Emergency Action Plan (EAP) Exercises

• Chapter 1 discusses the organization and administration of emergency care in the context of sports and athletics.

Emergency Situations

• Emergency medical situations can occur in athletics at any time.
• It is important to have an emergency action plan (EAP) in place to provide the best possible care in potentially life-threatening situations.
• Developing and implementing an EAP ensures quality care for athletes.
• An EAP minimizes response time to life-threatening situations or medical emergencies.

Components of Emergency Care Preparation

• Developing an EAP
• Proper coverage of athletic events and practices
• Maintaining emergency equipment and supplies
• Selecting appropriate personnel for the sports medicine team
• Continuing education for the sports medicine team in emergency medical care

Organization and Administration of Emergency Care

• Development and implementation of an EAP
• The sports medicine staff and emergency team
• Initial patient assessment and care
• Emergency communication
• Emergency equipment and supplies
• Venue locations
• Emergency transportation
• Emergency care facilities
• Legal needs and documentation

Developing and Implementing an EAP

• The National Athletic Trainers' Association recommends that every organization or institution that sponsors athletic activities should develop and implement a written EAP.
• EAPs should be developed by organizational or institutional personnel in consultation with local emergency medical services.
• The development and proper use of an EAP can make the difference in the outcome of an injury.
• All components of an EAP are connected and must be considered for a complete and favorable outcome in a dangerous situation.
• Once realized and developed, the EAP must be implemented through documentation, education, and rehearsal.
• An EAP must provide a clear explanation of how it works to maintain continuity among sports medicine staff and the emergency team.
• Equipment needs vary by sport and venue; for outdoor sports with heat illness risk, equipment such large tubs for cooling athletes may be needed.
• A copy of the venue-specific EAP should be posted near an available phone or prominent location.

Sports Medicine Staff and Emergency Team

• Forming an emergency team is necessary to implement an EAP.
• Primary team members include the sports medicine staff (athletic trainer and team physician).
• During an emergency, the makeup of the emergency team can vary depending on who is at the scene.
• The emergency team can include athletic trainers, team physicians, athletic training students, team coaches, and equipment managers.
• A first responder is a person trained to provide emergency care before EMS arrives.
• Any member of the emergency team can act as a first responder.
• Roles of the emergency team in Box 1-2 include:
  • Athletic trainer: first responder, immediate care
  • Team physician: first responder, immediate care
  • Team coach: first responder, activate emergency medical system
  • Athletic training student: first responder, equipment retrieval
  • Equipment manager: first responder, direct EMS to scene
• Roles of team members vary during emergencies based on team size, venue, and athletic trainer preferences.
• The four roles within the emergency team include:
  • Immediate care of the athlete
  • Emergency equipment retrieval
  • Activation of the EMS system
  • Direction of EMS to the scene of the emergency

Immediate Care of the Athlete

• The first and most important role involves giving immediate care to the injured athlete.
• The most-qualified individual on the site should be either the athletic trainer or the team physician, who gives the patient acute care in an emergency situation.
• An individual needs to be trained in patient care and should have a good knowledge of the organization’s EAP.
• Less qualified individuals need to yield to those that have more appropriate training.

Emergency Equipment Retrieval

• A person familiar with the names and locations of required equipment should perform emergency equipment retrieval.
• Athletic training students fit this role nicely.
• Necessary emergency equipment should be onsite, in good condition, and easily accessible.
• Emergency Equipment includes:
  • Splints
  • Spine board
  • Bag valve mask
  • AED device
  • First aid kit
  • Cell phone

Activation of the EMS System

• Activating the EMS system is a priority where emergency transportation is not already present.
• The emergency team designates an individual to open gates or doors, and direct local EMS to the emergency scene.
• The equipment manager is typically the appropriate person for the responsibility because he or she is responsible for keys to locked gates or doors.
• Activiation of the EMS System includes:
  • Making the call - 911 (if available) OR;
  • Using direct telephone numbers to local police, fire, and/or ambulance departments
  • Providing your name, address, and phone number to the EMS System
  • Number of athletes involved in the emergency
  • Condition of the athlete(s)
  • Treatment initiated by members of the emergency team
  • Specific directions to the emergency scene.

Initial Patient Assessment and Care

• The immediate care of any injured person needs to be the main concern for the emergency team.
• A CHECK-CALL-CARE system should be put into place for every member of the emergency team to follow when an emergency occurs.
• The CHECK-CALL-CARE System includes:
  • The scene to make sure it is safe to aid the athlete
  • The scene to find evidence on what happened to the athlete
  • The victim for airway, breathing, circulation, fractures, and bleeding
  • Call 911 or the local emergency management
  • Give proper directions to the injury site
  • Meet ambulance at scene and direct to injured athlete
  • Calm and reassure the injured athlete
  • Reassess and monitor all vital signs
  • Control any bleeding
  • Immobilize any injured body part
  • Provide CPR/AED and appropriate first aid as needed

Emergency Communication

• Communication is key to quick and effective emergency care in an athletic trauma situation.
• Athletic trainers, emergency team members, and EMS personnel must work together to provide the best possible care to injured athletes.
• Communication before events will help establish relationships between all groups of professionals.
• When emergency medical transportation is unavailable the emergency medical system needs to be contacted.
• A list of all appropriate emergency numbers should be near the communication system used by athletic trainers.
• Specific directions to on-site venues should be included and posted with the emergency numbers.

Emergency Equipment and Supplies

• Appropriate emergency equipment and supplies must be present at every practice or event.
• All assigned team members should be aware of the location and function of equipment and supplies.
• Emergency equipment and supplies are properly inventoried annually and stored in a secure area for safekeeping

Emergency Equipment and Supply List

• The equipment includes:
  • AED Unit
  • Immobilization Splints
  • Stretcher/Spine Board
  • Airway bag-valve mask
• Supplies Include
  • First Aid Kit
  • Sterile Bandages
  • Tape and elastic wraps
  • Bloodborne pathogen kits

Venue Locations

• The EAP for each venue should include the accessibility to emergency personnel, communication systems, emergency equipment, and emergency vehicle transportation.
• Specific Venue Location EAP includes:
  • Emergency Personal On-Site (Athletic trainers, physicians, coaches, EMS personnel).
  • Emergency Communication (Phones, radios, emergency phone numbers).
  • Emergency Equipment (AED, first aid kits, splints, spine boards, and ambulances on-site).
  • Emergency Procedures (Venue drawings, maps, and directions, instructions on CHECK, CALL, CARE items, directions to nearby emergency care facility).

Emergency Transportation

• The EAP needs to have policy that shows how and when transportation if needed for all athletic events.
• Per definition, the transportation should be via EMS.
• The policy on transportation should explain in detail when and where an ambulance will be during all athletic events.
• EMS response time to an accident should be reflected in said policy.
• The levels of transportation service and equipment needs to also be laid-out in written plans.
• Should include Basic Life Support (BLS) and Advanced Life Support(ALS) availability.

Basic Life Support (BLS)

• It is delivered through Emergency medical technicians (EMT).
• Provides basic airway support, AED, splinting, spine boarding

Advanced Life Support (ALS)

• Provided by paramedics.
• Gives advanced airway support.
• Offers invasive procedures such as IVs, use of medications as directed by a physician.

Emergency Care Facilities

• EAPs need to contain the transportation and directions of medical emergencies stemming from all athletic venues
• The facility location (proximity to venues) and level of care that is going to offered is a factor when choosing facilities.
• Emergency care facilities and local emergency medical services that athletic organizations work with need advance notice of all scheduled events.
• An athletic organizations’ EAP needs to be practiced and reviewed important information concerning athlete such as athlete equipment removal(helmets, shoulder pads, etc.).

Legal Need and Documentation

• The National Athletic Trainers' Association has said that all Athletic organizations should be well-organized with well put together EAPs.
• An EAP needs to be rehearsed because it’s something that is essential in sports medicine programs.
• Documentation needed as part of the EAP:
• Athlete Emergency Information Card: Use for the description of the medical conditions of the athlete. Only to be used with the patients approval.
• Individual Injury Evaluation Form: Use for the documentation of the athlete's injuries.

Other Important Documentation

• Delineation of the person or group that is responsible with documenting all the information.
• Follow up documentation on the response to the emergency.
• Documentation on personal training and regular rehearsal of EAP’s.
• Documentation of purchase, inventory, and maintenance of all emergency equipment and supplies.
• School and athletic organizations coaches’ Emergency Information Palm Cards: for sports medicine teams and coaches to have quick references for EAP documents.