Study Notes on Organization and Administration of Emergency Care

Organization and Administration of Emergency Care

Introduction to Emergency Situations

  • Emergency situations can occur during any type of activity, especially in athletics.

  • It is vital to have an Emergency Action Plan (EAP) in place to ensure the best possible care for athletes experiencing potentially life-threatening injuries or illnesses.

Box 1-1: Components of Emergency Care

  • Preparation

    • Development of an EAP.

    • Coverage of athletic events and practices by proper personnel.

    • Regular maintenance and upkeep of emergency equipment and supplies.

    • Selection of appropriate personnel as part of the sports medicine team.

    • Continuing education for the sports medicine team in emergency medical care.

Importance of EAP

  • An EAP is crucial for saving individuals in life-threatening situations.

  • Key factors to consider for effective organization and administration of emergency care:

    • Documentation.

    • Availability of emergency care facilities.

    • Venue location and accessibility.

    • Emergency team personnel roles.

    • Emergency action communication plan.

    • Adequate equipment and supplies.

    • Transportation logistics.

Figure 1-1: Components of an EAP

  • Documentation

  • Emergency care facilities

  • Venue location

  • Emergency team personnel

  • Emergency action communication plan

  • Equipment and supplies

  • Transportation

EAP Development and Implementation

  • Development: EAPs must be formulated by organizational or institutional personnel in conjunction with local emergency medical services (EMS).

  • Implementation: Achieved through three components:

    • Documentation: Record the plan's details.

    • Education: Inform all involved parties.

    • Rehearsal: Practice the plan frequently.

  • A copy of the EAP specific to each venue should be prominently displayed near communication tools (phones).

The Emergency Team and Roles

  • Key Members of the Emergency Team:

    • Athletic Trainer: First responder and provides immediate care.

    • Team Physician: Also a first responder involved in initial treatment.

    • Team Coach: Responsible for activating the EMS.

    • Athletic Training Student: Assists as first responder and retrieves equipment.

    • Equipment Manager: First responder, guides EMS to the scene.

FIRST RESPONDER Training

  • Any emergency team member may act as a first responder.

  • Definition: A first responder is someone trained in emergency care prior to the arrival of EMS.

  • All emergency team members must be certified in:

    • First aid.

    • Cardiopulmonary resuscitation (CPR).

    • Use of an automated external defibrillator (AED).

    • Prevention of disease transmission (particularly concerning bloodborne pathogens).

Roles in Emergency Response

  • Role 1: Athletic Trainer/Team Physician - Most qualified for acute care.

  • Role 2: Athletic Training Students - Ensure emergency equipment is accessible and functional. Common equipment includes:

    • Splints

    • Spine boards

    • Bag valve masks

    • AED devices

    • First aid kits

    • Cellular phones.

  • Role 3: Coach

    • Activates EMS System when needed.

    • Box 1-3 outlines the activation of EMS:

    1. Make the call (dial 911 or direct local emergency numbers).

    2. Provide essential information to EMS:

      • Name, address, and phone number of the caller.

      • Number of athletes involved.

      • Condition of the athletes.

      • Treatments initiated.

      • Directions to the emergency site.

  • Role 4: Equipment Manager - Responsible for opening access points and guiding EMS.

CHECK—CALL—CARE System for Initial Patient Assessment

  • CHECK: Assess the scene for safety and gather details about the incident; check the victim's airway, breathing, circulation, fractures, and bleeding.

  • CALL: Contact 911 or local emergency services, provide directions to the injury site, meet the ambulance, and guide them to the injured athlete.

  • CARE:

    • Calm and reassure the injured person.

    • Continuously reassess vital signs.

    • Control any bleeding.

    • Immobilize injured areas.

    • Provide CPR/AED and necessary first aid.

Emergency Communication

  • Effective communication is essential for rapid and efficient emergency care during athletic incidents.

  • Establish communication protocols prior to events to foster cooperation among professionals.

  • If on-site emergency transportation is unavailable, direct communication with EMS is critical.

  • Ensure access to functioning telecommunication devices (mobile or landline).

  • A backup communication system should be in place in case of primary system failure.

Box 1-5: Emergency Equipment and Supply List

Equipment

  • Automated External Defibrillator (AED) Unit

  • Immobilization splints

  • Stretcher/Spine Board

  • Airway Bag-Valve Mask

Supplies

  • First Aid Kit

  • Sterile Bandages

  • Tape and Elastic Wraps

  • Bloodborne Pathogen Kits

Maintenance of Emergency Equipment

  • All emergency equipment must be functional and regularly checked.

  • Every emergency team member should be trained in the use of all first aid equipment.

  • Regular practice in the application of equipment and supplies should be conducted to avoid delays during real emergencies.

Automated External Defibrillator (AED)

  • Definition: An AED automatically analyzes heart rhythm; if a critical issue is detected, it delivers a shock to restore normal heart rhythm.

  • Increasingly utilized due to their small size and user-friendly design, AEDs are installed in numerous public places (e.g., schools, airports) to enhance opportunities for life-saving interventions.

Benefits of AEDs

  • Pads with electrodes adhere to the patient's chest.

  • The device checks heart rhythm and can deliver an electric shock.

  • Written and verbal instructions are provided to the user.

Venue Location Considerations

  • Each EAP must address:

    • Accessibility to emergency personnel.

    • Available communication systems.

    • Availability of emergency equipment.

    • Arrangements for emergency vehicle transportation.

  • Venues with unique needs (e.g., cross-country courses, swimming pools, narrow stairs, ice-hockey rinks) require specific EAP adaptations.

Box 1-6: Specific Venue Location EAP

Components Include:

  1. Emergency Personnel on-Site: Trainers, coaches, EMS at practices, games, tournaments.

  2. Emergency Communication: Phones and radios, emergency contact numbers.

  3. Emergency Equipment: AED, first aid kits, splints, spine boards, on-site ambulance.

  4. Emergency Procedures: Venue maps, directions, CHECK-CALL-CARE instructions, nearest emergency care facility directions.

Emergency Transportation Policies

  • EAP should stipulate transportation policies for ill or injured individuals at athletic events.

  • Emergencies are defined as requiring transport via EMS, typically an ambulance.

  • Consideration of transportation service levels is critical, differentiating between Basic Life Support (BLS) and Advanced Life Support (ALS).

Box 1-7: BLS vs. ALS

  • Basic Life Support (BLS):

    • Provided by EMTs, includes basic airway support, AED use, splinting, spine boarding.

  • Advanced Life Support (ALS):

    • Administered by paramedics, allows for advanced airway management, invasive procedures (IVs), and medication administration per protocol.

Emergency Care Facilities

  • Each EAP must include transportation details to emergency medical facilities from athletic venues.

Box 1-8: Legal Requirements and Documentation

  • Development of EAPs is a legal obligation for athletic trainers, team physicians, and administrators to ensure quality care for physically active individuals.

  • Important documentation components include:

    1. Athlete Emergency Information Cards: Document current medical conditions and medications, with athlete's consent for confidentiality.

    2. Individual Injury Evaluation Forms: Document athlete injuries with specific details.

    3. Assigned Responsibilities: Provide clarity on who documents emergency events.

    4. Follow-up Documentation: Evaluate emergency response efficacy.

    5. Training Documentation: Record of emergency team training and EAP rehearsals.

    6. Equipment and Supply Maintenance Records: Document purchase, inventory, and maintenance of emergency supplies.

    7. Coaches' Emergency Information Palm Cards: Handy reference for sports medicine teams and coaches regarding the EAP.

Conclusion

  • Proper organization, administration, and continuous improvement of Emergency Action Plans are vital for effective emergency response in athletic settings. Ensuring all personnel are trained, equipped, and familiar with protocols will save lives and ensure high-quality emergency care for athletes in distress.