Athlete Safety in Emergency Response

National Athletic Trainers' Association Position Statement: Preventing Sudden Death in Sports

• Objective: To present recommendations for the prevention, screening, recognition, and treatment of sudden death in organized sports.
• Background: Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (lightning, diabetes) are the most common causes of death in athletes.
• Conditions Covered:
  • Asthma
  • Catastrophic brain injuries
  • Diabetes
  • Exertional heat stroke
  • Cervical spine injuries
  • Exertional hyponatremia
  • Exertional sickling
  • Lightning
  • Sudden cardiac arrest
  • Head-down contact in football
• Recommendations: Guidelines are intended to provide relevant information on preventing sudden death in sports, and recommendations for certified athletic trainers.
• Emergency Action Plans (EAPs): Crucial for organizations sponsoring athletic activities. EAPs should be written, structured, and coordinated with local emergency services, safety officials, and administrators. Protocols should be specific to the venue and practiced annually. The plans should directly consider:
  • Athlete, parent/guardian, coach, and director instruction and expectations
  • Medical professionals to provide care during practices and games
  • Prevention, recognition, treatment, and return-to-play policies for common causes of sudden death

Asthma

• Prevention and Screening: Athletes with suspected asthma should undergo a medical history and physical exam. Warming up before exercise is crucial to minimize asthma symptoms and exacerbations. Educating athletes on asthma medications (prophylaxis), spirometry, triggers, and compliance with medication are necessary.
• Recognition: Sports medicine staff must be aware of major signs and symptoms such as confusion, shortness of breath, low oxygen, wheezing, cyanosis, and others. Spirometry tests, at rest and with exercise, should be done for athletes suspected of having asthma. Bronchodilator responses also help confirm the diagnosis.
• Treatment: Short-acting beta-2 agonists are used for acute exacerbations. Severe exacerbations need immediate referral to a healthcare facility. Inhaled corticosteroids or leukotriene inhibitors provide long-term asthma prophylaxis and control.

Catastrophic Brain Injuries

• Prevention: Educational sessions for athletes and coaches on concussion recognition (signs, symptoms), severity of traumatic brain injuries, and the importance of reporting concussions and refraining from participation while symptomatic. Enforcing the use of certified helmets, while acknowledging they can't prevent all concussions.
• Recognition: Standardized objective concussion assessments are recommended (symptoms, cognitive and balance measures). These assessments should not be considered alone to manage or diagnose a concussion.
• Management: Immediate acute-care plans should be in place for intracranial hemorrhage or cerebral edema. A medical plan with physician referral if symptoms persist or if the level of consciousness deteriorates. Written home care instructions should be provided to the athletes and responsible adults.

Cervical Spine Injuries

• Prevention: Athletic trainers are responsible for understanding sport-specific causes of catastrophic injuries and the body's physiologic responses to spinal cord injury. Ensuring safety rules for injury prevention are widely implemented among athletes and coaches.
• Recognition: Immediate assessment for unconsciousness or altered consciousness, bilateral neurological findings, significant midline spine pain, and obvious spinal column deformities warrants initiation of the injury protocol.
• Management: Neutral cervical spine position, immediate manual cervical spine stabilization, avoiding traction, and exposure and access to airways, breathing, and circulation should be prioritized.

Diabetes Mellitus

• Prevention: Each athlete with diabetes needs a care plan (including blood glucose monitoring, insulin guidelines, treatment for hyper/hypoglycemia, emergency contact info). Emphasis on blood glucose monitoring, carbohydrate supplementation, and insulin adjustments to prevent hypoglycemia. Blood glucose monitoring and insulin adjustments, and urine testing for ketones to prevent hyperglycemia.
• Recognition: Hypoglycemia (tachycardia, sweating, hunger, etc.) and hyperglycemia (dehydration, lethargy, etc.). Differentiating from other causes of collapse. Significant changes in blood sugar call for rapid medical attention.
• Management: Treatment for mild hypoglycemia usually involves immediate carbohydrate administration (e.g., glucose tablets, honey). Severe hypoglycemia requires emergency medical services (EMS) and glucagon administration.

Exertional Heat Stroke

• Prevention: Preseason screening, gradual heat acclimation (7-14 days), consistent hydration, access to fluids, and educating relevant personnel about EHS prevention and response protocols. Modifications for athletes with protective equipment.
• Recognition: Core body temperature above 104-105°F (40-40.5°C) with central nervous system (CNS) dysfunction (disorientation, confusion).
• Management: Immediate cooling (cold-water immersion is the fastest), followed by hospital transfer if required to prevent complications or death.

Exertional Hyponatremia

• Prevention: Individualized hydration protocols based on sweat rates, activity type, environmental conditions, education regarding hydration before, during and after exercise. Sufficient consumption of adequate dietary sodium and fluids. Education about symptoms of excessive fluid intake and importance to avoid exceeding sweat loss
• Recognition: Overconsumption of fluids. Signs include nausea, vomiting, muscle twitching, peripheral tingling, headache, mental status changes, pulmonary edema, and severe cases, seizures or decreased consciousness.
• Management: Mild cases benefit from fluid restrictions and consumption of salty foods, severe cases require IV hypertonic saline to increase blood sodium. Prompt transport to a medical facility.

Exertional Sickling

• Prevention: Education regarding the condition and its triggers (intense exercise, high altitudes, dehydration, asthma). Targeted training that avoids excessive, sustained activity is key.
• Recognition: Muscle cramping, pain, swelling, weakness. Unable to catch breath. Fatigue. Differentiating from other medical conditions requiring similar care
• Management: Immediate cessation of activity when symptoms appear. High-flow oxygen, monitoring of vital signs, and activation of an emergency protocol Immediate medical attention for severe cases

Head-Down Contact in Football

• Prevention: Educating athletes on proper tackling techniques (head up, shoulder contact) and enforcing rules to discourage head-down contacts (spearing). Emphasis on axial loading as primary mechanism of spine injury.
• Recognition: Any head-down contact should be regarded with suspicion, particularly if it causes sudden collapse. Emphasis on the importance of proper technique, along with ongoing monitoring efforts.
• Management: Enforcing rules and increasing awareness of the risk associated with head-down contact. Immediate cessation of activity. If severe, immediate medical attention.

Lightning Safety

• Prevention: Remain indoors during lightning activity. Identify safe structures (with solid roofs, adequate walls, and electrical wiring). Avoid activities like touching electronic devices or plumbing while lightning is occurring.
• Recognition: Educating personnel on recognizing a lightning-struck victim.
• Management: Treatment in safe locations. Immediate triage and attention to life-threatening situations. Providing CPR and defibrillation as needed.