Emergency Action Planning

1. Emergency Action Planning

3. 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

4. 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.

5. 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”

6. 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

7. Implementation • Implementation of the EAP Step 1 : Written Down * Continuity * Modified for different athletic venues * Location and type of equipment modified based on location

8. Implementation • Implementation of the EAP Step 2 : Education * Must include all members * Written copy to all possible members * Must be posted by all telephones

9. 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

10. 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

11. Equipment • Good operating condition • Regular inspections (splints, etc.) • Batteries for AED • Available at each venue

12. 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?

13. Communication • What do I need to know before I call EMS? 1) type of emergency 2) suspected injury 3) present condition 4) current assistance 5) location of phone being used 6) location of emergency **Most importantly make sure you stay on the line until the EMS dispatcher says otherwise!**

14. 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

15. Transportation • Emphasis must be placed on having an ambulance on site at high risk events • Response Time – parents transporting

16. 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

17. 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

18. 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

19. 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.

20. Timber Creek High School • Equipment • Splints • Crutches • AED ‘s • Centrally located in each athletic venue • Spineboard Policy • Biohazard Materials

21. 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

22. Timber Creek High School • Transportation • Golf Cart at outside venues • Gates for ambulance entry • Directions to side door for easy gymnasium entry if needed

23. Timber Creek High School • Venue Location • Specific to each location, circumstances, entry points and communication available

24. Emergency Action Planning • Venue Map • School Map • Example of Emergency Action Plan

25. “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

26. Notification • Notification depends on district policies • Principal • AD • Assistant AD • Head Athletic Trainer • Athletic Coordinator • Superintendent

27. 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

28. 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

29. 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

30. The Unconscious Athlete • Must be considered to have life-threatening 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)

31. 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 life-threatening injuries -sometimes done on the field and other times it can wait till the athlete is off the playing field

32. 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

33. 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

34. 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

35. 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 -COMPRESSION • REST -ELEVATION • ICE

36. 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

37. 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

38. 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

39. 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)

40. 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

41. 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

42. 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

43. 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

44. Suspected Spinal Injury

45. Suspected Spinal Injury

46. 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

47. 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

48. Basket Carry

49. 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

50. 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