EMERGENCY PLANNING IN ATHLETICS HEATHER HARVEY, MA, ATC CHASE PAULSON, MS, ATC

OBJECTIVES Educate Provide Advocate Review Educate athletic administrators about the need for emergency planning Educate Provide guidelines in the development of an Emergency Action Plan (EAP) Provide Advocate documentation and implementation of emergency planning Advocate Review resources Review

THE AD’S NIGHTMARE Everyone is at risk for a medical emergency!! Athletes, coaches, students, staff, fans, and officials. Thursday afternoon, 950 with high humidity, thunder clouds in sight 4 sports in progress: JV football game at home, Frosh on the road, XC practice, Volleyball game in the gym 3:45 pm head injury occurs in the gym to your star volleyball player 3:55 pm a call comes through from the Frosh football coach “We had to call 911 for Johnny...I think it was his knee...mom & dad aren’t here...what do I do?” Your visiting JV football team is requesting ice for multiple injuries on their sideline A parent approaches you saying “I thought I saw lightning strike in the distance.” ...and your Athletic Trainer is out sick… Or your school doesn’t have one...

BACKGROUND Physical activity and youth sports trends in the United States The United States promotes physical activity and fitness, and as we know, youth sports are an essential element in that effort. More children play sports than ever before, with an increase in the number of girls participating of particular note. It is recommended that children and adolescents spend approximately 60 minutes a day engaged in physical activities, most of which should be aerobic exercise. Physical inactivity increases risk for heart disease, diabetes, colon cancer, high blood pressure and premature death. We also know that habits formed in youth can last a lifetime.

Not without risk... Asthma Exertional hyponatremia Catastrophic brain injuries Cervical spine injuries Diabetes Exertional heat stroke Exertional hyponatremia Exertional sickling Head-down contact in football Lightning Sudden cardiac arrest Unfortunately, physical activity is not without risk. If you’re following along with our interactive Q&A, take out your phone and submit a guess to this question: what are the ten most common ways athletes die while participating in athletics? Brain injury, sudden cardiac arrest, exertional heat stroke, exertional sickling, cervical spine fractures and other injuries and illnesses are all serious and potentially life- threatening. According to the National Athletic Trainers’ Association, as many as 50 young athletes die each year, the majority from sudden cardiac arrest. And, it’s not just about football. Risk is involved in almost every extra-curricular activity such as cheerleading and marching band. Fortunately, risks and adverse outcomes can be minimized or eliminated when secondary school athletes have proper equipment, available health care professionals and a safe environment.

RECOGNIZING THE NEED FOR EAPs Statistics of injuries and death in youth sports Public awareness SF Chronicle LA Times Benefits of a well-developed EAP There were 120 sports-related deaths of young athletes in 2008-2009 in the US; 49 in 2010; and 39 in 2011. Since 2010, there have been at least 25 student athlete deaths while participating in California alone. High school athletes suffer 2 million injuries, 500,000 doctor visits and 30,000 hospitalizations each year. There are three times as many catastrophic football injuries among high school athletes as college athletes. 62 percent of organized sports-related injuries occur during practices. These are frightening statistics; with proper planning at your site, it is possible to reduce the likelihood of negative outcomes to potential catastrophic injuries or emergency situations. Most injuries that you might have seen relating to athletics can be or have been relatively minor. However, potentially limb- or life-threatening emergencies in athletics or physical activity are unpredictable and can occur without warning. When something goes wrong during practice or a game, the public is quick to point the finger at the institution. Without a well documented, thorough emergency plan, schools are placed at risk for the possibility of legal liability. There are many benefits to having a well-developed EAP. Overall, this is a positive risk management strategy that may help lead to prevention of athletic injuries. Your personnel will all be equipped to effectively handle emergency situations. Having a plan will ensure that appropriate care is provided in a timely manner. It can decrease the chance of legal action taking place. It protects liability of athletic administrators and athletic trainers. Finally, it will lead to more effective emergency response, which will result in timely and effective care to your injured or ill student athletes. When accidents or emergencies occur, rapid and controlled response will likely make the difference between and effective and ineffective emergency response.

DEVELOPING YOUR PLAN Resources Self Analysis NATA Emergency Planning In Athletics NATA Preventing Sudden Death In Sports NFHS Recommendations Self Analysis Strengths Weaknesses Opportunities Threats The National Athletic Trainers’ Association recommends that each organization or institution that sponsors athletic activities or events develop and implement a written emergency plan. The NCAA has recommended that all member institutions develop an emergency plan for their athletic programs. The National Federation of State High School Associations has recommended the same standards at the secondary school level. Emergency plans should be developed by organizational or institutional personnel in consultation with local emergency medical services. It is recommended that each venue where athletic activity occurs should have a specific plan of action. Emergency plans should be reviewed and rehearsed annually, with written documentation of any modifications. The plan should identify responsibility for documentation of actions taken during the emergency, evaluation of the emergency response, institutional personnel training, and equipment maintenance. Training of the involved personnel should include automatic external defibrillation, cardio- pulmonary resuscitation, first aid, and prevention of disease transmission.

COMPONENTS OF A HIGH QUALITY PLAN Emergency personnel Emergency communication Emergency equipment Emergency transportation Components of the emergency plan include identification of the emergency personnel involved, an established mode of communication to summon emergency care, specification of the equipment needed to respond to the emergency, and identification of the mode of emergency transport. This can include the specification of the venue or activity location. Emergency plans should be reviewed and rehearsed annually, with written documentation of any modifications. The plan should identify responsibility for documentation of actions taken during the emergency, evaluation of the emergency response, institutional personnel training, and equipment maintenance. Training of the involved personnel should include automatic external defibrillation, cardio- pulmonary resuscitation, first aid, and prevention of disease transmission.

EMERGENCY PERSONNEL Personnel will vary Chain of Command Who is on your staff? Assign roles for each situation In an athletic environment, the first person who responds to an emergency situation may vary widely; it may be a coach or a game official, a certified athletic trainer, an emergency medical technician, or a physician. This variation in the first responder makes it imperative that an emergency plan be in place and rehearsed. With a plan in place and rehearsed, these differently trained individuals will be able to work together as an effective team when responding to emergency situations. The plan should also outline who is responsible for summoning help and clearing the uninjured from the area. Look at who you have on your staff for each team or sport and ensure that those individuals are given a specific role in each emergency situation. The chain of command should be delineated before practices or competitions begin.

EMERGENCY COMMUNICATION Access to a working phone or other telecommunications device, whether fixed or mobile, should be ensured. The communications system should be checked before each practice or competition to ensure proper working order. A back-up communication plan should be in effect in case the primary communication system fails. A listing of appropriate emergency numbers should be either posted by the communication system or readily available, as well as the street address of the venue and specific directions (cross streets, landmarks, and so on). Examples about cell phone use and ensuring batteries aren’t dead, coaches have contact numbers, etc. Walkie-talkie/radio communication?

EMERGENCY EQUIPMENT On site and readily available Appropriate equipment for the sport or competition Annually check the equipment To AED or not to AED? All necessary supplemental emergency equipment should be at the site and quickly accessible. To ensure that emergency equipment is in working order, all equipment should be checked on a regular basis. Also, the use of equipment should be regularly rehearsed by emergency personnel, and the emergency equipment that is available should be appropriate for the level of training of the emergency medical providers and the venue. It is imperative that health professionals and organizational administrators recognize that recent guidelines published by the American Heart Association call for the availability and use of automatic external defibrillators and that defibrillation is considered a component of basic life support. EDUCATION CODE - EDC 49417. (a) A public school may solicit and receive nonstate funds to acquire and maintain an automated external defibrillator (AED). These funds shall only be used to acquire and maintain an AED and to provide training to school employees regarding use of an AED. (b) Except as provided in subdivision (d), if an employee of a school district complies with Section 1714.21 of the Civil Code in rendering emergency care or treatment through the use, attempted use, or nonuse of an AED at the scene of an emergency, the employee shall not be liable for any civil damages resulting from any act or omission in the rendering of the emergency care or treatment. (c) Except as provided in subdivision (d), if a public school or school district complies with the requirements of Section 1797.196 of the Health and Safety Code, the public school or school district shall be covered by Section 1714.21 of the Civil Code and shall not be liable for any civil damages resulting from any act or omission in the rendering of the emergency care or treatment. (d) Subdivisions (b) and (c) do not apply in the case of personal injury or wrongful death that results from gross negligence or willful or wanton misconduct on the part of the person who uses, attempts to use, or maliciously fails to use an AED to render emergency care or treatment. (e) This section does not alter the requirements of Section 1797.196 of the Health and Safety Code.

EMERGENCY TRANSPORTATION Plan for transporting ill or injured student athletes Away events Transportation complications Onsite emergency services (?) The emergency plan should encompass transportation of the sick and injured. Emphasis should be placed on having an ambulance on site at high-risk events. Emergency medical services response time should also be factored in when determining on-site ambulance coverage. In the event that an ambulance is on site, a location should be designated with rapid access to the site and a cleared route for entering and exiting the venue. In the emergency evaluation, the primary survey assists the emergency care provider in identifying emergencies that require critical intervention and in determining transport decisions. In an emergency situation, the athlete should be transported by ambulance to the most appropriate receiving facility, where the necessary staff and equipment can deliver appropriate care. In addition, a plan must be available to ensure that the activity areas are supervised if the emergency care provider leaves the site to transport the athlete.

DOCUMENTATION Delineation of the person and/or group responsible for documenting the events of the emergency situation Follow-up documentation on evaluation of response to emergency situation Documentation of regular rehearsal of the EAP Personnel training Emergency equipment maintenance A written emergency plan should be reviewed and approved by sports medicine team members and institutions involved. If multiple facilities or sites are to be used, each will require a separate plan. Additional documentation should encompass the following: Delineation of the person and/or group responsible for documenting the events of the emergency situation 2. Follow-up documentation on evaluation of response to emergency situation 3. Documentation of regular rehearsal of the emergency plan 4. Documentation of personnel training 5. Documentation of emergency equipment maintenance It is prudent to invest organizational and institutional ownership in the emergency plan by involving administrators and sport coaches as well as sports medicine personnel in the planning and documentation process. The emergency plan should be reviewed at least annually with all involved personnel. Any revisions or modifications should be reviewed and approved by the personnel involved at all levels of the sponsoring organization or institution and of the responding emergency medical services.

BRINGING IT TOGETHER Your responsibilities as the Athletic Administrator/AD Overview of the components of your EAP Personnel Communication Equipment Transportation

DON’T REINVENT THE WHEEL CIF State Resources Event Emergency Guidelines Athletic Department EAP (example) Game & Crowd Management Guidelines Diamond Bar HS EAP Collaboration Athletic Trainers and EMS I’ll add screenshots of the CIF’s EAP etc. I want to make this a hyperlink?

Further questions? Heather Harvey - AB Miller HS HarvHM@fusd.net Chase Paulson - Diamond Bar HS cpaulson@wvusd.k12.ca.us