TOTAPS is used in the assessment of injuries to determine the nature and extent of the injury and whether the athlete can continue to play. Given any scenario in sport where an injury occurs the steps of First Aid should be followed, BEFORE a specific injury is assessed.
The first steps after an injury occurs, and before assessment of injuries can happen, is DRSABCD. Remember that as you go through these steps, you STOP once it has been determined that the next step is not needed (for the purposes of assessment for injuries this is usually during the response stage, though an Ambulance may need to be called or medical attention sought).
- Danger – check for danger to self, others and the casualty. Depending on the sport play may need to be stopped and people removed before the casualty can be assessed.
- Response – check for a response from the casualty. Are they conscious etc should be checked before assessment of injuries.
- Send – if the casualty requires medical attention an ambulance should be called at this point.
- Airway -if the casualty is unconscious their airway should be cleared and maintained for ease of breathing.
- Breathing – check that the casualty is breathing.
- CPR – if the casualty is not breathing CPR is administered.
- Defibrillation – a defibrillator should be used as soon as possible if CPR is required.
In HSC PDHPE the scenarios given will usually have a person who responds, which means DRSABCD should slow down at Response and the assessment of injuries process will then help determine if Sending for help is required, and if the player is right to continue playing, or needs to be withheld from the field.
The assessment of injuries follows TOTAPS. If it is determined at any point throughout the steps that the athlete cannot continue to play, the TOTAPS assessment it stopped, the athlete is removed from play, and medical treatment is usually sought. TOTAPS stands for:
Talk – The first step of TOTAPS is to talk to the athlete in order to gather as much information about the injury as possible. Of particular importance during this time is to gather information around the symptoms of the injury, which might include: pain or other things felt such as grating or cracking. Often the sports trainer, or first aid officer will ask questions such as:
- where does it hurt?
- how painful is it out of 10?
- is the pain sharp or dull?
- did you hear a snap or a crack?
- How did it happen? etc
If the casualty reports that they have immense pain, or that they heard a snap or crack or does not respond, the process is stopped immediately, and First Aid is applied as medical attention is found.
Observe – The second step in TOTAPS is to observe the injured area. During observation you are comparing both limbs or sides of the body in order to determine if there is an obvious abnormality and whether there are any signs of the injury. Signs could include: obvious abnormalities, swelling, redness, blood etc.
If there is an obvious abnormality or the areas is already inflamed or swollen, then the process it stopped, and First Aid is applied as medical attention is sought.
Touch – The third step in TOTAPS is to touch the casualty, again comparing to the other limb or other side of the body. During his step of the assessment of injuries you are looking to see where the pain begins moving along the limb or injured side towards the site of injury. You are also feeling for abnormalities, heat, and swelling.
If an abnormality or excessive pain exists during touch, then the assessment of injuries is stopped, and First Aid is applied as medical attention is sought.
Active Movement – The fourth step in TOTAPS is to ask the casualty to move the injured area. During this step, you are looking to see if the athlete has full range of motion around the injured site and that this movement is pain free. You may also place a hand on the injured area to feel for grating as the athlete moves.
If there is excessive pain, or a limited range of motionthen the assessment of injuries is stopped, and First Aid is applied as medical attention is sought.
Passive Movement – The next step in TOTAPS is passive movement. This is when you move the injured area for the injured athlete. This often involves applying force to the area such as pulling or pushing the joint as well as moving the joint through its full range of motion. The pushing and pulling around a joint is done to test the ligaments, tendons and joint stability. If there is no pain and full range of motion then the next step applies.
However, if the injured athlete reports pain and a lack of mobility then the assessment of injuries is stopped, and First Aid is applied as medical attention is sought.
Skills Test – The final step in TOTAPS is a skills test. By this point, if there is an injury it is not likely to be a serious one. A skills test is used to assess the injury to determine if the injured area can undergo the forces often found in the sport being played. Skills tests are specific to the sport and progress from basic low intensity/force movements (such as putting weight on the injured limb, walking or jogging) to the faster more powerful and forceful activities (such as jumping and changing direction at speed). It will also progress from no equipment to the full range of equipment being used as it would be used in the sport, e.g. serving with a tennis racket at top speed, hitting back hands and forehands as well as volleys and other strokes, while running and changing directions for a tennis player.
If a player fails a skills test, normally because of pain then the First Aid is applied and medical attention may be sought.