Sunday’s NCAA Tournament saw one of the most stomach-turning injuries ever televised live when University of Louisville sophomore Kevin Ware landed awkwardly after jumping to block a shot, breaking his right leg so severely that several inches of bone protruded from the skin. Unfortunately, most of us in the gymnastics world have seen injuries like this.
As gruesome as the injury was, Ware benefited from medical staff being on hand. In fact, within hours he had completed surgery to repair the bone and punctured skin, and by Monday the university distributed photos of Ware already on crutches. While he faces a long road back, the 20-year-old may play again.
Aside from Ware’s injury, it raises a broader questions: While such injuries are rare, what if it happens where there isn’t medical staff nearby— I have some great doctors and hospitals near by, but other than coaches with first aid training, I really do not have medial staff on site.
Here are 7 things to do if a gymnast or coach suffers a compound fracture, dislocated joint, or other serious injury in the gym:
1. Call 911. This should be obvious, right? But people often skip this step, thinking that it might be faster to drive someone to the hospital themselves. “The dispatchers are trained to talk you through first aid,” says Jeffrey Rabrich, D.O., medical director of the emergency room at St. Luke’s-Roosevelt Hospital in New York. Keep the line open, even if you have to set your cell phone down, until the paramedics show up.
2. Check for breathing. Horrific, bloody injuries sometimes make you miss even more critical problems. “Someone who hits the ground from an injury like Kevin Ware’s could hit their head at the same time and stop breathing,” says David Forsh, M.D., chief of orthopedic trauma at Mount Sinai Hospital. If he’s awake and talking—or howling from the pain—that’s good. If not, look to make sure his chest is rising and falling evenly. Tilt his head back and look to make sure his tongue isn’t blocking his throat. If it is, gently turn his head to the side and push the tongue out of the way to open the airway.
3. Immobilize the injury. Even if the bone is clearly bent at an unnatural angle, don’t try to move it back into place yourself. “You can turn a dislocation into a fracture, or make any fracture worse,” Dr. Rabrich says. Use whatever is handy to make a splint—a thick magazine and strips of cloth, for example, can splint a wrist. If it’s a leg injury, you’ll want to immobilize the entire leg. With an arm injury, you can also make an over-the-shoulder sling.
4. Cover the wound and slow the bleeding. When a broken bone tears through skin, both skin and bone are going to bleed. Applying gentle pressure with a cloth to the wound should be enough to slow blood loss. “Even if all you have are sweaty shirts and your gym towels, it’s better to prevent bleeding than worry about infection at that point,” Dr. Forsh says. If you see a lot of blood spurting out in time with the heartbeat, that’s a sign the bone may have nicked an artery. Use a belt or whatever else is at hand to tie off tightly, along the limb between the bleeding and his heart, to stop the bleeding.
5. Treat for shock. Shock can be even more life-threatening than the actual injury. If blood pressure drops dramatically from loss of fluids, the heart must go into overdrive to deliver oxygen to the brain and vital organs. Your plan: Have them lay down, and elevate one or both legs slightly (if the legs aren’t injured) so his feet are higher than his heart and head. “That will help the blood flow back to the heart so it doesn’t have to work as hard,” says Dr. Forsh. If he starts vomiting, help him roll to the side so he doesn’t choke.
6. Make sure blood is still flowing below the injury. In rare cases, a dislocation or bone break can twist the limb enough that it cuts off blood flow. You’ll see his hand or leg start to turn blue, and it will feel cold to the touch. “This is the only time where you may want to try to gently straighten the limb to a more natural position, just to get blood moving again,” Dr. Forsh says.
7. Don’t do anything else. Don’t give someone who has a traumatic injury food, pain relievers, or even water. “Chances are he’s going to need surgery, and if that’s the case he has to go in with an empty stomach,” says Dr. Rabrich. You’ve done all you can. Stay with them until medical professionals arrive.