Practical Injury Response and Assessment in a Pole Studio
By Dr. Kenneth Kao, D.C.
To watch the video summary of this article, enroll in the Pole Mechanics Course found here:
Intro
In a pole studio, the most dangerous injury is usually from a pole malfunction and/or a fall, especially to the head and neck. While I am a doctor, and I’ve had to respond to an unusually high number of acute trauma situations in my life (most not when I was teaching, btw), I am not an EMT. Honestly, there is no one better to be with you than an EMT in a potentially life-threatening or emergency situation. Take these recommendations as the expert opinion of a non-specific expert.
This is educational material supplementary to emergency response training and is meant as a helpful resource; it is not an authoritative guide.
This is also not meant to be comprehensive to all trauma in a pole studio, and in any uncertain situation, consult your emergency service and/or local healthcare provider for additional guidance.
Reminder: If you are a studio/instructor/business representative, and you do not call an ambulance appropriately, you are assuming liability should anything go wrong. First responders should be required to know CPR.
The acute injuries we’ll be discussing are: head/neck/spine trauma, general fractures, dislocations, and sprains/strains.
There is always the possibility that the situation falls outside of the scope of this article, such as a sudden stroke.
First Response
If you see a potentially serious injury, here is a general response overview:
Make sure the surroundings are safe. Do not pick up or move the victim unless it’s an immediately life-threatening situation (fire, car, whatever).
Observe the victim. Assess if they are conscious. Do your best not to move them. Unconscious: check for breathing and pulse and obvious bleeding. If they are stable, breathing, and have a pulse, call for help and be available should they come back to consciousness. If they are not breathing or do not have a pulse, begin CPR--moving the patient if necessary.
If they are conscious, immediately ask the injured individual not to move. This is the most common mistake in traumatic situations. They may resist, be combative, or argue “I’m fine”. Communicate calmly but firmly. Why? If the trauma is any type of unstable fracture, movement could lead to serious complications such as death, paralysis, or further trauma to the injured site. I have usually had to use fear tactics in order to gain compliance.
Listen to one of my stories on the subject here:
4. Even if they are conscious, if there was head, neck, or spinal injury, get help immediately. If you suspect a broken arm, ankle, or otherwise non-life-threatening injury, after assessment in the below sections, make a decision if the victim can get to a hospital themselves or will need help getting to a hospital. Regardless, always recommend an examination from a professional healthcare provider as soon as possible.
5. Be conservative. Don’t take risks. Even health care professionals cannot guarantee lack of serious injury without imaging, and neither can you.
“Bedside Manner”
Remain calm and supportive. Your apprehension will not help. Yes, their arm might be pointed the wrong way; don’t freak out. Act like it’s the most normal thing in the world. Communicate in a friendly way the entire time, distract them from focusing on the injury itself when not assessing.
Continuous communication is one of the most important actions you can take in an emergency situation. Do not provide diagnosis, promises, or make suggestions during this time.
As a general rule, you are there to provide comfort as you can and to be ready to help if you are instructed to do so.
Even with trauma, there may be other factors at play. For instance, if the individual has a health history of heart or lung disease, or sensitivity to toxic poisoning from chemicals in their environment that led to fainting, or they are on drugs that led to dizziness or fainting. Do not offer any drugs, painkillers, etc., to the individual. Just in general, in potential emergency situations, do not offer ice or other intervention until enough information has been gathered.
Pole Specific Notes:
If someone was inverted, especially if were looking at the ground during a fall, it is critical that you call help immediately. A fall in the “scorpion” position is extremely vulnerable and has a higher likelihood of paralysis if the neck was fractured. This is also the most important situation to STOP the victim from any movement. They could, just by turning their head, become paralyzed. You should be yelling “don’t move don’t move don’t move” as soon as you see this type of incident.
Side-point: learning to fall properly is critical in pole. I am currently very dissatisfied with the falling education in the pole industry. While I do provide basic landing education in my Acrobatic Foundations courses, I will be creating a comprehensive falling course for pole in the future. Until then, I have falling drills in the Silent Tutorial course below:
Click image to check it out.
The quality and installation of a pole is essential for safety. Do not neglect this. As a community, I urge you to recommend only trusted brands and safe installation practices. If you are using an off-brand, this is the risk you are willing to take in order to save a hundred bucks: your life.
Studios, create a schedule for regularly checking and updating your equipment. This is not merely “shaking” the pole for a safety check. Check the integrity of your floor, the bolts, the mounts, spin/static screws and mechanisms, and take down the pole to examine it thoroughly.
In training alone, the additional risk is that you may not be able to get help in serious injury. It is always recommended to have someone around while training, or, notify someone you are training and check in with them. While not always possible or practical, it is always encouraged. In these days of Covid, video chat and training across streaming video is a good safety precaution.
Assessment:
If dealing with a head/neck/spine injury, and all is safe in the environment, you can run the following tests. Remember, they will try to move. They will ask to move. Do not let them (it is best not to move anything, but if there’s an unrelated area that needs to be moved for comfort, that is fine):
Look for bleeding as well as any obvious signs of intense swelling and discoloration, additional areas of trauma, or gross deformation. If there is no gross deformation, but swelling, watch for rapidly growing swelling that isn’t slowing and is changing colors which could indicate internal bleeding.
If there is gross deformation, i.e. a leg that is bent the wrong way, stabilize the area for the injured individual’s comfort. Don’t try to put the toe/leg/arm/whatever back into the “right” place. Just provide support so that it takes the injured less effort NOT to move it. No matter how disgusting it looks, leave it alone and use pillows, props, and stable surfaces to help them relax while you wait for help.
Talk to them. Ask them questions. Who are they? What year is it? What’s their dog’s name? What’s the last thing they remember? Where are they? Do they know your name? Are they forgetting things? Do this on occasion even (if applicable) hours later.
Tell them to notify you if they feel anything strange. Numbness, tingling, burning down the extremities (assuming the sensation isn’t local to the injury which can be normal). Dizziness, a desire to vomit, difficulty breathing? A sense that they are falling unconscious or actually going unconscious. Intense headache. Some of these occur with any trauma, but they are indicators for more serious issues.
While talking to them, do you see any strange eye movement? Strange pupils? Foaming at the mouth, fluids leaking out their ears or nose? Are they having trouble breathing? Are they seizing?
Continue to assure they are breathing well and there is no change in communication or cognitive function. Even if someone doesn’t think they hit their head, often they have hit it without realizing it. Look out for slurring, aberrant movements or changes in behavior or personality.
Is there a pulse distal (downstream) to the injury? Is there sensation below the injury to soft touch, squeezing pressure, pain? Can they move something distal to the injury?
Are they older or on blood thinners?
If you still haven’t called for help, and you see any of these indicators, call for an ambulance immediately. These are all potentially life-threatening indicators.
Additional note:
Let’s say that the victim had head trauma, and you still decided not to take them in the hospital. Watch for any loss of consciousness randomly from seconds to hours. If there’s a headache that gets worse persistently. If there is any seizure, vomiting and nausea, dilation or visual disturbances, fluids draining from the nose or ears, inability to wake up, weakness and numbness in the extremities, loss of coordination, convulsions, confusion, personality changes, slurred speech--go immediately to the hospital.
Head injuries are the most overlooked injuries. If they have no symptoms at all, you might consider not worrying about waking them up through the night, but if they are of an older demographic, you should. If they are on blood thinners, they should always get a CT for head trauma.
The first night in particular, you should be waking them up hourly to talk to them and ensure they are acting normally and you should run through all the questions as before. Do not leave a symptomatic head trauma victim alone their first night. 10% of head trauma patients are hospitalized, and those 10% represent 1/3rd of all injury related deaths.
Non-Life-Threatening
There is a certain “practicality” that (at least in the US, unfortunately) money is a real issue if you go to the hospital. People risk death frequently because of the potential health care costs, and that’s a reality that even health care providers understand. I cannot officially recommend any action but the most safe, which is to go to a hospital or call an ambulance, but here are some assessments that you can perform for more information.
Assessments:
If you suspect a potential break, sprain, dislocation, or other soft tissue injury that may not be serious, before moving the patient, here is what you can do to improve the chance that it is safe to move.
Distal to the injury, pinch the fingernails and toenails. Look for blood and color to come back. If the nails are painted, you can do something similar by pinching the toes and fingertips and looking for the skin color to come back to normal from pale. This should happen quickly and evenly in all fingers and toes. If you’re trained to take distal pulse, you can do so as well and check for faint or rapid pulse.
Next, check sensory information. Ask if the injured if they can feel your pinches. Then do the same with soft touch by brushing lighty distal to the site of injury. Do this on each and every extremity even if unrelated. If there are patches of numbness, burning pain, inability to sense squeezing pressure, that’s an indicator they need more help and again, should not move.
If all the above tests are clear, ask the injured if they can wiggle body parts distal to the injury. If they can, ask them to contract the injured area isometrically (without moving). If they can do that without pain, that’s a good thing.
If they can contract without pain, give them some light resistance as they contract. Start with the most distal areas (ie if they have an upper arm break, test the strength of the fingers, first). If you feel abrupt weakness anywhere, or it causes extreme pain, this is a hospital situation.
If there is discomfort, but they have strength, and there is no gross deformation, no neurological indicators of head/spine trauma, this is when you can ask them to move non-injured parts of the body, starting from the distal part of the non-injured areas, to the areas distal to the injured site, to the injured site itself. Remember to continue monitoring them and ask them questions.
At this point, if the discomfort is local to the area, but they are able to contract with mild discomfort and perform all tests without intense pain, then you can consider letting them move slowly. If they feel any intense pain anywhere that prevents movement, stop and get help.
If they can move the joint or area of injury with only mild discomfort, that’s when you stop harassing them to stay still. You do not do anything at this point. At this point, you recommend them to go to a hospital or doctor through the soonest appointment rather than through emergency. All trauma should ideally get imagery. Imagery is not so expensive to skip. Get help from friends if you cannot afford it. Take a loan if you need to and don’t have insurance.
Dislocations:
Dislocations in the elbows and shoulders are probably the most common type of dislocation we’ll see in pole dance. In all dislocation situations, stabilize with a splint or whatever you have, and do not move the victim. There are complications to dislocations that could happen with relocation, so do not try to reduce a dislocation yourself.
Elbows and knees and hips should be ambulance calls. There are complications around these areas. For example, the muscles that go into seizure can in themselves break the femur which is a life threatening situation as it can cause internal bleeding and death.
Last Steps
At this point, the most likely injuries left to consider are soft tissue/bruising, ligament sprain strains, or stable vs unstable fractures. Even though I’ve presented these last, these are the most common situations in pole injuries. All the above is to reduce the chance of serious complications because, if you are wrong about it “just” being a sprain or strain, then death or paralysis could result.
Stable vs Unstable Fracture:
Hospital Immediately cases:
If the bone moves at all where it shouldn’t, for instance, where there is no joint, it’s definitely an unstable fracture.
Any fracture to the humerus (upper arm), pelvis, or femur (upper leg). Blood loss in these areas could be life threatening, even if the fracture is a stable fracture.
A stable fracture means that no bones are moving around still. You can imagine it as a crack that didn’t go all the way through. An unstable fracture is one where the bones are freely moving where they should not move, and that means they could do serious harm in their movement such as severing arteries, cutting nerves and soft tissue, or other serious concerns.
There are a few tests that can help you narrow things down, but they are not in themselves conclusive. The only way to be sure is with imaging.
A fracture often has extreme pain in a specific location. Swelling and bruising in that local area that can spread quite widely. Extreme pain on palpation to that area, and inability to bear weight. Loss of strength, sensitivity, or function.
The inability to bear weight is a major indicator of unstable fracture. It is innate, in most cases, that the person will not have confidence to put weight on the injured part. If this is the case, suspect that it is an unstable fracture. If they can, even with discomfort, it is far more likely that it is a stable fracture.
When testing weight bearing ability, do this very very gradually, and with support, if you are self assessing.
And finally, aside from obvious deformity, if the bone freely moves where it shouldn’t, that’s a sign of an unstable fracture. This is not something I can recommend any layperson to test for, however, but it is an indicator.
Final Summary
If this is all overwhelming, remember these simple things:
Make sure the person is safe in the environment.
Don’t move them and don’t let them move. Do NOT pick them up and carry them somewhere.
Call for help.
Comfort them.
Monitor them as best as you can.
Be ready to assist.
By doing so, you’ll surely help rather than harm.
Thanks to Michael Head for consulting me on this piece.