Christopher Ina, MA, ATC, LAT, is the athletic training coordinator for Wake Forest Baptist Health and former assistant athletic trainer for Wake Forest University football and men’s tennis. During this presentation, he provides an overview of Emergency Action Plans (EAP), the research behind EAP and the importance of these plans. He also discusses potential barriers and solutions to implementing EAP as well as tips to preparing them.
CHRISTOPHER INA: Good evening, everybody. My name is Chris Ina. I am the athletic trainer coordinator for Wake Forest Sports. Or I'm sorry, Wake Forest Baptist Health. I just took that position. I worked at Wake Forest here 14 years. Worked about 80 some football games right on this field here. We won't go over the record for those 80 some football games. But over about 180 total. So I have a lot of experience with football and emergency action plans and being prepared like Dr. Mosse was talking about. So just raise your hand here, how many football coaches we have in the room? Raise your hand nice and high. How about EMS workers? Paramedics? Athletic trainers? Any high school administrators? Not too many. Congratulations. You guys are all crucial parts of the emergency action plan. This is something that affects everybody at every school. Something everyone can be a part of and really should be aware of when it comes to something bad happening. So why are emergency plans important? Number one, it gives you a template or a specific guideline to follow when an emergency happens. Like we talked about before, when an emergency happens a lot of people panic, right? They don't know what to do. Seconds seem like minutes, minutes seem like hours. So if you guys have a specific plan of what to do and who does what then things get done a lot more efficiently and appropriate help arrives in time. If you look there, Dr. Miles talked about cardiac death, sudden death, heat illness, sickle cell. We got asthma. We got shock. Lightning. Did you guys know that North Carolina's third in lightning strike deaths? So that's a possibility. And 4% of deaths were under the age of 17 in high school athletics. So getting someone there, getting appropriate medical care there fast is the key. So what does the research say? We base everything off of research nowadays. So first of all, it says your kids come in, they all take their pre-participation physical. So you figure, hey, they're young. They're 16, they're 15, they're 17, young, healthy athletes, right? Most physicals don't take into effect cardiac issues. So if a kid has an underlying cardiac issue he's probably going to get full clearance from that doctor. So you need to be prepared for if he's out there and his heart stops or he drops after a conditioning drill or something like that due to some undisclosed issue that he might have. All emergency action plans need to be reviewed every year. Again, things change. Personnel changes. Construction changes. Venue changes. The names on the buildings change. A lot of things change. So you guys need to review those things every single year. Make sure everyone's on the same page. Activating the emergency system 911 is, again, one of the key parts of the emergency action plan. Again, you're trying to get additional help for your problem. And then early fibrillation with the AED. Within three minutes is the best survival rate. So the sooner you can get your AED on site and activated, the more likely you are to save someone's life. So why is this important? So why is it important to A, let's say develop a specific emergency action plan for each venue? You can't just say I'm at Reagan High School. That's not going to help dispatch. That's not going to help the paramedics. They're not going to know where to go. So you need to have a specific emergency action plan for each of your venues. And that's indoor venues, that's outdoor venues, that's on campus, that's off campus. That's even multiple gyms. If the wrestling gym is different from the basketball gym then you need to have specific emergency action plans. The more information you can give the dispatch on the phone, the better chance you are of having someone get to you quicker. Number two, why is it important to identify personnel? Everyone has different medical backgrounds. Head coach versus athletic trainer versus maybe your doctors on site. Maybe the school nurse is there. Maybe it's just a teacher. Maybe it's a parent. Everyone has different medical backgrounds. So identifying who knows what and who has a good skill level is important in an emergency action plan. So what else have we got here? So we've got to develop and practice with your local EMS crews. You guys-- all the athletic trainers should get together with the EMS crews. Get together, walk through your site, take notice of stairwells, take a notice of construction, take notice of gates. Is it locked? Who has a key? Stuff like that. You guys walk through that stuff together so when something does happen everyone's on the same page. You've got to identify all emergency equipment that you need. You need, obviously, just basic first aid stuff. You need emergency splints, AEDs, stuff like that. Those are all things you're going to need to bring with you to emergency site. Number five is there. You've got to have documentation. So you do activate your emergency action plan. You follow it. You do the best you can. And then after it you review it and you say, hey, this worked, this didn't work, this worked, this didn't work. So you can review it and then you have documentation that if God forbid a lawyer comes knocking or something like that you have hey, this is our emergency action plan. This is what we did. This is how we followed it. And then the last thing is you don't want to be unprepared. You want to be prepared. So the best way is communication is the key when it comes to this stuff. Everyone has to calm down, relax, take a deep breath, and work together as a team to kind of get this stuff done. So our essential framework. Some of the key personnel we're looking at here. Like I said before, you've got to athletic trainers. Coaches are going to be there. Parents might come down from the stands. Administrators. Of course, our EMS and paramedic personnel. And then some of the equipment you guys need to think about you might need. Keys to gates. Does only the coach have the key? Does the athletic trainer have the key? What if the athletic trainer is off site? How is that gate going to get open? Lamination of your emergency action plans. Again, those should be posted outside our venues, inside locker rooms, inside dugouts, outside by the track. So anyone can just look at that emergency action plan and activate it when necessary. And then of course, the most expensive thing there is going to be your AEDs. $1,000 plus. So we're going to identify what your organization does well. Maybe you guys have been there for 30 years and everybody knows the campus and everyone knows the traffic patterns. Everyone knows every building. That's a good strength. Maybe your weaknesses you have a bunch of new staff members and no one knows where anything is. They don't even know how to get to Harris Teeter on the corner. So they're not going to be very helpful when it comes to giving directions to the paramedics. Consider who the key personnel in your organization are, whether it's your athletic trainer, whether it's your head coach. Identify those personnel. Most importantly is review. Create your initial plan, review it with everybody. Send it out to everybody. Parents, teachers, whoever wants to read this. Get feedback on those things. If they don't understand it then it needs to be changed. Everyone has to have a clear understanding of these emergency action plans. So potential barriers. Everyone's got excuses, right? I can't do this. Number one, our fields are all public. How are we supposed to post an emergency action plan? You can still post your emergency action plan on public fields. Just make it specific to your high school. Reagan High School football practice field or football stadium. This is our emergency action plan. That way if there is someone else-- there's a couple of people running doing gassers on the field or something and something happens, they have a nice document that they can look at that they can get some extra help. Number two, I don't have any medical staff. Well, you don't need medical staff. All you need is someone that can look at the plan and activate it. You don't have to be an athletic trainer. You don't have to be a doctor. Anybody can do this. This is just basic information. We have tons of venues, right? We got fields all over the place. Well, that's where it becomes like we talked about earlier having that specific plan for that specific venue. Specific addresses, specific directions, stuff like that for each venue. That shouldn't really be an excuse. And then what if people don't understand? I got a bajillion people in my school. How am I supposed to get this emergency action plan to every single person? Once again, you don't really need to. If you send it out and you have it reviewed by different peer groups-- teachers, coaches, trainers, doctors, parents. I put on here write it at an eighth grade level. Write something simple, something that everybody can understand and everybody can implement. You don't have to use big fancy words and show how smart you are. You just need people to get help to you as fast as you can. All right. Tips and tricks. So number one, we talked about this earlier. Know your role, right? Who's in charge? Is the athletic trainer there? If they're not, can you get a hold of them? How do you contact him? Who's calling EMS? Know your role. Those roles should be easily delineated on those emergency action plans. Who does what, who goes to the gates, who does all that stuff. What's your location? Again, the more information you can give dispatch, the easier it is they're going to get someone there to help you. The worst case scenario is you're at the baseball field and they go to the football stadium and they're not close to each other. How do they get to you? Again, detailed instructions. Get together with your EMS folks, map out your route. Is there an ambulance turn around there? Is there road construction? Did the name of the high school gym change because someone threw a bunch of money in and changed the name on it? Those are all things that you need to know and you need to relay to the appropriate personnel. And number five, again, the correct information. Again, more information. Is the patient conscious? Who's there? Who's providing care? Is it an athletic trainer? Is it a doctor? Is it a coach? Who's doing the care? What happened? All these things are important information that you can give those people and they can get you the help you need. This doesn't present too well, but wrote this about 5 or 6 years ago. And this is the emergency action plan for the field out here. Again, it's on the website. I think all emergency action plans should be posted. But it just talks about some of that stuff we talked about earlier. Emergency personnel, communication. We always had a phone on the sidelines. Obviously, everyone has a cell phone nowadays. The role of the first responders. Someone always went to the gate to meet the bus when it got there. So they knew exactly where to go. That was always someone's role. Someone's role was to call 911. Someone's role was to get the AED. Someone's role was to perform CPR. So everyone had a specific role. And then if you pan down there, it gives our specific location of the stadium. You figure, everyone who went to Salem knows where BB&T football stadium is. That's not true. You can't just assume that everyone you can just say the football stadium at Wake Forest. Some people might not know where that is. So if you give them, again, a specific street address, specific directions on how to get here, it's going to avoid confusion and get everyone here as fast as you can. Like Dr. Miles said, last night at Wake they had to call an ambulance. They had to activate their emergency action plan because a basketball player fell in the gym and needed to be spine boarded. So that was just yesterday. I can't count how many times that we've needed to use it on this field or on a practice field over there at Wake. So it's something you're going to have to use. So I guess the more advanced you are, the more prepared you are with your emergency action plan, the better results you're going to have for those student athletes. That's it. Any questions? So just practice, practice, practice. You can't practice enough.