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 Four of a nine-part series.
Stakeholder Feedback, Scheduled Rehearsals and Review
EAPs should be distributed and reviewed with athletic trainers, team and attending physicians, athletic training students, institutional and organizational safety personnel, institutional and organizational administrators, and coaches. Additional external reviews include visiting the team’s athletic training/medical staff (as part of the “Medical Time Out”) and primary receiving facility emergency department.1–5
It is crucial for the success of the EAP that all personnel involved review and practice it regularly. In cases where medically qualified personnel are not present, or the situation exceeds their capabilities, coaches, and administrators should be educated on the EAP and their roles in activating it. These individuals have a professional responsibility to provide emergency care in an emergency.
The written plan should integrate with local EMS, fire, law enforcement, hospital, and health care coalition preparedness/response plans.1–3,6,7
It is vital for the success of an emergency action plan (EAP) that it is reviewed and rehearsed regularly by all personnel involved. This includes key stakeholders such as coaches and administrators, who share the professional responsibility of providing emergency care in the event of an emergency. In addition, the EAP should be reviewed and updated periodically in collaboration with school or event administrators, local emergency medical services, fire and police.
Rehearsal is an essential component of the EAP as it improves the skills of those involved in carrying out the plan. Literature on memory recall suggests that knowledge deteriorates quickly if not used or updated regularly. This can be demonstrated through CPR retraining literature, which indicates that knowledge decays as soon as two weeks after training, up to 18 months. Therefore, CPR re-training is conducted every two years. Similarly, school fire drills are conducted regularly to ensure that students and staff know their evacuation routes and assembly points. Research shows that feedback on the location of fire drill assembly points can differ three months after a fire drill compared to the day after the fire drill.
The EAP should be reviewed, rehearsed, and updated annually (at a minimum), although more frequent review and rehearsal may be necessary. Immediate updates are warranted if there have been significant changes in the venue, personnel, and/or an after-action report/evaluation which would trigger an immediate update. The results of these reviews and rehearsals should be documented and should indicate whether the EAP was modified, with further documentation reflecting how the plan was changed.1,8–24
The EAP should be reviewed, rehearsed and updated annually as a minimum requirement, as it is essential to ensure that the plan is up-to-date and that all parties involved are familiar with the procedures.1,8–24
An annual review ensures that the plan remains relevant and effective in case of an emergency. Furthermore, more frequent review and rehearsal may be necessary, depending on the type of event, the venue, and the level of risk involved.
Immediate updates to the EAP should be made if there have been significant changes in the venue, personnel, or if an after-action report/evaluation reveals areas of improvement.1,8–24 For example, if a new venue is used for a sporting event, it is essential to review the EAP to ensure that it is appropriate for the new location and that all personnel are familiar with the layout and emergency procedures.
Additionally, if there are changes in personnel, such as new staff members or volunteers, it is essential to ensure that they are familiar with the EAP and their roles in an emergency.
An after-action report or evaluation is a critical tool in assessing the effectiveness of the EAP in an emergency. It provides an opportunity to identify areas of improvement and to make necessary changes to the plan. Therefore, any changes made to the EAP as a result of an after-action report or evaluation should be documented and communicated to all involved parties.
The EAP should be rehearsed with all internal organizational staff (including but not limited to healthcare professionals, coaches, etc.) on a regular and planned basis as determined by the organization or agency.2,5,8,25
Rehearsing the EAP with all internal organizational staff on a regular and planned basis is crucial for ensuring that staff members are prepared to respond effectively to emergencies, that the EAP is up-to-date and effective, and that the organization or agency is meeting legal and regulatory requirements.2,5
Regular rehearsals ensure that all staff members are familiar with the EAP and understand their roles and responsibilities in the event of an emergency.2,5,25 This knowledge can help to minimize confusion and improve response times in the event of an actual emergency.
EAP rehearsals provide an opportunity for staff members to practice their emergency response skills in a controlled environment, which can help to improve their confidence and effectiveness in responding to a real emergency.2,5,25 The more familiar staff members are with the EAP, the more likely they will be to act quickly and appropriately in an emergency.
Identification of weaknesses or gaps in the EAP is another critical role that rehearsals provide an opportunity for the organization or agency to identify any weaknesses or gaps in the EAP, and make necessary adjustments.2,8 This can help to ensure that the EAP is up-to-date and effective and that it considers any changes in the venue, personnel, or other factors.
Finally, regular rehearsals are also important for meeting legal and regulatory requirements.2,8 Many organizations and agencies are required to have emergency plans in place, and regular rehearsals can help to demonstrate that the organization or agency is taking the necessary steps to protect staff and visitors in the event of an emergency.
The EAP should include a mechanism for the performance and assessment of annual competencies and readiness drills conducted to maintain readiness for potential catastrophic injuries/illnesses.2,26–28
Regular and planned rehearsals of the EAP should be conducted with all relevant emergency team members, such as athletic trainers, consulting physicians, coaches, and emergency medical services, at least once a year.2,26–28
This allows team members to maintain their emergency skills and communicate effectively regarding specific policies and procedures. The rehearsal can be held during an annual in-service meeting, ideally before the sports season with the highest risk, such as football, ice hockey and lacrosse.
Various scenarios should be practiced during the rehearsals, including cervical spine immobilization/spinal motion restriction, cardiac arrest, and other life-threatening situations, as well as managing multiple simultaneous injuries.
EAPs should be distributed to public safety agencies that may respond to emergency situations occurring at the organization’s activities/functions.2,5,8,9,26,28–31
For potential intentional events like active shooter scenarios that require multi-agency/interdisciplinary involvement, it is recommended to include local/regional resources to participate in training.2,5,8,9,26,28–31Regular reviews and rehearsals should be conducted throughout the sports season as emergency medical procedures and personnel may change. Although one annual rehearsal is recommended, more frequent rehearsals and subsequent reviews ensure prompt and organized delivery of care.
The EAP should be rehearsed with all pre-hospital (e.g., emergency medical services, police, fire) and hospital staff (e.g. emergency department physicians, nurses, etc.).2,5,8,10,26,29,32
Local public safety and emergency management personnel should be invited to participate in all drills and take an active role in the evaluation and revision of the EAP as necessary.
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.
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.
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