Athletic Training Management

Athletic Training Management Chapter 14 Emergency Care Planning

Emergency Care Planning • Bobby Barton once said if you are in this business for over 5 years at the college level you will see a potentially catastrophic injury • Emergency care plans are written documents that show what the course of action will be in the event of an emergency

Standard Operating Procedures • These are the procedures that will happen each time when the need arises • They show that preplanning has happened to insure that all possible risks have been identified and planned for • They insure all necessary equipment is available and in good working order

Key Personnel • Available resources dictate who is in charge and who will be involved • Where there are few resources like in a HS, key personnel will be selected on their ability to multitask • In a college setting with more specialized personnel available, key personnel will probably be specialized

Key Personnel • Open communications with law enforcement, security, athletic administration, central administration, and custodial personnel are all important to the effective ECP

Qualifications • Both the NCAA and the American College of Sports Medicine have established guidelines for an emergency • The NCAA policy is that there must be someone present at all practice and game venues that is current in CPR and first aid

Qualifications • The NATA requires all certified athletic trainers to be current in CPR for the professional rescuer • Noncertified athletic training students should also be current in first aid and CPR for the professional rescuer to be able to function in the ECP • This requirement is what the lawyers call “reasonable and prudent”

Roles • Items such as, but not limited to, the following should be included: • Who will go onto the field when an athlete goes down? • How is the emergency medical system activated? • Where is the communication equipment (phone, two-way radio)? Who will make sure the rescue squad finds the accident scene? Who will provide emergency first aid or CPR if necessary? • Who will provide crowd control? • Who will complete an incident report that is thorough and accurate?

Roles • People assigned to the ECP must be assigned to their role before the emergency occurs • Eliminates confusion • Roles may be rotated or may be permanently assigned • Rotated roles allow backup substitution should someone not be present on a particular occasion

Roles • Role 1 (Physician, highest ranking staff ATC, or designated person) • 1. Take charge of the emergency until relieved by higher authority. • 2. Assess patient. Begin rescue breathing or CPR as needed. • Role 2 (Next highest staff ATC, athletic training student or designated person) • 1. Assist with rescue breathing or CPR. • 2. Keep written record of all conditions and actions.

Roles • Role 3 (Next highest staff ATC, athletic training student or designated person) • 1. Activate the emergency medical system; call 911. • 2. Assist emergency personnel to the emergency site. • Role 4 (Athletic training student, coach, or designated person) • 1. Bring crash cart to the scene. • 2. Assist with rescue breathing or CPR as needed.

Roles • Role 5 (Athletic training student or designated person) • 1. Bring biohazard disposal containers to the site. • 2. Once the athlete and medical personnel have left the scene, clean the area using OSHA standards for handling blood-borne pathogens.

Equipment • Appropriate equipment must be available in order to administer sufficient advanced support techniques whether at practice or competition • Types of equipment will vary with activity type, budget constraints, professional’s experience, athlete’s needs, and team physician preference

Equipment • The equipment must be easily accessible and the location known by all members of the team • All team members must be proficient in the use of equipment for which they are certified and familiar with equipment they are not certified for • It must be emphasized that ATs do not use things they are not licensed for (see your state practice act)

Equipment • Standard equipment will include backboards, splints, stethoscopes, sphygmomanometers, one-way valve masks, and blood-borne pathogen containers • AEDs are getting to be standard in many places • Additional equipment may include oral-pharyngeal airways, tongue forceps, BVM, oxygen, suctioning apparatus, and cell phones or other communication devices

Equipment • In some jurisdictions there may also be a physician’s “crash kit” which contains drugs, cricoid thyrotomy kits, nasal airways, syringes, needles, IV setups, IV media (D5W, isotonic saline), oral and metered dosage injectable units and other life support items for use only by physicians

Implementation • Everyone involved should know their role well enough to perform it without having to refer to a written plan • Helpful to have a laminated card with everything on it including contact phone numbers • Rehearse the plan a minimum of twice a year to meet legal requirements • Rehearse more often is a good idea

Implementation • Drills should be both announced and unannounced • Following practice, a report of the drill should be completed and gone over with all team members • Failure to execute the plan may have catastrophic effects both for the patient and your liability

Implementation • Example: • Hank Gathers, a basketball player at Loyola Marymount University in Los Angeles, had a known arrhythmia and continued to play • The university had a defibrillator but when he had an attack he was MOVED OUT IN THE HALL so it would not be seen by the public and scare them • HE DIED • This was part of the litigation after his death

Implementation • Many colleges and high schools practice and play at multiple facilities • In addition, when you are on the road you will be in an unfamiliar surrounding, both for practice and competition • ECPs must be developed for ALL of these venues

Implementation • You need to get a copy of the host’s ECP including all information in your own ECP BEFORE you get there • It is not an acceptable defense to say you relied on the presence of a host who would know their ECP • You should send your ECP to teams traveling to your sites

Implementation • Professional sports teams are a good example of cooperation • Major league sport athletic trainers exchange all this information in book form through the league office each year • Since the team physician is the ultimate decision maker in health care decisions, he/she MUST be involved in the construction of the plan

Implementation • Check to see if there is an institution-wide ECP before constructing your own • When the 1st edition of this book was written we sought out our university’s ECP and was told there isn’t one, would we like to write one? There is one NOW.

Consistency • Check the athletic department policy against the institution plan for any conflict • Check your plan with the EMS for consistency with their protocols

Contacts • Who must be contacted • We used to HAVE to call campus police before any emergency vehicles could come on campus • If EMS is contacted, once on site they are now in charge and your ECP may no longer have any standing • Have EMS participate in developing the plan to minimize problems

Contacts • This means whether to remove football helmets or not is out of your hands • Taking off the helmet without removing the shoulder pads is dangerous for hyperextension of the C-spine • You may need to have an in-service to show them how to remove face masks and, if necessary, helmets

Writing the plan • Use all resources available • Law enforcement, EMS, physicians, physical plant personnel, coaches, administrators, institution legal staff • Once completed share it with all members who will have to execute • Give a condensed version to parents to show how their son or daughter will be covered

Procedures • Chain of command • Internal • Team physician • Head certified athletic trainer • Assistant certified athletic trainer • Athletic training student • Coach • External • EMS • Law enforcement

Procedures • Emergencies • Life-threatening is when the victim’s life is in immediate danger • Non-life-threatening is of a lower priority and your actions may be limited until the EMS arrives • When contacting the EMS you need to follow the following guidelines:

Procedures • 1. Identification: The emergency operator needs the caller’s name, the patient’s name, the telephone number, and the location where the call is being made. • 2. Nature of emergency: The operator will ask about the type of emergency (heart attack, seizure, etc.), the number of people injured or ill, and the seriousness of the injury or injuries.

Procedures • 3. First aid implemented: The operator needs to know what has been done to the victim and what type of assistance and/or equipment is needed. • 4. Directions: The operator needs directions to the site of the emergency. It is also recommended that someone be available to meet the ambulance at a gate or entrance with keys to all doors to expedite the entry of emergency personnel.

Procedures • 5. Termination of phone call: The operator will tell the caller when to hang up the phone. It is essential not to hang up before this, even if one sees the ambulance arriving at the scene. • Notification of parents • If the athlete is a minor then the parents MUST be called to authorize any treatment • Actual consent may be obtained before an emergency

Procedures • Actual consent is in effect only when it is INFORMED consent • This means you must contact the parents and tell them what is wrong and what you want to do • Obtaining actual consent prevents problems with parent’s preferences or religious beliefs • If the parents cannot be reached then predetermined plans can be implemented

Procedures • If the parents are not available and no plan exists, minor consent may apply where a minor gives his/her binding consent • You must continue to try to reach the parents • Implied consent to live is always present when the athlete is unconscious and parents cannot be reached

Procedures • When the athlete is an adult, then contacting parents is only permitted when the athlete agrees • Implied consent applies here as well

Scope of Coverage • Who is covered drives the whole plan • The plan should center on caring for athletes • Spectators, coaches, and other staff should be secondary • Ideally spectators should be covered by a separate ECP staffed by a separate group

Records • Incident report is critically needed and must be appropriately filed • Make sure all findings are recorded, dated, and signed • Informed consent forms should be kept here, too

Athletic Training Management