March 2013 • Volume 20/Number 2

Continuing the Little League® tradition of making it “safer for the kids.”

Chronic Asthma and Baseball by Kelly Wheeler, ASAP Hotline Operator

This is a topic with which I am quite familiar. My oldest son CJ (now 23) was diagnosed with asthma before his first birthday and with juvenile diabetes when he was four. This was quite a one-two punch for health issues. As his parents, we fought long and hard to make sure CJ had every experience that a non-chronically ill child could have. CJ played in Little League for many years. He started in Tee Ball and played through middle school. In high school, he ran track, wrestled for a season, and played football. He rode his bike, and then later had a motorcycle. He learned to hunt and fish, stayed overnight at friends’ homes, in short, he had a normal childhood.

Establish an Action Plan We learned very early about having an action plan. It detailed what medications CJ was taking, when he was to take them (both scheduled and as needed), contact information, what signs and symptoms to look for, and what to do when CJ became distressed. In addition to the action plan, we took a lot of time to educate the people around CJ. We shared the action plan with school administrators, teachers, coaches, counselors, school nurses, and anyone else who would be in charge of him. It wasn’t always easy. People can be very intimidated by the words asthma and diabetes, but knowledge is power and a little education went a long way in keeping CJ healthy. An action plan is a communication tool to be shared with the adults in charge of the child. It doesn’t replace a parent’s responsibility to assure the child is healthy

Asthma Facts

As a member of the ASAP Hotline team, I receive many requests for information. Occasionally, a topic will arise that needs more than a single email to address. That’s what happened when Mike Crusik, safety officer for Belmont Redwood Shores Little League, asked for information and advice on kids with asthma. 1 in 11 children and 1 in 12 adults have asthma. In 2008, asthma caused 14.2 million missed days of work and 10.5 million missed days of school. Symptoms of an asthma attack include: • Coughing • Wheezing • Shortness of breath • Tightness or or trouble breathing pain in the chest

enough for the planned activity, nor does it require anyone to dispense medications. The most important thing we taught people was to observe CJ. Most people don’t know what to look for and as a result, symptoms can escalate.

Live the Plan If you have a player that has a chronic illness, there are several steps you can take to make sure you, the child, and your team, can have a safe and fun season. • Get a copy of the player’s action plan and discuss it with the parents/guardians of the child • Understand the signs and symptoms of distress • Check that necessary items are available to the child – inhaler, proper snacks, etc. • Have the child’s contact information at hand • Do not dispense prescription medications Throughout CJ’s childhood, he sat out part of one game; one time due to his diagnosis. It did take a lot of people caring about my son to have this success, but because we had an action plan and kept in communication with the people around him, CJ was able to participate fully. See resources on page 2.

This poster is provided for use in your league to help make players, volunteeers, and parents more aware of the signs of an asthma attack and the procedure to follow. For more resources on action plans and asthma, visit: www.cdc.gov/asthma.

Visit www.LittleLeague.org, Forms and Publications, ASAP, and click on the Warwick, Rhode Island plan to see how they included information in their winning ASAP safety plan.

Asthma Emergency Signs Seek Emergency Care If A Child Experiences Any Of The Following: + Child’s wheezing or coughing does not improve after taking medicine (15-20 minutes for most asthma medications)

+ Child’s chest or neck is pulling in while struggling to breathe + Child has trouble walking or talking + Child stops playing and cannot start again + Child’s fingernails and/or lips turn blue or gray + Skin between child’s ribs sucks in when breathing Asthma is different for every person. The “Asthma Emergency Signs” above represent general emergency situations as per the National Asthma Education and Prevention Program 1997 Expert Panel Report.

If you are at all uncertain of what to do in case of a breathing emergency...

Call 9-1-1 and the child’s parent/guardian! Michigan Asthma Steering Committee of the Michigan Department of Community Health

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(From the Grandville, Mich., Little League 2001 Safety Plan)

Keeping Player’s Heads Safe...and in the Game keep an eye out for symptoms of concussion. According to the CDC, mental problems a concussed player will display include: • Confusion • Slurred speech • Headache • Amnesia • Trouble focusing • Overly emotional

The word concussion is derived from the Latin word “concutere,” which means “to shake violently.” That’s just what happens to a player’s brain if he/she gets hit in the head forcefully enough to cause a concussion. According to the Center for Disease Control (CDC), almost four million sport and recreation-related concussions happen each year in the U.S. It’s no surprise that young children are more prone to, and less protected against, the onset of a concussion. While they happen by accident, a good understanding of concussions, as well as a preparedness to handle one, goes a long way.

Symptoms You may not always see a player get hit in practice or during a game. So Some states have specific concussion laws. Go to http://www.LittleLeague. org/learn/programs/childprotection/ concussions.htm for more information.

Physical signs are also a good indication of a player’s condition. These indicators include: • Sluggish behavior • Clumsiness • Nausea or vomiting Treatment The American Academy of Neurology has guidelines ranking concussions from grades one through three, growing in severity. No matter the level, if a player appears concussed, even if their symptoms are gone, they need to be examined by a medical professional with experience in concussions before returning to play. Time is the only real medicine, although the proper dosage of painkillers can be given by parents to help alleviate headaches. As a rule generally accepted in all sports, if a player gets a concussion (or even if you think they may have one), they should be removed from play and examined by a medical professional at once.

Prevention and Action We’ll never know when an accident will strike, but we can do our best to limit these occurrences and protect players and spectators. Make sure players are properly equipped with

a snug fitting helmet at bat. The catcher should wear snug fitting protection, and providing pitchers in younger leagues with helmets or face masks/head protection appropriate to the position should be a serious consideration. Keep facilities safe for players and spectators. Bleachers behind home plate need a tall protective fence, as do the fronts of dugouts. If available, consider installing netting above bleachers, and have signs instructing spectators to watch out for foul balls and to refrain from running and jumping on and around bleachers. Parents need to know their role in protecting younger children on metal bleachers and concrete. Finally, every league should have an action plan on handling concussions. Coaches should have a list of phone numbers for parents, health care professionals, and emergency dispatch. This can be incorporated into the key personnel list in your safety plan, given to all coaches. Even if not critically injured, continue to monitor players. Those who have had a concussion are more likely to experience another. Repeat concussions can cause much more serious brain injury, including death, especially if the first concussion is not yet healed. Convenient online resources exist on the Little League website and other sites that make learning about concussions easier than ever. Coaches and volunteers should get educated, and keep kids’ heads safely in the game. For more thorough training on concussions, visit: http://www.cdc. gov/concussion/headsup/online_ training.html. March 2013

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When Treating Sports Injuries, Remember to Follow:

Protect • Rest • Ice • Compression • Elevation Some of the most common injuries in baseball and softball are bruises, sprains, and strained muscles or ligaments. The good news is that these problems usually do not require immediate medical attention, and no more than an appropriate time away from the field. The body’s process of healing damaged tissues is amazingly intelligent and effective. Sometimes though, the body needs help to heal properly. By following the steps of PRICE (Protect, Rest, Ice, Compression and Elevation), an athlete’s discomfort and time away from activity can be minimized.

Protect The first step is to protect damaged tissue from sustaining further strain. Pad and protect the affected area. If a player sprains his/her ankle, for instance, prevent painful movement with an ankle brace or wrap. Also, use crutches if affected by a leg strain; removing weight from a stressed area helps it heal.

Rest Time off is an athlete’s best bet to a speedy recovery. Never encourage a player to “walk it off” and continue to play. Even small injuries should be allowed time to heal. Giving the

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body rest not only relieves the player’s discomfort, but also allows it uninterrupted focus on the healing process.

Ice Icing an injury to reduce swelling and numb pain is perhaps the most straightforward step in PRICE, but there are still factors to consider. If allowed to heal on its own, a swollen area may be left with an excess of scar tissue. Icing reduces blood flow to the injured area, reducing what could otherwise be painful swelling and damage to surrounding, uninjured, areas. Cold packs, bagged ice, ice baths, and even frozen peas work. Be sure to separate the cold source from the skin with a towel to prevent ice burn. Apply ice for 10-15 minutes then allow the area to warm again for at least an hour.

Compression Compression is a good way to further reduce swelling and shorten the healing time. Do not be misled by the word. “Compression” means nothing more than restraining an area from swelling too much through the use of gentle pressure. Wrapping an affected area with gauze or medical tape so that it is barely tight is a good way to contain swelling. Pay close attention to an athlete’s reaction to determine

how compressed an injury should be, to prevent constricting major blood flow.

Elevation By elevating an injured area above the heart, you can reduce painful blood flow to a swollen injury. If a knee or ankle is injured, lay an athlete down and raise their leg using several pillows. The same goes for a swollen wrist. Though most convenient while sleeping, this method should be used whenever possible (say, on the couch watching TV). When an injury occurs, blood tends to pool at the site, hindering return flow, so making the organ’s job easier by raising the limb prevents painful blood pressure and swelling. Bruising is the body’s natural reaction to damaged cells, and a way that it protects damaged tissue. Sometimes, however, the body can overdo it and damage surrounding areas, and delay the healing process. The best option when dealing with an injury is to seek medical attention, but by following PRICE for common injuries, your athlete can return to play (and good health) in less time. Ask your doctor for details about PRICE or any one of the steps during your next visit for further advice and explanation. 

ICE

IT!

Icing Shoulder and Elbow after Throwing May use cubed ice, crushed ice, frozen peas, or make your own. Recommendation: Shoulder 15-20 minutes Elbow 15 minutes

Make your own ice pack • In a plastic bag with seal • 3 parts water • 1 part rubbing alcohol

Ice Massage Therapy Ice massage is an excellent intervention for cumulative trauma like elbow and shoulder pain after throwing.

Ice Massage Guidelines

Make your own ice cup • Fill a small paper or Styrofoam cup • Freeze until it is solid • Once it is frozen, peel off the top edge around the cup to expose an inch or so of ice. • Leave the bottom of the cup intact to comfortably hold it.

1. You may use an ice cube, but it’s easier to use an ice cup for ice massage. 2. Remove any clothing that covers the painful area and assume a comfortable, supported position. 3. Place a small towel beneath the area you are icing as the ice will melt and drip. 4. Gently rub the ice in small circles on and around the affected area. Always keep the ice moving to avoid frostbite or ice burn! 5. If the ice melts to the point where the cup rubs your skin, peel off more of the cup. 6. Continue for no more than 6 to 7 minutes. Over that period of time, you will likely feel 4 different sensations: a. Initially you will feel a fairly intense cold sensation. b. After a few minutes, you will likely feel a burning sensation. c. After about 5 minutes, you may feel an aching sensation, which is accompanied by the skin turning pinkish-red. d. Continue icing until the burning sensation disappears around the area that feels numb. 7. You can do an ice massage several times a day if it helps you. During early phases I usually recommend performing this once every 2 hours between the end of play and bed. Mahaska County National Little League

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AED: JUMP START A LIFE Sudden Cardiac Arrest (SCA) can happen to anyone. Many factors contribute to its likelihood (like age), but even children and teenagers can suffer from this swift and dangerous occurrence. A sudden strike to the chest by a ball, or overexertion during a game or practice might pull the trigger that leaves a player fighting for his/her life. Every league should consider making the investment that can save someone’s life: an Automated External Defibrillator (AED). When someone’s heart stops functioning (moving oxygen-carrying blood through the body), damage to cells can happen very quickly. This can be caused by a weak or irregular pulse, and, in many cases, complete lack of a pulse. Each minute that defibrillation (an electric shock to the heart) is delayed lowers someone’s chance of survival by around 10%. This is an extremely frightening figure, considering that the average time for emergency responders to arrive after placing a 9-1-1 call is 8-to-12 minutes.

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If a player or spectator collapses, and their pulse is too weak to feel, the first step is to perform basic CPR while someone calls emergency services. Leagues should consider providing training, so both coaches and other volunteers can be proficient in the proper methods of CPR. Often, breathing and chest compressions can help someone’s heart begin beating again. A new study has found that even just chest compressions greatly increase the survival of someone who has suffered SCA, without the breaths. Even if the heart does not return to normal function during compressions, the procedure can help prevent damage to brain tissue until help arrives. If the situation is not improving after several minutes, it is time to break out the Automated External Defibrillator. The investment of an AED cannot be measured. The devices are continually

being improved to be safer and easier to use. Each kit comes with step-bystep instructions so anyone can help save a life. Many even give verbal commands. Most important of all, the devices are designed to monitor heart rate, and only administer an electrical shock if the situation warrants, to limit the risk of further injury. The decision to invest in an AED and training can seem like a tough one. Keeping up to date and maintaining an AED can cost a thousand dollars or more. However, knowing that over 350,000 cases of SCA occur each year makes the decision easier. Taking the steps required to own an AED, train volunteers, and be ready in the case that you have to jump start a life is highly encouraged. Visit the American Red Cross website (www.redcross.org) for more information on AEDs.

Topics for Local Training Sessions Every year, local Little Leagues are required to conduct training as a critical step in fulfilling safety plans. Yet, in many cases volunteers may say “I’m already trained.” Here are some important topics to discuss that provide value beyond the initial training. Provide Updated League Information As each new season begins, individuals serving as safety officer, league president, or in other leadership positions may change. With these changes it’s important to inform ALL volunteers of the correct contact information for persons responsible for safety, facilities, and equipment. In addition, providing updates on fields and facilities is vital. This information may include areas that are off-limits due to construction, locations of new restrooms, or places that children should be kept clear of, such as a pile of rocks. How to Handle Injury Situations Review what to do when a player is injured. Volunteers should understand that the first step in an injury situation is to stop the game, assess the injury, and avoid moving the player unless they are able to move on their own. Moreover, volunteers should check Medical Release Forms for preexisting conditions or allergies. If the injury is severe enough for professional assistance, call 9-1-1 and notify the parents or guardians. It may be a good idea to remind volunteers during training

to have someone go to the road to direct emergency responders to the correct parking lot and field location. Someone should stay with the injured player until medical personnel arrive, or until the player is no longer in need of care. After the injured player has been removed from the field, call the president or league safety officer to report the incident and fill out an Accident Notification Form.

Emergency Procedures Documenting evacuation procedures for when games should be stopped is essential in situations involving weather, especially lightning. Identifying where players and fans should go and how the evacuation will be announced can help maintain a calm environment in a stressful

situation, and should be reviewed and updated annually. Providing a process that will keep clear lines of communication open once a delay has taken place will allow for coaches, players, and league officials to remain on the same page. This could be as simple as providing coaches with updates every 15 minutes to eliminate confusion. Also, communicating to volunteers about how to handle a situation involving a missing child could save precious time. Who is to be contacted? What does the league do? How do you provide notification to those at the complex of the details about an emergency situation? Where do you organize volunteers? These are just a few questions that should be answered and discussed before the season begins, during your leagues training sessions.

IMPORTANT DOs and DON’Ts DO:

DON’T:

• Provide reassurance and aid to children who are injured, frightened, or lost.

• Administer medications.

• Carry your first-aid kit to all games and practices. • Have any first aid information or booklets in your first-aid kit. • Assist those who require medical attention – and when administering aid, remember: − LOOK for signs of injury. − LISTEN to the injured person and remain calm. − FEEL softly around the injured area for signs swelling, or broken bones.

• Hesitate to evaluate an injury and call for emergency professional assistance • Be afraid to ask for help with proper medical procedures like CPR. • Provide any food or drink, with the exception of water. • Transport individuals except in extreme emergencies. • Leave a child unattended at a practice or game. • Hesitate in reporting a safety hazard to the Safety Officer. March 2013

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March 2013 • Volume 20/Number 2

Suggestions from the Hot Line: Check out these helpful ideas from other leagues. Each practice will include 20 minutes of safety training for the kids on subjects like safe sliding, bat handling, and proper use of safety equipment. District 46, California Rest is by far the most powerful therapy in youth sports injuries. Nothing helps an injury heal faster than rest. Middlesex, New Jersey Each team is expected to maintain a supply of ice sufficient to treat minor injuries during the course of a game or practice. Lionville LL, Pennsylvania

Use a local physical therapist as a resource for teaching coaches and managers about stretching, recognizing overuse injuries, evaluating players’ return from injury, and pitching techniques from an injury prevention standpoint. North Issaquah LL, Washington To help prevent injuries, we improved the field playing surface by using a sports surface composed of 10% Turface, 50% sand, and 40% clay. Dixie LL, Virginia Inspect all coolers and freezers for proper temperatures at the beginning of the year and repair if necessary. Repeat inspections on a weekly basis. Davenport East LL, Iowa

The concession stand has a new First-Aid Station that is complete with a new emergency AED defibrillator for added player safety. Crystal Lake LL, Illinois It is inexpensive to develop colorful, eye-catching safety signs to post around the ballpark, reminding all participants of good safety practices. District 18, Florida

Have a tip to share? Call the ASAP Hotline at 800-811-7443 today!

March 2013 PRESORTED FIRST-CLASS MAIL U.S. POSTAGE PAID DES MOINES, IA PERMIT NO. 4053