Key aims in developing emergency action plans
Define roles and minimise errors
Having a written emergency action plan with which all staff are familiar, reduces the amount of stress in an immediate care situation as each member of the team is clear about their role, responsibilities and the chain of command. Establishing clear roles will improve team-working and reduce mistakes. When coupled with frequent medical team practice, it will encourage a degree of autonomy to allow the team leader to think, rather than having to constantly direct others.
Regular equipment maintenance and checks
Modern sports immediate care training includes a multitude of equipment used in adverse conditions. Plan development should ensure that emergency equipment is appropriate for the situation and in good condition when needed, for example the automated external defibrillator should be checked regularly to ensure it has a fully charged battery and “in date" pads. All checks should be documented as evidence. Plans must mandate that all equipment is stored in a position appropriate for immediate access and short transport time, for example an AED must be stored and accessible, so that a shock can be delivered within the recommended three minutes from a cardiac arrest.
For some equipment the extremes of climate should be considered with regards to storage, for example the operating temperature of the defibrillator battery may be 0-30 degrees centigrade, which could be a problem in harsh winters or warmer climates and appropriate storage adaptations should be considered. Similarly other equipment such as oxygen or spinal equipment should be included in a plan to ensure it is available and checked for any damage that may have occurred in storage or transit.
Risk assessment and planning for new environments
Unfamiliar venues may present unexpected hazards with regard to equipment, staffing or extrication routes. Developing a culture of emergency action planning should ensure such considerations are checked on arrival at the ground and final protocols and extrication routes agreed in the best interests of the casualty, avoiding hazards such as stairs or narrow doorways.
As well as encouraging effective team working, planning should include recommended lines of communication, both on site for local assistance, and to the emergency services. Challenges such as remote training venues or poor mobile phone signal should be anticipated and overcome in the plan for example by using radios or other methods of communication.
Standards for skill training and retention
“Sports pre-hospital immediate care" is a distinct subspecialty of pre-hospital care where the skills taught and the clinicians involved, reflect the needs and backgrounds of pitch side staff and the common injury profiles of particular sports. Staff training should be included in the plan to reflect this, including certification and refresher training.
Practical skill retention is an issue for all healthcare practitioners with up to 92% of practical skills being lost at 1 year if not refreshed. It is important that the emergency action plan mandates and fosters a culture of in-house drill practice at least every 2-3 months for common scenarios such as management of an unconscious player, equipment familiarity or extrication. It is not sufficient to rely on annual updates.
Training and match day venues.
Players spend up to 80% of their time training. The training environment often has fewer staff around should an emergency situation occur. Plans and standard operating procedures should be established for both home and away venues as well as for training environments.
Reflective practice and learning through Clinical Governance.
Any immediate care incidents that occur provide opportunities for reflection and learning for all staff. Having a governance system in place that allows debrief, reflective practice, audit and scope for changes to the emergency action plan is important. The plan may also need adjustment as we learn more about the injury profiles of a particular sport.
Figure 1: Reflective practice in emergency action planning development
Developing standard operating procedures (SOP’s) and emergency response planning has the following benefits:
- reduces stress for clinical staff
- minimise mistakes
- minimise equipment failure through checks
- improves team working
- improves player care
- support minimum standards of care for all scenarios
- supports reflection, learning, significant event analysis (SEA) and audit