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 Seven of a nine-part series.
Venue Implementation and Response
The EAP should be specific to the activity venue. That is, each activity site must have a defined EAP that is derived from the overall institutional or organizational policies on emergency action planning.1–12 The EAP should address games/events, practices, conditioning activities and other activities.1–12
The EAP should include a separate plan for each specific venue where the team plays, considering any unique challenges that may affect the arrival of emergency services. These plans should be derived from the broader emergency action planning policies of the institution or organization and should consider any additional activities that may take place away from the primary facility. This will ensure that the EAP is tailored to the needs of each venue and will help to minimize the potential for delays in emergency response times.
A copy of the EAP specific to each venue should be posted and readily available to all medical team members. The EAP should be shared and readily available to the visiting team, ideally prior to an event.1,5
It is essential to have a copy of the EAP specific to each venue readily accessible to all medical team members and shared with the visiting team, ideally before an event. This can be achieved by using a standardized template that includes all necessary components of the EAP that is specific to each venue or activity conducted by the organization. Additionally, published copies of the EAP must be posted at all facilities and should be easily accessible to local public service agencies (and emergency departments at receiving hospitals).
Implementation of the EAP at each venue should include an on-site advanced life support (ALS) ambulance at all high-risk events. These are events that have historically resulted in catastrophic medical situations that can be life-threatening or events with many spectators. It is recommended to have an ALS unit if an ambulance is contracted to be at the event, as the expertise is significantly higher than a Basic Life Support (BLS) unit.
Each plan should be compiled with direct input from local public safety and EMS agencies. It should include ingress and egress routes, gate codes, and other important information. Agencies should be notified of any ongoing construction that may affect response to emergencies, and there should be mitigating procedures in place for these situations.
The Medical Time Out (which may be also referred to as a pre-event medical meeting) should be conducted prior to athletic events and practices to enhance communication and coordination with respective team medical staff members, coaches, EMS, game officials, venue administrators, and public safety.5,7,13
The importance of having an updated, venue-specific emergency action plan (EAP) for all activities cannot be overstated. However, it is also crucial to clearly communicate and document emergency procedures before structured events and activities. The Medical Time Out (MTO) is an effective tool that ensures that athletic trainers, emergency medical services, team physicians, and other individuals responsible for the medical well-being of athletes and spectators are aware and educated about the EAP for the specific venue.
Effective communication and coordination between these event professionals are essential to eliminate confusion and chaos, leading to better outcomes in the event of serious injuries.
Before the start of an athletic event, the posted EAP should be reviewed with visiting team medical staff using a pre-event MTO checklist.
The MTO should be conducted before events and practices to enhance communication and coordination between team medical staff members, coaches, EMS, game officials, venue administrators, and public safety. This should be the standard operating procedure for all levels of sport and regional or state EMS systems may also have specific procedures for minimum requirements of the MTO.
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.
Venue Implementation and Response
- The EAP should be specific to the activity venue. That is, each activity site must have a defined EAP that is derived from the overall institutional or organizational policies on emergency action planning.1–12 The EAP should address games/events, practices, conditioning activities, and other activities.1–12
- A copy of the EAP specific to each venue should be posted and readily available to all medical team members. The EAP should be shared and readily available to the visiting team, ideally, before an event.1,5
- The Medical Time Out (which may also be referred to as a pre-event medical meeting) should be conducted before athletic events and practices to enhance communication and coordination with respective team medical staff members, coaches, EMS, game officials, venue administrators, and public safety.5,7
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.
References
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