Actions to Consider After Life-Saving Event at Contest

Some people recall the calm, quiet of the crowd with a systematic approach to compressions, AED shock and bag valve breaths being performed in the middle of a football field. Others recall chaos, bursts of tears and audible prayers with a huddle of people rushing around in the middle of the football field. But one thing is consistent – everyone remembers THAT night. It was Friday night lights in Texas on September 2, 2011, and overtime of a preseason football game when a fourth-year varsity athlete lay lifeless, gray in the face, in the middle of the football field. Fast forward an eternity, the athlete is now being transported to the local trauma center with no pulse and not breathing.

Now What?
Administrators must be prepared to manage the decision-making, communication, crowd management, psychological support, media requests and overall crisis management during and after a life-saving event has taken place. Simultaneously, many tasks will need to be completed so that the situation is dealt with seamlessly.

Since the care of the athlete has been transferred to emergency services, now is the time to take care of the people who have witnessed the event or who will be impacted by the events that have just occurred. It is important to consider the business at hand. How will the game itself be handled? Is it required to be completed? If it is, then a suspension of the game and resume later may be the most prudent thing to do. If it is not required to be completed, then strong consideration should be given to end it as a non-completed game or a tie.

The most immediate needs are to care for and communicate to those who responded and/or witnessed the event. If possible, conduct an immediate hotwash with all stakeholders who were involved with the event. A hotwash is an immediate collaboration between the individuals involved where the most significant and immediate actions are discussed and documented. This is an opportunity to capture the most glaring strengths and areas of concern from the event. Areas of concern should be noted so that in if in the future a similar event occurs, these concerns will be addressed. The documented responses from the hotwash should be included in the After-Action Review that is concluded post-event.

It is important to have other administrators accomplish different tasks such as:

• Pre-designed announcements instructing spectators who wish to gather to do so at a pre-determined location, NOT the emergency department. As an example, establish an Information and Assistance Center.

• School representatives need to be immediately available at the entrance of the emergency department to divert non-family members to the Information and Assistance Center.

• A designated individual who is trusted and respected should oversee protecting the athletic trainer/staff responders from spectators who want to know what happened, how the athlete is doing, or have well-meaning but unnecessary questions that cannot and should not be answered.

• Activate the individuals such as mental health professionals who can provide psychological care for the coaching staff, athletes, athletic training student aides, and other sideline occupants (journalism students, ball boys, etc.)

• Properly communicate the events of the evening to the student body and staff.

• Non-critical needs should also be addressed, including who is going to pick up the field equipment. Also, who will be responsible for collecting the AED and performing the diagnostic follow up and replacing the used pads, battery, etc.

On that evening 12 years ago, after the athlete was in the ambulance, I remember both teams kneeling together in the end zone, praying. Immediately after, the visiting athletic training program took it upon themselves to selflessly move our equipment off the sideline and into the building, so that we could stay together as a team. But what I remember most is the immediate support that I received from my spouse, who happened to be at the game that night. Those providing life-saving measures need support.

I am beyond grateful that the athlete who laid lifeless on the field on September 2, 2011 survived the crisis. He never played football again but continues to live a successful life. I watched him graduate from high school and college, develop a successful career, and is recently married.

A few things to avoid:

• Don’t allow the people who performed life-saving measures to immediately become part of the communication or psychological response team. The individuals who have performed CPR have physically exerted themselves and are experiencing an emotional response.

• Don’t allow crowds to form at the emergency department.

• Don’t expect everyone to process the experience the same way. There is no playbook for how everyone is going to respond emotionally to the event.

After the inertia of the events settle, consider the need to review each step taken during the event. Within a few days, but not more than a week, an After-Action Review (AAR) should be conducted. Although the AAR should include an overview of actions, it is not designed to evaluate the performance of individuals.

The AAR should include the key personnel who were involved in the events as well as individuals who are involved with the decision- making processes leading up to the event and post-event. The location of the AAR should be a space that allows for open communication and discussion and should be led by a neutral party such as the county or city Office of Emergency Management.

Framing the AAR conversation is important. Especially if the outcome of the event results in the loss of life or limb, it is imperative that the conversation be framed such that this is an objective review and not an evaluation of performance. AARs are not designed to assess blame to any individual or group but rather to determine what went well and what can be improved upon. It is important to note whether an action went well because it was planned, or did it just happen to go well. If the action went well, should it be built into the Emergency Action Plan (EAP)? Also, do improvements need to be made because the current plan is not adequate or not realistic?

The AAR will likely elicit strong emotions and, therefore, the process should allow for time to process and to patiently work through each action that impacted the event.

I remember that September night so clearly, but when I hear others describe what they witnessed, it seems like it was a different event. It is imperative that those vantage points are captured so that the EAP can be updated with the most impactful information.

Another important item to consider is consistent follow-up. Insist that those closest to the event seek professional help or that of a trusted mentor. Everyone processes events such as this differently and at different speeds. Even on an informal basis, administrators being genuine and letting the individual know that they are thinking of them is part of the processing and healing post-event.

The first time that I taught CPR to my coaches about a year after the events that occurred, I didn’t realize that the pressing on the chest of a mannequin would flood my emotions with the events from that evening that I performed CPR on the athlete on the football field.

The immediate actions that need to occur after a life-saving event cannot be successful through improvised decision-making. It is crucial that a plan is in place. The plan must be created with the stakeholders involved. Finally, the plan must be communicated to those who will be involved in the event preferably ahead of the event to take emotion out of the decision-making process.

The most effective part of the response is the pre-planning that must be conducted.

• Prior to the start of the school year, meet with your internal and external stakeholders. This includes but is not limited to the athletic trainer(s), coaches, campus administration, communications team, counselors, maintenance staff, technology, and any other individual that the administrative team deems important for this.

• Include in the pre-planning that immediately after any event such as this, a hotwash should be conducted.

• Consider what is going to impact the reaction and response of those involved and those who are witnessing the event.

• Communicate early and often that there is a plan. This includes pre-season parent meetings, event PSAs and media requests.

The athletic trainer is the most knowledgeable individual in planning for athletic emergencies. Tapping into that resource is critical in the success of any emergency.