National Study on Emergency Action Plans for High School Athletics

Nita Unruh, Ed.D.Scott Unruh, Ed.D., ATCUniversity of Nebraska Kearney

Background for Study

• Death of 15 year old High School Football player Max Gilpin at Pleasure Ridge High School in Louisville, Kentucky.– Settled for $1.75 Million

• Presentation at 2010 SRLA by Moorman, Greenhalgh, Hambrick, & Simmons on Gilpin case and Kentucky HB 383.

Issues Connected with the need for an EAP

• Duty to plan • Need to assess an athletes physical fitness

to participate• Need to supervise• Need to maintain safe playing conditions• Duty to provide proper emergency care• Need to have an Emergency Action Plan

Study Information

• N=4394– Randomly selected 10% of high schools from all 50

states– Used the Clell Wade State Coaches Directory

• Used Qualtrics Email Survey Program• 29.76% response rate (1308)• Responses from all 50 states

Title of Individual Completing Survey

Size of Schools that Responded

SPORT # of Schools reporting sport teams

SPORT # of Schools reporting sport teams

BOYS BASKETBALL 1169 GIRLS TENNIS 794

GIRLS BASKETBALL 1162 WRESTLING 793

TRACK & FIELD 1108 BOYS TENNIS 767

FOOTBALL 1074 SWIM/DIVE 610

GIRLS VOLLEYBALL 1067 FIELD HOCKEY 174

SOFTBALL 1025 ICE HOCKEY 169

BASEBALL 1020 GYMNASTICS 133

CROSS COUNTRY 1020 WATER POLO 90

BOYS GOLF 998 RUGBY 28

BOYS SOCCER 838 RODEO 12

GIRLS SOCCER 816

GIRLS GOLF 797 OTHER 176

Emergency Action Plans

¼ of institutions did not have an EAP for athletic practices or events!

EAP Mandated for Practice and Competition

Practiced a Full Scale EAP for the following Events

92.82%

69.94%75.22%

33.19%

20.93%33.77% 29.68%

7.18%

30.09% 24.78%

66.81%

79.07%

66.23% 70.23%

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

Yes

No

Results based upon emergency preparedness for athletic practices

Training of Coaches and Athletic Staff

YES NoCoaches and Staff Regularly trained in CPR 888 166

Coaches and other athletic personnel trained for response to emergency situations

877 177

Percentage (n) of Schools That Reported Having a Certified/Licensed Athletic Trainer on Staff

N=438

N=622

*604 ATCs to intervene in an emergency

Number and Percentage of Schools by size Reporting having an Athletic Trainer on

Staff11, 2%

83, 13%

79, 13%

82, 13%144, 23%

98, 16%

124, 20%

51-150

151-500

501-750

751-1000

1001-1500

1501-2000

2000 +

The N for the category of schools with 50 or below students was to small for the data to be generalizable.

Persons Responsible for Making Decisions Concerning Emergency Scenarios at

Practice

How Prepared are you at an Athletic Practice to Handle the following:

Equipment Available for Practices

77% of schools said that emergency equipment was regularly maintained.

Person responsible for making EAP Decisions at practice and the availability of

Equipment for Cardiac EmergenciesPerson Responsible Yes

EquipmentSpecifically

AEDNo

Coach 338 333 151

Athletic Trainer 453 462 80

School Nurse 4 3 3

Athletic Director 6 9 5

Other 11 10 3

Person responsible for making EAP Decisions at practice and the availability of

Equipment for Heat IllnessPerson Responsible Yes

EquipmentSpecifically Cooling Tub

No

Coach 339 156 158

Athletic Trainer 450 321 78

School Nurse 3 4 2

Athletic Director 9 3 2

Other 11 5 2

Person responsible for making EAP Decisions at practice and the availability of

Equipment for Head InjuriesPerson Responsible Yes Spec.

Face Mask

Spec. Spine Board

No

Coach 308 229 92 139

Athletic Trainer 471 443 307 89

School Nurse 7 5 3 5

Athletic Director 8 4 2 4

Other 18 16 5 5

• Recent literature supports the assertion that between 45% – 50% of injury occurs in practice situations.

• Substantial risk exists in the event of extended time for emergency response due to rural settings.

Results based upon emergency preparedness for competitive events

Number of Schools That Reported Having the following present at Athletic Competitions

N=438

Persons Responsible for Making Decisions Concerning Emergency Scenarios at

Athletic Competitions

How Prepared are you at an Athletic Competition to Handle the following:

14 of the 50 states solicited had 30 or more schools respond. The results

from those schools present responses that are more generalizable to the

broader population.

Mandate for Emergency Action PlansStatistical Analysis

When the individual completing the response was an Athletic Director/Activity Director, there was significant difference (p<.000) in how the respondents identified

the “mandate” to have EAPs for athletic events.

Some viewed that the mandate was required by state legislation or by the state high school activity

association. Others responded that EAPs for an athletic event were not mandated.

Further discussion and findings• We could find no state statutes were in place for the

requirement of EAPs for athletic events (competition or practice).

• School size is typically indicative of employing an ATC for supervision practices and events.

• In most cases, ADs were the person who were responsible for making decision in cases of threat by weather.

• Institutions that had ATCs, were better prepared and had equipment available to handle emergencies.

• Interestingly, a number of schools who rely on coaches for decision making in cases of heat illness indicate that they do not have the proper equipment ready to handle the case.• Immersion is standard of care of heat stroke. • AEDs in place • Creation and implementation of EAPs for all athletic events.

(Position statements)

• National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics . Journal of Athletic Training 2002;37(1):99–104

• Inter-Association Task Force recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement. Journal of Athletic Training 2007;42(1):143–158

• Appropriate medial care for secondary school age athletes: A Consensus Statement. Feb. 2003

• Inter-Association Task Force on Exceptional Heat Illness. A Consensus Statement. 2003

• Pre-hospital Care for the Spine Injured Athlete. Inter-Association Task Guidelines. 2001

So Where does that Leave Us?

• Emergency Action Plans are essential to a Risk Management Plan.

• There is Standard of Care established by a variety of medical groups that support proper training and provision for medical emergencies at the high school setting.

• Many schools did not provide guidelines, equipment or trained personnel to deal with serious medical emergencies, especially for the practice environment.