Sports Injury Management Session Two

1. Sports Injury ManagementSession Two Emergency Action Plans

2. “A formal, written emergency plan should exist for every organized practice and competition.”

3. What is it?!?!?!? An emergency plan is a well-developed, clearly defined plan of action that activates emergency medical services at a venue site where an injury occurs should emergency transportation be required. This plan should be the shared responsibility of the athletic staff and the medical staff.

4. Why is it important? The risk of injury, catastrophic injury, and sudden death are inherent in athletics. When this happens, written plans for handling these incidences are more reliable that trying to think rationally in an energy-charged situation.

5. Emergency Action Plan Components • Identification of the appropriate personnel to render care • Specification and maintenance of emergency equipment needed to render care • Communication to summon appropriate emergency medical services • Mode of transportation for the sick or injured athlete from the site of injury to the sideline, athletic training facility, or medical care facility • Emergency procedures outlined and specified for each sport and practice venue (sample in packet)

6. Components – con’t. • Guidelines for event preparation, including home and away events. • Communication with emergency care facilities where sick or injured athlete may be taken • Written documentation outlining the implementation and evaluation of the emergency plan available for all personnel • An Emergency Plan that includes a chain of command for decisions related to suspension of play or practice

7. Example: Initial Emergency Care • Scene survey and body substance isolation: • Is scene safe? Identify potential hazards. • Who and how many are injured? • Evidence of injury mechanism or cause of illness. • Presence of bodily fluids that are potentially infectious and pose a risk. • Is more help needed?

8. Example: Initial Athlete Assessment • Level of consciousness (if unconscious, treat as spinal cord injury) • Airway, Breathing, and Circulation • Severe bleeding If athlete is unconscious, severely bleeding, or has evidence of respiratory or circulatory compromise, the situation should be considered a medical emergency, and EMS should be notified IMMEDIATELY.

9. Component One: Personnel • The responsibilities of each member of the health care team, coaching staff, and administration should be defined. The chain of command should be set forth prior to the start of the season. • Whenever possible, particularly for high risk athletic events, a physician or Licensed Athletic Trainer (LAT) should be available on-site or “on call” should an injury occur. • If a physician or LAT is not available, other emergency-trained personnel, such as EMTs, First Responders, or National Guard or Army Reserve medical personnel should be used. • Given limited resources, it is strongly recommended that coaches, administrators, and any other involved personnel be certified in CPR, Automated External Defibrillation, First Aid, and management of Blood-borne Pathogens.

10. Component Two: Communication • There should be a planned procedure for summoning assistance at each sport venue. • Telephone location and access should be clearly defined for each venue. • Emergency phone numbers should be available. • Cell phones, walkie-talkies, or other communication devices should be provided, especially if the venue is not near a standard telephone. • Communication between health-care providers on the field and those on the sideline, by hand signals or other methods, should be planned and practiced ahead of time.

11. Component Three: Equipment • The Emergency Action Plan should include what equipment is available at each venue and where it is located. • Water should be available at each venue. • Mode of transportation should be determined ahead of time. * Golf cart or other motorized vehicle * Access for police, ambulance, fire, etc.

12. 3: Equipment – con’t. • Appropriate first aid and CPR supplies should be stocked at each venue. Depending on sites and medical personnel available, these may include: Device for maintaining an airway Bag-valve mask for rescue breathing Oxygen Automated External Defibrillator Essential first aid supplies (gauze, bandaids, etc.) Items for proper care and protection against blood-borne pathogens Face-mask removal tool for helmeted sports Cellular phone Cervical collar Crutches Head immobilization device and spine board Ice or chemical ice packs, water, and towels Knee immobilizer Sling Splints Stretcher

13. Component Four: Emergency Treatment Permission Cards/Forms • Emergency Treatment Permission Cards/Forms should be carried in the first aid kit for each sport (will talk more about this in a later session) • Information on each card should include: * Pre-existing conditions, diseases, allergies; * Emergency contact numbers; * Use of inhalers, bee-sting kits, or other medications being taken; * Primary care provider’s phone number * Permission to be treated by school physician, LAT, emergency room personnel; * Permission to be transported to emergency facility, if deemed necessary by school personnel, emergency vehicle; and * Date of previous tetanus immunization

14. Component Five: Prevention / Event Preparation • Know which athletes are at an increased risk through pre-participation screening and medical history questionnaires. • Have medical information and release forms for all athletes available and accessible prior to the start of each event. • Check communication systems for good working order prior to each event. • Ensure emergency equipment is available and in good working order prior to each event. • Communicate with medical-care providers (EMS, hospitals). • Arrange for medical coverage for high-risk events when possible. • Keep emergency treatment cards/forms in the first-aid kit at all times and make sure they accompany the athletes on away events. • Review EAP prior to hosting any large tournament/event with all personnel involved to ensure familiarity with EAP.

15. Component Six: Facilities • Check Emergency Access and No Parking signs on all emergency access gates yearly. • Check keys and / or combination locks to ensure that they function properly. • Make sure necessary personnel have keys and/or combinations to locks on all emergency access gates. • Much of this can be / will be done by the Athletic Director.

16. Component Seven: Implementation • Copies of the EAP should be distributed to personnel who may encounter or be involved in emergency situations. • Educate staff as to the responsibilities of each member of the health-care team, coaching staff, and administration in the event of an emergency. • Provide access to appropriate personnel for necessary facilities and locations (i.e., keys or known access locations for equipment, medical facilities, and phones). • Educate and integrate new staff members as soon as possible after their hiring. • Regularly review and rehearse the plan to ensure a coordinative and efficient response when serious or life-threatening injury / illness occurs. • Meet regularly with representatives from the local EMS to re-evaluate / revise the EAP as changes in staff, facilities, sports schedules, and EMS services dictate. • Designate personnel to render medical care who are trained in CPR and AED, basic first aid, and management of blood-borne pathogens to provide immediate emergency care at all venues.

17. MANTEO HIGH SCHOOL EMERGENCY ACTION PLAN

18. REFERENCES • NFHS Sports Medicine Handbook, 3rd Edition, pgs. 10-15. • American Heart Association. http://www.americanheart.org • American Academy of Orthopedic Surgeons. Emergency Care and Transportation of the Sick and Injured. 7th ed. Boston: Jones and Bartlett; 1998. • Coaches Emergency Action Card. http://www.nata.org/consumer/docs/coachescard. pdf. • National Athletic Trainers’ Association. University of Georgia Sports Medicine Emergency Action Plan. http://nata.org/statements/position/emergencyplanning.pdf: 2002. • Andersen, J.C., Courson, R.W., Kleiner, D.M., McLoda, T.A., 2002, National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics. Journal of Athletic Training, 37,2, 99-104. • National Athletic Trainers’ Association: Official Statement – Automated External Defibrillators; 2004. http://nata.org/statements/official/AEDofficialstatement.pdf. • National Collegiate Athletic Association; Guideline 1c. Emergency Care and Coverage. 2008-09; NCAA Sports Medicine Handbook. (19th ed.). 2008: 11-12. http://www1.ncaa.org/membership/edoutreach/health:safety/index.html.