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
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
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
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.
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.
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.