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 Five of a nine-part series.
Contemporary Equipment and Supplies
The EAP should specify the equipment needed to carry out the tasks required in the event of an emergency. In addition, the EAP should outline the location and availability of all emergency equipment for use by medical and non-medical personnel at each venue.1–24
Medical equipment at each venue must match the level of personnel training and the types of injuries/illnesses that may occur. This includes having equipment for high-risk activities with potential exertional heat stroke, including cold water immersion tubs (or alternative methods for cooling such as tarp with “taco method”) for whole-body cooling, rectal thermometers and wet-bulb globe thermometer (WBGT) to monitor weather conditions. Venues with spectator areas should also have emergency medical equipment readily available and clearly marked.
Regular equipment checks and maintenance should be conducted and documented to ensure emergency readiness. Routine maintenance of equipment should be conducted per the manufacturer’s recommendation.4,25 The organization should evaluate and adopt a process for documenting regular maintenance checks.
Equipment/supplies should be: 1) clearly labeled/identifiable in conspicuous locations, and 2) accessible at all times; this includes events/activities off-school premises or conducted outside normal business hours of the organization.2,4–7,10–13,15–17,20,26–28
The development and implementation of emergency action plan policies and procedures for athletic settings are crucial for ensuring the safety of athletes, staff and spectators. This includes having the appropriate medical equipment and supplies on hand to address a variety of potential injuries or illnesses. Minimal emergency equipment for every venue includes CPR pocket masks, AED, personal protective equipment, bleeding control measures, splints, and sanitation supplies.
However, organizations should also consider tailoring their medical equipment to the level of training and qualification of on-site medical personnel. This can include spine motion restriction equipment, medical diagnostic equipment, supraglottic airway and suction devices, supplemental oxygen, and rescue medications.
Since the COVID-19 pandemic, organizations must now consider the implementation of additional equipment and supplies to prevent disease transmission. This includes N95 NIOSH masks, hand sanitizers, social distancing signage and other patient isolation equipment.
AEDs should be always immediately available and locations prominently marked, and public access bleeding control kits are strongly recommended for all venues. The probability of AED use decreases by half for every 100 meters traveled to retrieve the unit. For this reason, institutions with large physical facilities and separate venues with overlapping events must consider obtaining multiple AEDs.20
Public access bleeding control kits with tourniquets, dressings and bandages are strongly recommended for all venues. Ideally, every public access AED cabinet should include a bleeding control kit.
The availability of specific rescue medications such as aspirin, beta-2 agonists, epinephrine auto-injectors, oxygen and diabetic medications may be necessary for patients or staff with comorbidities. Medical staff should be educated on the specific medication and its administration, consistent with state laws and under the guidance of the team physician. Staff should be prepared to either administer or assist in the administration of the medication in an emergency, in accordance with written medical protocols developed by the team physician.
Athletes with sickle cell trait (SCT) are at high risk for exertional collapse associated with sickle cell trait (ECAST). All personnel, including coaches, should receive training on the recognition and treatment of ECAST and review that training at the beginning of each sport season. Treatment of ECAST includes the immediate activation of emergency medical services and the immediate administration of supplemental oxygen (if available) by the athletic trainer. The availability of oxygen may be restricted by state practice regulations and local building codes, so proper storage measures and signs indicating oxygen is in use are required.
Rescue medication for suspected opioid overdose should also be considered. Naloxone is a medication used to reverse respiratory depression caused by opioid overdose. Naloxone can be administered by intravenous, intramuscular, intraosseous or intranasal routes. All routes are effective, although the bioavailability of naloxone by the intranasal route is approximately 50%, so a larger dose is necessary. It is important to note that the primary treatment of opioid overdose is to treat the resultant respiratory depression with basic airway techniques to ensure adequate oxygenation.
The availability of equipment above the minimal level cited depends upon the personnel level of training and governmental practice acts. Athletic trainers should consult individual state practice acts when reviewing these recommendations and discuss any intervention with their supervising physician. Specific protocols consistent with state scope of practice legislation should be developed and reviewed at least annually.
Athletic trainers are trained and proficient in using various medical equipment, including automated external defibrillators (AEDs), bleeding control measures, splints, airway management equipment, spine motion restriction equipment, medical diagnostic equipment and rescue medications.
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.
Contemporary Equipment and Supplies
- The EAP should specify the equipment needed to carry out the tasks required in the event of an emergency. In addition, the EAP should outline the location and availability of all emergency equipment for use by medical and non-medical personnel at each venue.1–24
- Equipment/supplies should be: 1) clearly labeled/identifiable in conspicuous locations, and 2) accessible at all times; this includes events/activities off-school premises or conducted outside normal business hours of the organization.2,4–7,10–13,15–17,20,26–28
Appendix 2
GUIDELINES FOR DEVELOPING A NEW EMERGENCY ACTION PLAN (EAP)
For organizations that do not have an established EAP, or their EAP needs to be reviewed, we recommend the following criteria to ensure you have met best practices:
- Create a working group – this should include key members/stakeholders within the organization including medical personnel, the organization’s public safety officer, local police, fire and EMS, legal representation, and when appropriate – someone from the institution’s health office.
- Collect Reference Material – there are many templates available to those starting or in the process of reviewing their current EAP. Reviewing former best practices is a good start.
- Inventory Capabilities – As the EAP is developed, there will be specific contemporary equipment, supplies, and staffing that will be needed. Do all of these factors fit into your EAP and venue needs?
- Develop Objectives – For each venue or activity that the organization is responsible for, it is critical to delineate basic goals and objectives. Depending on the activity, location, time of year, and other factors, those objectives can be very different.
- Practicing Objectives – While writing an EAP can assist in an emergency, practicing various aspects of the EAP is vital. Is the emergency equipment in good working order?; Is the communications system operational as a crisis arises? Creating “muscle memory” is a great way to ensure the written plan comes to life and works to its fullest potential.
- Consideration should be taken to create a gap analysis. While writing the EAP, certain deficiencies, educational/training, or capability gaps will become apparent. Understanding and filling those gaps can mean the difference between life and death.
Finally, every critical incident should include an immediate after-action discussion post-event and evaluation of performance following an emergency. It is crucial for all stakeholders that developed the plan to have the ability to review its success or failure for continuous quality improvement. Even with all the time and effort put into your planning, post-event evaluations are a key to long-term success.
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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