Emergencies will inevitably occur when interscholastic practices and competitions take place. It is the responsibility of all parties involved to be prepared to act in an appropriate manner by enacting an Emergency Action Plan (EAP).
An EAP is a written document that identifies the people involved in providing emergency care and the procedures they are to follow when those emergencies occur. These written EAPs should be distributed and reviewed by all parties involved in an emergency, including visiting staff. The EAP should be easily accessible and routinely practiced ensuring the best possible outcomes. They should be specific for practices and competitions, as well as being specific to location and activity.
1. Why have an EAP?
The National Federation of State High School Associations (NFHS) and the NATA (National Athletic Trainers’ Association) recommend the creation of an EAP for each venue that hosts events involving students, staff and spectators. It is important that the auditorium used for musical and theatrical events also have a detailed EAP just as venues that host athletic events.
Secondary school administrations have a professional and legal responsibility to establish an EAP for all activities hosted by the school. The absence of an EAP may put organizations and personnel at risk. Medical and environmental emergencies should be covered by the EAP. These should include but not limited to cardiac arrest, lightning, heat-related injuries, as well as active shooter incidents.
2. Who is involved with the EAP?
In high school athletics, the most likely to be affected requiring an emergency response are the athletes. However, do not forget to account for coaches, officials, administrators and spectators. The individuals tasked with responding to the emergency should have their roles clearly defined.
Ideally, injuries that occur on the playing field or court would be attended to by an athletic trainer or team physician, whereas injuries occurring in the stands would be the responsibility of another designated responder, who could be either an internal and external individual. Internal responders would include athletic trainers, coaches and administrators.
At times, it may be appropriate to recruit students (athletic training student aides) to play a role in the EAP if given proper training and instruction. External responders include emergency medical services such as Emergency Medical Technicians (EMTs), and hospital emergency room personnel. It is extremely important to coordinate EAP practice sessions with external responders prior to the season to ensure that all parties understand the roles and directives incorporated in the EAP.
It is not unusual for some EMS protocols to conflict with protocols adopted by the school. An example would be the “cool first, transport second” protocol for Heat Related Emergencies. School personnel and EMS should discuss the transfer of care of the patient to clear up any misunderstandings prior to an emergency.
3. What information should be included within the EAP?
All persons who are onsite and trained to perform life-saving rescue techniques should be identified within the EAP. Specific roles for each responding individual should be clearly determined.
4. Creating the EAP
The creation of the EAP should be a collaborative effort between all individuals involved in the care of emergencies. This should include administrators and athletic trainers, since they would primarily be the ones taking the lead. Communicate and discuss with the coaches to gain insight with respect to their specific practice and competition venues. Reach out to local EMS to ensure their vehicles can gain access to buildings and fields. Are the gates wide enough for their units? Once the EAP is created it should be placed in a location that is easily accessible by all.
5. Rehearsing the EAP
EAP rehearsals should be scheduled at regular intervals. All responders need to understand the chain of command before an emergency occurs. These incidents can be very chaotic in real time if not practiced beforehand.
While the principal is “in charge” during the school day, the appropriate health care professional, e.g., the athletic trainer, may be in charge when an athlete suffers an emergency incident. The last thing a patient needs to hear is the responders arguing over who is in charge.
EAP team members also need to know the location of the emergency equipment and its proper use. This information should be communicated to each visiting team. A simple card that contains the facility address, emergency phone numbers for on and off campus assistance, and the locations of emergency medical equipment can mean the difference between life and death for the patient. It is strongly recommended that a “Medical Time-out” be held prior to the start of a contest with the visiting medical staff, officials, administrators and coaches to review proper procedures and location of emergency equipment.
These “Medical Time-outs” are commonplace at the professional and collegiate sports levels. Being proactive always outweighs a reactive approach. The need to practice the EAP cannot be overstated. After the practice, debrief all the participating members. What went well? What needs to be improved? Is there a better way to access the playing field, gym or pool? Was everyone aware of their role?
When it comes to preparation for an event, planning is crucial. The time taken in planning for an emergency is well worth it, especially for the injured party. The health and well-being of the individuals participating in or watching the event is paramount. It is the responsibility of the host to ensure that they are providing the best care possible when it is needed the most.
Reach out to your school’s/team’s athletic trainer for assistance in creating, implementing and rehearsing your EAP. If an athletic trainer is not available, a template is available from the NATA EAP Position Statement.
Lynne Young, M.Ed, LAT, ATC, is a certified athletic trainer with over 25 years’ experience. She is employed by Orthopedic Physicians Alaska and assists with outreach coverage to local schools in Alaska. She is a past member of the NFHS Sports Medicine Advisory Committee (SMAC) and currently is a member of the Alaska School Activities Association SMAC. Mark D’Anza became a licensed athletic trainer in Nevada in 2006. He began at Durango High School in Las Vegas in 2008 as the athletic trainer before becoming a full-time teacher in 2013, and he continues in that role. D’Anza is a per diem athletic trainer for Dignity Health Physical Therapy. He serves as the District 8 representative to the Secondary Schools Athletic Trainers’ Committee for the National Athletic Trainers’ Association.