Emergency Situations: What\'s the Coach\'s Role?

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Football is a collision sport and by its very nature invites injury. Participation in football requires all out exertion. There are numerous situations involving oftentimes high speed contact with other bodies or with the ground. While coaches focus on strategy and victory, they also must be aware of injury risks and know their role when a situation does transpire. Fortunately most injuries do not result in emergency situations, however, when emergencies do occur, prompt care is essential. With sports medicine, just as in football, the adage "proper preparation prevents poor performance" holds true. With advance preparation, everyone is prepared to deal with emergencies when they occur.

In the best scenario, coaches can rely on a sports medicine staff, complete with certified athletic trainers and a team physician to handle emergencies. While the medical staff turns their attention to the injured player, coaches adjust their game and maintain a sense of order and calm among the team.

This in itself is not always easy. It becomes even more difficult if the coach must play a larger role in the injury management but difficult does not mean impossible. Coaches can take steps in advance to help make sure emergency situations are handled in the best possible manner.

How much day-to-day interaction do you have with head football coach Bob Stoops or with other members of his staff?

I would say in most cases, I see at least one member of the football staff virtually everyday. I personally interact with Bob Stoops at least three or four times per week, depending on the time of year, his schedule, the demands of recruiting and game preparation.

Emergency Plans

Knowing what to do before a crisis occurs is the single most important element of emergency management. Institutions that do not already have a thorough emergency plan should begin developing one as soon as possible, taking care to provide for all possibilities.

The first step is organizing the people likely to be involved.

"You need to know who's going to call 911, who's going to tend the athlete, who's going to tend the crowd, who's going to make sure the ambulance crew gets to the scene," explained Jim Berry, MEd, ATC, SCAT, of Myrtle Beach High School in South Carolina. "In short, what are the responsibilities of the various people involved? Get that straight first."

Coaches should work with their medical staff, athletics directors and administrators to establish this chain of command in advance, making sure to include local ambulance crews as well. Know how the group will communicate in the situation, whether by cellular telephone, radio or other means.

Emergency plans also must take into account the specifics of each football venue. Conditions at practice fields, for example, are often vastly different than those at stadiums. Be sure the entire coaching staff knows where the field is located in relation to the main campus, the nearest shelter, the nearest automobile access and the nearest line of communication, if cell phones and radios are unavailable.

After the chain of command is set forth and the physical elements of each venue are noted, coaches developing or reviewing an emergency plan should consider a wide range of policies and procedures, said Joe Iezzi, ATC, head athletic trainer at Downingtown Senior High School in Pennsylvania.

"In our district, every coach gets a coaching kit that includes the emergency plan, and the plan sets forth our district's policy for lightning, heat illness, return to play following an injury and things of that nature," Iezzi said. "These are issues everyone needs to know before the season starts, because you don't want to be out at practice in the middle of a thunderstorm wondering whether you should call it off or not."

Bill Weatherly, athletics director and head track coach at Garden City High School in Kansas, said coaches can gain a measure of confidence by knowing their school district's policies before an emergency occurs.

"We go over our emergency plan with every coach every year," Weatherly said. "When you're in the middle of a bad injury and you're worrying about your player and trying to think about all your coaching duties and keep the team calm and take care of the player's parents, that's a pretty tough balancing act.

"It's so much easier if you've got a [certified athletic] trainer to handle the injury, but if that's not the case, then you should at least know your policies so there will be no time wasted in making a decision," Weatherly added.

CPR and First Aid

Basic health care training is a good idea for coaches at every level of competition. All coaches at NCAA member institutions are recommended to have current training, and a growing number of states are making CPR and first aid mandatory for high school coaches as well.

Tim Flannery, assistant director of the National Federation of High School Associations, said he has seen a marked increase in the number of coaches obtaining and maintaining basic sports medicine knowledge.

"Sports medicine and CPR have really come to the forefront, and we feel eventually it will be a requirement in every state," Flannery said. "We certainly support the idea of coaches having CPR or some sort of rescue training. Right now, we estimate that only eight percent of [high school] coaches have any kind of coaching coursework, and 25 to 30 percent have some kind of CPR training.

"Those are pretty powerful statistics indicating there is a need."

The National Federation offers several programs for coaches, including "Sports First Aid," a seminar created for the federation by the American Sport Education Program, or ASEP, Flannery said.

"It's a hands-on, four-hour clinic that teaches coaches how to tape, how to evaluate major and minor injuries, how to create an emergency plan," he explained. "CPR training can come from local branches of the American Red Cross or from local fire departments. Many times, schools will have certified athletic trainers or school nurses or team physicians who can teach these courses as well."

Maintaining current training in both CPR and first aid is important for all members of the coaching staff, even if medical personnel are in attendance.

Working as a Team

During a crisis, good communication between all parties is key to a successful outcome. The coaching staff should know and have a good rapport with the athletic training staff, team physicians, ambulance personnel and game officials.

Each party should understand his or her role in managing the situation. The most important thing to remember, however, is that those roles should be defined in advance.

The National Football League has led the way in developing an on-field injury management policy. This policy specifies the roles of each individual involved - from the athletes to the coaching staff to the sports medicine personnel.

The NFL policy states that coaches are to remain on the sidelines with players. It is often difficult for a coach to stand back and let others care for the athlete, particularly when it appears the injury is catastrophic. However, it is in the best interest of the injured athlete to let the sports medicine team do its job. The safety and the health and welfare of the athlete is the first priority and of the utmost importance for everyone on the field. Through advance preparation, communication, and team work, the injured athlete may receive the best possible health care.

Athletic Program Safety Recommendations

A Complete Emergency Plan
Emergency plans should include an established set of action items that is implemented in the event of an emergency situation. The types of questions to ask are:

• Who will provide emergency first aid?
• Who and how will Emergency Medical Services (EMS) be summoned?
• Who will monitor non-injured members of the team during an emergency?
• How will parents be notified in the event of an emergency?
• Are emergency medical devices readily available, i.e. inhalers/EpiPens, at all times and are coaches and athletic health care providers educated in the administration?
• Is there and adequate communication system in place at all athletic practices and contests?
• Is documentation of emergency phone numbers and a list of conditions for each student readily available at all practices and games?
Full Time, On Site, Qualified Athletic Health Care Provider
There should be a qualified health care provider available to student athletes at the school on a daily basis. This person should be educated in the prevention, immediate care, treatment and rehabilitation of athletic injuries.

Team Physician/Consulting Physician
There should be a medical physician affiliated with the school who is well versed in sports medicine. The athletic health care provider in the school should establish communication with the team physician.

Preseason Medical Screening/Physical for All Athletes Annually
An annual physical should be performed by a physician prior to athletic participation. Documentation should be reviewed by the school based athletic health care provider bringing to the attention of the coaching staff any student athlete participating with a medical alert (such as asthma, diabetes, etc.) Schools should also establish guidelines for athletes with medical alerts to insure that emergency life sustaining medications, i.e., bronchial inhaler for asthma and Epi-Pen for anaphalaxis, are readily available and administered properly when needed.

Inclement Weather Guidelines
Guidelines regarding inclement weather, such as lightning storms and extreme heat, should be established well in advance of the athletic season, and adhered to by all athletic participants and spectators. Adequate methods for rehydration should be available in all sports at all times with athlete education on proper hydration provided on regular basis.

Coaches Education
The coaching staff should be required to participate in ongoing education in both coaching techniques, CPR and first-aid.

Return to Participation Following Injury Plan
Every school's athletic health care provider should implement protocol specific for returning an athlete to participation following an injury. This qualified person should be knowledgeable in injury recovery and return to competition procedure.

Field/Facility Maintenance Plan
All schools should have a plan in place to ensure facilities and fields are properly cared for and inspected on a regular schedule. If repairs are needed, they should be administered in a timely manner.

Athletic Equipment
The equipment that the school provides should be safe, properly fitted, in good repair and inspected on a regular basis. All equipment inspections, repairs, and reconditioning should be documented. Equipment that is in ill-repair, should be discarded and/or secured out of harms way.

Conditioning Programs
Provision of supervised pre-season, in-season and out-of-season conditioning programs should be available to all student athletes. The program should be designed utilizing up-to-date, scientifically sound advice by a person who is educated in the conditioning of the adolescent athlete.

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