Noble Middle School ATHLETICS EMERGENCY ACTION PLAN

Noble Middle School ATHLETICS EMERGENCY ACTION PLAN

Introduction Unfortunately there is an inherent risk of medical emergencies in any sport or athletic activity. It is pertinent to have an emergency plan that serves as a guide during these hectic events. Emergency planning is essential for providing fast, efficient, and appropriate care for injured individuals. It is also important that the entire athletic community reads, practices, and is comfortable with the emergency plan. This includes, but is not limited to: athletes, parents/guardians, officials, coaches, school officials, athletic trainers, athletic training students, team physicians, and EMS personnel. Components of the Emergency Plan These are the basic components of every emergency action plan for athletics: 1. Emergency Personnel 2. Roles of Emergency Personnel 3. Emergency Communication 4. Emergency Equipment 5. Venue Directions With Map 6. Severe Weather Precautions Emergency Plan Personnel A member of the sports medicine staff is usually the first responder to an injury during athletic events; ideally the certified athletic trainer. However, due to the multitude of practices/games, number of athletes, and travel; the athletic trainer will not always be able to respond to an emergency. It is in these incidences, other emergency team personnel must be first responders, specifically coaches. Certification in cardiopulmonary resuscitation (CPR), first aid, prevention of disease transmission, blood borne pathogen, and emergency plan review is strongly recommended for all athletics personnel associated with practices, competitions, skills instruction, and strength and conditioning. Noble Emergency Personnel 1. Administration 2. Coaches 3. Athletic Director 4. Resource Officer Roles of the Emergency Personnel The most important role of any emergency personnel is to recognize a possible medical emergency. There are several injuries or behaviors that dictate immediate EMS activation. This includes but is not limited to: loss or altered consciousness, breathing difficulties, head or neck injuries, seizures, chest pain, heat related illness, severe allergic reactions, profuse bleeding, severe fractures and dislocations, and shock. Any time an injury, behavior, condition and/or situation is questionable; activate EMS. When in doubt send out: Call 911. Recognizing an Emergency 1. Loss of Consciousness or Altered State of Consciousness 2. Head or Neck Injury (do not move) 3. Breathing Difficulty 4. Chest Pain 5. Heat Illness 6. Severe Allergic Reactions 7. Seizures

8. Profuse Bleeding 9. Severe Fractures & Dislocations 10. Shock Roles of emergency personnel can vary due to the type, number, and severity of the injury. It is highly recommended that the most qualified member of the emergency team take the lead in delivering acute care; this is usually the athletic trainer or the team physician. There are four basic guidelines to follow when reacting to a medical emergency. First, make sure the scene is safe for any emergency personnel to enter. Second, activate the EMS by calling 911. Noble Middle School does not have onsite EMS personnel present at games. Depending on the situation, the response time for EMS at Noble is approximately 10 minutes. Any member of the emergency team can make the call. However, it is suggested that the team member that activates EMS should be someone who is familiar with the local area, can remain calm, and communicates well with other individuals. In most instances it is easiest to assign a team member other than the person who is giving acute care. For instance, if an athletic trainer is stabilizing an athlete, a coach or athletic director should call 911 so the athletic trainer can focus on providing appropriate care. In any situation that is considered an emergency it is essential for the 911 call to be made as quickly as possible. The third guideline is to retrieve any emergency equipment needed. Examples include, but are not limited to: an Automated External Defibrillator (AED), vacuum splint kit, and American Red Cross CPR Pocket Mask. The fourth role of the emergency team is directing EMS to the scene. One person of the team should direct and meet the EMS upon arrival. This person should be familiar with the facility and should have keys for all doors and gates. Athletic directors, resource officers, and coaches are ideal for this role. It is important to note that care should continue until the EMS arrives. This can include, but is not limited to: stabilizing the athlete, CPR, monitoring vital signs, and wound care. Please review the maps included in Appendix B and C to assist with the familiarization of the school s location of emergency equipment and EMS routes. Roles within the Emergency Team 1. Establish scene safety and immediate care of the athlete 2. Activation of the Emergency Medical System 3. Emergency equipment retrieval 4. Direction of EMS to scene Activating the EMS System Making the Call: 911 Providing Information: name, address, telephone number of caller nature of emergency, whether medical or non-medical number of athletes condition, age, and sex of athlete(s) first aid treatment initiated by emergency personnel specific directions as needed to locate the emergency scene other information as requested by dispatcher (stay on the line) Not all emergency team members will be present during each emergency. In such instances bystanders, athletes or officials might have to assist the first responder. It is important that all instructions given to untrained individuals be clear and concise. When the team is traveling without a certified athletic trainer, coaches should ask the host school if an athletic trainer will be present during the competition. It is important to note that all high school athletic events in the state of North Carolina must have a certified athletic trainer or a first responder in attendance for emergency purposes. If an emergency occurs at an away location, the emergency plan should be activated with the assistance of the host school s emergency personnel. It is also important for all coaches to have pre-assigned roles within their staff for home or away emergencies. For instance the roles can include: a coach to assist the medical staff on the field, a coach to

meet the EMS and direct them to the emergency, a coach that will travel with an athlete to the hospital, and so on. An ideal time to assign various roles is during the emergency plan annual practicing sessions. Any athlete that has to be transported by the EMS must have a member of the emergency team accompany them if a parent or legal guardian is not present. A legal guardian also must be contacted and informed of the emergency situation, the care provided, and which hospital the athlete will go to. It is highly suggested that coaches travel with their athlete s emergency contact information and pertinent medical histories. An example of a Coach s Emergency Action Card can be found at the National Athletic Trainers Association (NATA) website at https://www.nata.org/consumer/docs/coachescard.pdf. This information can be very helpful in decreasing the time that a physician can provide appropriate care to an injured athlete. Communication Communication is essential for a successful emergency response. All members of the emergency team should know where a fixed or mobile telephone is in relation to their practices and games. It is important to complete communication planning prior to athletic events as well as developing a telephone tree. Personnel that decide to use cellular phones should make sure they are charged and that they have a signal at their location; this is especially important when traveling. Coaches should also meet and discuss which staff members carry a cellular phone. There should be an established back up plan as well. Emergency Equipment Emergency equipment should be accessible to all practices and games. Emergency equipment should be checked and updated on a regular basis. It is important to establish one person to be in charge of updating equipment and for that person to document and rate performance level of such equipment. Emergency personnel should also practice with the emergency equipment at least once per year. Training will ensure that each member of the emergency team is proficient in the use of all equipment. It is important to know the proper way to care for and store the equipment as well. Equipment should be stored in a clean and environmentally controlled area. It should be readily available when emergency situations arise Conclusion Preparedness can mean the difference between life and death during an emergency. It is very important for all members of the emergency personnel team to keep up to date in their training for athletic emergencies. Personnel that practices for emergencies will feel more comfortable and ready to act when an emergency occurs. Emergency personnel should practice at least once per year as a team and then again within their coaching staff prior to their athletic season. It is highly suggested that automated external defibrillation (AED), CPR, first aid, and head/neck stabilization techniques be reviewed during practice sessions. It is important to note that documentation such as an incident report must be completed directly after any emergency.

Noble Middle School Athletics Emergency Plan The following emergency plan is a general outline for Noble Middle School athletics staff: Recognition of an Emergency: Activate Emergency Plan 1) Establish scene safety and immediate care of the athlete *Follow American Red Cross CPR & First Aid guidelines: check, call, care. *ABC s - check airway, breathing, and circulation When in Doubt Send Out: Call 911 2) Activation of the Emergency Medical System: Call 911 *Name *Address if at Noble: 6520 Market Street, Wilmington, NC 28405 *Number of Caller ( ) - *Nature of emergency, whether medical or non-medical *Condition, age, sex, and number of athlete(s) *First aid treatment initiated *Specific directions as needed to locate the emergency scene (see below) *Stay online for other information as requested by dispatcher **Other important Numbers: -Noble School Nurse, Jessica Fell - (910)350-2112 -Athletic Director: Robert Shaw (910)471-5201 -New Hanover Regional Medical Center: 910-343-7000 -Cape Fear Hospital: 910-452-8100 ***Provide appropriate care until EMS arrives 3) Emergency equipment retrieval *AED is located in the hallway outside gym beside the Weight Room. 4) Direction of EMS to scene / athlete *Events held on the Football, Softball, Soccer, and Lacrosse Fields: -Enter the complex on Blair School Road and proceed Past the school to the blacktop area on the right of school.. -EMS can access all of these fields to the right of the main building.. -EMS can enter the complex through the open gate just behind the backstop on the softball field. *Events held in Noble gymnasium: - enter the complex on Blair School Road and proceed to the Front of the School.. - EMS can access the gymnasium by entering the front doors of the school. Gym is on the right. Emergencies that occur at away practices, games, or athletic events: *Activate Emergency Plan *If possible, enlist a member of the host school s athletic staff to assist with local address, equipment retrieval. * If athletic staff is unavailable, find someone who is familiar with the area & facility. Emergency Personnel

1. Athletic Director Robert Shaw Office located in Room 15 Office (910) 350-2112 Mobile (910) 471-5207 2. School Administrators & Main Office Administrators are present at home sporting events Noble (910) 350-2112 Principal, Wade Smith o Office (910) 350-2112 o Mobile (910) 232-4867 Assistant Principal, David Bostian o Office (910) 350-2112 o Mobile (910) 620-1104 Assistant Principal, Sarah Buchanon o Office (910) 350-2112 o Mobile (910) 619-6202 3. School Nurse Jessica Fell Office (910) 350-2112 4. Coaches Please contact Athletic Director for each individual sport s coach contact information Many of our Coaches are American Red Cross Adult & Child CPR/AED certified 1 st 9Wks Sports: Football, Softball 2 nd 9Wks Sports: Boys Basketball, Girls Soccer 3 rd 9Wks Sports: Boys Soccer, Girls Baseball 4 th 9Wks Sports: Baseball, Volleyball, Boys & Girls LAX SEVERE WEATHER PRECAUTIONS When conducting practices outdoors, coaches and athletic trainers must be aware of weather conditions and act appropriately if these conditions change. Every year there are news reports about athletes being injured or killed by lightning strikes. These situations are preventable. Lightning however not the only severe weather problem is encountered. Very intense rainstorms and high wind conditions can also pose a threat to the safety and well being of our athletes. Anytime extreme weather conditions exist, athletes should be removed from the field and into a safe structure.

FACTS ABOUT LIGHTNING The average lightning stroke is six miles long The average thunderstorm is six to ten miles wide The average thunderstorm travels at a rate of 25 miles per hour Once the leading edge of thunderstorm approaches within 10 miles, you are at immediate risk due to the possibility of lightning strokes coming from the overhanging anvil clouds. Because of this, many lightning deaths occur with clear skies directly overhead On average, thunder can only be heard over a distance of three to four miles Thunderstorm cause an average of 200 deaths and 700 injuries in the U.S. each year The method of counting between flash and sound to determine the distance of a lightning bolt is not a good safety guideline to use because if you can hear the thunder, lightning is already close enough to be potentially dangerous SAFETY PRECAUTIONS DURING A THUNDERSTORM Move in to a safe structure at the first sign of a storm. If you see a flash or hear thunder, you are at risk. If using a lightning detector, move inside when flashes are in a 3-8 mile range. Do not seek refuge under a tree or beside any tall object in an open area. Avoid contact with metal If caught in an open area, be a small target, crouch down with only your feet touching the ground Avoid high terrain and bodies of water Avoid electrical appliances and telephones inside Do not shower or take a bath during a thunderstorm Wait at least 20 to 30 minutes after the last flash or sound of thunder before resuming outside activities WE HAVE LIGHTNING DETECTORS, USE THEM!! HOT WEATHER GUIDELINES FOR ATHLETICS Heat related illness is an ever-present danger in athletics. By following the proper precautions, we can reduce the risk of athletes being affected by the heat. Some basic precautions to follow are: 1. Gradual acclimatization of athletes with moderate activity to get them accustomed to working in the heat. Ideally this should take place prior to the first practice in the fall, and gradually in the spring as the weather heats up. In the spring sports, be aware of an unusually warm day early when athletes are not used to the heat. 2. Frequent water and rest breaks during practice to allow athletes to rehydrate and cool themselves. Allow helmets to be removed when possible to allow cooling.

3. When temperature and humidity are high limit practices in full pads. Schedule full pad practices for cooler times of the day, or practice in limited gear for part of practice and full pads part of practice. 4. Monitor high-risk athletes especially the overweight or unfit athlete, or athletes that are not acclimatized. 5. Monitor the over motivated athletes, the one who will not let you know if they are having problems with the heat. You should always encourage athletes to let you know if they are having problems. 6. Monitor athlete s weights by use of weight charts and have athletes weigh before and after practice and make sure they are replacing fluids to maintain their weight from day to day. If an athlete does not gain back to within 3% of their weight from the previous day, they are dehydrated and should not practice until the weight has been regained. 7. Encourage athletes to keep themselves well hydrated during the day. 8. Recognize the early signs of heat related illness. Heat Cramps: Painful muscle spasms, thirst, fatigue, decreased performance Treatment: Rest in a cool place, cool fluids to drink, stretch and massage cramped muscles Heat Exhaustion: Cool, moist, pale, flushed, or ashen skin; headache, nausea, dizziness, weakness, profuse sweating. Treatment: Rest in a cool environment, loosen clothing/remove equipment, cool player by fanning, applying cool towels, cool fluids if conscious. If improvement is not rapid or you think heat stroke may be developing, call 911 immediately. Heat Stroke: High body temperature, skin may be red and hot, and wet or dry, rapid and weak pulse, rapid or shallow breathing, change in level of consciousness. Treatment: This is a definite medical emergency, call 911 immediately, and give care for heat exhaustion by cooling. Do not give fluids if unconscious. HEAT INDEX CHART Follow Heat Index chart guidelines below; when in doubt remove athletes from dangerous climates Water should be available in plentiful amounts at all times for practice & games. At least 6-10oz water should be consumed every 20 minutes. No athlete should lose more than 3% of body weight while participating. Use pre-participation weight as guideline

GUIDELINES Heat Index for determining water breaks & equipment levels 85-95 index: Water breaks every 15 minutes 96-104 index: Water breaks every 15 minutes. Remove Pads; shorts and shirts only 105-up index: OFF FIELD; ALL PARTICIPANTS INDOORS Heat index caution levels 90-105 index: Watch for signs of heat cramps and heat exhaustion 100-120 index: Heat cramps and heat exhaustion likely 120-130 index: Heat stroke very likely CARE OF THE DIABETIC ATHLETE Athletes with type 1 diabetes should have a diabetes care plan for practices and games. The plan should identify the following topics: Blood glucose targets for practices and games, including exclusion thresholds Strategies to prevent exercise-associated hypoglycemia, hyperglycemia, and ketosis A list of medications used for glycemic control or other diabetes-related conditions Signs, symptoms, and treatment protocols for hypoglycemia, hyperglycemia, and ketosis Emergency contact information.

The athlete must have access to supplies for managing glycemic emergencies at all times. When the athlete requires assistance, the Athletic Trainer and/or other members of the diabetes management team (coach etc.) must have immediate access to these supplies. The athlete or parent/guardian should provide the necessary supplies and equipment. Proper management of blood glucose levels during practices and games allows the athlete with diabetes to compete in a safe and effective manner. Maintaining a near-normal blood glucose level (100 to 180 mg/dl, or 5.5 mmol/l to 10 mmol/l) reduces the risk of dehydration, lethargy, hypoglycemia, and autonomic counter regulatory failure. Hypoglycemia Is when blood sugar drops significantly below normal for a diabetic. Hypoglycemia can be caused by improper nutrition, too much insulin, or over exertion. The symptoms of hypoglycemia (low blood sugar) include Weakness/fatigue Shaking Fast heartbeat Sweating Dizziness Anxious Hunger Impaired vision Headache Irritable Emergency Treatment for Hypoglycemia Drink ½ glass of juice or regular soft drink 1 glass of milk Eat some soft candies (not chocolate) *If symptoms worsen quickly or do not subside after 30 minutes, ACTIVATE EMS NEW HANOVER COUNTY SCHOOLS ATHLETICS CONCUSSION AND HEAD INJURY INFORMATION DOCUMENT What is a concussion and what are its potential consequences? A concussion is a traumatic brain injury (TBI) caused by direct or indirect impact to the head that results in disruption of normal brain function, which may or may not result in loss of consciousness. The severity of a TBI may range from mild, i.e., a brief (sometimes barely noticeable) change in mental status or consciousness, to severe, i.e., an extended period of unconsciousness or amnesia after the injury. Signs Things You Can Observe SIGNS & SYMPTOMS OF A CONCUSSION Symptoms Things the Athlete Tells You

Behavior or personality change False/imagined memory Delayed spoken or physical responses Balance problems Disorientation (confused about time, date, location) Trouble controlling emotions Loss of consciousness (blackouts) Slurred/unclear speech Empty stare Memory loss of event before, during, or after injury Table 1 AAN Confusion Dizziness Blurry vision/double vision Feeling hazy, foggy, or groggy Headache Inability to focus, concentrate Nausea (stomach upset) and/or vomiting Not feeling right Sensitivity to light or sound Feeling very drowsy, having sleep problems TBI can cause a wide range of functional short- or long-term changes affecting Thinking (i.e., memory and reasoning), Sensation (i.e., touch, taste, and smell), Language (i.e., communication, expression, and understanding), or Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). Concussions (TBI) can also cause epilepsy and increase the risk for conditions such as Alzheimer s disease, Parkinson s disease, and other brain disorders that become more prevalent with age. Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal. What is Second Impact Syndrome? Second impact syndrome is a rare, yet often fatal, condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results. Second impact syndrome can result from even a very mild concussion that occurs days or weeks after the initial concussion. Most cases of second impact syndrome have occurred in young athletes. Proper Medical Care If you are an athlete and think you have suffered a concussion, notify your Athletic Trainer, Coach, Guardian, Physician IMMEDIATELY & remove yourself from all physical activity. Not all Concussions (TBI) show visible signs and symptoms. If you have experienced a traumatic blow to the head while participating in sports without the obvious signs & symptoms, seek proper medical care accordingly. If you are a coach, guardian, volunteer and observe an athlete with concussion signs (no matter how mild) notify medical personnel IMMEDIATELY & remove the athlete from all physical activity. It is critical that an athlete that has suffered a concussion be properly evaluated by a Medical Doctor (M.D.) trained in the recognition of concussions. The athlete SHOULD NOT return to their sport until the symptoms of the head injury are gone, the athlete has participated in a physical exertion progression program without a return of symptoms, and has been cleared to participate by the overseeing M.D.. It is also highly recommended that an athlete should not return to school until symptoms have cleared. Athletes should avoid activities including school-related reading/work, computer use, videogames, text messaging, hot tubs, and excessive socializing with peers. These activities can affect the concussed area of the brain & also prolong the concussion symptoms. For more information about concussions, please visit the Matthew Gfeller Foundation, the Center for Disease Control and Prevention, and the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC Chapel Hill