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.
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.
Figure 1. Checklist for setting up an EAP
