HMS, TIP 2019 HSC 30a

i.    TOTAPS assessment

• TOTAPS assessment provides systematic evaluation of the shoulder injury. Talk involves questioning the athlete about pain location, intensity, and mechanism of injury. This determines initial severity and helps identify potential fracture or dislocation.
• Observe compares the injured shoulder to the uninjured side for deformity, swelling, or abnormal positioning. This reveals obvious structural damage or displacement indicating serious injury requiring immediate medical attention.
• Touch assesses tenderness, heat, and structural abnormalities through gentle palpation. This identifies specific injury location and severity. However, if significant deformity or severe pain exists, assessment should stop immediately.
• Active and passive movement testing would not proceed due to suspected hard tissue injury. This occurs because movement attempts could worsen fracture displacement or joint damage, requiring immediate medical intervention instead.

ii.   Management of fractures and dislocations

• Fractures require immediate immobilisation to prevent further tissue damage and reduce pain.
• Support the injured area using splints, slings or bandages without attempting realignment.
• Monitor for shock symptoms including pale skin, rapid pulse and decreased consciousness.
• Transport to medical facilities immediately for professional treatment including X-rays and surgical intervention if required.
• Dislocations involve joint displacement requiring professional medical reduction.
• Never attempt to relocate the joint as this may cause additional nerve or blood vessel damage.
• Immobilise the joint in the position found using appropriate supports.
• Apply ice to reduce swelling and pain while monitoring circulation below the injury site.
• Arrange immediate medical evacuation for proper diagnosis and professional joint reduction procedures.