National Study on Emergency Action Plans for High School Athletics Nita Unruh, Ed.D. Scott Unruh, Ed.D., ATC University of Nebraska Kearney

Background for Study Death of 15 year old High School Football player Max Gilpin at Pleasure Ridge High School in Louisville, Kentucky. – Settled for $1.75 Million Presentation at 2010 SRLA by Moorman, Greenhalgh, Hambrick, & Simmons on Gilpin case and Kentucky HB 383.

Issues Connected with the need for an EAP Duty to plan Need to assess an athletes physical fitness to participate Need to supervise Need to maintain safe playing conditions Duty to provide proper emergency care Need to have an Emergency Action Plan

Study Information N=4394 – Randomly selected 10% of high schools from all 50 states – Used the Clell Wade State Coaches Directory Used Qualtrics Survey Program 29.76% response rate (1308) Responses from all 50 states

Title of Individual Completing Survey

Size of Schools that Responded

SPORT# of Schools reporting sport teams SPORT# of Schools reporting sport teams BOYS BASKETBALL1169GIRLS TENNIS794 GIRLS BASKETBALL1162WRESTLING793 TRACK & FIELD1108BOYS TENNIS767 FOOTBALL1074SWIM/DIVE610 GIRLS VOLLEYBALL1067FIELD HOCKEY174 SOFTBALL1025ICE HOCKEY169 BASEBALL1020GYMNASTICS133 CROSS COUNTRY1020WATER POLO90 BOYS GOLF998RUGBY28 BOYS SOCCER838RODEO12 GIRLS SOCCER816 GIRLS GOLF797OTHER176

Emergency Action Plans ¼ of institutions did not have an EAP for athletic practices or events!

EAP Mandated for Practice and Competition

Practiced a Full Scale EAP for the following Events

Results based upon emergency preparedness for athletic practices

Training of Coaches and Athletic Staff YESNo Coaches and Staff Regularly trained in CPR Coaches and other athletic personnel trained for response to emergency situations

Percentage (n) of Schools That Reported Having a Certified/Licensed Athletic Trainer on Staff N=438 N=622 *604 ATCs to intervene in an emergency

Number and Percentage of Schools by size Reporting having an Athletic Trainer on Staff The N for the category of schools with 50 or below students was to small for the data to be generalizable.

Persons Responsible for Making Decisions Concerning Emergency Scenarios at Practice

How Prepared are you at an Athletic Practice to Handle the following:

Equipment Available for Practices 77% of schools said that emergency equipment was regularly maintained.

Person responsible for making EAP Decisions at practice and the availability of Equipment for Cardiac Emergencies Person ResponsibleYes Equipment Specifically AED No Coach Athletic Trainer School Nurse433 Athletic Director695 Other11103

Person responsible for making EAP Decisions at practice and the availability of Equipment for Heat Illness Person ResponsibleYes Equipment Specifically Cooling Tub No Coach Athletic Trainer School Nurse342 Athletic Director932 Other1152

Person responsible for making EAP Decisions at practice and the availability of Equipment for Head Injuries Person ResponsibleYesSpec. Face Mask Spec. Spine Board No Coach Athletic Trainer School Nurse7535 Athletic Director8424 Other181655

Recent literature supports the assertion that between 45% – 50% of injury occurs in practice situations. Substantial risk exists in the event of extended time for emergency response due to rural settings.

Results based upon emergency preparedness for competitive events

Number of Schools That Reported Having the following present at Athletic Competitions N=438

Persons Responsible for Making Decisions Concerning Emergency Scenarios at Athletic Competitions

How Prepared are you at an Athletic Competition to Handle the following:

14 of the 50 states solicited had 30 or more schools respond. The results from those schools present responses that are more generalizable to the broader population.

Mandate for Emergency Action Plans Statistical Analysis When the individual completing the response was an Athletic Director/Activity Director, there was significant difference (p<.000) in how the respondents identified the “mandate” to have EAPs for athletic events. Some viewed that the mandate was required by state legislation or by the state high school activity association. Others responded that EAPs for an athletic event were not mandated.

Further discussion and findings We could find no state statutes were in place for the requirement of EAPs for athletic events (competition or practice). School size is typically indicative of employing an ATC for supervision practices and events. In most cases, ADs were the person who were responsible for making decision in cases of threat by weather. Institutions that had ATCs, were better prepared and had equipment available to handle emergencies. Interestingly, a number of schools who rely on coaches for decision making in cases of heat illness indicate that they do not have the proper equipment ready to handle the case. Immersion is standard of care of heat stroke. AEDs in place Creation and implementation of EAPs for all athletic events. (Position statements)

National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics. Journal of Athletic Training 2002;37(1):99–104 Inter-Association Task Force recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement. Journal of Athletic Training 2007;42(1):143–158 Appropriate medial care for secondary school age athletes: A Consensus Statement. Feb Inter-Association Task Force on Exceptional Heat Illness. A Consensus Statement Pre-hospital Care for the Spine Injured Athlete. Inter- Association Task Guidelines. 2001

So Where does that Leave Us? Emergency Action Plans are essential to a Risk Management Plan. There is Standard of Care established by a variety of medical groups that support proper training and provision for medical emergencies at the high school setting. Many schools did not provide guidelines, equipment or trained personnel to deal with serious medical emergencies, especially for the practice environment.