Organization and Administration of Emergency Care - The University of Faisalabad - PDF

Chapter 1 Organization and Administration of Emergency Care The University of Faisalabad  EMERGENCY SITUATION During the second half of a boy’s high school basketball game a player collapses on the court. Play is immediately stopped by the referee, and he goes to...

Chapter 1 Organization and Administration of Emergency Care The University of Faisalabad  EMERGENCY SITUATION During the second half of a boy’s high school basketball game a player collapses on the court. Play is immediately stopped by the referee, and he goes to check on the player. The referee then yells for assistance from the athletic trainer covering the event. The athletic trainer runs onto the court to check on the unresponsive player. He checks all vitals and finds that the player is not breathing and has no pulse. At this point, what should the athletic trainer do to help the stricken player?  EMERGENCY SITUATION Emergency medical situations can occur in athletics at any time. When they do occur, it is important to have the proper emergency action plan (EAP) in place to provide 1. The best possible care to the athletes with potentially life threatening injuries or illness. 2. The development and implementation of the EAP will help ensure that the quality of care provided to the athletes is the best possible. 3. EAP will minimize the time needed to provide an immediate response to a potentially life-threatening situation or medical emergency Organization and Administration of Emergency Care 1. Development and implementation of an EAP 2. The sports medicine staff and emergency team 3. Initial patient assessment and care 4. Emergency communication 5. Emergency equipment and supplies 6. Venue locations 7. Emergency transportation 8. Emergency care facilities 9. Legal need and documentation  Develop and Implement an EAP In a National Athletic Trainers’ Association Position Statement it was recommended that each organization or institution that sponsors athletic activities or events develop and implement a written EAP. Emergency action plans should be developed by organizational or institutional personnel in consultation with local emergency medical services.  Develop and Implement an EAP The development of an EAP and proper use of this plan often can make the difference in the outcome of an injury. All components of an EAP are connected, and they all must be considered to ensure a complete and favorable outcome in a potentially dangerous situation Once the importance of the EAP is realized and the plan has been developed, the EAP must be implemented. This is done through documentation of the plan, education of those involved, and frequent rehearsal of the plan itself.  Develop and Implement an EAP The EAP must provide a clear explanation of how it is going to work, allowing continuity among all members of the sports medicine staff and emergency team members. Location and type of equipment required may be different among the sports teams and venues. For example, outdoor sports with a high risk of heat illness may require a large tub or wading pool to be used for emergency cooling of athletes at risk of heat stroke. This equipment would not be required for indoor sports. A copy of the EAP specific to each venue should be posted by an available phone or some other prominent marked position at that site  Sports Medicine Staff and Emergency Team The implementation of an EAP cannot take place without the formation of an emergency team. The primary members of this team consist of the sports medicine staff, which includes the athletic trainer and the team physician. During an emergency the makeup of the emergency team can vary depending on who is at the scene at the time of the emergency. The emergency team can include athletic trainers, team physicians, athletic training students, team coaches, and equipment managers  First Responder A first responder is defined as a person who has been trained to provide emergency care before EMS arrives on the scene. Any member of the emergency team can act as a first responder.  In any emergency situation the roles of the members of the emergency team will vary depending on how many people are on the team, the venue that is being used, and the preferences of the athletic trainer (who is usually in charge of executing the EAP).  The four roles within the emergency team are as follows: 1. Immediate care of the athlete 2. Emergency equipment retrieval 3. Activation of the EMS system 4. Direction of EMS to the scene of the emergency  1.Immediate care of the athlete The first and most important role involves the immediate care of the injured athlete. The most qualified individual on the scene is usually the athletic trainer or team physician, either or both of whom should provide acute care in an emergency situation. This person should be trained in patient care and have good knowledge of the organization’s EAP. Individuals who are less qualified, such as coaches or equipment managers, should yield to those who have more appropriate medical care training  2.Emergency equipment retrieval Emergency equipment retrieval may be performed by a person on the emergency team who is familiar with the names and locations of the specific equipment that is required. Athletic training students would fit this role nicely. All necessary emergency equipment should be on site, in good condition, and easily accessible. Examples of emergency equipment include splints, spine board, bag valve mask, an AED device, first aid kit, and cell phone  3.Activation of the EMS system Activation of the EMS system is a priority where emergency transportation is not already present at the location of the emergency. The emergency team should designate an individual to be in charge of opening any locked gates or doors and directing the local EMS to the scene of the emergency. An appropriate person for this responsibility would be an equipment manager because he or she typically is responsible for keys to locked gates or doors around the playing areas.  Initial Patient Assessment and Care 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.  Emergency Communication Communication is the key to quick and effective delivery of emergency care in any athletic trauma situation. Athletic trainers, other emergency team members, and EMS personnel must work together to provide the best possible care for injured athletes. Communication prior to an event is a good way to establish a positive working relationship between all groups of professionals. If emergency medical transportation is not available on site during a particular event, then direct communication with the emergency medical system at the time of injury or illness is necessary.  Emergency Communication A list of all appropriate emergency numbers, such as local emergency medical services, should be posted by the communication system most used by the athletic trainers and should be readily available to all emergency team members. Specific directions to on-site venues should also be included and posted with the emergency numbers. Emergency Communication  Emergency Equipment and Supplies All appropriate emergency equipment and supplies must be on hand at all athletic practices and events. All assigned emergency team members should be aware of the location and function of all emergency equipment and supplies. Ensure that emergency equipment and supplies are properly inventoried annually and stored in a secure storage area for safekeeping by the athletic training staff. Emergency Equipment and Supplies  Venue Locations The EAP for each venue should include information concerning the accessibility to emergency personnel, communications systems, emergency equipment, and emergency vehicle transportation.  Emergency Transportation The EAP should include a policy for transportation of the sick and injured for all athletic events. By definition, an emergency dictates that transport should be via EMS vehicles (ambulance). 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 also be considered when developing a transportation policy. Consideration should also be given to the level of transportation service and equipment that is available. An example of this would be that of Basic Life Support (BLS) versus Advanced Life Support (ALS) availability  Emergency Care Facilities The EAP should include information regarding the transportation directions to an emergency medical facility from all athletic venues. When selecting an appropriate emergency care facility, consider the proximity of the emergency facility to the venues and the level of care available at the facility  Emergency Care Facilities Notify the emergency care facility and local emergency medical services that are used by the athletic organization in advance of all athletic events that are scheduled at any of the organization’s venues. It is also recommended that the EAP be reviewed and practiced with both the emergency care facility administrators and medical staff in regard to important information concerning athlete care. An example of the information that must be reviewed is the proper removal of athletic equipment, such as football helmets and shoulder pads, in the emergency care facility  Legal Need and Documentation The National Athletic Trainers’ Association has stated that a well-organized and well- written EAP document that is regularly rehearsed is absolutely essential for all athletic organizations and sports medicine programs.  Legal Need and Documentation The following are important pieces of documentation needed as part of the EAP: 1. Athlete Emergency Information Card, used to describe current medical conditions and medications being used by the athlete. This card should only be used when there is written approval from the athlete in accordance with patient confidentiality considerations. 2. Individual Injury Evaluation Form, used for the documentation of the athlete’s injuries. 1. Delineation of the person or group responsible for documenting the events of the emergency situation. 2. Follow-up documentation on the evaluation of response to emergency situation. 3. Documentation on personnel training and regular rehearsal of the emergency action plan. 4. Documentation of purchase, inventory, and maintenance of all emergency equipment and supplies. 5. School/athletic organization coaches’ Emergency Information Palm Card, provided to members of the sports medicine team and coaching staff for easy EAP reference.