Table 4

Potential situations and injuries that can occur during sport with associated PPE guidance

RiskInjuries that may present in the non-elite sports settings and guidance on managementPPE level
Maintaining social distancing as advised1
Not maintaining social distance Simple airway manoeuvres±manual in-line stabilisation (MILS) for suspected cervical spine injuries. 2
With face-to-face contact riskAn airway can become compromised for many reasons; one of the most common in the sporting setting is due to loss of consciousness resulting in the risk of the participants tongue occluding their own airway. A simple head tilt chin lift, in the absence of any suspected head or neck injury, or jaw thrust can be applied after first ensuring there is nothing occluding the participants airway. All other airway interventions are level 3.
Wounds and bleeding 2
Wounds that are open but do not involve the oral or nasal cavities are not classed as AGPs. However, keep other participants/parents away from the area. Use a spill kit if available, using the PPE in the kit and follow the instructions provided. If no spill kit is available, place paper towels/roll onto the spill and seek further advice from emergency services when they arrive.
Soft tissue injuries and fractures 2
Include soft tissue injuries to the upper and lower limbs.
Excluding those injuries with C-spine or facial involvement.
Head injuries/medical emergencies that do not involve the airway 2
Are not considered AGPs and can be dealt with as normal by a first aider with appropriate training. If no first aider is present, then the coach can assist from a distance where practically possible until a parent, a household member or the first aider or ambulance arrive (will vary dependent on club EAP).
Cardiac arrest* 2
Cardiac arrest with face covered (towel or non-rebreather mask acceptable) including continuous compressions and use of automated external defibrilator (AED).
Not maintaining social distance Loss of consciousness (LOC) 3
With face-to-face contact riskIf the mechanism of an injury involving LOC has not been witnessed, one must assume that a head/neck injury is present until proven otherwise. MILS will be required. In these circumstances, there is potential for an airway compromise, particularly when a participant has lost consciousness or has an altered level of consciousness.
And potential risk of AGPs Airway compromise 3
Any airway intervention beyond simple airway manoeuvres including all ventilatory support.
Tier 2 first aid responders on recognising airway difficulty should immediately call for medical assistance because an ambulance will be essential.
Choking* 3
Another form of airway compromise is choking. If the participant is choking then the responder should approach the participant from behind and follow the choking algorithm51 (up to five back slaps, followed by up to five abdominal thrust, repeated until the airway is clear).
Please note: emphasis on care when checking the airway between sets is advised as this is an AGP especially in scenarios where level 3 PPE is not available to mitigate the additional risk.
Nasal or oral wounds with the potential for spitting, coughing or sneezing would be considered a potential for an AGP and a higher level of PPE required for any management.27 51 3
For tier 2 first aid responders on approaching nasal or oral wounds, ensure more than the government advised social distance is maintained from the participant by all concerned and seek urgent medical assistance. Where parents or household members are close by, they can be allowed to assist, and the first responder can advise from a safe distance.
Postural drainage positions, such as leaning forwards or side lying with the head facing towards the ground can help drain fluids from the face or nose. This can be considered if injuries allow, while awaiting medical help from those in appropriate PPE or the emergency services. If the participant is unconscious, then the recovery position should be used.
Complicated head injury with potential for airway compromise 3
Where additional airway management is required beyond simple airway opening, such as adjuncts or suction, this would then be classed as AGP.
Cardiac arrest* 3
Without covered compressions (adults and adolescents 30:2, children 15:2), AED and airway interventions.
  • AGP, aerosol-generating procedure; EAP, emergency action plan; PPE, personal protective equipment.