KIN 188 – Prevention and KIN 188 – Prevention and Care of Athletic InjuriesCare of Athletic Injuries

Emergency Plans and Emergency Plans and EquipmentEquipment

IntroductionIntroduction

Coverage considerationsCoverage considerations

Emergency response personnelEmergency response personnel

Emergency plan componentsEmergency plan components

Emergency care equipment and Emergency care equipment and suppliessupplies

Coverage ConsiderationsCoverage Considerations

During practices, ATC is typically the only During practices, ATC is typically the only health care professional in attendancehealth care professional in attendance

During games, often team physicians During games, often team physicians present in addition to ATCpresent in addition to ATC

During games for contact sports, often During games for contact sports, often have on-site ambulance coverage per have on-site ambulance coverage per contract arrangement – set up before contract arrangement – set up before season startsseason starts

Emergency Response Emergency Response PersonnelPersonnel

Certified athletic trainer (ATC)Certified athletic trainer (ATC)

Team physicianTeam physician

EMS personnelEMS personnel EMT and/or paramedicEMT and/or paramedic Fire department vs. ambulanceFire department vs. ambulance

Coaches and administratorsCoaches and administrators

OthersOthers

Certified Athletic Trainer Certified Athletic Trainer (ATC)(ATC)

Typically responsible for set up of emergency Typically responsible for set up of emergency equipment and method of communication for equipment and method of communication for eventsevents Requires perspective on type of equipment necessary, Requires perspective on type of equipment necessary,

accessibility of the equipment and knowledge of useaccessibility of the equipment and knowledge of use

Typically the first responder to emergency Typically the first responder to emergency conditionsconditions May direct care on own or summon additional personnel May direct care on own or summon additional personnel

for assistancefor assistance

Manages situation in absence of team physicianManages situation in absence of team physician Requires trust, communication amongst emergency Requires trust, communication amongst emergency

response team membersresponse team members

Team PhysicianTeam Physician

Ultimately responsible for directing care in Ultimately responsible for directing care in emergency conditions, even if not present at emergency conditions, even if not present at sitesite Pre-season planning and communication are key Pre-season planning and communication are key

elements to having viable emergency responseelements to having viable emergency response

If on-site, often not initial evaluator but If on-site, often not initial evaluator but typically summoned for assistance once typically summoned for assistance once circumstances of situation are identifiedcircumstances of situation are identified May be able to administer some forms of May be able to administer some forms of

emergency care ATC is unable to do while EMS is emergency care ATC is unable to do while EMS is activated (IV, advanced airways, etc.)activated (IV, advanced airways, etc.)

EMS PersonnelEMS Personnel

Variability across country regarding initial response when Variability across country regarding initial response when EMS activated – critical to know specifics in your areaEMS activated – critical to know specifics in your area Initial response may be from fire department with or without Initial response may be from fire department with or without

paramedicsparamedics Initial response may be from local ambulance service, again with Initial response may be from local ambulance service, again with

or without paramedicsor without paramedics Regardless of personnel, they work under protocols from Regardless of personnel, they work under protocols from

hospital or county medical director – communication key to hospital or county medical director – communication key to minimizing “turf wars”minimizing “turf wars”

EMTEMT Trained primarily to stabilize patient and prepare for Trained primarily to stabilize patient and prepare for

transportation (BLS) – role growing with technology (AED, etc.)transportation (BLS) – role growing with technology (AED, etc.) ParamedicParamedic

Has advanced training in pre-hospital care (ALS)Has advanced training in pre-hospital care (ALS) Able to administer IVs and medications as well as cardiac Able to administer IVs and medications as well as cardiac

monitoring, advanced airway management and intubation, monitoring, advanced airway management and intubation, defibrillationdefibrillation

Coaches and AdministratorsCoaches and Administrators

Primary responsibility is to follow instructions Primary responsibility is to follow instructions of ATC/team physician/ EMS personnel to of ATC/team physician/ EMS personnel to assist in providing care when necessaryassist in providing care when necessary

Administrators often present at games and Administrators often present at games and can have vital role in emergency plan from a can have vital role in emergency plan from a facility accessibility and/or communication facility accessibility and/or communication standpointstandpoint

Ideal if all coaches and administrators Ideal if all coaches and administrators required to have first aid and CPR certificationrequired to have first aid and CPR certification

OtherOther

Other personnel that may be present Other personnel that may be present or nearby and called upon for or nearby and called upon for assistance in emergency situationassistance in emergency situation School nurseSchool nurse TeacherTeacher Parent (ideally not of injured individual)Parent (ideally not of injured individual) Police officer (often present at games for Police officer (often present at games for

security concerns)security concerns)

Emergency Plan Emergency Plan ComponentsComponents

Steps to be taken in emergency Steps to be taken in emergency situationsituation

Communication considerationsCommunication considerations Equipment considerationsEquipment considerations Transportation – emergency care Transportation – emergency care

facilitiesfacilities Record keepingRecord keeping Training of personnelTraining of personnel

Emergency Plan StepsEmergency Plan Steps

Prior to emergency situation occurringPrior to emergency situation occurring Proper certification of personnel (CPR, etc.)Proper certification of personnel (CPR, etc.) Proper clearance for participation for all individuals – via PPEProper clearance for participation for all individuals – via PPE Emergency contact information current for all individuals Emergency contact information current for all individuals

(insurance, phone numbers, pertinent medical history, etc.)(insurance, phone numbers, pertinent medical history, etc.) Personnel perspective on location and accessibility of Personnel perspective on location and accessibility of

emergency equipmentemergency equipment Communication methods and location/accessibility – for Communication methods and location/accessibility – for

activation of EMS as well as for summoning personnel and/or activation of EMS as well as for summoning personnel and/or equipment to emergency site (hand signals vs. walkie-talkie)equipment to emergency site (hand signals vs. walkie-talkie)

Emergency Plan StepsEmergency Plan Steps

Prior to emergency situation occurringPrior to emergency situation occurring Personnel (including local EMS) familiar Personnel (including local EMS) familiar

with accessible routes to all facilities with accessible routes to all facilities (directions, gates/keys, etc.)(directions, gates/keys, etc.)

Different emergency plans for each facilityDifferent emergency plans for each facility Will team physician and/or EMS be Will team physician and/or EMS be

present – if so, where located and how present – if so, where located and how summonedsummoned

Communication of emergency procedures Communication of emergency procedures to visiting team personnelto visiting team personnel

Emergency Plan StepsEmergency Plan Steps

In the event of an emergency situation, all In the event of an emergency situation, all personnel must have understanding of personnel must have understanding of roles and responsibilitiesroles and responsibilities Who is initial evaluator?Who is initial evaluator? Who will activate EMS? How/where done?Who will activate EMS? How/where done? Who will bring necessary equipment to site?Who will bring necessary equipment to site? Who has access to locked gates/doors?Who has access to locked gates/doors? Who will direct EMS once they arrive on scene?Who will direct EMS once they arrive on scene? Who makes decisions about transportation of Who makes decisions about transportation of

injured individual?injured individual?

Emergency Plan StepsEmergency Plan Steps

After an emergency occurrenceAfter an emergency occurrence Who will contact parents/guardians and/or administrators?Who will contact parents/guardians and/or administrators? Completion of medical records for documentation of eventCompletion of medical records for documentation of event

Information provided to EMS at time of activationInformation provided to EMS at time of activation Type of emergencyType of emergency Possible injury/condition of injured personPossible injury/condition of injured person Assistance being given to injured personAssistance being given to injured person Exact location of facility and injured person – including Exact location of facility and injured person – including

point of entry to facilitypoint of entry to facility Name/phone number of person calling – always wait for Name/phone number of person calling – always wait for

EMS operator to hang up firstEMS operator to hang up first

Communication Communication ConsiderationsConsiderations

EMS activated via 911 systemEMS activated via 911 system

Must have access to reliable telephoneMust have access to reliable telephone Direct land line – most reliable, access issuesDirect land line – most reliable, access issues Nearby pay phone – free for 911 calls, operable/reliableNearby pay phone – free for 911 calls, operable/reliable Cellular phones – signal strength, battery life, where does call Cellular phones – signal strength, battery life, where does call

gogo

When multiple facilities used at once, often use walkie-When multiple facilities used at once, often use walkie-talkies to communicate need for EMS to central talkies to communicate need for EMS to central locationlocation

When circumstances allow, should contact parents When circumstances allow, should contact parents and/or administratorsand/or administrators

Equipment ConsiderationsEquipment Considerations

Must consider all possibilities and have Must consider all possibilities and have appropriate equipment for facility on handappropriate equipment for facility on hand Budgetary and/or personnel limitations often dictate Budgetary and/or personnel limitations often dictate

what is needed and appropriate to havewhat is needed and appropriate to have

Must know when and how to utilize equipment – Must know when and how to utilize equipment – must be accessiblemust be accessible

Communication with local EMS regarding area Communication with local EMS regarding area protocols is advisedprotocols is advised Issues can arise relative to helmet removal, spine board Issues can arise relative to helmet removal, spine board

strapping techniques, splinting devices, etc.strapping techniques, splinting devices, etc.

TransportationTransportation

Must be able to differentiate significant Must be able to differentiate significant but not limb- or life-threatening conditions but not limb- or life-threatening conditions that can be transported via personal car, that can be transported via personal car, school vehicle or parentsschool vehicle or parents Liability issues and concernsLiability issues and concerns

Must recognize limb- or life-threatening Must recognize limb- or life-threatening conditions and utilize EMS personnel for conditions and utilize EMS personnel for transportation to nearest appropriate transportation to nearest appropriate facility for definitive carefacility for definitive care

Record KeepingRecord Keeping

As with any injury/illness, emergency care As with any injury/illness, emergency care rendered must be documented for individual’s rendered must be documented for individual’s medical filemedical file

Careful and detailed documentation of all Careful and detailed documentation of all components of care provided from initial components of care provided from initial presentation through transfer of care to EMS presentation through transfer of care to EMS personnel is criticalpersonnel is critical Best done ASAP after emergency event to enhance Best done ASAP after emergency event to enhance

recallrecall Can provide protection in case individual/family sues Can provide protection in case individual/family sues

against care providersagainst care providers

Training of PersonnelTraining of Personnel

Good for all potential members of Good for all potential members of emergency care team to have solid grasp of emergency care team to have solid grasp of emergency planemergency plan

Optimal for all members to practice Optimal for all members to practice elements of plan via scenarios to identify elements of plan via scenarios to identify and address weaknessesand address weaknesses Must be done regularly, once yearly not enoughMust be done regularly, once yearly not enough Enhances likelihood of reactionary response to Enhances likelihood of reactionary response to

address needs of situation vs. emotional address needs of situation vs. emotional response where actions may be less than ideal response where actions may be less than ideal due to stress of situationdue to stress of situation

Emergency Equipment and Emergency Equipment and SuppliesSupplies

Airway managementAirway management

Cardiac equipmentCardiac equipment

Spine injury considerationsSpine injury considerations

Musculoskeletal injury considerationsMusculoskeletal injury considerations

Airway ManagementAirway Management

Pocket masksPocket masks Used during rescue breathing/CPR to minimize Used during rescue breathing/CPR to minimize

contact between patient and rescuercontact between patient and rescuer Bag-valve-masks (BVM)Bag-valve-masks (BVM)

Uses bag for ventilation vs. rescuers breathsUses bag for ventilation vs. rescuers breaths Oropharyngeal airwaysOropharyngeal airways

Allows for establishment and maintenance of Allows for establishment and maintenance of patent oral airwaypatent oral airway

Supplemental oxygenSupplemental oxygen Used when injured individual is ventilating but Used when injured individual is ventilating but

not perfusing (transfering oxygen) well in tissuesnot perfusing (transfering oxygen) well in tissues

Cardiac EquipmentCardiac Equipment

Development of automatic external defibrillators Development of automatic external defibrillators (AED) to address need for early defibrillation of (AED) to address need for early defibrillation of abnormal heart rhythms to increase survival rateabnormal heart rhythms to increase survival rate Previously limited to paramedics and hospital personnel – Previously limited to paramedics and hospital personnel –

now commonly available (aircraft, airports, schools, malls, now commonly available (aircraft, airports, schools, malls, etc.)etc.)

AEDs able to provide basic cardiac monitoring, AEDs able to provide basic cardiac monitoring, instructions for electrode placement and delivery of instructions for electrode placement and delivery of cardiac conversion techniques (shocks)cardiac conversion techniques (shocks) ““Idiot proof” – do require specific training for perspective Idiot proof” – do require specific training for perspective

(typically done with in conjunction with CPR/first aid)(typically done with in conjunction with CPR/first aid) Must ensure that batteries are charged at all timesMust ensure that batteries are charged at all times

Spine Injury Considerations Spine Injury Considerations

EquipmentEquipment Spine board – various sizes, materialsSpine board – various sizes, materials Cervical immobilization devices/collarsCervical immobilization devices/collars Strapping devices (“seat belts”, 9-point straps, “spider” Strapping devices (“seat belts”, 9-point straps, “spider”

straps)straps)

ProtocolsProtocols Different approaches to strapping techniques, removal Different approaches to strapping techniques, removal

of equipment (helmets, shoulder pads) in different areasof equipment (helmets, shoulder pads) in different areas Must have understanding of approach to maximize Must have understanding of approach to maximize

delivery of care and minimize conflict regarding delivery of care and minimize conflict regarding proceduresprocedures

Musculoskeletal Injury Musculoskeletal Injury ConsiderationsConsiderations

Equipment needed to immobilize Equipment needed to immobilize fractures, dislocations and/or joint fractures, dislocations and/or joint sprainssprains Vacuum splints – usually today’s standardVacuum splints – usually today’s standard Air splints – not common todayAir splints – not common today Cardboard gutters – typically adhered with Cardboard gutters – typically adhered with

ace bandageace bandage Sam splints /Ladder splints – flexible, Sam splints /Ladder splints – flexible,

conform to body partconform to body part