Orange High School Athletic Emergency Action Plan

Orange High School Athletic Emergency Action Plan Principal: Jason Johnson Athletic Director: Earnie Price Athletic Trainer: Emily Gaddy MS, LAT, ATC...
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Orange High School Athletic Emergency Action Plan

Principal: Jason Johnson Athletic Director: Earnie Price Athletic Trainer: Emily Gaddy MS, LAT, ATC, PES Revised: July 29, 2014

Table of Contents Introduction ..................................................................................................................................................................2 SPECIFIC INJURIES .........................................................................................................................................................5 Neck or Spine Injury ..................................................................................................................................................6 Cardiac Emergencies ................................................................................................................................................9 Fractures .................................................................................................................................................................11 Dislocations.............................................................................................................................................................13 Heat-related Emergencies ......................................................................................................................................14 Hemorrhage/Lacerations/Wounds ..........................................................................................................................16 Seizure Emergencies ..............................................................................................................................................18 Diabetic Emergencies .............................................................................................................................................20 Sickle Cell Emergencies .........................................................................................................................................22 Asthmatic Emergencies ..........................................................................................................................................24 Anaphylactic Emergencies ......................................................................................................................................26 Concussion Management Protocol for Orange High School ...................................................................................28 Lightning Safety Policy ............................................................................................................................................31 Heat Management and Prevention Guidelines and Recommendations ..................................................................32 Heat Acclimatization Plan .......................................................................................................................................33 Exposure and Infectious Control Policy...................................................................................................................36 Venue Specific Emergency Action Plans.................................................................................................................41 Auman Stadium/Field House/Track Emergency Action Plan ..................................................................................42 Football Practice/Lacrosse Field Emergency Action Plan .......................................................................................43 Soccer Field Emergency Action Plan ......................................................................................................................44 Tennis Courts Emergency Action Plan....................................................................................................................45 Baseball Field Emergency Action Plan ...................................................................................................................46 Softball Field Emergency Action Plan .....................................................................................................................47 Main Gym/ Small Gym/ Wrestling Room/ATR Emergency Action Plan ..................................................................48 Weight Room Emergency Action Plan ....................................................................................................................49 Track Auxiliary/Band Practice Field Emergency Action Plan ..................................................................................50 Cross Country Course Emergency Action Plan ......................................................................................................51

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Orange High School Emergency Action Plan (EAP) Introduction Emergency situations may arise at anytime during athletic events. Expedient action must be taken in order to provide the best possible care to the sport participant of emergency and/or life threatening conditions. The development and implementation of an emergency plan will help ensure that the best care will be provided. Components of the Emergency Plan These are the basic components of every emergency action plan for athletics:

1. 2. 3. 4. 5.

Emergency Personnel Emergency Communication Emergency Equipment Roles Of Certified Athletic Trainers, Student Trainers, Coaches, And Administrators Venue Directions With map

Emergency Plan Personnel With athletic practice and competition, the first responder to an emergency situation is typically a member of the sports medicine staff, most commonly a certified athletic trainer. A team physician may not always be present at every organized practice or competition. The type and degree of sports medicine coverage for an athletic event may vary widely, based on such factors as the sport or activity, the setting, and the type of training or competition. The first responder in some instances may be a coach or other institutional personnel. Certification in cardiopulmonary resuscitation (CPR), first aid, prevention of disease transmission, and emergency plan review is strongly recommended for all athletics personnel associated with practices, competitions, skills instruction, and strength and conditioning. Emergency Communication Communication is the key to quick emergency response. Athletic trainers and emergency medical personnel must work together to provide the best emergency response capability and should have contact information such as telephone tree established as a part of pre-planning for emergency situations. Communication prior to the event is a good way to establish boundaries and to build rapport between both groups of professionals. If emergency medical transportation is not available on site during a particular sporting event then direct communication with the emergency medical system at the time of injury or illness is necessary. Points of communication are predestinated in this plan to ensure the proper and most immediate care is given to the injured student-athlete. Emergency Equipment All necessary emergency equipment should be at the site and quickly accessible. Personnel should be familiar with the function and operation of each type of emergency equipment. Equipment should be in good operating condition, and personnel must be trained in advance to use it properly. Emergency equipment should be checked on a regular basis and use rehearsed by emergency personnel. The emergency equipment available should be appropriate for the level of training for the emergency medical providers. Creating an equipment inspection log book for continued inspection is strongly recommended. The school’s Certified Athletic Trainers should be trained and responsible for the care of the medical equipment.

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Medical Emergency Transportation Emphasis should be placed at having an ambulance on site at high risk sporting events. In the event that an ambulance is on site, there should be a designated location with rapid access to the site and a cleared route for entering/exiting the venue. If an ambulance is not present at an event, entrance to the facility should be clearly marked and accessible. In the event of an emergency, the 911 system will still be utilized for activating emergency transport.

Any emergency situations where there is impairment in level of consciousness (LOC), airway, breathing, or circulation (ABC) or there is neurovascular compromise should be considered a “load and go” situation and emphasis placed on rapid evaluation, treatment and transportation. In order to provide the best possible care for Orange High School athletes, all emergency trauma transports are to be sent to either Duke Hospital or UNC Hospital. Chain of Command

These are the individuals who monitor and make the decision to remove a team or individual from an athletics site or event. This decision plan should include instructions for participants as well as spectators. Athletic Director Assistant Athletic Director Head Athletic Trainer Head Coach Assistant Coach AED and Lightning Safety Locations The map on the following page indicates the locations of AEDs within the school and lightning safety locations for athletic events. This equipment and locations will be mentioned throughout this emergency action plan. All personnel should be familiar with the locations of the closest AED and lightning safety location. Conclusion The importance of being properly prepared when athletic emergencies arise cannot be stressed enough. An athlete’s survival may hinge on how well the athletic healthcare providers are trained and prepared. It is prudent to invest athletic department “ownership" in the emergency plan by involving the athletic administration and sport coaches as well as sports medicine personnel. The emergency plan should be reviewed at least once a year with all athletic personnel, along with CPR and first aid refresher training. Through development and implementation of the emergency plan, Orange High School helps ensure that the athlete will have the best care provided when an emergency situation does arise.

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SPECIFIC INJURIES

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Neck or Spine Injury The following factors should be taken into consideration when determining if an athlete should be transported under the Neck or Spine Injury protocol. This protocol incorporates the General Guidelines outlined in the InterAssociation Task Force for Appropriate Care of the Spine-Injured Athlete’s report on Pre-hospital Care of the Spine-Injured Athlete:     

Loss of consciousness Swelling or deformity of spine Significant spinal pain, tenderness or paraspinal muscle spasm Significant neurological dysfunction in bilateral upper extremities, or any lower extremity Pain, decreased ROM or neurological signs or symptoms with AROM

All athletes who suffer a loss of consciousness should be presumed to have an associated neck injury and should be transported under the Neck or Spine Injury protocol.      

Any athlete suspected of having a spinal injury should not be moved and should be managed as though a spinal injury exists The athlete’s airway, breathing and circulation, neurological status and level of consciousness should be assessed. The athlete should not be moved unless absolutely essential to maintain airway, breathing, and circulation. If the athlete must be moved to maintain airway, breathing, and circulation, the athlete should be placed in a supine position while maintaining spinal immobilization. When moving a suspected spine injured athlete, the head and trunk should be moved as a unit. The Emergency Medical Services system should be activated. EMS providers should take the lead in immobilization of an athlete for transportation because they are far more practiced in immobilization techniques and will be responsible for the athlete during transportation.

The roles of Orange High School personnel within this protocol are as follows: 

  

Certified Athletic Trainer at the scene is the Team Leader and will take charge of the care of the injured athlete. o The Team Leader will also be responsible for maintaining head and neck immobilization until care is positively transferred to appropriate EMS personnel. o The Team Leader should be aware that this responsibility will prevent them from being able to move during the care of the athlete and should prepare themselves to fully delegate all other tasks until head and neck immobilization is positively transferred to EMS personnel. Athletics representative (athletic director, coach, etc) at the scene will be responsible for contacting EMS, retrieval of emergency information card, and will assist in monitoring of the student-athletes vital signs. An Athletics representative, other than the person with the aforementioned responsibilities, will arrange for EMS to be met and ‘flagged down’ to assure their arrival at the proper location and will be responsible for crowd control as necessary to allow for the appropriate care of the student-athlete. Coaches may be called upon to assist the Athletic Training staff in retrieval of emergency supplies from the sideline.

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All Athletic Department personnel should be aware that a suspected head or neck injury is a serious situation and may require their assistance in providing for a successful outcome.

When an athlete is injured during practice or competition the following initial steps should be taken: 



Primary Survey assessing o Airway o Breathing o Circulation  Hemorrhage control o Disability o Exposure of injury site if needed Secondary Survey assessing o Non-life threatening conditions specific to the injury site (fracture, dislocation, sprain, strain, etc)

When caring for a suspected spine-injured athlete, the certified athletic trainer should utilize techniques (in-line stabilization, jaw thrust, no movement) to ensure protection of the athlete’s spine while performing the primary and secondary survey. Any athlete suspected of having a spinal injury should not be moved until appropriate personnel are present, and should then be placed into a supine position while the spine is safeguarded.

If the attending athletic trainer suspects that the injured student-athlete might be spine-injured the following steps will be taken:  

 

The athlete will not be moved unless absolutely necessary to maintain airway, breathing, circulation. o The attending athletic trainer will serially and regularly assess the athlete’s vital signs, monitoring for any possible changes An athletics staff personnel on-scene will contact EMS providing them with the following information: o Their name, location and phone number o Number of injured athletes o Condition of athletes (vitals) – specifying a suspected spinal injury o Treatment already rendered by AT staff o Specific directions to emergency scene o Any other information requested by the dispatcher A member of the athletics staff will be sent to ‘flag down’ the arriving EMS units and provide direction to the specific location of the injured student-athlete per the venue’s EAP If it becomes necessary to move the athlete to ensure airway, breathing or circulation, a multi-person log roll will be used, maintaining in-line stabilization of the head, neck and spine. (If possible a back board should be utilized at this time in an effort to keep from moving the athlete twice.) o The Team leader will control the head and neck and direct all team movements  If possible, a rigid cervical collar should be utilized to allow for immobilization at all segmental levels o One rescuer positions themselves at the chest o One rescuer positions themselves at thigh level o One rescuer positions themselves on the opposite side of the athlete with the backboard

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   

o The athlete’s arm on the side to which he is to be rolled is placed at his side above his head o On the command, “Prepare to roll, roll” the rescuers should roll the athlete toward them in an even, controlled manner o The backboard is placed against the athlete’s back at a thirty degree angle o On the commands “Prepare to lower, lower” the athlete is lowered onto the backboard. The attending athletic trainer will continue to monitor vital signs and to reassess the athlete regularly and serially while EMS is enroute. The attending athletic trainer should also work to calm and reassure the conscious athlete. Upon EMS arrival on-scene, the attending athletic trainer will provide a clear, concise report of the situation detailing a brief mechanism and history, current vital signs and treatment rendered to that point. The attending athletic trainer should also be available to answer questions from EMS personnel. If present the athlete’s parents/guardian will accompany the injured athlete to the hospital, it not a member of the athletics staff will accompany the athlete. The athletic trainer or athletic director trainer will contact the athlete’s parents and administration as necessary.

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Cardiac Emergencies Some factors that should be taken into consideration when deciding whether or not to transport a patient who has suffered/is suffering a cardiac emergency via EMS should include:     

Level of consciousness Presence or absence of pulse Radiating left arm pain Dyspnea, (labored or painful breathing) Feelings of irregular heartbeat

When an athlete falls ill during practice or competition the following initial steps should be taken:         

 

Primary Survey assessing Airway Breathing Circulation Hemorrhage control Disability Exposure of injury site if needed Secondary Survey assessing Full vital signs  Pulse  Respiration  Blood Pressure  Temperature  Skin Color  Pupils  Level of consciousness  Movement  Nerve response Patient medical history History questioning of the current condition

If the attending athletic trainer makes the determination that an athlete who is suffering a cardiac emergency needs to be transported via EMS the following steps should be taken: 



The athletic trainer will assess the athlete via a primary survey o If action needs to be taken (no pulse, no respiration), CPR will be initiated at this juncture and AED retrieved by athletics staff member, coach, athlete, or other adult.  AED is with the athletic trainer or gym lobby An athletics staff member on-scene will contact EMS via 911 providing the dispatcher with:  Their name, location and phone number  Number of injured athletes  Condition of athletes (vitals)  Treatment already rendered by AT staff

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     

Specific directions to emergency scene Any other information requested by the dispatcher

o The athletics staff member will inform the athletic director or other school administration that EMS has been summoned. o An athletics staff member will be instructed to “flag-down” person to be assigned at the access point for the venue as outlined in the venue’s EAP The athletic trainer will continue to monitor the athlete’s vital signs, making sure to serially and regularly assess the athlete’s condition. The athletic trainer will also work to calm and reassure the conscious athlete. If the athlete ceases to have a pulse/respirations during this time, CPR procedures will be initiated. Upon EMS arrival on-scene, the athletic trainer will provide a clear, concise report of the situation detailing a brief mechanism and history, current vital signs and treatment rendered to that point. The athletic trainer should also be available to answer questions from EMS personnel. If present the athlete’s parents/guardian will accompany the injured athlete to the hospital, it not a member of the athletics staff will accompany the athlete. Upon arrival at the hospital, if the parents/guardian is not accompanying the athlete they will be contacted with information and updates on the status of the athlete. The attending personnel will update parents as information is made available to them and in a timely manner.

If the attending athletic trainer does not deem immediate EMS activation necessary the following protocol should be undertaken:  

The attending athlete trainer should closely monitor the athlete’s vital signs and condition while transporting him/her to the training room/infirmary. The athlete should be evaluated by a physician as soon as possible

If an athlete suffers a cardiac emergency while on a road trip away from Orange High School, the attending athletic trainer or athletics staff should take measures to manage the situation and to determine if emergency transport is needed just as they would when at a home event. They should then seek assistance from the host institution’s athletic trainer in activation of the EAP for that venue. If emergency transport is not deemed necessary, this does not preclude the examination of the athlete by a physician as soon as practical.

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Fractures Athletes who present with a significant fracture need to be evaluated and treated by a physician as soon as possible. Emergency transportation by EMS will be needed by athletes who present with the following:       

Visible, marked deformity Open fracture (compound fracture) Severe, uncontrollable hemorrhage Signs and symptoms of shock Compromised airway Pseudojoint motion Injury to the neck or spine (see special protocol)

When an athlete is injured during practice or competition the following initial steps should be taken: 



Primary Survey assessing o Airway o Breathing o Circulation  Hemorrhage control o Disability o Exposure of injury site if needed Secondary Survey assessing o Non-life threatening conditions specific to the injury site (fracture, dislocation, sprain, strain, etc)

If the athletic trainer makes the determination that an athlete has suffered a fracture the following steps should be taken:  



The attending athletic trainer should evaluate the athlete to determine: o If it is safe to move the athlete from the area of competition o If the athlete needs to be transported emergently via EMS If the attending athletic trainer determines that EMS needs to be activated: o An athletics staff member on-scene will contact EMS via 911, providing the dispatcher with  Their name, location and phone number  Number of injured athletes  Condition of athletes (vitals)  Treatment already rendered by AT staff  Specific directions to emergency scene  Any other information requested by the dispatcher o An athletics team member will assign someone as a “flag-down” person to be assigned at the access point for the venue as outlined in the venue’s EAP The athletic trainer will perform, or direct the performance, of any splinting or immobilization needed by the athlete. o The fracture is to be splinted in the position it is found in. Fracture reduction should not be attempted on-scene.

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   

The athletic trainer will continue to monitor the athlete’s vital signs, making sure to serially and regularly assess the athlete’s neurovascular status, particularly distal to the fracture. The attending athletic trainer will also work to calm and reassure the athlete Upon EMS arrival on-scene, the athletic trainer will provide a clear, concise report of the situation detailing a brief mechanism and history, current vital signs and treatment rendered to that point. The athletic trainer should also be available to answer questions from EMS personnel. If present the athlete’s parent/guardian will accompany the athlete to the hospital. If unavailable a member of the athletics staff will accompany the athlete The athletic trainer or a member of the athletics staff will update parents as information is made available to them and in a timely manner.

The athlete may not need to be immediately referred to a physician if :  the suspected fracture is non-displaced (without visible deformity)  pain is not severe  neurovascular status at the injury site and distal to the injury site is intact and stable  the athletic trainer is able to stabilize/splint the fracture in an effective manner  the athletic trainer is otherwise comfortable with delaying referral  delay in physician evaluation likely will not impact long-term prognosis  the delay in referral will not be lengthy (ie. not on road trip, SHS available next-day)  the athletic trainer will be able to serially monitor the athlete’s status If an athlete is not immediately referred to a physician for evaluation, then the athletic trainer should take every precaution as if the injury is a fracture. The athlete should be serially and regularly monitored for changes in condition. Worsening of symptoms or evaluation warrants referral to physician for evaluation If an athlete suffers a fracture while on a road trip away from Orange High School, the attending athletic trainer or athletics personnel should determine if emergent transport is needed just as they would when at a home event. They should then seek assistance from the host institution’s athletic trainer in activation of the EAP for that venue. If the attending athletic trainer decides that emergent transport is not necessary, this does not preclude examination by a physician. The attending athletic trainer should seek transport to a physician as soon as possible for prompt care of the athlete.

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Dislocations Athletes who present with a dislocation should be referred to a physician for evaluation and treatment. This may or may not need to be undertaken emergently. Factors to be taken into consideration when deciding whether or not to transport an athlete with a dislocation via EMS include, but are not limited to:      

Vascular compromise Nerve entrapment Athlete’s level of pain Athlete’s emotional state Joint involved Possibility of significant/unstable fracture

If the athletic trainer makes the determination that an athlete has suffered a dislocation the following steps should be taken:  

    

The attending athletic trainer should evaluate the athlete to determine: o If it is safe to move the athlete from the area of competition o If the athlete needs to be transported emergently via EMS If the attending athletic trainer determines that EMS needs to be activated: o An athletics staff member on-scene will contact EMS via 911, providing the dispatcher with  Their name, location and phone number  Number of injured athletes  Condition of athletes (vitals)  Treatment already rendered by AT staff  Specific directions to emergency scene  Any other information requested by the dispatcher o An athletics team member will assign someone as a “flag-down” person to be assigned at the access point for the venue as outlined in the venue’s EAP The athletic trainer will continue to monitor the athlete’s vital signs, making sure to serially and regularly assess the athlete’s neurovascular status, particularly distal to the dislocation. The attending athletic trainer will also work to calm and reassure the athlete The athletic trainer will perform, or direct the performance, of any splinting or immobilization needed by the athlete. Upon EMS arrival on-scene, the athletic trainer will provide a clear, concise report of the situation detailing a brief mechanism and history, current vital signs and treatment rendered to that point. The athletic trainer should also be available to answer questions from EMS personnel. If present the athlete’s parent/guardian will accompany the athlete to the hospital, if not present then a member of the athletics staff will accompany the athlete The athletic trainer or member of the athletics staff will update parents as information is made available to them and in a timely manner.

If emergent transportation is not undertaken, then the attending athletic trainer should stabilize the athlete as indicated by the dislocation and seek evaluation and treatment by a physician as soon as practical.

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Heat-related Emergencies Some factors that should be taken into consideration when deciding whether or not to transport a patient with a heatrelated emergency via EMS should include: 1. 2. 3. 4. 5. 6.

Core Body temperature Level of consciousness Pulse, respirations, skin color, amount of sweating Past medical history Availability of appropriate facilities to cool/treat the athlete Improving/degradation of athlete’s status

When an athlete falls ill during practice or competition the following initial steps should be taken: 1. Primary Survey assessing a. Airway b. Breathing c. Circulation i. Hemorrhage control d. Disability e. Exposure of injury site if needed 2. Full vital signs i. Pulse ii. Respiration iii. Blood Pressure iv. Temperature v. Skin Color vi. Pupils vii. Level of consciousness viii. Movement ix. Nerve response b. Patient medical history c. History questioning of the current condition i. Heat related illnesses can further be examined via accurate core body temperature 3. Heat-related conditions: These conditions represent a continuum of possible heat-related conditions. Athletes may begin with symptoms anywhere in this continuum and worsen or improve. a. Heat Cramps i. Signs and symptoms: muscular cramping normally beginning in stomach and calves then progressing to other areas of body. b. Heat Exhaustion i. Signs and symptoms: fatigue, dizziness, profuse sweating, cool and clammy skin, pale skin, nausea, rapid respiration and pulse c. Heat Stroke i. Diminished or loss of consciousness; extremely high body temperature; possibly red, dry skin; possible vomiting; rapid pulse. Heat stroke in young persons is often not associated with red, dry skin, but rather appears as a worsened set of heat exhaustion symptoms.

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If certified athletic trainer makes the determination that an athlete is suffering from a heat related illness the following steps should be taken in an attempt to reduce core body temperature: 1. 2. 3. 4.

If it is safe to do so, the athlete should be moved to a cool place – indoors if possible Loosen or remove as much clothing as possible and appropriate If conscious and able, give cool/cold water for the athlete to drink Begin cold water immersion cooling technique

If the athlete refuses water, begins to vomit repeatedly or starts to lose consciousness: 1. Continue with cold water immersion cooling techniques, while continuing to monitor core body temperature. DO NOT transport until core temperature is