Jan 29, 2015Prepared For The Worst
By Ryan Johnson
Do you have an emergency response plan for when a crisis occurs at your facilities? Wayzata High School in Plymouth, Minn., does. Recently, that plan was put to the test when an athlete had a seizure. Ryan Johnson, CSCS, Strength and Conditioning Coach and Coach Practitioner at the school, was first on the scene and blogs about the lessons he learned from the incident.
Injuries can and will occur in a weightroom, and most coaches and athletes know how to react when they do. Medical emergencies, however, are a completely different story and it has been my experience that no amount of planning can fully prepare you for every situation. As a volunteer firefighter and first responder for the past six years, I’ve learned the importance of establishing a base plan of action that allows you and your support staff to hit the ground running should something happen.
Last month, our plan was tested when an athlete had a seizure in our gym while going through a series of agility drills. The athlete was okay, and overall, I was pleased with our response. However, I did walk away from the situation having realized that our plan could use some minor improvements. Learning from each experience and adjusting your plan accordingly is an important part of the process.
Planning for our emergency response begins at the start of every season. On the first day of each term, I talk to administrators, coaches, and students about our emergency protocol, which starts with someone dialing 911. I also explain to my classes where our training room is located and how to gain access with my keys should an accident occur and I need something out of the room. And I just recently ordered a wall mounted first aid kit to have installed in a highly visible location. This provides easy access in the event of any injury while also showing the community that we have safety measures in place.
So, to set the scene for our most recent incident: The athlete hit the floor during a morning training session and one of his teammates immediately ran over an apprised me of the situation. I jogged over to the athlete and quickly realized he was having a seizure. I calmly grabbed the young man’s wrist and began monitoring his pulse as well as his respirations while making sure that his airway was open.
Looking at my watch, I was able to determine how long the seizure lasted, which is important news to pass along to his doctors. During this time, a number of coaches arrived on the scene and our emergency plan went into action.
Having taken the lead in the situation, my job was to remain calm, keep a level head, and speak slowly and directly to the rest of the staff. My training as a first responder has taught me that if your voice and actions become accelerated, so will the tension and mood in the room. Remain calm and speak clearly but firmly, so everyone knows that you are in control.
I told one coach to call 911 and direct the ambulance to an entrance at the side of our gymnasium, as it was the nearest door to the athlete. Our school is a quarter mile long, and given this expanse, that detail was vital. I didn’t want the ambulance parking in front of the main entrance, which is a long distance from the room, and I didn’t want it in front of the main athletic entrance because the incident occurred right before the start of the school day and I did not want traffic to be an issue.
Next I informed the coaches that the individual was having a seizure and the best thing to do was keep him stationary, make him comfortable, and let it run its course. They knew I was monitoring him and the paramedics were on the way. The coaches moved the remaining 75 athletes to the other side of the room and modified the drill so it wouldn’t interfere with what I was doing. Keeping the kids busy was important because the seizing athlete was in the doorway, and I didn’t want a bunch of kids trying to step over him as they exited the room.
As the seizure passed, the athlete slowly came around. Often, individuals come out of a seizure having no idea what happened, especially if it is the first episode, which in this case it was. The athlete awoke considerably confused, so I told him who I was and where he was.
During this time, I also assessed his level of consciousness by using the AVPU (Alert, Voice, Pain, Unresponsive) scale. It’s important to note any time an individual is anything other than fully alert and share that information with the paramedics so they can relay it to the ER doctors. The kid had been unconscious, but regained consciousness within a minute and a half and was somewhat alert in three minutes.
As the athlete became more alert, I asked him for his father’s phone number and began a series of questions that is part of a medical first responders course of action. This round of questions assesses patients and follows the acronym of SAMPLE: • Signs and Symptoms • Allergies • Medications • Past Medical history (has this happened before?) • Last oral intake, (food or drink) • Events leading up to this incident.
As this was going on, our head football coach went to the main office to inform the principal of what was going on. Our top assistant football coach was in charge of addressing the team and letting them know that the player had a seizure, but that he was going to be okay. Our athletic director met the ambulance at the ER, which was great because it allowed me to to talk to the attending physician on the AD’s cell phone and describe exactly what had occurred.
A CT scan and an MRI showed no evidence of anything out of the ordinary and the doctors determined the athlete had a high white blood cell count and had been dealing with flu-like symptoms off and on for a week prior to this incident. They speculated that he had a viral infection of some sort that contributed to this particular episode. Because he was determined to be in good health otherwise, the doctors felt that no further tests were needed and released him.
Despite such a scary incident, the athlete was back in school by lunchtime. He has not had another episode since.
The situation taught me and our staff that no amount of planning on paper can fully prepare you for every situation, but having the base plan established is vital to creating a calm and controlled environment. During a debriefing after the situation, the coaches, administrators, and I determined that our weakest moments came when the paramedics arrived and the communication between coaches was interrupted, which we chalked up to our human nature to step back and not interfere with the chain of command. For example, I had been in charge, but once the paramedics came, I left the scene to phone the athlete’s parents, which disrupted the communication link between the the athlete and our staff. In hindsight, had I stepped back but stayed near the athlete, I could have directed our coaches better.
However, all in all, I felt that our plan contributed to the situation’s successful outcome. And the next time a medical emergency occurs, our staff will have even more confidence in the plan and their role in making it work.