1. Emergency Action Plans (EAP)
Michael D. Milligan M.D. CAQSM
Andrews Institute
Gulf Breeze, FL

2. Objective
Define the purpose and responsibility of the EAP

3. Emergency Action Plan
The Emergency Action Plan (EAP) is a document

5. Emergency Action Plan
The Emergency Action Plan (EAP) is a document Plan of Action Steps that should occur in the event of Injury or Emergency Should be Written and Rehearsed

6. Emergency Action Plan Why? Health, safety, and welfare of
Student-athletes
Staff
Fans

7. Emergency Action Plan
What are we preparing for? Urgencies and Emergencies What is the most common cause of death on high school campuses? Cardiac: Sudden Cardiac Death

8. Emergency Action Plan
Four Conditions represent 94% of deaths in Secondary School Athletics Heart Head [neck and brain injury] Heat [heat stroke] Hemoglobin [sickle cell trait] (Lightning)

9. Emergency Action Plan
Heart, Head, Heat, Hemoglobin (Lightning) Create a document that prepares for these conditions

10. Heart
EAP (Emergency Action Plan) CPR (CardioPulmonary Resuscitation) AED (Automated External Defibrillator) Goal: 1 minute Collapse to Pads Survival rate declines 7-10% per minute* With CPR, survival declines 3-4% per minute*

11. Heart Standards for High School Athletics
AED program under physician supervision (medical director)
Select school staff trained and certified
AED accessible and good signage
AED accessible - All school sanctioned athletic events/activities
ATC, coaches, administrators, school nurses, PE teachers
AED within 3 minutes – each venue (practices, games, events)
Coaches and select staff – CPR and AED trained
AED locations – well marked, publicized, and known
AED application anytime athlete collapses and is unresponsive, while EMS/911 and CPR
AED inspections (manufacturer recommendations)

12. Exertional Heat Stroke Medical Emergency

13. Exertional Heat Stroke
Management
EAP (Emergency Action Plan)
Core body temperature
ICE WATER IMMERSION
Slow RTP
Cool First,
Transport Second

14. Heat
Standards for High School Athletics Wet Bulb Globe Temperature Policy Heat modification policy for any sanctioned activity Heat policy based off of WBGT Regional specific policy At least 4 steps of modification Equipment modifications (sports specific) Work:Rest ratio modifications Total practice time modifications Modifications of water breaks Shaded area for rest breaks
Temperature
Humidity
Wind speed
Sun angle
Cloud cover

15. Heat
Standards for High School Athletics Heat Acclimatization Policy Day 1-5 of practice – maximum 1 per day Total practice time not greater than 3 hours any day 1 hour walk through allowed days 1-5 (3 hours between practice & walk through) Football Specific equipment policy Double practice policies Athletic Trainer present for preseason practices (higher risk)

16. Head Head and Neck Injuries

17. Contact & Collision Sports
Baseball Basketball Diving Field Hockey Football Gymnastics (Cheer) Ice Hockey
Lacrosse Pole Vaulting Rugby Soccer Softball Water Polo Wrestling
9% of all Spinal Cord Injuries occur in sports and recreation

18. Head
Standards for High School Athletics Concussion Policy Certified helmets/equipment Preparticipation exam should included concussion questions Preseason education for personnel, coaches, and athletes Athletes suspected of sustaining a concussion should not be permitted to return to any exertional activity on same day Athletes suspected of a concussion – no return to participation without written release (Physician/ATC) No return to sports without return to school Return to Play progression EAP for potentially life-threatening injuries and referral plan Comprehensive medical-management plan for acute care of a potential head or neck injury

19. Hemoglobin
Sickle Cell Trait

20. Hemoglobin Sickle Cell Trait (SCT)
Normal Hemoglobin Gene (HbA) & Abnormal Beta globin sickle gene (HbS)
8% of blacks in the US
0.8% of nonblacks
Randy Eichner MD – Oklahoma – retired. Most of the early work in college athletics

21. Hemoglobin Sickle Cell Trait (SCT)
Muscle “cramps”
Pain in muscle, muscle is soft
Dyspnea
Chest Pain
Abdominal Pain
Mental Status Changes

22. Hemoglobin Sickle Cell Trait (SCT)
Collapse of a SCT Athlete is a Medical Emergency
Presentation of Sickle Cell Trait Crisis
Oxygen!
IVF
(cardiovascular collapse, renal & other end organ injury)
Cooling
(may lower risk of development of rhabdo)
Transport
Educate EMS & ED

23. Lightning

24. Emergency Action Plan Responsibility Coaches Athletic Directors
Collaborators
Athletic Trainers
Team Physicians
EMS
Assistant Coaches
Administrators
Student Athletes
All Venues
Copy in the Athletic Directors Office
Abbreviated Copy at Each Venue

25. Emergency Action Plan
Things to Consider: Every Coach should know ALL AED locations Every Student-Athlete should know ALL AED locations What is your protocol for reviewing the EAP with the visiting team? When your team travels to other schools do your coaches review the EAP and identify the location of the AED?