So your friend landed on their head ...

Over the last month I have personally heard of 2 concussions and one serious neck injury in acro.  All of these injuries happened at parks, and at least 2 of them involved highly skilled acrobats.  The skill of the acrobats is almost besides the point; I mention this merely to illustrate that accidents can occur regardless of skill level.   As it turns out, accidents are common, and it seems that by and large people do not know what to do when they occur.  Ultimately it is fairly simple ... when someone falls, and the injury appears to be serious, do not move (or massage) the fallen acrobat, and call emergency services.  For a more indepth look at what to do, and what not to do, when someone falls on their head, neck, or back, read on.  Or better yet - go get trained in basic first aide, or wilderness first aide.

No one was injured in this photo
(because nobody needs to see an image of someone being hurt)

This blog is LONG and will be split into two posts.  The first post will discuss what to do - and almost more importantly what NOT to do - when someone falls.  The second post will describe what you can do to improve your recovery if you have experienced a concussion. 

I encourage each of you to at the very least, learn CPR and first aide.  If you are training at a high level, in a public space, IT IS YOUR RESPONSIBILITY TO HAVE SOME SEMBLANCE OF AN IDEA OF WHAT TO DO WHEN SOMETHING GOES WRONG.  If you are a teacher, IT IS YOUR RESPONSIBILITY TO HAVE SOME SEMBLANCE OF AN IDEA OF WHAT TO DO WHEN SOMETHING GOES WRONG.  Partner acrobatics is not a risk-free activity; please behave accordingly.  

If someone falls on their back, neck, or head:

·      Do not move them unless it is absolutely necessary for their safety that they be moved.  If this is the case, use enough people so that you can stabilize the head and neck of the fallen acrobat when you move them.

·      If there are other folks training nearby, have those people move away from the scene, rather than moving the fallen acrobat.   Do not congregate around the fallen acrobat and discuss what happened, what didn’t happen, what should have happened or who’s fault it is or isn’t – those conversations can and should WAIT (or happen elsewhere).

·      With any luck, there will be someone in nearby proximity that is a trained first responder, or at the very least has a basic idea of trauma medicine.  If that is not the case, and you are left to your own devices, following are a few simple steps you can take to ensure the best possible care for your friend who has just fallen.  

ASSESS ORIENTATION by asking the following simple questions.  Make sure you can verify the answers.  Orientation is likely to be altered if someone has a significant head injury.  Shock can also affect orientation.

1.     What is your name?

2.     Can you tell me where we are?

3.    What day is it?

4.     What is my name?

5.     Can you tell me what happened?

Make sure to introduce yourself, and give a very brief explanation of what happened – something along the lines of this:  “My name is Liz.  You just had a fall, and we are trying to make sure you are not badly hurt.  I’m going to ask you a few questions, and have you do a few simple tests. Try not to move until we can make sure it is ok to do so.” 

Side note:  Lying down after a fall does wonders for the nervous system.  Even if someone is not badly hurt, their nervous system has been traumatized and needs a bit of a time to recover.  

IF SOMEONE CAN’T ANSWER BASIC QUESTIONS

1.     Call EMS.

2.     Stay with this person, keep them comfortable, and stay calm.

3.     Keep the immediate area quiet and calm – you may need to ask people to step away from the scene.  While probably well intended – hovering over someone who just fell is not helpful, in fact it is likely just the opposite.   Not everyone likes to be the center of attention, let alone when they are disoriented and injured. 

4.     Keep talking to the person in a calm voice.  Keep it relevant to the situation, and simple.   Try to avoid extraneous conversations, as this can be very confusing if someone is coming in and out of consciousness.   If someone can’t answer your questions, don’t keep asking questions, but do keep talking to them in a soft and reassuring voice. 

ASSESS SEVERITY and get help as needed.  The following questions will help determine risk of spinal cord injury, broken bones, and/or brain injury.

1.     Are you in pain?  Where does it hurt?

2.     Are you having any numbness or tingling in your hands, or feet?

3.     Can you wiggle your toes?  Can you wiggle your fingers?

**If someone has numbness and tingling in their fingers and toes, OR they are having difficulty wiggling their fingers or toes – there is a concern for a spinal cord injury.  At this point it is crucial that extra measures are taken to keep the fallen acrobat from being jostled around, or further moving their head or neck.   

--  By all means -- DO NOT START MASSAGING THE NECK OF SOMEONE WHO JUST FELL ON THEIR HEAD!!!!  Let me repeat:  IF SOMEONE FELL ON THEIR HEAD, DO NOT MASSAGE THEIR NECK; YOU COULD FURTHER DAMAGE THEIR SPINE, OR INJURE THEIR SPINAL CORD.    

*** Please note:  shock can sometimes mask pain.  If the fall was serious enough that you have any semblance of concern for an injury to the spine, or spinal cord, DO NOT move the acrobat until EMS has arrived on the scene.  

The following questions will help determine whether or not there is a concussion:  

1.     Are you nauseous? 

2.     Is your vision altered?  Are you seeing spots?

3.     Does my voice sound stranger than usual?   (I have a fairly high-pitched voice, so for me, asking this question brings a bit of levity to the situation, while also giving me a sense of potential severity).

4.  Assess their pupils:   if the pupil sizes are dramatically different from each other, this is not normal.  If it is bright out but the pupils are huge, this is not normal.  

IF EMS HAS BEEN CALLED, AND YOU ARE WAITING  --  Avoid extraneous conversations – especially if someone is confused.  Ideally have someone keep people from congregating around the scene as more people create more noise and general confusion, which just isn't helpful if someone has a serious injury. 

IF THE ANSWERS/RESPONSES TO ALL OF THE ABOVE QUESTIONS/TESTS ARE NORMAL:

At this point several minutes will have passed since the fall and it should be ok to start moving the person, if they are ready for it.  Remember - if you have any suspicion of an injury to the spine, do not move the acrobat until EMS has arrived.  If you are confident there is no spinal injury, encourage the acrobat to roll to their side before sitting up.  Once they are sitting – give it a minute or so before leaving the person unattended.  Once a minute or so has passed, check in and ask the person what they need.   This could be ice, water, a hug, physical space … the answers to this question will vary between people.  If you determine it is ok to leave someone, make sure that you, or someone else, follows up within 15-20 minutes.  This will provide a nice opportunity for closure, as well as give you another chance to make sure that symptoms have not started to evolve or escalate in the wrong direction.  It is not uncommon for signs of a concussion to show up minutes, hours, or days after the traumatic event.

REMEMBER:  If someone is unable to communicate basic needs, there may be a more serious problem that has not shown up in other tests.  If this is the case – do not leave the person unattended, and seek further care from a licensed medical professional (if you are not one yourself).

FOLLOW UP CARE:  As a first responder, it is likely and normal that you will be a bit rattled.  Make sure that you give yourself the time that you need to recover before re-engaging in the practice.  

TAKE A PAUSE:  When possible and safe to do so – separate yourself from the fallen acrobat and take the space that YOU need to decompress from being a first responder.   Get a sip of water, take a few deep breaths, keep your feet planted on the earth and try to connect with what you may need to decompress.  Make sure that you give yourself the time that you need to come back into your own body before re-engaging with partner work. 

My background and why am I writing this:  I have been working as a physical therapist since 2005, and spent about 6 years of my career in neuro-trauma rehabilitation (the rest being in acute medical, orthopedics, and sports medicine).   My certifications in basic life support, CPR, and wilderness first-aide are current, and have been since 2003.   I mention this because while I have a decent amount of experience, I am by no means an expert in trauma medicine.  These blog posts are not meant to replace training, or serve as a gold standard of care.   They are simply meant to start filling in the gaps in safety within the acro community.  

Thank you for reading, and thank you for taking good care of each other.  Stay tuned for more information on concussions.  

Upcoming events with Precision Acrobatics in SF:

March 14, 21, 28:  Standing Acro 3 Week Series

March 24:  Intermediate Day Long Intensive

April 11, 18, 25:  Reverse Hand to Hand 3 Week Series

May 30:  Handstand Workshop with Ariel

June 6, 13, 20:  Dance Acro 3 Week Series

You can also find us at FemPower Acro Fest in Porland, OR in April

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Liz's PT practice in Oakland, CA

Liz's PT practice in SF, CA