Emergency Action Planning in Secondary School Settings: Updates for Athletic Trainers and Doctors

Abstract

Background:

Proper implementation of an emergency action plan (EAP) in the secondary school setting has been shown to reduce response times for a medical emergency but should be reinforced with regular EAP practice and maintenance.

Indications:

Understanding the proper implementation and maintenance of an EAP as well as the pivotal role athletic trainers play in adopting and rehearsing a successful EAP.

Relevance:

Many secondary school settings have EAPs in place but have a higher risk of failing to properly implement them without regular EAP rehearsal and maintenance.

Discussion/Conclusion:

With regular EAP rehearsals and maintenance under the supervision of an athletic trainer, secondary schools are more readily prepared for an emergency while also understanding clear role delineations each bystander plays.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Graphical Abstract

This is a visual representation of the abstract.

Video Transcript

Hello everyone and thank you for joining this presentation. Today we will discuss an update on emergency action plans (EAPs) in secondary school settings and the athletic trainer's role in the successful implementation and activation of EAPs.

There are no financial disclosures related to this work. All athletic trainers and doctors involved in this project are employed by Stanford Medicine: Children's Health.

The main goals of this presentation are as follows:

• Define EAPs

• Identify the components involved in an EAP

• Highlighting the benefits of EAPs in secondary school settings, describing the athletic trainer's role in this process, and promoting an understanding of proper EAP maintenance and implementation

Background

A large population of student athletes participates in sports annually. McLeod and Cardenas ⁸ approximate that 7.8 million students participate in secondary school sports. During a 35-year span, there were 777 fatalities and 1169 nonfatal incidences reported. Of note, Scarneo et al ⁹ found that EAPs were not present in 62% of these fatalities. Furthermore, an additional study by Scarneo-Miller et al ¹¹ in 2020 demonstrated a 35% increase in survival rate when EAPs were present.

Sudden cardiac arrest is the leading cause of death in adolescent athletes. Importantly, 90% can survive if an automated external defibrillator (AED) is applied correctly within the first 3 minutes of collapse, and these rates decline by 7% to 10% for every minute elapsed. While this topic is ever present in secondary school sports medicine settings, it was highlighted on the national stage in 2023 when Damar Hamlin sustained a commotio cordis during a primetime National Football League game. Fortunately, the medical team and event staff had a well-rehearsed and planned EAP, and he survived this event.

The 3 leading causes of sports-related death are cardiac arrest, head injury, and heat-related illness.

Sport participation is the fourth leading cause of spinal injuries in young athletes.

EAPs are defined by McDermott et al ⁷ as “written standard protocols that coordinate efforts of athletic trainers, physicians, emergency medical services, and all other parties involved in the coverage of athletic events.” Athletic trainers are vital to the proper implementation and adoption of evidence-based EAPs.

An athletic trainer's unique skillset allows them to provide expertise and timely care in emergent scenarios. This was best put by Jones et al, ⁵ who stated “Increased presence leads to improved care.” Secondary schools display increased rates of EAP implementation and rehearsal when athletic trainers are present.^1,3,4 This, in turn, positively affects response times to injuries and survival rates. Improved injury and concussion recognition was also noted. Schools that employ athletic trainers full-time correlate with increased recognition and reporting of injuries.^6,10,11 Despite this information, just 67% of schools nationwide employ athletic trainers, and just 34% to 53% of those athletic trainers work full-time hours. Athletic trainers promote health literacy, and schools that lack athletic trainers can place students at higher risk during sports-related critical incidences. ¹²

In 2002, the National Athletic Trainers’ Association (NATA) developed an EAP position statement that highlights the key components involved in emergency planning. EAPs help to provide a defense against medicolegal concerns, preparation for an emergency response, guidelines for equipment maintenance, and defined roles for personnel.

Technique Description

Andersen et al ² identified 12 key components in EAPs that are noted on these next 2 slides. Each component is a critical piece to an evidence-based EAP.

There are 2 key areas highlighted on this slide: venue-specific EAPs and annual review and rehearsal. These are 2 sections that are most commonly found lacking when schools and athletic trainers are polled about their EAPs, yet they are critical to the promotion of timely and effective EAP activation.

This video will highlight both of these sections and help to provide a framework for annual rehearsal.

In the first scene, the athletic trainer will explain the roles and responsibilities to the coaches and describe the scenario.

The athletic trainer will then walk through the initial assessment and discuss the proceeding steps.

This will include looking, listening, and feeling for signs of breathing and checking for a pulse.

Next, the athletic trainer will identify the nearest AED and EAP guide. We have each site-specific EAP posted above our AEDs in every venue. All emergency numbers and emergency department locations should be clearly labeled and identifiable.

After checking understanding of the assigned roles, the coaches will take turns rehearsing each role while the athletic trainer watches and provides feedback.

Once the practice scenario is finished, it is important to allow time for questions and to check understanding about the EAP.

Discussion

Despite the evidence, there are still persistent barriers associated with EAP implementation. Schools that lack athletic trainers place the responsibility of EAP development on coaches and administration. In many cases, coaches lack the proper background for this task and tend to overestimate their skills in this area. ¹² One major barrier is the lack of funding for qualified personnel and equipment. ¹⁰ Recent studies have shown a lack of compliance with the NATA position statement evidence-based practices and displayed compliance ratings as low as 9.9%. Annual rehearsal and venue-specific planning are frequently omitted. These deficits can promote delay and error when accuracy and timeliness are needed most.

Let’s take a look at some facilitators. Statewide policies have shown higher adoption rates at the secondary school level. ¹¹ Emphasizing the annual rehearsal and venue-specific planning can improve the effectiveness of EAPs and reduce error. Having an athletic trainer present improves compliance. It is important to have access to proper training, equipment, and qualified personnel.

Remember, EAPs are essential to the safety of secondary school athletes and can mean the difference in an athlete's survival if enacted correctly. Athletic trainers are a vital component to the successful implementation and rehearsal of EAPs, but improvements can be made in ensuring all secondary schools have access to them. The NATA position statement provides an evidence-based framework for a robust EAP, but compliance can be improved specifically with annual rehearsal and venue-specific planning.

Here are our references and we thank you for your time and attention.