Tricks of the Trade
Fortunately, in my 15 years as a personal trainer, I have experienced only two medical emergencies.
The first incident occurred 3 years ago when I was leading a Nordic walking class with 10 participants along one of Toronto’s beautiful ravine trails. A woman who was about 60 slipped and twisted her ankle about halfway through the walk. It was only a minor injury, but she needed to return to the trailhead to rest and ice her ankle. I was in a difficult position because in an outdoor class there’s no front desk or staff person to call for assistance.
I didn’t want to leave the other participants to finish the walk on their own while I went back with the injured woman, because they didn’t know the trails well enough. However, I also didn’t feel comfortable sending the woman to her car by herself. In the end, a friend of mine who happened to be in the class escorted the woman to the trailhead and saw that she got home safely. After the class, I followed up with her to be sure she was icing her ankle and suggested that she see her physician if the pain and swelling persisted. Luckily she was back in class 2 weeks later. After this incident, I purchased some chemical ice packs (they freeze when you squeeze them). Now I always have these handy, along with other first-aid items, in case a similar situation arises.
Late last year I had my second medical emergency, but this one was much more serious. I arrived at the home of an elderly client to find her incoherent and wild-eyed on the living-room floor and her husband frozen with fear. I ended up managing the situation, calling one of their adult children and then calling 911 shortly after. I later learned that she was suffering from a combination of dementia and alcohol withdrawal. (I hadn’t known that she had a drinking problem. Her husband had hidden the alcohol that day to force her to quit.)
It was a stressful situation, but it made me glad that I had confidence in my crisis management abilities and CPR skills. (Even though I didn’t have to use them, I was running through the steps in my head, just in case.) When the ambulance arrived, I was able to tell the paramedics about my client’s health issues and medications, details that we had discussed during her health and fitness appraisal.
I’m hoping for 100% healthy future encounters with all of my clients. But these two experiences have shown me that calm, quick thinking, along with proper CPR/first-aid training, systems and paperwork, is the best way to be prepared, should another emergency present itself.
Barb Gormley CustomFit Personal Training Toronto, Ontario
I am grateful to say that in 17 years of working in the fitness industry, I have never witnessed a client (or class participant) experience a medical emergency during an exercise session. I have, however, been the first responder to three medical emergencies, two of which took place in fitness centers where I was working at the time. The specifics of the incidents differ, but the common thread among them was the need to quickly and decisively recognize that an emergency was taking place. Following these events, it was also important to document what had occurred and which actions were taken.
In one situation I was called into the men’s locker room because a member had passed out. I had to remind myself that, yes, in this instance, it was okay for me to rush into the men’s room. Looking back, that seems pretty obvious, but at the time, [with adrenaline running through me,] I had to quickly talk myself through the proper procedures while under the watchful eyes of the other members in the vicinity. When I found the man, “Tim,” lying on the floor, I checked for responsiveness by tapping him and shouting his name. He was unresponsive. I checked for breathing and a pulse and found both. Understanding that this could change, I sent a member to call 911 while I gathered information from eye witnesses. Next, I elevated Tim’s feet. He was sweating, and his skin felt warm, so I had someone bring a damp towel to keep him cool. Fortunately, Tim returned to the gym the following week in good health.
I think, if asked, most of us could recite the signs and symptoms of a medical emergency. However, real-life events are not always so clear-cut. I have learned to trust my instincts. In one case, a woman who suffered from a cardiac emergency initially complained of a “fluttery” feeling in her chest. She was in the fitness center but had not yet begun to exercise. Her blood pressure was normal. Her pulse was rapid, but she said she was under a lot of stress. In another situation, a man complained of vertigo from having “walked down the steps too quickly.” He seemed content to close his eyes and rest. However, soon he was sweating.
Both individuals denied the need for medical attention. As fitness professionals, we walk a fine line between respecting an individual’s boundaries and taking prudent action on the person’s behalf. We must provide the standard of care without going beyond our scope of practice. In these instances, my response was to have the individuals lie down; prepare to treat them for shock; and monitor for consciousness, cognition, skin pallor, pupil size and blood pressure—while at the same time explaining the need for further evaluation. I called emergency medical services and had a staff member notify the clients’ respective emergency contacts. Their conditions became more serious within a matter of minutes, and thankfully, help was already on the way.
Our clients depend on us to make good decisions on their behalf. Knowing how to respond in an emergency situation is only half the battle. The ability to quickly apply that knowledge, while under stress, takes confidence that can only develop over time and with practice. After that first incident early in my career, I became a certified first-aid/CPR/AED instructor. There are always a few fitness professionals in attendance at these classes, and it has been a great opportunity for me to teach important skills and learn from others’ experiences.
Dana Schlossberg Weatherspoon, MS, MPH Owner, Custom Health Concepts Arlington, Virginia
Emergency protocol always needs to be in place and well rehearsed, whether in a private training situation or a larger facility. My home studio has CPR equipment, gloves, emergency phone numbers taped to the phones and a first-aid box readily available. The hospital facility I work at has a very specific protocol mandated by the state in place for emergency situations.
As fitness professionals it is important for us to know the scope of our practice, ensure that our certifications are up-to-date and keep current records, including pre- and post-pain scale perception in every training session. I initiate every session by asking how clients slept the night before and whether they’ve been having any new challenges or discomforts; then I observe closely for exercise tolerance. Even with these precautions, situations can occur. We need to be trained and ready in first aid and know emergency protocol within our scope of practice.
When emergencies occur, my first step is to stay calm and reassuring and not to add to the situation by increasing anxiety. That allows me to think before I react and to respond objectively and follow protocol. Once I’ve assessed the situation by taking note of signs and symptoms and checking heart rate and blood pressure, all exercise activity is discontinued regardless of whether the client has given his or her consent to move forward. It is my experience that clients will often minimize their pain and not want to create a scene. Many times clients are so worried about getting the “value” of their prepaid sessions that they will disregard the importance of their own safety. However, as a fitness professional, my first obligations are the safety of my clients and knowing my own scope of practice.
For example, one day a client was experiencing radiating arm pain from her neck area and complaining of chest pain. She told me she was all right to exercise. I took her vitals and they were normal, but I called her husband and he came and took her to the emergency room. The pain was from anxiety and lack of sleep and was nothing serious, but I thought referring her to a medical professional was in everyone’s best interest. I did not charge her for the session.
I take the stance that it is not in my scope of practice to diagnose but only to assess and allow the appropriate healthcare professional to take charge of the situation. I have always found that clients appreciate the more conservative route of care and would rather be safe than sorry.
Sarah A. Collins, MS Exercise Physiologist, St. Vincent’s Medical Center Bridgeport, Connecticut n
If you have a question, send it to IDEA Fitness Journal via regular mail (see “Your Membership” page); e-mail (email@example.com); or fax (858-535-8234). Include name, company, city, state/province and phone number.