Athletic Medicine and Rehabilitation

November 2001
From the Editor Mike Braid, M.S. E. D. , A.T., C.


It is hard to believe that we are nearing completion of another fall season of sports. This fall has been an especially difficult one as our country has had to deal with the September 11, 2001 tragedy. Without minimizing the events on that day I do believe that some good has come out of that event. First, our country has showed a renewed sense of patriotism. It is great to hear people singing the national anthem and knowing they are proud to be American. Our nation's colors are now in vouge and the Stars and Stripes is proudly displayed everywhere you go.

Second, it has put into perspective what is important in life. Believe it or not, sports are not on that list. While I have made my career around working with and dealing with athletes and athletic programs, I have always known that in the big picture these athletes are just playing a game. That game may be entertainment to some or a diversion from life's routine, but it is still just a game.

As we get back to our normal routines let us not forget those who were lost in the tragedy. Let us remember the true heroes who worked to save lives, not hit home runs. Let us stand tall and proud the next time we hear the Star Spangled Banner or see the Stars and Stripes. Let's put things in proper perspective and get on with life. Now I have to get on with my job, so read on, enjoy and remember to keep sport's little cuts and scrapes in perspective.

Steps to control bleeding from a wound
Mike Braid


I. Apply latex gloves, to protect yourself from bloodborne pathogens.

2. Apply direct pressure with sterile gauze pad or clean cloth (wash cloth or towel). Make sure pressure is even and constant.
- This usually stops most bleeding.
- If bleeding does not stop, and gauze becomes saturated, DO NOT remove gauze, simply apply another gauze pad or clean cloth.

3. If bleeding does not stop in 10 minutes:
- Check direct pressure, and make sure it is even and constant. If needed press harder over a wider area.
- Elevate extremity above the heart, and continue to give direct pressure.
- If none of the above procedures work, and athlete is losing a lot of blood, call 9-1-1.

4. Cleansing of wound:
- Run wound under warm water and wash it out with soap. DO NOT scrub the wound; this could increase bleeding and disrupt clotting.
- Apply triple antibiotic cream.
- Cover appropriately and provide follow-up instructions.
- Monitor for signs of infection (red, warm, swollen, painful wound, and a white or yellowish discharge from the wound).

5. Watch for signs of shock:
- Low blood pressure, rapid and weak pulse
- Athlete appears sluggish and drowsy
- Breathing that is shallow and extremely rapid
- Pale, cool, clammy skin

Steps to control nose bleeds
Mike Braid


1. Apply latex gloves to protect yourself from bloodborne pathogens.

2. Have athlete stay upright and tilt them forward. DO NOT tilt head back. If blood is swallowed, it may cause nausea.

3. Pinch nose together below nasal bone for 5 minutes, ice may be applied for 5-10 minutes.

4. DO NOT blow nose for at least 2 hours, this could disrupt the clotting process, and cause bleeding to occur again.

5. Seek medical attention if there is any deformity, swelling, or profuse bleeding of the nose.

Removing Blood From Athletic Uniforms
Jon P. Romkema, A.T,.C.


There are many products on the market designed to remove blood from athletic uniforms.

The very first product actually was a formula of 1 part household bleach to 10 parts water. This bleach - water solution is very effective to kill all transmittable diseases, but it has two significant drawbacks.
- The solution has a short shelf-life, and must be made new every day.
- It is harmful to virtually any fabric in uniforms, not to mention what it does to the color.

The most used product by athletic trainers to remove blood from uniforms is Precise®. It is made by Caltech Industries, Inc®. (Midland, MI) and is as effective as bleach-water solution, without the drawbacks. Precise® comes in two sizes, 20 ounce and 6 ounce aerosol cans. Benefits of Precise® include:
- Removes blood very effectively from uniforms.
- kills virtually all transmittable diseases.
- Is safe for all uniforms and colors.
- Is inexpensive and widely available (carried locally by Jone's Sporting Goods).

Another product available is Formula One®. It is also very effective in the removal of blood from athletic uniforms, and similar to Precise® except for two main differences:
- It is very expensive, it costs almost 2-3 times more than Precise®.
- It is not readily available.

Biohazardous Waste Management
Jon P. Romkema, A.T,.C.


Any items which become soiled with human body fluids are considered biohazardous waste. In the athletic environment, these may include disposable supplies used for the wound care and management of bleeding, and other items such as cotton towels, elastic wraps, and uniforms. Management and removal of bloodborne pathogens in these traditionally non-disposable items is discussed in another article in this issue.

Proper management of the disposable supplies such as gauze pads, Band-Aids, paper towels, and other wound care and bleeding products is essential. When OSHA first published their guidelines in 1990, any and all soiled items were considered biohazardous waste. After 11 years of study and research, it has been determined that not every item which is soiled with body fluids is considered biohazardous. New guidelines recommend that items must be fairly saturated with blood or body fluids to be considered biohazarous.

If the person handling the soiled items is unsure of the level of saturation or is in question of how to properly dispose of the items, they should follow through as though it is bioharzdous. Management of potentially biohazardous items begins with following Universal Precautions:
- Use surgical gloves.
- Utilize a disinfectant to kill transmittable diseases.
- Dispose in a red biohazardous bag.
- Properly tie bag closed.
- Wash hands.

Another aspect of the management of the biohazardous material is proper removal by a licensed biohazardous material transportation company. One company is BFI Medical, which is based in Grand Rapids. They provide large red biohazardous bags and cardboard boxes to collect, store, and dispose of the small red biohazardous bags when they become full. This company picks up the bio-waste containers every 90 days as specified by law.

Staff Profile
Welcome Dr. Stephen R. Fisher


The staff at Hackley Athletic Medicine and Rehabilitation would like to welcome Dr. Stephen R. Fisher to the practice of Orthopedic Specialists of Muskegon (Dr. Hoeksema, Lachniet & Pallante). Dr. Fisher is an Orthopedic Surgeon who has just completed a Sports Medicine Fellowship at the Lake Tahoe Orthopedic Institute.

Dr. Fisher completed his Orthopedic Residency at Wayne State University. He attended Medical School at the University of Pittsburgh where he also completed his undergraduate degree in exercise physiology. He is a native of Pennsylvania and as a high school athlete competed in football, baseball, swimming and power lifting. He went on to play club level hockey at Pitt where he served as captain of the team.

Dr. Fisher's wife Kimberly is a Physician Assistant and has joined the medical staff at Norton Family Practice. We are excited to have them in Muskegon. With his medical expertise and athletic background, Dr. Fisher will make a great contribution to our Sports Medicine Team.

We wish Dr Fisher and Kimberly the best as they begin life and work in the Muskegon area!