobacco (nicotine cause the blood vessels to constrict).
The other extreme is heat stroke and heat exhaustion. Perspiration cools the body by evaporation and helps keep the internal temperature normal. Heat exhaustion occurs when the body sweats too much causing dehydration and salt loss. This in turn produces cramps, dizziness, vomiting, clammy skin, flushed complexion, and weak pulse. The player should be moved to a shady, cool area and given liquids. In heat stroke, the player stops sweating, the skin is hot and dry, and the pulse may be pounding. Confusion, seizures, and loss of consciousness may occur. Immediately call for an ambulance, move the victim to a cool, shaded area, and sponge with cool water.
Bug bites and stings are another common problem. If a stinger is visible, it should be removed with tweezers or the edge of a credit card. Ice can re-applied to bites or stings for pain control. On rare occasion, an individual may be allergic to stings and develop hives, wheezing, or complain that their throat is closing. This is an emergency and requires help immediately. Some coaches (or players) carry a bee sting allergy kit (available in pharmacies) if they know they have an allergic individual on the team. Be sure you know-how to use it ahead of time!
Perhaps the most common weather related problem is lightning. The best way to deal with lightning is planning and prevention. Know where safe shelters are. These include enclosed vehicles with the windows up, enclosed buildings, and low ground. DO NOT stand near metallic objects such as fences, flag poles, bleachers, and gates. Stay away from trees, water, and open fields. Two of the most dangerous times for a fatal lightning strike are before the storm arrives and after the storm has passed. Lightning may travel as far as 10 km horizontally from the thunderhead, reaching the ground some distance ahead (or behind) the storm clouds. Every five seconds between the flash of light and the sound of thunder is approximately 1 mile. So when the flash and bang are separated by 15 seconds or less, it is time to seek shelter. Make sure to allow for time to reach the shelter. Plan on waiting at least 30 minutes after the storm has passed before resuming outdoor activities. If an individual should be "struck" by lightning, they do not carry an electric charge and it is safe to touch them. The most dangerous problem is cardiac arrest (the heart stops beating). Call for help and begin immediate CPR. In any event the victim should go to an emergency room since there can be some subtle and delayed reactions to a lightning strike.
Head injuries range from bumps to cuts to nosebleeds. Scalp lacerations can bleed profusely (accentuated if it is raining) and often require stitches. The more serious problems, however, are difficult to see since they occur inside the head, affecting the brain. Bumps and bangs to the head require observation mostly. Ice may be used to limit the swelling. The player should be examined by qualified medical personnel if there was loss of consciousness, disorientation or confusion, bleeding from the ear, unequal pupils, or inability of the eyes to follow movement of your finger. Severe headaches are also a danger sign, but it is difficult in children to quantify the severity of a headache. Unconscious players should not be moved since a spine injury cannot be ruled out. Do not use ammonia capsules to "bring them around" since the quick movements of the head to get away from the inhalant can cause more injury. Be sure to check that the player is breathing and has a pulse. If not, call for help and begin CPR.
Nosebleeds can be frightening to small children. Apply pressure to both sides of the nose, and ice to the bridge of the nose, and hold for 2 to 5 minutes. Do not tilt the head back since this allows the blood to drip down the back of the throat and may make them feel as though they are choking. If bleeding cannot be stopped, or there is a suspicious that the nose is broken, seek medical attention.
Foreign bodies in the eye are common especially on windy days. Do not rub the eye since this can scratch the cornea. If the player can cooperate, the eye can be gently rinsed with water. In general, the tearing action will wash away the offending particle. If the player continues to complain of a feeling that there is something in the eye even though there is nothing visible, it is possible that their cornea was scratched and they should seek medical attention.
Cuts inside the mouth may occur and are usually not severe although some may require stitches. It is recommended that players use mouth guards, particularly children with braces since these can cut severely. If a permanent tooth is knocked out: 1) handle it by the top (crown), not the root; 2) rinse it in clean water; and 3) try to reinsert the tooth into its socket (have the player hold the tooth in place by biting down on a clean gauze). If the tooth cannot be reinserted, wrap it in a clean gauze wet with water or milk, and immediately seek dental care (on occasion, teeth can be reinserted into the jaw).
The rule of thumb with any potential damage to the neck or remainder of the spine is to assume the worst. Never force a player to move, or try to move them if they cannot or will not move themselves. Call for help immediately. Do not move the player yourself!
The majority of injuries tend to be scrapes and cuts. However, broken bones (particularly about the wrist) and dislocations (especially involving the fingers and shoulders) also do occur. If in doubt regarding the severity of an injury, always err on the side of caution.
Prevention is worth more than a pound of cure in this case. Male players should wear an athletic support and cup. If an injury does occur, most are limited to pain and discomfort. Marked swelling and persistent pain indicate a need for medical examination
Once again cuts and scrapes are the predominant injury, especially about the knee. Sprained ankles are also common. The player should rest, ice the ankle region, and elevate the foot. It is probably best to leave the shoe on to minimize the swelling. If the pain subsides and the player is willing, they may return to the game. Persistent pain, marked swelling, or obvious deformity suggest a fracture and require medical attention.
Knee injuries including cruciate ligament tears are more common in the older age groups. Significant swelling or persistent pain indicates a need for an exam by qualified medical personnel.
Players often complain of pain in the heel after playing on hard ground. This is probably caused by repeated pounding as the foot hits the ground and the force is transmitted through the studs of the cleats. New shoes are changing the stud pattern to try and relieve this problem. Alternatively, heel cups or additional cushioning may help. Some players use "turf" shoes when playing on hard, compacted surfaces to avoid this problem.
Blisters are extremely common. They can be avoided, to a certain extent, by wearing well-fitted shoes, keeping the feet dry and wearing good quality socks. Do not tear away the skin covering a blister, it protects the new, tender skin underneath it. NU-Skin can be used to make a plastic bandage over the skin for blister prevention. If you must "pop" a blister, use a sterile needle. Moleskin can be used on the area around the blister (not on the blister) to prevent further irritation.
Updated 7 April 1999