Emergency Action
Planning
Why?
Chaos
– Emergencies are never planned
– There are always “wild cards” in certain
situations
The more prepared you are for an
emergency situation, the better the reaction
Why?
Professional Need
– NCAA has recommended that all member
institutions develop an emergency plan for
their athletic programs
2001 survey of NCAA institutions revealed that at
least 10% do not maintain an emergency plan
The same survey revealed that 1/3 of institutions do
not maintain plans for off-season strength and
conditioning activities
– The National Federation of State High School
Associations has recommended the same for
secondary schools.
Why?
Legal Need
– Organizational medical personnel, including certified
athletic trainers have a duty to ensure high-quality care
of athletic participants
– Gathers v Loyola Marymount University
Settlement included a statement that care was delayed for
the injured athlete, and the defendants acted negligently
and carelessly in not providing an appropriate medical
response
– Kleinknecht v Gettysburg College
Court ruled that the college owed a duty to the athletes
who are recruited to play at the school
That duty included “prompt and adequate emergency
services while engaged in the school-sponsored
intercollegiate athletic activity for which the athlete has
been recruited”
Components
Athletic injuries may occur at any time
and during any activity
– Does not always involve impact sports
– The athletic trainer may not always be the first
responder
Management involves:
–
–
–
–
–
Athletic trainers
Student AT’s
Emergency Medical Personnel
Physicians
Coaches
Implementation
Implementation of the EAP
Step 1 : Written Down
* Continuity
* Modified for different
athletic venues
* Location and type of
equipment modified based
on location
Implementation
Implementation of the EAP
Step 2 : Education
* Must include all members
* Written copy to all possible
members
* Must be posted by all
telephones
Implementation
Implementation of the EAP
* Step 3 : Rehearsal
* Provides team members chance to
maintain competent skills
* Allows communication between
ATC’s and emergency personnel
* Annual in-service / spring game
* Take into account turnover of
personnel
Personnel
It is imperative that the EAP outline
who is responsible for summoning
help and clearing the uninjured from
the area
CPR / First Aid / AED Certification
Equipment
Good operating condition
– Regular inspections (splints, etc.)
– Batteries for AED
– Available at each venue
Communication
Must have access to a working telephone
or a two way radio-DO NOT ALWAYS RELY
ON A CELL PHONE!!!!!
Established equipment and helmet
removal policies and procedures before an
emergency happens
Who accompanies the athlete to the ER?
Communication
What do I need to know before I call EMS?
1)
2)
3)
4)
5)
6)
type of emergency
suspected injury
present condition
current assistance
location of phone being used
location of emergency
**Most importantly make sure you stay on
the line until the EMS dispatcher says
otherwise!**
Communication
Paperwork, paperwork, paperwork,Importance of having current
paperwork(provided at start of
school year) on all athletes.
With no informed consent, consent
implied on part of athlete to save
athlete’s life
Transportation
Emphasis must be placed on having
an ambulance on site at high risk
events
Response Time
– parents transporting
Venue Location
Emergency Action Plan should be
venue specific
Plan should encompass accessibility
to emergency personnel,
communication systems, equipment
and transportation
Home Teams : Communicate
Visiting Teams : Familiarize
Timber Creek High School
2 Gyms (Large and small)
Wrestling Room
Tennis Courts – 4 courts with easy street
access
1 baseball fields and 1 softball fields
Game field (sub varsity football / soccer
games / track)
3 ½ Practice Fields (football , soccer)
KISD Stadium – Varsity football games
played on Keller High School campus
Five Emergency Action Plans
Timber Creek High School
Five Different Emergency Action
Plans
Plans are printed in Policies and
Procedures Manual issued to each
coach
Plans are also printed and posted at
each venue near fixed phone line
Timber Creek High School
Implementation
– Student AT’s get CPR/AED certified
before they begin working FB practice at
the beginning of each school year.
– Review session at beginning of each
season with coaches during CPR/First
Aid Training.
Timber Creek High School
Equipment
– Splints
– Crutches
– AED ‘s
Centrally located in each athletic venue
– Spineboard Policy
– Biohazard Materials
Timber Creek High School
Communication
– Fixed telephone lines in :
AT Rooms
Coaches Offices
– Cell phones
– Two way radios at each venue with
administrators / game administrators
Timber Creek High School
Transportation
– Golf Cart at outside venues
– Gates for ambulance entry
– Directions to side door for easy
gymnasium entry if needed
Timber Creek High School
Venue Location
– Specific to each location, circumstances,
entry points and communication
available
Emergency Action Planning
Venue Map
School Map
Example of Emergency Action Plan
“Curve Balls”
Gates and keys
Parents calling EMS
Parents, in general
Absence of parents
Crowd Control
Response Time
Weather
–
–
–
–
Need to have EAP’s for events when weather threatens
Evacuation to safe areas for all (1) players (2) spectators and (3) officials
Notification of these threats
Need to clarify who makes this call
Notification
Notification depends on district
policies
– Principal
– AD
– Assistant AD
– Head Athletic Trainer
– Athletic Coordinator
– Superintendent
Documentation
Document, document, document
Best if we document when it is fresh on
our minds to avoid mistakes
– Little Note Pad
– Computer Program
– Paper Copies
Principles of Assessment
Appropriate acute care cannot be provided
without an assessment done on the field
On-field assessment
– Determine nature of injury
– Decide on a plan - direction of
treatment
– Divided into primary and secondary
survey
Primary survey
Performed initially to establish presence of
life-threatening condition
-Life threatening injuries take precedents
Airway, breathing, circulation, shock and
severe bleeding
Used to correct life-threatening conditions
The Unconscious Athlete
Must be considered to have lifethreatening condition
– Note body position and level of
consciousness
– Check and establish vitals; (look, listen,
and feel for pulse) then start
compression, airway, breathing, (CAB)
– may need to log roll
– Assume neck and spine injury
– Remove helmet only after neck and
spine injury is ruled out (facemask
removal will be required in the event of
CPR)
Secondary survey
Life-threatening condition ruled out
Determine injury severity and
transportation from field
Perform a more detailed evaluation of
conditions that do not pose lifethreatening injuries
-sometimes done on the field and other times it
can wait till the athlete is off the playing field
Off-Field Assessment
Performed by athletic trainer or physician
once athlete has been removed from site
of injury
Divided into 4 segments
– History
– Observation
– Physical examination
– Special tests
Off-Field Assessment
History
– Obtain information about injury
– Listen to athlete and how key questions are
answered
Visual Observation
– Inspection of injured and non-injured areas
– Look for gross deformity, swelling, skin
discoloration
Off-Field Assessment
Palpation
– Assess bony and soft tissue
– Systematic evaluation beginning with light
pressure and progressing to deeper palpation –
beginning away from injured area
Special Test
– Designed for every body region for detecting
specific pathologies
– Used to substantiate findings from other
testing
Immediate Treatment Following
Acute Injury
Primary goal is to limit swelling and extent
of hemorrhaging
If controlled initially, rehabilitation time
will be greatly reduced
Control via PRICE
– PROTECTION
– REST
– ICE
-COMPRESSION
-ELEVATION
Immediate Treatment Following
Acute Injury
PROTECTION
-Prevents further injury
-Immobilization and appropriate forms of
transportation will help in protecting an
injury from further damage
REST
-Stresses and strains must be removed
following injury as healing begins
immediately
-Days of rest differ according to extent of
injury
Immediate Treatment Following
Acute Injury
ICE (Cold Application)
-Initial treatment of acute injuries
-Used for strains, sprains, contusions, and
inflammatory conditions
-Used to decrease pain, promote
vasoconstriction
-Lowers metabolism, tissue demand for
oxygen and hypoxia
Immediate Treatment Following
Acute Injury
-Ice should be applied initially for 20 minutes
and then repeated every 1 - 1 1/2 hours and
should continue for at least the first 72 hours
of new injury
-Treatment must last at least 20 minutes to
provide adequate tissue cooling and can be
continued for several weeks
Compression
-Decreases space allowed for swelling to
accumulate
Immediate Treatment Following
Acute Injury
-Important adjunct to elevation and
cryotherapy and may be most important
component
-A number of means of compression can be
utilized (Ace wraps, foam cut to fit specific
areas for focal compression)
-Compression should be maintained daily and
throughout the night for at least 72 hours
(may be uncomfortable initially due to
pressure build-up)
Immediate Treatment Following
Acute Injury
Elevation
-Reduces internal bleeding due to forces of
gravity
-Prevents pooling of blood and aids in
drainage
-Greater elevation = more effective reduction
in swelling
Moving and Transporting
Injured Athletes
-Must be executed with techniques that will not
result in additional injury
-No excuse for poor handling
-Planning is necessary and practice is essential
-Additional equipment may be required
Suspected Spinal Injury
-Coach should access EMS immediately and wait
for rescue squad before attempting to move
athlete
-Transportation and movement should be left to
trained experts
-Maintain head and neck in alignment with long
axis of body
Suspected Spinal Injury
Placing Athlete on Spine Board
– EMS should be contacted if this will be required
– Must maintain head and neck in alignment of
long axis of the body
– One person must be responsible for head and
neck at all times
– Primary emergency care must be provided to
maintain breathing, treating for shock and
maintaining position of athlete
Suspected Spinal Injury
Suspected Spinal Injury
Ambulatory Aid
– Support or assistance provided to injured
individual to walk
– Prior to walking, serious injury should be ruled
out along with further injury with walking
– Complete and even support should be provided
on both sides by individuals of equal height
when providing ambulatory aid
– Arms of athlete are draped over shoulders of
assistants, with their arms encircling his/her
back
Basket Carry
– Used to move mildly injured athlete a greater
distance than could be walked with ease
– Carrying the athlete can be used
– following a complete examination
– Convenient carry is performed by two people
Basket Carry
Stretcher Carry
– Best and safest mode of transport
– With all segments supported/splinted
athlete is lifted and placed gently on
stretcher
– Careful examination is required if
stretcher is needed
– Various injuries will require different
positioning on stretcher
Proper Fit and Use of Crutches
-When lower extremity ambulation is
contraindicate a crutch or cane may be required
-Faulty mechanics or improper fitting can result
in additional injury or potentially falls
-Fitting athlete
– Athlete should stand with good posture, in flat
soled shoes
– Crutches should be placed 6” from outer
margin of shoe and 2” in front
Proper Fit and Use of Crutches
– Crutch base should fall 1” below anterior
fold of axilla
– Hand brace should be positioned to
place elbow at 30 degrees of flexion
– Cane measurement should be taken
from height of greater trochanter
Walking with Crutch
– Corresponds to walking
– Tripod method
Swing through without injured limb making
contact with ground
– Four- point crutch gait
Foot and crutch on same side move forward
simultaneously with weight bearing
Walking with
Crutch
Stair climbing
should be
introduced
when athlete is
able to move
effectively on
level surface
(‘up with the
good – down
with the bad’)
Questions??