Creating an Emergency Action Plan
By Dr. Gregory Rubin
In just a couple of weeks, many sports medicine physicians will head to the sideline for high school football. Although a low incident of catastrophic injuries occur in sports, an emergency action plan (EAP) can be the difference between life and death in the athlete. Sudden cardiac death accounts for the most deaths in young athletes (Jackie Reagan, 2019). In patients with a sudden cardiac event, the goal for first shock is less than 3 to 5 minutes (Jackie Reagan, 2019). The National Athletic Trainers Association says that every organization that sponsors athletic activities MUST have an EAP (JC Andersen, 2002).
In 2013 published in the British Journal of Medicine, Jonathan Drezner looked at outcomes from sudden cardiac arrest in US high schools. They enrolled 2149 high schools and looked at their emergency planning. They found that 83% of high schools had EAPs and 67% used local EMS to help create their EAP (Jonathan Drezner B. T., 2013). We like to think that our first responders are trained physicians, but Drezner found the most frequent first responders were administrators followed by athletic trainers (Jonathan Drezner B. T., 2013). A well-planned EAP can improve survival no matter who responds to an event. Drezner showed that in schools with an EAP, 79% of sudden cardiac arrest athletes survived and 44% survival rate was seen in schools without an EAP (Jonathan Drezner B. T., 2013).
For the purpose of this article, we will focus on the emergency action plan (EAP) for collision sports, as high school football season is just around the corner. However, an EAP should be present for every sport.
Creating an EAP
When creating an EAP, there are many samples available on the internet. The University of Connecticut Korey Stringer Institute has instructions on creating an emergency action plan. The seven components include emergency personnel, emergency communication, emergency equipment, medical emergency transportation, venue directions with a map, roles of first responders, and emergency action plan for non-medical emergencies (University of Connecticut, 2019).
The first step for an institution is to write down the process and steps for the emergency team members (JC Andersen, 2002). As we mentioned earlier, there are multiple samples available (JC Andersen, 2002). After the plan is formulated, the staff must be educated and copies disseminated to all involved parties (JC Andersen, 2002). The final phase is rehearsal of the plan with the athletic trainers and EMS (JC Andersen, 2002).
An EAP should be visible in public areas and is a set of instructions that provides a plan in response to a medical incident or emergency (Katie Rizzone, 2013). This can include steps in recognizing an emergency, calling EMS, stabilizing patient, and a map of facilities (Katie Rizzone, 2013). A sample EAP is shown below.
Due to the large number of athletes taking part in sports that are not covered by athletic trainers, we need to focus on the education of the coaches and game officials since they are on site. In youth football, it is recommended that coaches be educated on CPR and use of an AED (Katie Rizzone, 2013). Some of these protocols already exist as Pop Warner requires a CPR trained adult be present for all practices and games (Katie Rizzone, 2013). The AHA also endorses having coaches and athletic trainers trained in recognizing cardiac arrest and how to perform CPR and use the AED per guidelines (Mark Link, 2015). The need for coaches to provide CPR and AED use is even more glaring in sports outside of football because the majority of sports medicine physician coverage takes place at football games at the high school level (Douglas Aukerman, 2006). The variation in first responders makes it necessary to post the EAP in a location that is easily found and easy to interpret.
The NCAA also provided guidelines in their annual handbook regarding emergency action plans. They provided recommendations to the athletes and coaching staff regarding their involvement in serious on field injuries. To summarize, they advise players and coaches to return to their bench and not touch or move an injured player (NCAA Sports-Medicine Handbook, 2013-2014).
As part of the EAP, an automatic external defibrillator needs to be present and kept in good working order (JC Andersen, 2002). The EAP should include information on the type of defibrillator and how to use it in case the first responder is unfamiliar with how to use the AED and requires instructions (Jonathan Drezner R. C., 2007). The AED should be placed within a 3-minute walk from the field in order to provide the first defibrillation within 5 minutes (Jackie Reagan, 2019). The AED should be located within 3 minutes to both the main practice field and stadium, as Drezner found that 19% of the sudden cardiac arrests in US high schools occurred during practice or training and 46% were in student athletes or school visitors participating in activities on campus (Jackie Reagan, 2019). The AHA also recommends use of bag-valve mask and advanced airways in ACLS trained individuals (JC Andersen, 2002).n
EAPs can include the use of mobile phones, but a fixed working telephone should also be considered in case the primary system fails (JC Andersen, 2002). Prior to each game or practice, there should be a check of the communications system (Jonathan Drezner R. C., 2007). The EAP should also include the address of the venue so that the caller can notify EMS (Jonathan Drezner R. C., 2007).
A recent study published in the Journal of Athletic Training looked at the rates of secondary schools that had an EAP and if the school met the recommendations from the NATA guidelines. They found that only 53% of the 1030 trainers who responded to the survey rehearsed the EAP annually (Samantha Scarneo, 2019). They found that only 9.9% of schools met all 12 guidelines (Figure 1) in formulating and enacting an EAP (Samantha Scarneo, 2019). Based on this data, a team physician should review the EAP for the school that they are covering and make sure that it is being practiced annually.
An Emergency Action Plan is a necessary part of any institution hosting an event. However, it is not enough to just have an EAP, but to have regular practice and integration with local EMS. As highlighted above, we must get our coaches and staff educated on CPR and AED use. We encourage all physicians and ATCs to review and practice their EAPs prior to this football season.
Sample Football EAP from (Courson, 2007): Butts-Mehre Hall, Woodruff Practice Fields
ADDRESS: 1 Selig Circle, Athens, GA
Butts-Mehre Hall is located on Pinecrest Street (cross-street Lumpkin). Two entrances provide access to building:
Main entrance: front of building on Pinecrest Street (directly across from Barrow Elementary School).
Athletic training room entrance: rear of building, access from driveway off of Smith Street.
Football practice fields are located with two fields adjacent to Rutherford Street and two fields adjacent to Smith Street. Two gates provide access to football practice fields: Smith Street opens to artificial turf practice fields and access road. Gate on East Rutherford Street opens to grass practice fields.
GPS Coordinates (in event of the need for a medical helicopter transport): 33 56.54 / 83 22.83 (practice field 2)
Butts-Mehre Hall: certified athletic trainers, student athletic trainers, and physician (limited basis) on site in athletic training facility, located on first floor.
Football Practice Fields: certified athletic trainers and student athletic trainers on site for practice and workouts.
Butts-Mehre Hall: fixed telephone lines in Butts-Mehre Hall (000-000-0000) and athletic training facility adjacent to practice fields (000-000-0000).
Football Practice Fields: certified athletic trainers carry cellular telephones. Physician #1 name @ 000-000-0000; Physician #2 name @ 000-000-0000; Physician #3 name @ 000-000-0000. Fixed telephone line under practice shed (000-000-0000).
Butts-Mehre Hall: emergency equipment (AED, trauma kit, splint kit, spine board, ProPak vital signs monitor, Philips MRx 12-lead ECG/defibrillator) located within athletic training facility on first floor.
Football Practice Fields: emergency equipment (AED, trauma kit, splint kit, spine board) maintained on motorized medical cart parked adjacent to practice shed during practice; additional supplies maintained under practice shed; additional emergency equipment accessible from Butts-Mehre athletic training facility adjacent to track.
Roles of First Responders
Immediate care of the injured or ill student-athlete.
Activation of emergency medical system (EMS).
9-911 call (provide name, address, telephone number, number of individuals injured, condition of injured, first aid treatment, specific directions, other information as requested.
Notify campus police at 000-0000.
Emergency equipment retrieval.
Directions of EMS to scene.
Open appropriate gates (Smith Street gate has keycard entry; other gates secured with padlocks for M60 key).
Designate individual to “flag down” EMS and direct to scene.
Scene control: limit scene to first aid providers and move bystanders away from area.
Courson, R. (2007). Preventing Sudden Death on the Athletic Field: The Emergency Action Plan. Current Sports Medicine Reports, 93-100.
Douglas Aukerman, M. A. (2006). Medical Coverage of High School Athletics in North Carolina. Southern Medical Journal, 132-136.
Jackie Reagan, N. M. (2019). Automated External Defibrillator and Emergency Action Plan Preparedness Amongst Canadian University Athletics . Canadian Journal of Cardiology, 92-95.
JC Andersen, R. C. (2002). National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics. Journal of Athletic Training, 99-104.
Jonathan Drezner, B. T. (2013). Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED. British Journal of Sports Medicine, 1179-1183.
Jonathan Drezner, R. C. (2007). 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, 143-158.
Katie Rizzone, A. D. (2013). Sideline coverage of youth football. Current Sports Medicine Reports, 143-149.
Mark Link, R. M. (2015). Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators. Journal of the American College of Cardiology, 2434-2438.
(2013-2014). NCAA Sports-Medicine Handbook. Indianapolis: NCAA.org.
Samantha Scarneo, L. D. (2019). Emergency Action Planning in Secondary School Athletics: A Comprehensive Evaluation of Current Adoption of Best Practice Standards. Journal of Athletic Training, 99-105.
University of Connecticut. (2019, July 22). Emergency Action Plans. Retrieved from Korey Stringer Institute : https://ksi.uconn.edu/prevention/emergency-action-plans/