Development and Implementation of an Emergency Action Plan in Football.

Although uncommon, life-threatening injuries and illnesses do occur in American football, and the emergency response team must be ready to act when an emergency arises during training, practice, or competition. An emergency action plan (EAP) is central to the care of an athlete with a suspected life-threatening injury or illness. This set of step-by-step instructions on how the emergency response team will act during an emergency details the members of the team and their roles, plus information on emergency equipment, procedures at each venue, and the transportation of a player to the hospital. The emergency response team should keep the EAP up-to-date and rehearse annually.

A conceptual model to establish preventive and corrective actions to guarantee water safety following scenarios of tailing dam failure.

One of the impacts related to mining dam failures is the change in water quality downstream of the rupture and a knowledge gap is observed in terms of methodologies aimed at the prognosis of impact in water abstractions, a vulnerability that can be identified before a rupture event. Thus, the present work aims to describe a novel methodological proposal, not currently considered by control agencies, of a standard protocol that enables a comprehensive prognosis of the impacts on water quality impact in scenarios of dam failure. Initially, extensive bibliographic research was carried out on the main disruptions events since 1965 intended to better comprehend the impacts on water quality and to identify mitigatory actions proposed by the time. The information provided a framework to propose a conceptual model for the prognosis of water abstractions, with the suggestion of software and studies to comprehend the different scenarios in the event of dam failure. A protocol was prepared to obtain information on potentially affected inhabitants and a multicriteria analysis was developed using the Geographic Information System (GIS) to suggest the employment of preventive and corrective actions. The methodology was demonstrated in the Velhas River basin considering a hypothetical scenario of tailing dam failure. Changes in water quality would be observed in 274 km of its extension, mainly related to alterations in solids, metals, and metalloids' concentration, in addition to the impact on important water treatment plants. The map algebra and the results suggest the need for structuring actions in cases where the water abstraction is intended for human supply and in populations greater than 100,000 inhabitants. Populations smaller than these, or usages other than human supply, could be supplied by water tank trucks or mixed alternatives. The methodology pointed out the necessity for structuring supply actions with due notice, with the potential to prevent water shortages in scenarios of tailing dam failure and to complement the enterprise resource planning of mining companies.

Current status of cardiopulmonary resuscitation training and automatic external defibrillator availability in high schools in Halifax, Nova Scotia, Canada.

Background: School-based cardiopulmonary resuscitation (CPR) training and early use of an automated external defibrillator (AED) have proven to increase the survival of victims of sudden cardiac arrest (SCA). This study aimed to determine the status of CPR training, availability of AEDs, and medical emergency response programs (MERPs) in high schools in Halifax Regional Municipality. Method: High school principals were asked to participate in a voluntary online survey comprising questions about demographics, AEDs availability, CPR training for staff and students, the existence of MERPs, and perceived barriers. Three autogenerated reminders followed the initial invitation. Results: Out of 51 schools, 21 (41%) responded, only 10% (2/21) and 33% (7/21) reported providing CPR training to students and staff, respectively. About 35% (7/20) of the schools reported having AEDs, but only 10% (2/20) have MERPs for SCA. All respondents reported in favor of AED availability in schools. The reported barriers to CPR training included limited financial resources (54%), perception of low priority (23%), and time constraints (23%). Respondents reported limited financial resources (85%) and the lack of trained staff to use (30%) as the main reasons for the unavailability of AEDs. Conclusion: This survey showed that all respondents overwhelmingly favour having access to AEDs. However, the availability of CPR and AED training for staff and students in schools remains inadequate. Emergency action plans have not been devised, and few schools have AED devices. More education and awareness are needed to ensure lifesaving equipment and practices in all Halifax Regional Municipality schools.

On-Field Sports Emergencies: Preparation and Readiness.

The foundation of preventing and treating an on-field emergency is preparation and readiness. The sideline medical team should coordinate the utilization of an emergency action plan (EAP). A successful EAP is accomplished through attention to detail, rehearsal, and self-assessments. Every EAP should include site-specific implementation, personnel, equipment, communication, transportation, venue location, emergency care facilities, and documentation. Improvements and advancements can be made to the EAP by self-evaluation after each on-field emergency and yearly reviews. A competent sideline emergency medical team can enjoy the competition while being ready to respond to a catastrophic on-field emergency.

General Medical Emergencies in Athletes.

This article focuses on the management of the most common on-field medical emergencies. As with any discipline in medicine, a well-defined plan and systematic approach is the cornerstone of quality health care delivery. In addition, the team-based collaboration is necessary for the safety of the athlete and the success of the treatment plan.

Acute and Emergent Spinal Injury Assessment and Treatment.

Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. Planning the process of transport for home venues before the start of the season and ensuring that a medical time out occurs at home and away games can reduce complications of transport decisions on the field of play and expedite transport of the spine-injured athlete.

Automated external defibrillator and emergency action plan preparedness amongst masters athletes.

OBJECTIVES: Sudden cardiac arrest/death (SCA/D) is the leading medical cause of death in athletes. Masters athletes (≥35 years old) are increasing in numbers and are responsible for the vast majority of sport-related SCDs. Automated external defibrillators (AEDs) and emergency action plans (EAPs) have been shown to unequivocally reduce SCD, however, their prevalence in masters athletics remains unknown. We sought to identify the perceived AED accessibility and EAP preparedness amongst a group of masters athletes. METHODS: A 40-item survey was sent to 735 master athletes identified through the Masters Athlete Screening Study. Participants were athletes with no known significant cardiac history. The survey inquired on the availability and location of AEDs within exercise settings, the presence of EAPs, and participants' cardiac concerns. RESULTS: Sixty-eight percent of athletes completed the survey. Ninety-seven percent and 99% of athletes believed CPR and AEDs were effective at saving lives, respectively. Thirty-eight percent of athletes were aware of an AED in proximity to where they exercise, with 40% aware of one available during competition events, and 28% during training events. Only 10% of athletes were aware of an EAP active in their place of exercise. Half of the athletes perceive their risk of cardiac arrest during exercise to be ≤0.5 in 100,000. CONCLUSIONS: These findings indicate that nearly all athletes believe CPR and AED are effective at saving lives, but only a minority are aware of an AED near their place of exercise, with even fewer aware of an active EAP. Master athletes underestimate their own risk for exercise-related cardiac events, affirming the importance of educating masters athletes on their increased cardiac risk and the importance of EAPs.

Food Allergies and Anaphylaxis in the Community: The School Nurse's Role.

Food allergy prevalence in the United States has been increasing among school-aged children. Many community-based pediatric caregivers (e.g., camp staff, sports coaches) are not trained to prevent, recognize, or manage allergic reactions due to a lack of available training and standard policies on this topic. Epinephrine is the first-line of treatment for severe allergic reactions and delayed administration of this medication can result in poor health outcomes and death. School nurses may use their knowledge and expertise to educate community-based pediatric caregivers on allergy topics. Professional practice projects can be utilized by school nurses to help improve allergy and anaphylaxis confidence and knowledge among community-based pediatric caregivers. By educating community members on anaphylaxis management, it can improve health outcomes for children of the school community and result in saved lives.

Risk Factors for Sudden Death in Athletes, Is There a Role for Screening?

Purpose of Review: Sudden cardiac death (SCD) in a young athlete is an infrequent yet devastating event often associated with substantial media attention. Screening athletes for conditions associated with SCD is a controversial topic with debate surrounding virtually each component including the ideal subject, method, and performer/interpreter of such screens. In fact, major medical societies such as the American College of Cardiology/American Heart Association and the European Society of Cardiology have discrepant recommendations on the matter, and major sporting associations have enacted a wide range of screening policies, highlighting the confusion on this subject. This review seeks to summarize the literature in this area to address the complex and disputed subject of screening young athletes for SCD. Recent Findings: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause myocarditis, which is one acquired cardiac disease associated with SCD. The coronavirus 2019 (COVID-19) pandemic has therefore resulted in an increased incidence of an otherwise less common condition, providing an expanded dataset for further study of this condition. Recent findings indicate that cardiac complications of athletes with myocardial involvement of SARS-CoV-2 infection are rare. Other contemporary work in SCD screening has been focused on the implementation of various screening protocols and measuring their effectiveness. Summary: No universal consensus exists for athlete screening for conditions associated with SCD with varying guidelines and protocols across cardiology and sport-specific organizations. No screening program will prevent all SCD; however, small programs managed by physicians familiar with the examination of an athlete that carefully personalize screening to the individual may maximize detection of dangerous cardiac conditions while minimizing false positives.

Promoting an Emergency Action Plan for Sudden Cardiac Arrest in Youth Sports During a Pandemic.

INTRODUCTION: Pandemic-related restrictions increased the risk of delayed emergency response of bystanders to sudden cardiac arrest among youth athletes. Education and SCA emergency preparedness, implemented by nurse leaders and adapted to environmental changes, can greatly reduce the risks associated with an SCA episode. METHOD: A nurse-led, quality improvement pilot project was implemented in a recreational youth soccer league. The project included the implementation of an emergency action plan (EAP; with or without the pandemic and social-distancing restrictions) for bystanders responding to SCA. RESULTS: Participants showed significant improvement in knowledge and perceptions of SCA and emergency response (p < .001). Willingness to initiate cardiopulmonary resuscitation (CPR) improved (p = .127), and fear to engage in EAP decreased (p = .119) following an educational intervention on SCA. DISCUSSION: Nurse-led SCA education and implementation of youth league EAP successfully demonstrated safety in SCA preparedness and best practice recommendations for youth sports from the Interassociation Task Force.

Improving Youth Sports Safety: Implementing an Emergency Action Plan for Sudden Cardiac Arrest.

BACKGROUND: Children who participate in youth sports are at risk for sudden cardiac arrest (SCA) related to undetected cardiac anomalies or abrupt impact to the chest. Nurse-led interventions may prevent sudden cardiac death by helping leagues implement an emergency action plan to respond to SCA and improve safety. A youth soccer league in the Southeast with participants between the ages of 5-19 years, led by volunteer board members and coaches, did not have reliable access to automated external defibrillators or receive standardized education on SCA and cardiopulmonary resuscitation with a site-specific action plan. METHODS: A nurse-led quality improvement pilot project used partnerships to provide league access to automated external defibrillators, institute preseason SCA and cardiopulmonary resuscitation training, and establish an emergency action plan for the league's volunteers. Anonymous pre- and post-training testing was conducted to measure participant knowledge, confidence, and willingness to respond to SCA. A cross-sectional survey, using a convenience sample of board members and coaches, evaluated sustainability of the intervention at midseason. INTERVENTION: Training targeted board members (Blue Shirts) to serve as leaders on the field during an SCA event and educated coaches on activating the emergency action plan. RESULTS: Blue Shirts and coaches showed significant (p < .05) improvement of knowledge, confidence, and willingness to respond to SCA after receiving the standardized preseason intervention; Blue Shirts' changes were sustained at midseason. CONCLUSION: Nurses are ideal for helping youth sports leagues implement a sustainable SCA action plan based on best-practice recommendations for emergency health and safety.

Influence of State-Level Emergency Planning Policy Requirements on Secondary School Adoption.

CONTEXT: Emergency action plans (EAPs) are a critical component in the management of catastrophic sport-related injury. Some state high school athletics associations and state legislation have required that schools develop EAPs, but little research exists on the influence of a statewide policy requirement on local adoption of these policies. OBJECTIVE: To examine the efficacy of a statewide policy requirement on local adoption of an EAP. DESIGN: Cross-sectional study. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Secondary school athletic trainers were invited to complete a survey (n = 9642); 1136 completed the survey, yielding an 11.7% response rate. MAIN OUTCOME MEASURE(S): Survey responses on the adoption of EAPs along with cardiopulmonary resuscitation and automated external defibrillator (CPR/AED) requirements were cross-referenced with published statewide policies to determine the prevalence of EAP adoption. We evaluated the adoption of emergency action plan components based on the National Athletic Trainers' Association's emergency planning position statement along with CPR/AED requirements to determine component-specific prevalence. We compared the prevalence of EAP and component adoption between states that required EAPs and specific components of EAPs and states without such requirements. RESULTS: Athletic trainers in states that required adoption of an EAP reported including more components of the emergency planning position statement (mean = 8 ± 4, median = 9) than in states without a requirement (mean = 7 ± 4, median = 8). The adoption of EAP components did not differ between states that required specific components of the EAP versus development of the EAP only. However, schools in states with both EAP and CPR/AED training requirements reported higher rates of CPR/AED training implementation (95.5%) than states that only required CPR/AED training (81.6%, prevalence ratio = 1.10, 95% confidence interval = 1.01, 1.20). CONCLUSIONS: Based on these data, statewide policy requirements for the development of an EAP may be associated with increasing adoption of EAPs.

Design and Implementation of an Emergency Action Plan for Sudden Cardiac Arrest in Sport.

Sudden cardiac arrest (SCA) is the leading cause of exercise-related fatalities in athletes. A comprehensive emergency action plan (EAP) is critical to facilitate a rapid and effective response to a cardiac emergency. SCA should be suspected in any athlete that collapses suddenly and is unresponsive. All potential responders to a collapsed athlete should be trained in the recognition of SCA, cardiopulmonary resuscitation, and use of an automated external defibrillator (AED). AEDs should be accessible on-site at sporting venues with a target collapse to first shock interval of less than 3 min. Every school, club, and sporting organization that sponsors athletic activities should have a written EAP for SCA. An EAP coordinator should be designated to foster compliance with training, practice, and rehearsal of the EAP at least once annually. Some sports require special considerations for equipment removal or access to emergency services in geographically broad or water-based venues.

Asthma Assessment in the School Health Office: Can They Stay or Should They Go?

The Assessment Refresher for School Nurses series will review the health assessment and interventions of common complaints of children in the school health setting, making it easier for school nurses to determine whether children should stay in school or be sent home. Initial topics to be covered include asthma and allergies, immunizations, bullying/depression, and diabetes.

Assessment of Evidence-Based Health and Safety Policies on Sudden Death and Concussion Management in Secondary School Athletics: A Benchmark Study.

CONTEXT:: Implementation of best-practice health and safety policies has been shown to be effective at reducing the risk of sudden death in sport; however, little is known about the extent to which these policies are required within secondary school athletics. OBJECTIVE:: To examine best-practice health and safety policies pertaining to the leading causes of sudden death and to concussion management in sport mandated at the state level for secondary school athletics. DESIGN:: Descriptive observational study. SETTING:: State high school athletic associations (SHSAAs), state departments of education, and enacted legislation. PATIENTS OR OTHER PARTICIPANTS:: United States (including the District of Columbia) SHSAAs. MAIN OUTCOME MEASURE(S):: A review of SHSAA health and safety policies for the 2016-2017 academic year, state department of education policies, and enacted legislation was undertaken to assess the polices related to the leading causes of sudden death and concussion management in sport. Current best-practice recommendations used to assess health and safety policies were specific to emergency action plans, automated external defibrillators, heat acclimatization, environmental monitoring and modification, and concussion management. The total number of best-practice recommendations required for each SHSAA's member schools for the aforementioned areas was quantified and presented as total number and percentage of recommendations required. RESULTS:: Four of 51 SHSAA member schools were required to follow best practices for emergency action plans, 7 of 51 for access to automated external defibrillators, 8 of 51 for heat acclimatization, and 3 of 51 for management of concussion. CONCLUSIONS:: At the time of this study, SHSAA member schools were not required to follow all best-practice recommendations for preventing the leading causes of sudden death and for concussion management in sport. Continued advocacy for the development and implementation of best practices at the state level to be required of all secondary schools is needed to appropriately serve the health and well-being of our young student-athletes.

Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care?

CONTEXT: Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care. OBJECTIVE: To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care). DESIGN: Cross-sectional study. SETTING: Public and private secondary schools in northwest Ohio and southeast Michigan. PATIENTS OR OTHER PARTICIPANTS: Thirty schools (24 public, 6 private) volunteered. MAIN OUTCOME MEASURE(S): Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care. RESULTS: Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle. CONCLUSION: Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.

Sudden cardiac arrest on the field of play: turning tragedy into a survivable event.

Sudden cardiac arrest remains the leading cause of death in exercising athletes, and recent studies have shown that it occurs more frequently than historical estimates. While out-of-hospital cardiac arrest often proves fatal, advance preparation can improve outcomes and the chance of survival. First responders to a collapsed athlete on the field of play may include team medical personnel, coaches, other athletes, officials, venue staff, emergency medical services personnel, or lay bystanders. Prompt and accurate recognition of sudden cardiac arrest, a comprehensive and rehearsed emergency action plan, early cardiopulmonary resuscitation, and immediate access to and use of an automated external defibrillator are each pivotal links in the chain of survival. This review summarises the components of an effective emergency action plan, highlights the critical role of automated external defibrillators, and reviews the diagnosis and management of sudden cardiac arrest on the field of play.

Sudden Cardiac Death in Athletes.

Sudden cardiac death is a tragedy at any age and under any circumstances but is perhaps most tragic when it claims the life of the athlete, the individual who epitomizes health and a healthy lifestyle. Sports cardiologists from around the world have worked to quantitate the incidence of sudden cardiac death (SCD) in the athlete, to identify risk factors, to develop pre-participation screening tools, and to formulate plans to deal with on-field SCD. Progress has been made, but much remains to be done in order to make both competitive and recreational sports safer for both patients with known cardiac disease and athletes without known or suspected cardiac abnormalities.

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes.

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided. (J Am Coll Cardiol 2016;doi: 10.1016/j.jacc.2016.03.527.)

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes.

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided.