July 24 th 2015 AHSAA ALL-STAR WEEK Presented by Dr. Lawrence “Larry” Lemak Major League Soccer (MLS), Chief Medical Officer Pop Warner Football, Medical Advisory Committee National Federation of High Schools (NFHS), Sports Medicine Advisory Board EMERGENCY ACTION PLANNING

HS FOOTBALL PLAYER DIES AFTER TACKLE HS FOOTBALL PLAYER DIES AFTER TACKLE Published by CNN June 23, 2015

BREAKDOWN OF CATASTROPHIC SPORTS INJURIES/FATALITIES AS REPORTED TO THE NFHS SPORTINJURIESFATALITIES*TOTAL FOOTBALL16925 BASKETBALL112 TRACK AND FIELD033 BOYS LACROSSE101 WRESTLING101 BASEBALL011 TOTALS191433

NATIONAL CENTER FOR CATASTROPHIC SPORT INJURY RESEARCH MISSION The mission of the National Center for Catastrophic Sport Injury Research (NCCSIR) is to conduct surveillance of catastrophic injuries and illnesses related to participation in organized sports in the United States at the professional, collegiate, high school, and youth levels of play. The goal of the Center is to improve the prevention, evaluation, management, and rehabilitation of catastrophic sports-related injuries. The most common types of fatal events are acute trauma to the head/neck/spine, exertional-related heat events, exertional-related cardiac events, and disruption of cardiac rhythm due to blunt chest impacts (commotion cordis). National surveillance of catastrophic sports-related injuries conducted by the NCCSIR over the last thirty years has facilitated the introduction of numerous sports safety interventions.

GOALS OF EMERGENCY ACTION PLAN 1.Develop the Emergency Action Plan 2.Disseminate the Emergency Action Plan 3.Practice the Emergency Action Plan 4.Review the Emergency Action Plan

WHAT IS AN EMERGENCY ACTION PLAN (EAP)? A written document that defines the standard of care for the management of emergencies. Provides an outline of the policies and procedures well in advance of an emergency to establish protocols and avoid debate/confusion about critical decisions during the emergency. Helps facilitate a prompt, efficient, coordinated response in a medical emergency.

Preventing Sudden Death on the Athletic Field: The Emergency Action Plan Ron Courson, ATC, PT, NREMT-I, CSCS Current Sports Medicine Reports 2007 SCIENTIFIC SUPPORT

SUDDEN CARDIAC ARREST Sudden Cardiac Arrest (SCA) is the leading cause of death in young athletes. Proper management of SCA in the athletic venue is critical. Preparation should include education and training, maintenance of emergency equipment and supplies, appropriate use of personnel, and the information and implementation of an emergency action plan (EAP).

National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics J.C. Anderson; Ronald W. Courson, Douglas M. Kleiner, and Todd A McLoda Journal of Athletic Training 2002 SCIENTIFIC SUPPORT

NATA POSITION STATEMENT 12 KEYS TO EAPs 1.Each organization must have a written emergency plan. EAP must be comprehensive and practical, yet flexible and adaptable. 2.Emergency plans must be written documents and should be distributed to all personnel and developed in a consultation with local emergency medical services personnel. 3.Identifies the personnel involved in carrying out the EAP and all involved personnel should be trained in AED, CPR, first aid, and prevention of disease transmission.

NATA POSITION STATEMENT 12 KEYS TO EAPs 4.The emergency plan should specify the equipment needed to carry out the tasks and location of equipment. The equipment available should be appropriate to the level of training of the personnel involved. 5.Establishment of a clear mechanism for communication to appropriate emergency care providers and identification of the mode of transportation for injured participant. 6.EAP should be specific to the activity venue. Each activity site should have a defined emergency plan that is derived from the overall organizational policies on emergency planning.

NATA POSITION STATEMENT 12 KEYS TO EAPs 7.Emergency plans should develop, incorporate, and notify the emergency care facilities to which the injured individual will be taken. 8.The emergency plan specifies the necessary documentation supporting the implementation and evaluation of the emergency plan. 9.The emergency plan should be reviewed and rehearsed annually or as frequent as necessary. The results of these reviews and rehearsals should be documented.

NATA POSITION STATEMENT 12 KEYS TO EAPs 10.All personnel involved with the organization and sponsorship of athletic activities share a professional responsibility to provide for the emergency care of an injured person. 11.All personnel involved with the organization and sponsorship of athletic activities share a legal duty to develop, implement, and evaluate an emergency plan for all sponsored athletic activities. 12.The emergency plan should be reviewed by the administration and legal counsel of the sponsoring organization.

EAP EXAMPLE: ANYONE CAN SAVE A LIFE

NFHS Offers New "After-School“ Emergency Response Training Program July 15, 2015 EAP EXAMPLE

Emergency Personnel – Describe the emergency team involved when the EAP is activated and the roles of each person. Emergency Communication – What communication devices are available, where, what number to call in an emergency, specific information and directions to the venue to provide to EMS response team. Emergency Equipment – Location of equipment should be quickly accessible and clearly listed. Equipment needs to be maintained on a regular basis. Medical Emergency Transportation – Describe options and estimated response times for emergency transportation. Venue Directions with a Map – (should be specific to the venue, and provide instructions for easy access to venue) Roles of First Responders – Establish scene safety and immediate care of the athlete, activation of EMS, equipment retrieval, direction of EMS to the scene Emergency Action Plan for Non-Medical Emergencies – These emergencies can refer to the school emergency action plan if one is in place

EAP EXAMPLE Allows athletic directors, coaches, and park and recreation directors the ability to answer a series of questions that will help build a customized EAP for a specific sports venue. The utility will help provide some general visualizations/site maps in order for user to customize their own rendering of a venue and assign responsibilities for emergency.

EXAMPLE OF EAP VISUALS USED AT A FOOTBALL FIELD OR STADIUM

EMERGENCY ACTION PLAN (EAP): EMERGENCY ACTION PLAN (EAP): WHY IT IS NECESSARY BUT DIFFICULT Rare events Will never happen to me! What do I do now? Multiple venues Must be venue specific Multiple individuals involved School and local EMS staff Constant turnover in personnel AD’s, coaches, AT’s Takes prep time and practice

THE EMERGENCY ACTION PLAN Can be recommended or mandated at state level Only works on a very local level Building by building Field by field Sport by sport Must have a plan in place: Must be for each team and each venue Phone access Field access AED access Local EMS has to be involved from beginning

MOST COMMON CAUSES OF DEATH OR CATASTROPHIC INJURY Medical Conditions Sudden Cardiac Arrest PPE, AED, EAP Asthma Medical management plan Diabetes Medical management plan Exertional sickling Suspicion/screening individual adjustments Traumatic Injury Catastrophic brain injuries Cervical spine injuries Environmental Conditions Lightning Recognize and respond Exertional heat stroke Plan, Monitor, Cool, Transport Behavioral Exertional hyponatremia Don’t overhydrate Suicide Awareness-Communication

EAP FOR EVERYBODY Everyone is at risk for a medical emergency - athletes, coaches, students, fans, and officials Facilities used for PE classes, rec and youth leagues Guidelines can be applied to entire campus Great opportunity for cooperation between school and local EMS

EAP EAP PLANNING TO AVOID CONFLICT Helmet/Facemask removal must be addressed when pertinent Must discuss with home team if you are on the road Must have someone in charge at each level- in organization, sport, site Must practice at least yearly with all involved

EAP EAP TRAINING AND AVAILIBILTY Multiple programs across US to increase AED access and availability

EAP EAP PRACTICE, PRACTICE, PRACTICE Takes prep time and practice “Typically don’t rise to the occasion, but default to level of training”

PEOPLE ARE WATCHING

GOALS OF EMERGENCY ACTION PLAN 1.Develop the Emergency Action Plan 2.Disseminate the Emergency Action Plan 3.Practice the Emergency Action Plan 4.Review the Emergency Action Plan

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