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Athletic Departments Must Design and Practice Emergency Action Plan

By Lawrence Lemak, M.D., and Brent Unruh on October 13, 2015 hst Print

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Good emergency action plans for school sports and activities are critical. Although rare, life and limb-threatening injuries can occur at any time, and it is the responsibility of the school to ensure everyone involved is prepared to handle the situation.

From a legal perspective, the absence of an emergency action plan (EAP) could be considered negligent on the part of the school if a serious injury occurs. All potential emergency situations such as sudden cardiac arrest, head/spine trauma, heat stroke, severe orthopedic or vascular trauma and severe weather all need to be considered when designing your emergency action plan.

Everyone involved in your school’s athletic/activity programs should have a clear understanding of the EAP(s) specific to their activities and their role in carrying out the plan. This includes coaches, school administrators, school medical personnel, local EMS personnel, venue workers and the student participants themselves. Available personnel to implement the EAP may change from activity to activity, and venue logistics will have a big impact on how you design your plan for a specific site. Certain components of the EAP will be consistent from plan to plan, but every EAP needs to be customized due to factors such as available personnel, the activity taking place and the venue itself.

Designing a comprehensive EAP and educating those involved is vital. One of the most important parts of the education process is practicing the plan. Any coach will tell you that practice reps are critical to athlete development and game success. The EAP is no different – if there is not sufficient practice and rehearsal, a successful activation of the plan is less likely. Unfortunately, in emergency situations there may not be a second chance for success. 

Athletic/activity administrators should require rehearsal of the EAP response annually (at minimum) by EVERYONE involved before the season begins. These practice sessions can make good preseason in-service training opportunities for the entire staff and can provide a good opportunity for school personnel to interact with medical providers in the community, including local EMS professionals. The greater the familiarity with those involved in carrying out the EAP, the smoother the response will be in a real emergency situation. If anything changes throughout the course of the season (personnel, emergency equipment or facility construction), the EAP needs to be reviewed and rehearsed again.

As you design EAP practice scenarios for your staff, keep in mind the following components:

Personnel – When practicing, identify everyone’s role(s). Keep in mind that certain personnel, such as a certified athletic trainer or physician, may not be available at every practice, but will hopefully be onsite for games. Coaches and student participants may need to assume a greater responsibility at practices and may need to learn more than one role in the plan. School administration should strongly consider requiring all coaches and activity sponsors to be trained in CPR/AED and First Aid. Coaches must also know which students on their teams have pre-existing, underlying conditions such as cardiac abnormalities, asthma, sickle cell trait, concussion history or heat illness history which could make them more susceptible to a situation that becomes an emergency.

Emergency Equipment – As part of the rehearsal, be sure everyone knows where the necessary equipment is kept. An automated external defibrillator (AED) is critical to have available for sudden cardiac arrest emergencies. Can the AED be retrieved and activated within three minutes (one minute is ideal) of a cardiac emergency? Is the AED located in an unlocked area, or will the person retrieving need a key? Personnel should be timed during rehearsal to ensure the AED can be delivered and activated within the appropriate amount of time. Other equipment such as spine boards/straps, splints, cervical collars and football helmet face mask removal tools should all be evaluated as to their current condition. Equipment removal, spine boarding and splinting scenarios should all be practiced with the appropriately trained personnel. A cooling tub or other rapid cooling mechanism is necessary for a potential heat stroke situation. Who will be responsible to ensure this equipment is ready when needed?

Communication Systems – Know who is responsible to call for emergency transport and what device will be used to make this call. Be sure a backup communication device is also available. During rehearsal of the EAP is a great time to be sure everyone understands how to use these devices, the devices are in working order and where to find the necessary phone numbers. Have phone number lists accessible to anyone who may need them. This list should include contact information for EMS, local hospital(s), school medical personnel, school administration and coaches. Be sure that the person making the initial call for EMS services understands the information he or she is responsible to provide over the phone.

Transportation – An ambulance and EMS crew will hopefully be present at high-risk events such as football games. When practicing your plan, determine with the EMS crew where they will be located during events and how they will be notified when their assistance is needed on the field. For events and practices when an ambulance will not be onsite, determine the approximate response time, where the ambulance will enter the venue and who is designated to meet the ambulance. Take into account if there are entrances that could potentially be locked during certain times of the day and who has access to keys. Also consider ongoing or upcoming construction projects and the impact they may have on emergency vehicle access. In instances of heat emergencies, be sure everyone (including your local EMS team) is on the same page that rapid cooling (cold tub immersion) will take place before transport. Also be sure everyone involved with the emergency response is in agreement on where the injured athlete will be transported. In larger communities there may be multiple hospitals that are better suited for handling different types of emergencies.
With proper documentation of your EAP, potential emergency scenarios can be practiced very smoothly and efficiently. The plans should be posted at all venues and easily accessible to anyone involved in carrying out the plan. Schools are responsible to provide a safe environment for all participants in their athletic and activity programs. Take the time to develop and implement good emergency action plans. Once in place, PRACTICE your plan!

References
Andersen JC, Courson RW, Kleinert DM, McLoda TA; National Athletic Trainers’ Association position statement: emergency planning in athletics. J Athl Train. 2002; 37(1): 99-104.
Casa DJ, Almquist J, Anderson SA, et al. The inter-association task force for preventing sudden death in secondary school athletics programs: best-practices recommendations. J Athl Train. 2013; 48(4): 546-553.