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Medical Time-out Important Part of Emergency Action Plan

By Rick O'Leary on September 11, 2018 hst Print

“Medical Time-out” was all that was written in the subject line of the email one Tuesday morning before our first away football game of the season; however, it was enough to grab my attention.

The email was from Matt Brennan, the athletic trainer and sports medicine teacher at Stanwood High School and our opponent that coming Friday. Stanwood’s athletic director, Tom Wilfong, was copied on the email, as was our athletic trainer, Delaney Farmer. The email was an invitation to attend a pre-game “medical time-out” prior to the start of the football game.

Even my phone conversation with Brennan didn’t prepare me for what I witnessed before the start of the football game that night. Even the most cursory scan of the consensus statements, position statements and other documents published by the National Athletic Trainers Association (NATA) and the National Federation of State High School Associations (NFHS) reveals a consistent call – a demand even – that all athletic organizations have venue-specific Emergency Action Plans (EAPs) that are written and rehearsed. EAPs help ensure the safety and appropriate care of athletic participants.

For the past few years, the NATA and the NFHS have further recommended that a medical time-out take place prior to the start of athletic contests to review the EAP as it applies to the upcoming contest. The term “time-out” is common to both athletics and medicine, signifying a brief time when activity stops and plans are reviewed by everyone involved. In hospitals, for example, time-outs conducted prior to surgery help ensure the correct procedure is done on the correct body part of the correct patient.

At the medical time-out that Friday evening, all parties with an interest in athlete and spectator safety were in attendance. The athletic directors and athletic trainers from both schools, the team physician, stadium manager, security officer, school administrators and local EMS providers for Stanwood High School all attended the meeting.

Following introductions, Brennan and Wilfong reviewed the role of each person present and their responsibility in the event of an on-field emergency. It became quite real for me when Brennan said to the security officer, the Stanwood High School administrators and me that “if we need a helicopter, you will be responsible for clearing the sidelines before it arrives.”

My suburban, Seattle-area high school is a few minutes away from the regional trauma center; the same is not true at Stanwood High (60 miles north of Seattle), so landing an air ambulance on the football field is a very real potential. Leaving the meeting, I felt confident we could handle any emergency that came our way that night.

Thankfully, the plans never needed to be put into action, as there were no serious injuries that night. But my mind raced throughout the drive home after the game, thinking of how to implement the same medical time-out at Lake Washington High School the following Friday. On Monday, Farmer listened to my desire to implement what we had seen the previous Friday night. He was willing but concerned when to find time for it, given the hectic pre-game schedule. Thirty minutes before kickoff became our agreed-upon time. The next step was to review the roles that needed to be filled in the event of an emergency and to determine who would fill each role. Questions included determining who will:

  • Open the stadium gates and direct in the arriving EMS resources?
  • Assist with crowd control, including finding and communicating with the parents of the injured athlete?
  • Oversee sideline management?
  • Evaluate and care for the injured athlete?
  • Secure and inventory any equipment removed from the athlete on the field?

Our first Friday night medical time-out wasn’t perfect, but we learned from it, improving the process at each subsequent home game. Besides on-field injuries, other potential emergency scenarios were considered – a fire in the concession stand, the collapse of the bleachers and, sadly, even a shooting or explosion. Considering these multiple casualty scenarios led to improvement of our communication with our local fire/EMS personnel.

As recommended by the NATA, we considered other factors that might hamper a well-coordinated emergency response – weather, traffic, overcrowded campus access points, etc. By the end of the football season, great strides had been made in implementing this pre-game “briefing.” This increased my confidence in our ability to respond to any emergency – on or off the field – in the stadium.

Ideally, these formal pre-game meetings would continue into other sports seasons. The reality is, however, the response “team” at many other events consists solely of Farmer, our athletic trainer. Yet, he always introduces himself to the visiting coaches and the officials and discusses the location of our AED and other emergency equipment. At some events, school administrators and our gym manager are present and can assist in case of an emergency by filling roles of crowd control and directing EMS to the scene.

Athletic administrators have a long list of items demanding their attention prior to the start of any athletic contest, especially a home football game. The last thing an athletic director needs is more to do – especially attending a meeting before kickoff. Yet, arguably, nothing is more important than the 10 minutes an athletic director spends in a medical time-out. Those 10 minutes could very well make a significant difference in the quality and efficiency of the care provided to the injured athlete.

Sample Medical Time-out Agenda:

  • Introduce everyone present, and specify their roles in an emergency.
  • Verify location of emergency equipment (AED, spine board, etc.).
  • Review plans for access and egress of emergency vehicles.
  • Review and test communication plans/equipment (radios, hand signals, etc.).
  • Review plans for multiple casualty incidents (MCI) including identification of potential triage areas, staging of responding resources and transport corridor.
  • Identify the receiving hospital.
  • Address all questions and concerns.

Resources

National Athletic Trainers’ Association Official Statement on Athletic Health Care Provider “Time Outs” Before Athletic Events, 2012. Accessed at www.nata.org.

Andersen J, Courson RW, Kleiner 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 Athletic Programs: Best Practice Recommendations. J Athl Train. 2013; 48(4):546-553.

Drezner JA, Courson RW, Roberts WO, Mosesso VN Jr, Link MS, Maron BJ. Inter-association Task Force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. J Athl Train. 2007; 42(1):143–158.

Huggins RA, Scarneo SE, Casa DJ, et al. The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues. J Athl Train. 2017; 52(4);384-400

Lemak LJ, Courson, RW. Sport Medicine Team Should Call ‘Time-out” Before Start of Events. 2014. Accessed at www.nfhs.org.

Swartz EE, Boden BP, Courson RW, et al. National Athletic Trainers’ Association position statement: acute management of the cervical spine-injured athlete. J Athl Train. 2009;44(3):306–331.