Emergency preparedness for the physical education teacher.

Bert, Korey B.

Physical education related injuries that result in a visit to the emergency room have increased significantly since the late 1990s (Nelson, Alhajj, Yard, Comstock & McKenzie, 2009, p.1). Due to this fact, it is more important than ever for P.E. programs to develop and implement comprehensive emergency plans. Most schools likely already have a crisis management plan or disaster preparedness plan for emergencies that effect large numbers of students and staff, but it is also important to plan for emergencies that may only impact a single student or teacher. Common sense tells us that emergencies due to injuries or other medical conditions are more likely to occur in a physically active P.E. setting than in a traditional sedentary classroom environment.

Why do I need a P.E. specific emergency plan?

In this era of terrorist attacks and school shootings, your school undoubtedly has some sort of school-wide emergency plan. Your school should have procedures for handling individual medical emergencies - sudden unexpected illness, seizures, falls, allergic reactions, etc. The question is whether those emergency plans are sufficient for the physical education department. The risk of an emergency situation arising in the physical education environment is heightened due to the nature of the activity. An asthma attack is less likely to occur to a student sitting in an algebra classroom than it is outdoors on a grass field where environmental conditions or even the act of exercising itself can trigger an attack.

The emergency action plan (EAP)

A physical education-specific EAP should be developed with input from school administration, school safety and security personnel, school medical staff (school nurse, athletic trainer), local emergency medical services (EMS) as well as members of the physical education department (Council on School Health, 2008). Separate EAPs should be developed for each individual venue (gymnasium, outdoor athletic fields, track, locker room, etc.) and should include the following components:

1) Emergency personnel

Teachers, administrators, safety and security personnel, local EMS, school medical personnel and even responsible students may all play roles in the response to an emergency. There are four basic roles within the emergency team.

The first role is to establish that the scene of the emergency is safe and to provide immediate first aid to the injured student (Courson, 2007, p. 94). The first responder in an emergency will likely be the physical education teacher, so making first aid and CPR certification a priority is important. Teachers should be prepared to provide first aid for the following life-threatening emergencies until EMS arrives: severe breathing problems such as asthma, choking, and anaphylaxis; chest pain and heart attack; diabetes and low blood sugar; stroke; seizure; shock; bleeding; head and spine injury; broken bones; burns; sudden cardiac arrest; heatstroke and hypothermia; and poisoning (Hazinski, et al, p. 282).

The second role is activation of EMS. This should be done as soon as the situation is deemed an emergency or life-threatening event. The person in charge of activating EMS should be able to communicate clearly over the telephone (Courson, 2007, p. 94). Your school likely has a procedure for activating EMS already in place.

The third role is equipment retrieval (Courson, 2007, p. 95). First aid kits, automated external defibrillators (AEDs), epi-pens, glucagon kits, respiratory inhalers or student-specific emergency medication are examples of things that may need to be retrieved in an emergency. The person charged with this role should know the exact location of the equipment. There is no time to search for things in an emergency.

The fourth role is directing EMS to the scene of the emergency. This person should meet emergency medical personnel as they arrive and should have keys to unlock any doors or gates that may prevent access to the scene (Courson, 2007, p. 95).

It may be a good idea to have several individuals assigned to each role. You may need one individual to retrieve the first aid kit while another gets the AED. There will be days when some members of your emergency team are absent, and a back-up is needed. Even the unfortunate situation of two emergencies occurring simultaneously may necessitate more than one person assigned to each role.

2) Emergency communication

A working telephone or two way radio should be available at all times. A back-up communication device should also be available (Anderson, Courson, Kleinert, & McLoda, 2002, p.103). The location of a land-line telephone is important in case cell service is not adequate. Access to a phone should be prearranged if one is not easily accessible (Courson, 2007, p. 95).

3) Emergency equipment

Emergency team members should be familiar with the proper operation of all emergency equipment in advance (Courson, 2007, p. 95). Regular inspection and maintenance of emergency equipment as well as proper storage are important. Remember though, emergency equipment should be quickly accessible. In the event of sudden cardiac arrest, a collapse to shock target goal of less than three to five minutes is strongly recommended (Drezner, et al., 2007, p. 92). This should be considered when determining the location of AEDs as well as the number of units within your school.

4) Emergency transportation

In most emergencies transportation to the hospital will be by ambulance, where the appropriate equipment and staff is available. Emergency care responders should refrain from transporting injured students in personal vehicles (Courson, 2007, p. 97).

5) Venue directions

Specific directions to each venue including the exact street address should be included in the EAP. Landmarks, cross streets and a map of the school/campus may also be helpful components to include (Courson, 2007, p. 97).

Once the EAP is complete, all members of the emergency team should rehearse the plan on a regular basis. Updates to the plan as situations change are appropriate.

Individual Emergency Care plans

Certain medical conditions such as asthma, life threatening allergies, diabetes, or epilepsy may necessitate an individual emergency care plan (IECP). The IECP should be developed in the same way that the EAP is developed, only specific to the student in question. The IECP should also not only include steps to take when an emergency occurs, but also steps that can be taken to prevent an emergency from occurring in the first place (i.e. a diabetic student checks his blood glucose prior to physical activity). Parental input can be extremely valuable during the IECP development process.

Prevention of Emergencies

Injuries are inherent in sports and emergencies cannot be entirely prevented, however certain steps can be taken to reduce the likelihood of an emergency from occurring. Examples of some steps that can be taken to reduce the chances of an emergency occurring are below:

1) Schools should make sure relevant medical information is communicated to PE teachers, who should, in turn, use this information to determine which students may require an IECP(Prince Edward Dept. of Education, 2012).

2) Safety precautions and protocols should be developed regarding environmental hazards such as excessive heat, cold, lightning, etc. (Prince Edward Dept. of Education, 2012)

3) Students should have access to water to keep hydrated.

4) Class activities should be appropriate for the age and abilities of the students. Students should be instructed on the proper use of equipment and warned against the dangers of inappropriate play (Prince Edward Dept. of Education, 2012).

5) Pre-activity safety checks of the environment and the equipment to be used should be performed. Sports equipment should be in good working condition and free of sharp edges, cracks or splinters. Fields should be free of holes, glass and rocks. Courts should be free of debris and standing water (Prince Edward Dept. of Education, 2012).

Emergency preparedness in the physical education setting can literally mean the difference between life and death. Life-threatening emergencies can happen at any time in any school. They can be the result of a pre-existing condition or a freak accident. While nothing can prevent all emergencies, a well-developed, well-rehearsed emergency action plan will provide students and staff members with the best opportunity to provide life-saving care to the victim of an emergency.

REFERENCES

Anderson, J.C., Courson, R.W., Kleinert, D.M., & McLoda, T.A. (2002). National athletic trainers' association position statement: Emergency planning in athletics. Journal of Athletic Training, 37, (1), 99-104.

Courson, R.W. (2007). Preventing sudden death on the athletic field: The emergency action plan. Current Sports Medicine Reports, 6, 93-100.

Drezner, J.A., Courson, R.W., Roberts, W.O., Mosesso, V.N., Link, M.S. & Maron, B.J. (March 2007). Inter-Association task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: A consensus statement. Clinical Journal of Sports Medicine. 17(2), 87-103.

Hazinski, M.F., Markenson, D., Neish, S., Gerardi, M., Hootman, J., Nichol, G., ... Smith, S. (January 20, 2004). Response to cardiac arrest and selected life-threatening medical emergencies: The medical emergency response plan for schools: A statement for healthcare providers, policymakers, school administrators, and community leaders. Circulation, 109, 278-291.

Nelson, N.G., Alhajj, M., Yard, E., Comstock, D., & McKenzie, L.B. (September 2009). Physical education class injuries treated in emergency departments in the US in 1997-2007. Pediatrics, 124(3), 1-8.

Prince Edward Island Department of Education and Early Childhood Development (2010). Physical Education Safety Guidelines. Available at http://www.gov.pe.ca/photos/ original/eecd_phyeduguid.pdf. Accessed December 13, 2012.

Korey B. Bert, MSE, VATL, ATC, Head Athletic Trainer, J.E.B. Stuart High School