What is the appropriate evaluation and management for a patient who was struck by a field hockey stick?

Evaluation and Management of Field Hockey Stick Injury

If the patient collapsed and remains unresponsive after being struck by a field hockey stick, immediately presume sudden cardiac arrest (SCA) until proven otherwise and initiate CPR with high-quality chest compressions and immediate defibrillator access. 1

Immediate On-Field Assessment

Critical First Steps

Any unexpected collapse without rapid recovery on the field must be treated as SCA, even if the athlete appears to be breathing or has their eyes open 1. This is the most life-threatening scenario and takes absolute priority.

For collapsed, unresponsive athletes:

• Access the athlete immediately where they fell—do not move them unless there are immediate safety concerns 1
• Start high-quality chest compressions with minimal interruptions 1
• Attach an AED or defibrillator immediately (goal: first shock within 2 minutes of collapse) 1
• If shockable rhythm persists, deliver minimum of 3 shocks (one per 2-minute CPR cycle) on the field before considering transport 1
• After third shock, give epinephrine 1 mg IV/IO and amiodarone 300 mg IV/IO if still unresponsive 1

Key pitfall: Athletes with SCA may continue breathing more regularly than typical agonal breathing and may have eyes open—do not let this falsely reassure you 1

For Conscious or Rapidly Recovered Athletes

If the athlete is conscious or regained consciousness quickly, they still require immediate removal from play for detailed assessment 1. The primary concerns are:

Head/Face Trauma:

• Field hockey has high rates of head/face injuries (20.6% of contact injuries) 2
• Concussions account for 9.2% of field hockey injuries 3
• Stick-related impacts cause higher initial symptom burden than other mechanisms 4

Immediate concussion evaluation should include:

• Symptom assessment (most sensitive indicator of concussion) 5
• Brief neurological examination
• Cognitive assessment (SAC component)
• Balance testing (modified-BESS)
• Cervical spine examination 5

Critical decision point: If any increase in symptoms occurs or concussion is probable/definite, no same-day return to play 5. Even if the athlete feels fine, they must be removed for proper medical facility assessment 1.

Injury Pattern Considerations

Field hockey stick injuries typically involve:

Upper extremity (19% of injuries):

• Hand and finger injuries are common 6
• Contusions are the most frequent injury type (48.6% of contact injuries) 2

Head/face (19% of injuries):

• Among moderate-severity injuries in females, 64.3% involve the head 7
• Stick-to-head contact warrants particular concern for concussion 4

Lower extremity (62% of injuries):

• Though less likely from direct stick contact
• Ankle sprains are the most common overall field hockey injury 8

Specific Management Algorithm

Step 1: Scene safety and mechanism assessment

• Ensure no ongoing danger from other players/equipment
• Note exact mechanism: stick-to-head, stick-to-body, stick-to-extremity

Step 2: Responsiveness check (5 seconds)

• Unresponsive → Initiate SCA protocol above
• Responsive → Proceed to Step 3

Step 3: Immediate symptom screen

• Any concussion symptoms (headache, dizziness, confusion, vision changes)?
• Any neck pain or neurological symptoms?
• Any deformity, severe pain, or inability to move affected area?

Step 4: Disposition

• Remove from play if: Any positive findings above, even if mild
• Emergency transport if: Severe symptoms, worsening condition, suspected fracture, significant head trauma
• Urgent evaluation if: Moderate symptoms, persistent pain, any concussion concern

Step 5: Protective equipment removal

• Remove mouthguard, shin guards as needed for examination 1
• Do this carefully to avoid exacerbating injuries

Post-Event Management

For confirmed/suspected concussion:

• Serial reassessment (concussion is an evolving injury) 5
• Vestibular/ocular screening (67-77% have vestibular symptoms, 45% have ocular impairment) 5
• No return to play until symptom-free and cleared by appropriate medical professional
• Stick-related head impacts may require closer early monitoring and enhanced school accommodations 4

Common pitfall: Do not rely solely on immediate post-injury assessment—symptoms may not appear until hours later or may normalize quickly but recur 5

For extremity injuries:

• Ice, elevation, immobilization as appropriate
• Radiographic evaluation for suspected fractures
• Hand/finger injuries require careful examination given their frequency in field hockey 6

The absolute risk of sustaining a contact injury in field hockey is 0.372 (37.2%), with contact injuries representing 33.1% of all field hockey injuries 2. This high rate underscores the importance of immediate, thorough evaluation of any player struck by equipment.