Ray Castle, PhD, LAT, ATC, NREMT; Ron Courson, ATC, PT, SCS, NRAEMT, CSCS; David Csillan, MS, LAT, ATC; Jim Ellis, MD, FACEP; Francis Feld, DNP, CRNA, LAT, NRP; Glenn R. Henry, MA, EMT-P; Jim Kyle, MD, FACSM, FAAFP; Robb Rehberg, PhD, ATC, NREMT; Samantha E. Scarneo-Miller, PhD, LAT, ATC; Chris Troyanos, ATC
Editor’s note: This is Part Six of a nine-part series.
Communications
The EAP should establish a clear mechanism for communication to appropriate emergency care service providers and identify the mode of transportation (ambulance; air flight) for the injured participant.1–16
Effective communication is crucial in activating an emergency response during an emergency action plan (EAP). Poor communication can lead to medical errors and delays in care. A clear mechanism for communication with emergency care providers and identification of transportation for injured individuals should be established in the EAP. Factors to consider in communication design include:
- timeliness and speed of delivery
- ease of use
- pre-identifying audience/recipients
- multiple communication paths/redundancy
- affordability and reliability
- regular testing of devices and communication pathways should also be done to ensure frequencies are viable
The communication plan should be redundant with a designated and deliberate backup plan (landline, mobile phone; hand signals; mobile transmitter/receivers) if the initial communication method fails.1,2,4,6,8–10,13,17
As stakeholders plan for emergency communication in athletic settings, establishing redundancy in case of failed communication devices is crucial. A backup plan should be in place for each communication objective, including landline, mobile phone call, mobile phone text messaging, hand signals, and handheld radios, in case the initial communication method is ineffective or becomes inoperable during an emergency event.
It is important to note that different activities and venues may require different primary, secondary, and tertiary communication methods. For example, in a fixed location such as an athletic training clinic or locker room, a landline may typically be the primary method for calling emergency services, while on an athletic field during practice or a game, hand-held radios may be the primary source of communication with mobile phones and hand signals serving as secondary and tertiary communication strategies.
It is also important to consider the potential impact of poor weather on communication methods and to have backup plans in place. For example, landlines may be disabled by poor weather, radios can have dead batteries, and cell towers may become overwhelmed at large events. To mitigate these risks, it is recommended to have a key contact list next to landline phones and to keep a similar list in medical kits.
Additionally, when using commercial radios, it is important to consider the type of radios and available bandwidth. Point-to-point systems using handheld radios can be unreliable, and commercial radios may be supported by either UHF or VHF bands, which have distinct differences and require proper equipment and FCC approval. Utilizing a repeater system can also expand the range of low-power radio units and allow for transmission over longer distances.
The use of commercial radio systems (UHF/VHF) can provide a reliable form of communication in emergency situations, especially when paired with repeater-based systems and a fixed base station. It is important to establish clear channels for emergency communications, such as separate channels for local EMS or campus security. Additionally, internal non-emergency communications should be kept on separate channels. Before each event, a radio test should be conducted with all involved parties to ensure proper conductivity and that radios are fully charged.
In athletic settings, there are no standard hand signals currently in sports medicine. Hand signals can also be used as a form of communication in case of failed radio transmissions or a lack of cell phone coverage. These hand signals should be specific to the medical venue and support staff involved. They can be covered during pregame meetings to ensure everyone is aware of their specific roles in case of a medical emergency.
Each venue-specific EAP should provide minimum information that must be communicated to emergency medical services (EMS). The EAP should incorporate information on the emergency care facilities to which the injured individual will be transported to based on state or regional medical response network (e.g. ST-elevated myocardial infarction, or STEMI; spine; stroke; trauma) facility capabilities.
The organizing/host organization should consider notifying emergency-receiving facilities regarding upcoming/scheduled events and contests. Additional consideration should also be given to including incorporating personnel from the emergency receiving facilities in the development of the EAP for the institution or organization.1–4,6,8,9,13,18
It is crucial to have a well-defined emergency action plan (EAP) in place, including minimum standard information for transmission to emergency medical services (EMS). The EAP should indicate the emergency care facilities that the injured individual will be transported to, based on state or regional medical response network facility capabilities (.e.g ST-elevated myocardial infarction, or STEMI; stroke; trauma) and local EMS protocols.
This includes the closest hospital, the closest trauma center, and any specialty hospitals (e.g., cardiac, spine, neuro, pediatric, burn as applicable) that may be relevant to the injury or illness. The 911 dispatcher should be provided with clear and specific information about the injury or illness and the location of the incident, to ensure a prompt and appropriate response. Additionally, designating an individual to meet EMS at a specific point on the scene can help guide them upon arrival.
It is also important to consider notifying emergency-receiving facilities about upcoming events and contests and involving personnel from these facilities in the development of the EAP. If possible, a member of the team medical staff should accompany the athlete to the receiving facility or, if not possible, direct communication with a physician at the emergency receiving institution should be established.
Appendix 1
Comparison of the 2002 NATA Emergency Planning in Athletics Position Statement with Recommended Contemporary Statements.
Best Practices for Emergency Action Planning and Implementation in Athletic Settings
The 2002 NATA Position Statement on “Emergency Planning in Athletics” 1 presented a total of 12 recommendations. Alongside the initial recommendations, the authors incorporated 5 adjustments to these original recommendations along with 17 new recommendations (HIGHLIGHTED AND EMPHASIZED). The updated recommendations have been aligned into eight (8) key operational components that are essential to any Emergency Action Plan (EAP), regardless of the athletic setting.
Communications
- The EAP should establish a clear mechanism for communication to appropriate emergency care service providers and identify the mode of transportation (ambulance; or air flight) for the injured participant.1–16
- The communication plan should be redundant with a designated and deliberate backup plan (landline, mobile phone; hand signals; mobile transmitter/receivers) if the initial communication method fails.1,2,4,6,8–10,13,17
- Each venue-specific EAP should provide minimum information that must be communicated to emergency medical services (EMS). The EAP should incorporate information on the emergency care facilities to which the injured individual will be transported to based on state or regional medical response network (e.g. ST-elevated myocardial infarction, or STEMI; spine; stroke; trauma) facility capabilities. The organizing/host organization should consider notifying emergency-receiving facilities regarding upcoming/scheduled events and contests. Additional consideration should also be given to including incorporating personnel from the emergency receiving facilities in the development of the EAP for the institution or organization.1–4,6,8,9,13,18
Acknowledgements
We want to thank Dr. Richard C. Hunt, MD, FACEP – Senior Medical Advisor, Office of Health Care Readiness, ASPR, U.S. Department of Health and Human Services (HHS) for his time and expertise guidance in the development of this manuscript.
Lead Authors
Ray Castle, PhD, LAT, ATC, NREMT, is owner and chief executive officer of Action Medicine Consultants, LLC, in Baton Rouge, LA. He has extensive experience with large-scale sports event medical coordination and sports emergency response training. He also is a preceptor for the Baton Rouge General Medical Center’s Primary Care Sports Medicine Fellowship Program.
Ron Courson, ATC, PT, SCS, NRAEMT, CSCS, is the executive associate athletic director – Sports Medicine at the University of Georgia in Athens, Georgia. He is active in sports and emergency medicine and served as the co-chair of the Spine Injury in Sport Group.
Co-Authors
David Csillan, MS, LAT, ATC, is an athletic trainer at The Hun School of Princeton in New Jersey. He has provided prevention, evaluation, emergency care and rehabilitation of athletic injuries at the secondary school level for over 30 years.
Jim Ellis, MD, FACEP, is an emergency physician who serves as medical director for Emergency Preparedness in Player Health and Safety with the NFL. He also is the chief medical advisor for the College Football Playoff as well as the chief medical officer for the United Football League.
Francis Feld DNP, CRNA, LAT, NRP, is a nurse anesthetist at UPMC Passavant Hospital in Pittsburgh. He has extensive prehospital experience with multiple hospital, fire and third service municipal agencies and has worked as an athletic trainer at the high school, university and professional football levels.
Glenn Henry, MA, EMT-P, is a retired vice president of Academic Affairs at Athens Technical College and has served as the on field paramedic for the University of Georgia football program. He is still currently a licensed paramedic and licensed paramedic instructor in the State of Georgia. He also currently serves as the medical advisor for the Oconee County Fire Department.
Jim Kyle, MD, FACSM, FAAFP, is a regional medical director for the West Virginia Office of EMS. He serves as Executive Director of The Kyle Group. Dr. Kyle is Sports Medicine Director and School Health Consultant for New River Health Clinic and medical director of Paramedic education at New River Community and Trade College.
Robb S. Rehberg, PhD, ATC, NREMT, is a senior medical advisor and director of Game Day Medical Operations for the National Football League, and a professor of Athletic Training and Sports Medicine at William Paterson University.
Samantha Scarneo-Miller, PhD, ATC is an assistant professor and program director at West Virginia University for the Masters of Science in Athletic Training Program. Her primary area of research is preventing catastrophic injury in sport through a healthcare administration and dissemination and implementation science lens.
Chris Troyanos, ATC, is a certified athletic trainer with extensive experience in providing medical care at large scale athletic events. He is entering his 28th year as the medical coordinator for the Boston Marathon. He is also a board member of the World Athletics Endurance Medicine Academy.
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