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.

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. In short, what are the responsibilities of the various people involved. Coaches should work with their medical staff, athletic 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 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, such as lightning, heat illness, return to play following injury, etc. Knowing the information ahead of time helps the coach waste no time in making a decision when one has to be made.

CPR and First Aid

Basic emergency 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.

It is important for coaches to know how to tape, how to evaluate major and minor injuries, and how to create an emergency plan. CPR training can be provided 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.

Having this training and maintaining the current training in both CPR and in 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 physician, 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 to 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 athletes health care providers educated in the administration?
• Is there adequate communication system in place at all athletic practices and competitions?
• Is documentation of emergency phone numbers and a list of conditions for each student readily available at all practices and competitions?

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

An annual physical should be performed by a physician prior to athletic participation. Documentation should be reviewed by the school based athletic 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-Pens 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 technique, CPR and first-aid.

Return to Participation Following Injury Plan

Every schools 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 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, scientific sound principles by a person who is educated in the conditioning of adolescent athletes.