Respect the Unexpected

January 13, 2017

By Timothy Neal

Timothy Neal, MS, ATC, is Assistant Professor and Clinical Education Coordinator of the Athletic Training Education Program at Concordia University Ann Arbor. He can be reached at: timothyneal1957@gmail.com. 

Whether they work in the collegiate, secondary school, or clinic setting, athletic trainers take on many responsibilities in providing care to athletes and patients. One of the most important duties is to prepare for the unexpected—a medical emergency that can occur at any time. Athletic trainers should respect the unexpected nature of medical emergencies by preparing to effectively manage them and give the victim the best chance at a positive outcome.

As an athletic trainer with a good deal of experience in managing medical emergencies, I can attest to the importance of preparing for, and quickly and effectively responding to, a medical emergency in the athletic setting. My emergency management experiences range from using an AED on a game official experiencing sudden cardiac arrest to an acute subdural hematoma to a fractured larynx to anaphylaxis, along with dozens of fractures and dislocations. Based on these experiences, I would like to offer some considerations that may benefit the reader in developing their own emergency action plan (EAP). 

To start, there are numerous resources that athletic trainers can utilize in developing an EAP. One great resource is the 2002 NATA Position Statement titled, Emergency Planning in Athletics. In addition to this document, consider the following five items when developing your EAP:

1. Emphasize the athletic trainer

Make sure that the EAP includes that the athletic trainer should accompany the athlete or patient to the hospital, when applicable. The athletic trainer is the athlete’s advocate, represents the school, and can provide real-time history information that is critical in assisting in the athlete’s care in the emergency room.

2. Make it venue specific

Each athletic venue should have its own EAP posted in plain sight. It’s helpful to have it laminated and Velcroed to the wall so that it may be pulled off and used at the immediate site of the emergency. The EAP for each venue should be sent to local EMS so they can better familiarize themselves with it.

Other elements to include in a venue-specific EAP are:

• Steps to follow in making a call for assistance. The caller should introduce themselves, inform the emergency dispatcher of the nature of the emergency, and stay on the line until help arrives.

• The exact address of the venue. This will allow EMS to enter the address into their GPS for quicker response time in the event of an emergency.

• Description of a designated area where individuals will be sent to flag down an ambulance to bring to the emergency scene.

3. Practice the EAP

It should be standard procedure to practice the venue-specific EAP prior to the school year. It is recommended to meet with EMS to review the EAP and answer any logistical or procedural questions they may have. This meeting should also review the updated NATA Appropriate Pre-Hospital Management of the Spine-Injured Athlete plan. In addition, prior to each contest where an ambulance is present, it is recommended that the home and/or visiting team athletic trainers meet with the ambulance crew to review the emergency procedures for the game.

Approach each practice, conditioning session, and game as if an emergency will occur ... Stay focused and vigilant. Stay off your cell phone unless using it for an emergency—this includes texting.

4. Monitor certifications and equipment

Athletic trainers should be trained and practiced in airway management, bleeding control, spinal injury care, EpiPen use, inhaler use, and facemask removal. Document this training annually. CPR/AED certification should be updated and documented for all sports medicine staff, strength and conditioning coaches, and, ideally, all sport coaches.

Sports medicine departments should consider developing a daily check-off sheet for all emergency equipment. Designate an athletic trainer to check all AED batteries daily, and keep a log of all EpiPen and inhaler expiration dates in order to ensure that the equipment is ready to go each day.

Additionally, contact information for all athletes, coaches, and staff should be kept in the athletic training field equipment. This ensures the athletic trainer can quickly access it during an emergency to expedite care and communication.

5. Have the right attitude

Though practices, conditioning sessions, and games only make up 20 percent of an athletic trainer’s day, emergencies in athletics occur during physical activity 95 percent of the time. Some key items in being practically and mentally prepared for an emergency during physical activity include:

• Approach each practice, conditioning session, and game as if an emergency will occur. Check all equipment prior to the activity and locate the venue-specific EAP.

• Carry the school EAP on a card for every activity. In the event of an emergency, using the venue-specific EAP is recommended, but having access to the phone numbers of team physicians, hospitals, and athletic administrators on the school EAP is also helpful.

• Stay focused and vigilant. Stay off your cell phone unless using it for an emergency—this includes texting. The activity that the athletic trainer is providing care for, including a potential emergency, is the most important thing they are presently doing. Limit all distractions.

Though rare in occurrence, a medical emergency may present itself at any time in athletics. Proper and practiced preparation, good communication, and vigilance in detecting the emergency in its earliest stages will ensure a positive outcome for all involved.

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