Emergency Action Plan E.A Laney High School 2700 N. College Rd. Wilmington, NC 28405 910-350-2089 Component of the Emergency Action Plan:

The components of this plan include: 1. Emergency Personnel 2. Emergency Communication 3. Emergency Equipment/Location 4. Transportation of an Injured Athlete 5. EAP: Holiday Stadium 6. EAP: Track Complex 7. EAP: Baseball Complex 8. EAP: Softball Complex 9. Weather policy: Heat Guidelines 10. Weather policy: Lightning Policy 11. Heat Illnesses 12. Head/C spine injuries 13. Concussions 14. Asthma 15. Sickle Cell Anemia

Emergency Personnel:

Depending on the event/sport, the amount of coverage provided by the sports medicine team may vary. All home competitions will be covered by a certified athletic trainer unless previously discussed. A team physician may or may not be present at the home events.

In the event of an emergency, the first to respond to an emergency situation should be handled by the most qualified individual to do so, and responsibilities will be

delegated to others as needed. The following list includes the role delineation in the event of an emergency.

Team Physician (Dr. Dale Boyd, Cape Fear Sports Medicine, 910-790-9714 office) Certified Athletic Trainer (Ashley Imgrund, MS, LAT, ATC, 757-870-2018) Athletic Director or other Administration (Mr. Fred Lynch, 910-512-1837) Student Athletic Trainer Coach

The first responder role should be left to whomever has the highest level of credentials and therefore be the one to handle the acute care of the injured individual. A majority of the time, the first responder role will be covered by the certified athletic trainer covering the event. The first responder role can also be covered by the team physician if they are at the event. The second role, emergency equipment retrieval, can be delegated to another member of the emergency action team who knows the exact location and types of emergency equipment needed. If deemed necessary, EMS activation will be completed by the person in the third role. This can be completed by any member of the emergency action team, however, they must be able to remain calm and supply necessary information to EMS services (see Emergency Communication). The fourth role will be to direct EMS to the location of the incident. This can also be performed by any member of the emergency action team. This individual should have necessary keys/access to ensure that all locks/gates are accessible and no time is wasted.

All members of the emergency personnel, including coaches, will have reviewed this emergency action plan. This will ensure that in the event of an emergency situation all individuals can attend to the individual in need of assistance Summary of Roles Within the Emergency Team: Acute care of the injured individual (First role) Emergency equipment retrieval (Second role) EMS Activation (Third role) Directing EMS to the incident (Fourth role) Emergency Communication:

All members of the emergency action team should gain an understanding of their roles prior to the event starting. This is extremely true for athletic trainers and members of an EMS squad covering a competition prior to starting an event. Members of the sports medicine team should meet with the EMT members to determine signals to activate their service and procedures for handling a situation that may occur. If an EMT squad is not covering the event, the emergency action team should delineate roles prior to the event and know what information to communicate with the EMS services. A primary and secondary means of gaining communication should be established prior to any competitions beginning. Cell

phones will be on person during events. There is a land line phone in the athletic training room.

The individual who is responsible for making the phone call should supply the following information to EMS: Identify EXACT location (which field, gym, etc.) and a telephone number that they can be reached at to operator. (Laney High School, 2700 N. College Rd. Wilmington, NC, 28405) Describe the nature and severity of the injury. Give specific directions to where the injured individual is. Details of care provided. Give their name and patient’s name. Tell operator name and location of where the individual directing the ambulance will be located. Do not hang up until instructed to do so by the operator. Emergency Equipment/Location:

The athletic trainer’s providing coverage for the event, whether it be practice or a game, should have necessary equipment needed to handle any emergency situation. In the event that the necessary equipment is not readily available, the individual in the second role should retrieve any equipment needed to provide proper care. All emergency equipment should be checked regularly to ensure it is in proper working order.

The emergency equipment will be in the following areas: AED- Located in athletic training office (should be carried with ATC out to event), field house weight room, on the wall next to the nurses station, and the locker room hallway of the gym. Splint Kits- Located under athletic training room exam tables (should be carried with ATC out to event) Crutches- in the athletic training room Face Mask Remover-Trainer’s Angel will be carried in a kit by the certified athletic trainer. Power screw driver-will be carried in the field kit of the certified athletic trainer. Transportation of an Injured Athlete

In the event an unstable athlete is in need of transportation, the athlete MUST be transported by an ambulance to the nearest hospital to ensure that proper medical attention can be given. In the event a minor’s parent is not able to transport the athlete an administrator (principal, athletic director) or coach should accompany the athlete. The certified athletic trainer should go to the hospital following the completion of the competition to check on the athlete. The certified athletic trainer is NOT allowed

to leave the competition until it is completed, or another certified athletic trainer has come to cover the remainder of the competition.

If an athlete is injured and is stable (such as a non-displaced fracture, dislocation, etc.) the means of transportation will be determined by the first responder (either team physician or certified athletic trainer). The primary means of transportation should be a parent/guardian. The certified athletic trainer or administrator will transport only if parent’s permission is obtained and is deemed necessary. Emergency Action Plan: Holiday Stadium (used by Football, Men’ and Women’s Soccer, and Men’s and Women’s Lacrosse): Address: 2700 N. College Rd. Wilmington, NC

Emergency Personnel: A certified athletic trainer and athletic training student will be on site for practice and competitions. Team physician will be available at most home football games. An EMS squad will be on site for ALL home varsity football games.

Emergency Equipment: A certified athletic trainer will bring out the AED, splint kits, crutches, and medical kits to all practices and competitions. An additional AED is located in the weight room of the field house.

Emergency Communication: A land-line is located in the athletic training room. The phone number is 910-350-2089. Phone numbers and addresses are also written on a card inside the AED case. Cellular phones are also readily accessible and should be carried by the certified athletic trainer. In the Event of Emergency: 1. Certified Athletic Trainer or Team Physician will initiate the emergency action plan. 2. The second role individual will collect any equipment needed to handle the situation. 3. The third role individual will activate EMS if needed and provide the necessary information (see information below). 4. The fourth role individual will meet EMS at the designated locations to direct them to the injured athlete (see designated areas below).

Activating EMS by third role individual: I would like to report an emergency at E.A. Laney High School at Holiday Stadium (2700 N. College Rd. Wilmington, NC) a phone number I can be reached at is ___________.

The athlete needs medical assistance for the following reason/s __________________________ (nature of injury). The athlete has been given the following initial care __________________________(state what treatment has been provided) My names is _______________________(state your name) and the athlete’s name is ___________________(athlete’s name). ______________________(name of escort) will be waiting for the ambulance at the front corner entrance and will direct the ambulance to the back gate.

Directions to Holliday Stadium from N. College Rd.: 1. US-117 N/N. College Rd 2. Right onto School Dr. 3. Right onto Danny Pence Dr. a. This will put you directly in front of the main building of Laney High School. Stay straight and make a left right before the “No Entrance-One Way” sign. This will put you in front of Holliday Stadium. A member of the sports medicine team will direct you in. Directing the Ambulance to the Incident by fourth role individual: The fourth role individual will meet the ambulance at the front entrance. You will escort them around to the back gate and direct them onto the field. You WILL be supplied with all necessary keys to have full access to the field. Emergency Action Plan: Track and Field Complex/Practice Football Field Address: 2700 N. College Rd. Wilmington, NC

Emergency Personnel: A certified athletic trainer and athletic training student will be on site for practice and competitions. Team physician will be available at ALL home football games, as well as SOME of the soccer and lacrosse games. An EMS squad will be on site for ALL home football games. Additional certified athletic trainers will be available in the athletic training room.

Emergency Equipment: A certified athletic trainer will bring out the AED, splint kits, crutches, and medical kits to all practices and competitions. An additional AED is located in the main lobby of the gym, or in the weight room of the field house.

Emergency Communication: A land-line is located in the athletic training room of the field house. The phone number is 910-350-2089. The phone number and the address to the complex is written on the inside of the phone box. Phone numbers and addresses are also written on a card inside the AED case. Cellular phones are also readily accessible and should be carried by the certified athletic trainers.

In the Event of Emergency: 1. Certified Athletic Trainer or Team Physician will initiate the emergency action plan. 2. The second role individual will collect any equipment needed to handle the situation. 3. The third role individual will activate EMS if needed and provide the necessary information (see information below). 4. The fourth role individual will meet EMS at the designated locations to direct them to the injured athlete (see designated areas below).

Activating EMS by third role individual: 1. I would like to report an emergency at the Track and Field complex at Laney High School, 2700 N. College Rd, Wilmington, NC. A phone number I can be reached at is ______________________. 2. The athlete needs medical assistance for the following reason/s __________________________ (nature of injury). 3. The athlete has been given the following initial care __________________________(state what treatment has been provided) 4. My names is _______________________(state your name) and the athlete’s name is ___________________(athlete’s name). 5. ______________________(name of escort) will be waiting for the ambulance at the front corner entrance and will direct the ambulance to the back gate. Directions to the Practice Football Field/Track: 1. US-117 N/N. College Rd 2. Right onto School Dr. 3. Stay straight onto School Dr. a. This will put you directly behind the high school. Follow the drive to the back along the baseball field. There will be a gate directly in front of you. A member of the sports medicine will meet you and direct you to the track/practice field.

Directing the Ambulance to the Incident by the Fourth Role Individual: You will meet the ambulance at the main gate of the football field and direct them to the back gate leading into the track and field complex Emergency Action Plan: Baseball Complex/Tennis Address: 2700 N. College Rd. Wilmington, NC

Emergency Personnel: A certified will be on campus during home baseball games. If another even with a higher risk of injury is going on, the athletic trainer will be on call, and can be reached by cell phone.

Emergency Equipment: A certified athletic trainer will bring out the AED, splint kits, crutches, and medical kits to all practices and competitions. An additional AED is located in the locker room hallway of the gym.

Emergency Communication: A land-line is located in the athletic training room of the field house. The phone number is 910-350-2089. Phone numbers and addresses are also written on a card inside the AED case. Cellular phones are also readily accessible and should be carried by the certified athletic trainers. In the Event of Emergency: 1. Certified Athletic Trainer or Team Physician will initiate the emergency action plan. 2. The second role individual will collect any equipment needed to handle the situation. 3. The third role individual will activate EMS if needed and provide the necessary information (see information below). 4. The fourth role individual will meet EMS at the designated locations to direct them to the injured athlete (see designated areas below).

Activating EMS by third role individual: 1.I would like to report an emergency at 2700 N. College Rd. Wilmington, NC, at the Baseball Field/Tennis Courts at E.A. Laney High School, a phone number I can be reached at is _________________. 2. The athlete needs medical assistance for the following reason/s __________________________ (nature of injury). 4. The athlete has been given the following initial care __________________________(state what treatment has been provided) 5. My names is _______________________(state your name) and the athlete’s name is ________________(athlete’s name). 6. ______________________(name of escort) will be waiting for the ambulance at the front corner entrance and will direct the ambulance to the back gate.

Directions to the Baseball Field/Tennis Courts: 1. US-117 N/N. College Rd 2. Right onto School Dr. 3. Straight onto School Dr. a. This will put you directly behind the high school. The baseball field will be directly in front of you. There will be a gate directly in front of you. A member of the sports medicine will meet you and direct you to the track/practice field. Directing the Ambulance to the Incident by the Fourth Role Individual: You will meet the ambulance at the right field gate entrance of the baseball field to direct in the ambulance to the field.

Emergency Action Plan: Softball Complex/Practice Soccer and Lacrosse Fields (located to the right side of Trask Middle School Address: 2900 N. College Rd. Wilmington, NC

Emergency Personnel: A certified will be on campus during home softball games. If another even with a higher risk of injury is going on, the athletic trainer will be on call, and can be reached by cell phone.

Emergency Equipment: A certified athletic trainer will bring out the AED, splint kits, crutches, and medical kits to all practices and competitions. An additional AED is located in the locker room hallway of the gym.

Emergency Communication: A land-line is located in the athletic training room of the field house. The phone number is 910-350-2089. Phone numbers and addresses are also written on a card inside the AED case. Cellular phones are also readily accessible and should be carried by the certified athletic trainers.

In the Event of Emergency: 1. Certified Athletic Trainer or Team Physician will initiate the emergency action plan. 2. The second role individual will collect any equipment needed to handle the situation. 3. The third role individual will activate EMS if needed and provide the necessary information (see information below). 4. The fourth role individual will meet EMS at the designated locations to direct them to the injured athlete (see designated areas below). Activating EMS by third role individual: 1.I would like to report an emergency at 2900 N. College Rd. Wilmington, NC, at the Softball Field located on the right side of Trask Middle School, a phone number I can be reached at is _________________. 2. The athlete needs medical assistance for the following reason/s __________________________ (nature of injury). 3. The athlete has been given the following initial care __________________________(state what treatment has been provided) 4. My names is _______________________(state your name) and the athlete’s name is ________________(athlete’s name). 5. ______________________(name of escort) will be waiting for the ambulance at the front corner entrance and will direct the ambulance to the back gate. Directions to the Softball/Practice Soccer and Lacrosse Field. 1. US-117 N/N. College Rd 2. Right onto School Dr. 3. Left into Trask Middle School parking lot. a. The Emergency gate will be located straight in front of you. The softball field will be directly on your and left and the practice lacrosse field

will be directly straight ahead. The practice soccer field will be directly behind the softball field. A member of the sports medicine team will meet you at the gate to direct you to the injured athlete.

Directing the Ambulance to the Incident by the Fourth Role Individual: You will meet the ambulance at the main entrance gate by Trask Middle School and lead the ambulance to the back to the softball field, practice lacrosse field or soccer field . Weather Guidelines for E.A. Laney High School Heat Guidelines and Heat Illnesses Per NATA Guidelines

Figure 1. Heat stress risk temperature and humidity graph. Heat stroke risk rises with increasing heat and relative humidity. Fluid breaks should be scheduled for all practices and scheduled more frequently as the heat stress rises. They should not be limited! Add 5º to temperature between 10 a.m. and 4 p.m. from mid-May to midSeptember on bright, sunny days. Practices should be modified for the safety of the athletes to reflect the heat stress conditions. Regular practices with full practice gear can be conducted for conditions that plot to the left of the triangles. Cancel all practices when the temperature and relative

humidity plot is to the right of the circles; practices may be moved into airconditioned spaces or held as walk through sessions with no conditioning activities. Conditions that plot between squares and circles: use work/rest ratio with 15 to 20 minutes of activity followed by 5- to 10-minute rest and fluid breaks, practice should be in shorts only (with all protective equipment removed, if worn for activity). Conditions that plot between triangles and squares: use work/rest ratio with 20 to 25 minutes of activity followed by 5- to 10-minute rest and fluid breaks; practice should be in shorts (with helmets and shoulder pads only, not full equipment, if worn for activity). Conditions that plot beneath triangles (through remaining range of chart): use work/rest ratio with 25 to 30 minutes of activity followed by 5- to 10-minute rest and fluid breaks. Adapted with permission from Kulka J, Kenney WL. Heat balance limits in football uniforms: how different uniform ensembles alter the equation. Physician Sportsmed. 2002;30(7):29-39.

Lightning Policy: Per NATA Position Statement

The ATC, if covering the event, will watch the radar for possible inclement weather and will make the call if the conditions become dangerous to continue. This will be done by making the game officials and coaching staff aware. During a practice, this wil be done by making the coaches aware.

Once lightning has been spotted, all athletes, coaches, officials, and others will move to an enclosed, frequently inhabited building with plumbing and electricity. If this is not possible, the next best thing is a car with a metal roof. Dug outs, sheds, convertibles, and golf carts are not safe. A lightning dector will be available when the athletic trainer is around. The athletic director also has a detector available. All athletes should be removed when the detector beeps between 3-8. The flash to bang technique should be employed if the detector is not available. Once a flash is seen, an individual shul begin to count the seconds until the bang is heard. By the time the method approaches 30 seconds, the field should be completely cleared as this is approximately 6 miles away. (30/5 = 6).

All will have to wait 30 minutes after the last flash of lightning in order to continue the event. The time will be kept by the ATC that is covering the event. If no ATC is covering the event, the AD will have to designate a time keeper and an individual to watch the radar for continuing poor weather. Recognizing Heat Illnesses

Heat Cramps: Signs and Symptoms: • Painful, involuntary muscle spasms Treatment: • Athlete should be removed from heat and allowed to cool off. • Certified athletic trainer should help massage and stretch the area. • Athlete should be advised to rehydrate using an electrolyte containing fluid (such as Gatorade, Powerade, of Gatorlyte). • Ice should be applied to the area to help aid in pain control. • In severe cases, IV fluids may be needed. Heat Syncope: Signs and Symptoms: • Suddent dizziness • Felling faint • Skin appears pale and sweaty • Normal body temperature • Rapid, weak pulse Treatment: • If the athlete faints, legs should be elevated 12 inches off the ground. • Athlete’s vitals should be monitored. • Athlete should be taking out of the heat. • Athlete should be giving fluids and not allowed to return to play.

Heat Exhaustion: Signs and Symptoms: • Pale, moist skin • Profuse sweating • Feeling faint, dizzy, or nauseous • Elevated core temperature (slightly above 100 degrees) Treatment: • Athlete should be removed from heat immediately • Ice packs should be applied to back of neck, forehead, armpits, and groin area. • Remove as much clothing as possible • Athlete should be given fluids as long as they are alert • IV fluid may be needed • Athlete needs to be monitored and possible referred

Heat Stroke: THIS IS A MEDICAL EMERGENCY! ATHLETE NEEDS MEDICAL CARE IMMEDIATELY! Signs and Symptoms: • Dry, red, hot skin • No sweating • Athlete is unresponsive or disoriented • Hyperventilation • Decreased blood pressure • Core temperature above 104 degrees Treatment: • Immediately activate EMS and EAP • Place athlete in a cool area and remove as much clothing as possible • Immerse athlete in a cool water tub (between 1-15 degrees celsius) until athlete’s core temperature drops to ~101-102 to avoid over cooling. • Ice packs should be applied to the back of neck, forehead, armpits, and groin area if immersing is not possible. • Monitor athletes vitals until EMS arrives Return to Play Guidelines after Exertional Heat Illness (EHI):

• Physician clearance is necessary before returning to exercise for severe heat ilness. The athlete should avoid all exercise until completely asymptomatic and all laboratory tests are normal. • Severity of the incident should dictate the length of recovery time.

• The athlete should avoid exercise for the minimum of 1 week after release from medical care.

• The athlete should cautiously begin a gradual return to physical activity to regain peak fitness and acclimatization under the supervision of an ATC or other qualified health care professional. Type and length of exercise should be determined by the athlete's physician and might follow this pattern: 1. Easy-to-moderate exercise in a climate controlled environment for several days, followed by strenuous exercise in a climate-controlled environment for several days. 2. Easy-to-moderate exercise in heat for several days, followed by strenuous exercise in heat for several days.

3. (If applicable) Easy-to-moderate exercise in heat with equipment for several days, followed by strenuous exercise in heat with equipment for several days.

Head/ C-Spine Injuries Policy: The following policy should be used when dealing with a student-athlete with a suspected head or c-spine injury:

Unconscious and Not Breathing: 1. Check CAB’s 2. Activate EMS. 3. If athlete is prone, logrool them over to supin position as an “unit” (minimum 4 people needed) a. Head-this person is to become the “team leader”. They are responsible for stabilizing the head and neck in it original position as found on the field NO MATTER HOW IT APPEARS. Do NOT apply traction. The team leaders is to stabilize head until the athlete is strapped down on spineboard. b. Trunk c. Hips and thighs d. Lower legs. 4. Establish airway. Remove facemask. The team leader should continue to stabilized head and neck. 5. Cut the shoulder pad strings spreading the pads apart. LEAVE PADS ON. 6. Peform CPR or rescue breathing, maintaining the airway and stabilizing the head and neck. The jaw thrust technique should be used. 7. Assist the EMTs upon arrival. Unconscious but Breathing: 1. Check ABCs 2. Activate EMS. 3. Team leader stabilizes head and neck until secured on spineboard. 4. If the athlete is prone, log roll the athlete to a supine position making sure to stabilize the head and neck ONLY IF NEEDED. 5. Remove the facemask. 6. Maintain the airway until EMS arrives. 7. Assist EMTs with securing the injured athlete on the spine board.

Conscious Athlete: 1. Check ABCs 2. Calm and reassure the athlete 3. Take a history of the incident 4. Evaluate for head/c-spine injury. If positive: stabilize head and neck, activate EMS. If negative: continue with follow-up evaluation on sideline.

Concussion: 1. All certified athletic trainers should be well aware of signs and symptoms indicative of a concussion. 2. A thorough on the field evaluation will be performed to rule out any cervical spine injuries that would warrant immediate transportation. 3. A thorough evaluation must be performed on the sideline and as a following up (SCAT2). 4. Athletes showing any of the following warning signs should be referred to physician: a. Drowsiness or extreme irritability. b. Unequal pupil size c. Pupils do not react to light d. Repeated vomiting e. Blurred, cloudy, or double vision f. Extreme dizziness g. Fluid or blood from mouth or ears h. Headache that worsens i. Weakness in arms, legs, or face muscles j. Twitching or convulsions k. Changes in breathing patterns l. Difficulty speaking, slurred, or incoherent speech m. Confusion, disorientation-abnormal behavior n. Loss of conciousness. 4. Any athlete displaying any signs or symptoms of a concussion should not be allowed to return to play. 5. The following criteria must be met prior to the athlete returning to play from a concussion, adapted from the Gfeller-Waller Concussion Act. • Athlete will be immediately removed from competition if a concussion is suspected. • An on the field evaluation will be completed by a certified athletic trainer (SCAT 2). • Athlete will be evaluated on a daily basis following the concussion until all symptoms have resolved and athlete has returned to play. • Any athlete found to have a concussion will be removed for a minimum of 7 days following the event. o This is dependent on the length of symptoms. • Athlete must complete a return to play progression program before returning to play. • Athletes must be cleared by a physician familiar with concussion management, Gfeller-Waller form must also be signed. (Urgent care physician and emergency room physicians typically do not clear athletes after one visit).

Chronic Illnesses: Asthma and Sickle Cell Anemia. Asthma: Procedures: 1. All athletes will undergo a preparticipation examination prior to the season to determine the severity of their asthma by a family physician. An asthma plan should be established at this time.

2. All staff and student athletic trainers should be well aware of the warning signs of an athlete having asthma, including: a. chest tightness b. coughing (especially at night) c. shortness of breath (dyspnea) d. sleeping difficulties e. wheezing (especially with exercise association) f. difficulty catching one’ breath g. decrease ability in physica activity due to breathing difficulty h. using accessory muscles to breathe i. difficulty breathing in the morning j. difficulty breathing when exposed to allergens k. symptoms increased with physical activities (exercise induced) l. family history of asthma 3. All athletes with a history of asthma should have a rescue inhaler with them at all times during athletic events. The athlete should also supply the athletic trainer with an extra inhaler in the event of an emergency. 4. Athletes should be re-evaluated by a physician peridocially (6-12 months) or whenever symptoms worsen.

5. Staff and student athletic trainers should be aware of the pharmaceutical strategies of both fast acting and long acting medications use to treat asthma.

6. An athlete should be referred to either their physician or emergency room in the event of respiratory distress when associated with the following signs and symptoms: a. significant increase in chest tightness, discomfort, or wheezing b. respiratory rate greater than 25 breaths/minute c. uncontrolled cough d. inability to speak in full sentences e. nasal flaring f. prolonged expiration phase of breathing g. paradoxic abdominal movement 7. Use of a peak-flow meter: All staff and student athletic trainers should follow these general guidelines when trying to obtain a peak flow measurement:

a. Peak flow meter should read zero or at its lowest reading before use b. The peak flow meter should be used while standing up c. Athlete should take a deep of breath in as possible d. Peak flow meter should be placed in mouth with the tongue placed under the mouthpiece e. Athlete should close lips around mouthpiece f. Have athlete blow out as fast as possible g. Have athlete breath normally for a few seconds and then repeat peak flow measures two more times. Write down the highest number obtained--do not average the numbers.

8. All athletes with a known case of asthma should have a baseline peakflow measure established. This should be done by obtaining peak flow measures, with the same peak flow meter, two to four times daily for two to three weeks. This can be done independently by the athlete. The athlete should record their highest measures, or their personal best peak expiratory flow rates (PEFR).

9. The athlete’s PEFR can help determine a guideline in the event that the athelte’s peak flow begins to decrease. The PEFR readings will be broken down into three zones, which are divided into colors, in order to make the best decision regarding the care for the athlete. The three zones are described below: Green (80-100% of personal best): Lungs are functioning well. If readings are in this zone, and symptoms are not present, athletes are able to continue with their regular medicines and activites. Yellow (50-80% of personal best): Airways are beginning to becomed narrowed. Medication changes or increases maybe necessary. Athletes should change or increase their medications in order to reverse the airway narrowing as discussed previously with their physician or the team physician. Red (50% or below personal best): Airways are significantly decreased and compromised. Immedite care is necessary. “Rescue” inhaler should be provided as prescribed. PEFR should be checked every 10-15 minutes following administration of rescue inhaler. If PEFR begins to improve, athlete should be monitored and PEFR should be measured throughout the day. If PEFR does not improve, athlete may require outside care and should be referred to physician or emergency room.

Sickle Cell Anemia: Procedure: All athletes who suffer from sickle cell anemia must let the athletic training staff know ahead of time. The preparticipation examination forms will have questions regarding sickle cell anemia. Any athlete who answers “yes” to these questions MUST be sent to their family physician prior to them being allowed to start the athletic season.

Athletes with known cases of sickle cell anemia should be monitored in cases of heat or when playing at an increased elevation. Certified athletic trainers should monitor for the following warning signs: 1. Unexplained muscle weakness 2. Acute chest pain 3. Acute abdominal pain 4. Severe, unexplained pain over entire body 5. Nausea, vomiting, diarrhea.

In the event that the student-athlete begins to show any of the following signs or symptoms they should immediately be sent to the emergency room. Emergency room physicians should be made aware that the athlete has sickle cell trait or sickle cell anemia and should expect explosive rhabdomyolysis and grave metabolic complications. An athlete may not return to their sport until they have been cleared by a physician.