All right, so obviously the Emergency Action Plan is a very serious topic. And so hopefully I can have your undivided attention. Hopefully everyone in this room has some bit of exposure to their Emergency Action Plan. So this is a little bit more of an overview and some items you may want to consider. So why would you have one? Let's just be frank. Emergencies are going to happen and it's a fact. You need to come up with a process that you're going to respond to these emergencies. Best way to think about it is what are you doing? What is your role? Are you in a high school? Are you in a college? What athletes do you have? That is the best way to start. We want to prevent death first and foremost. Our athletes are in a contact sport, which raises certain conditions. A lot of them are outside, which raise other conditions. Most of the EAPs really focus on athletes, but please remember they're game officials. You have coaches. Our coaching staff is over 30 people and very diverse. There's IT people. I'm sure in the college level, sometimes your sidelines are just full of people. You're responsible for all of them and it's worthy of consideration when you're developing your EAP. You can plan your physicals and pre-participation exams. You can have phenomenal physicians, get excellent histories, do everything right, and bad things will still happen. Sudden cardiac arrest, even in elite athletes, can happen. It's the most common cause of death. The statistics are there. Here's some examples of failures. These are all in the past couple years. There's a young teenager on an American Airlines flight from Honduras to Miami who died. The defibrillator was not charged. There were two high school students. These three, these moms banded together to try and get some legislation forward for AEDs because their sons died. One died because the AED did not work. Another one died because the AED was in the coach's office and not available. Show these videos. These are also recent events where players have gone down. This is college basketball, medical team on in seconds, prompt recognition, defibrillation, survival. This is from the Euro 2020, which was actually summer of 2021 when a player went down. This was a devastating case if you saw it on TV because it lasted for a couple hours. But again, another good outcome because of prompt recognition and activation of the EAP. So what is your nightmare scenario? Think about what it is. On January 2nd, Damar Hamlin made a tackle, got up, wobbled, and then collapsed. This is for most people your nightmare scenario. Thankfully, the Buffalo Bills athletic training staff and the medical staff promptly were out there, recognized that there was a problem, and activated their EAP. This allowed for them to have help. On an NFL sideline, you have the equivalent of 911 10 yards away. It's very helpful to have them there, but you need to be able to get on the field and recognize that there's a problem and call them, otherwise it's useless. He got CPR, the defibrillator was used, and thankfully, in this case, there's an excellent outcome. Now I know we always talk about return to play, return to play as being our ultimate outcome. But as far as the EAP is concerned, survival is what we talk about. And now, Damar is really an advocate for AED use. And this is, he came down to Florida a few weeks ago, and my son's on the right, where he's out telling people how important these EAPs are and having an AED available. To date, there's only been one death on an NFL field. I think our challenge is to keep that as the only one in history. So going back to what is an EAP, these are a set of processes that you put in place to account for the emergencies that we talked about. You want to make sure you think about when you're on the field or you're on the practice field, who is there? Who are you going to turn to when something happens? Because if the gate is closed for an ambulance and you need to talk to a security guard to open it, you better have that person in your EAP and bring them to meetings so they understand what their role is. What about your team's media person, your coaches? Think about all these people who are going to be there and you're going to need their help because that's who you need in your EAP. This is your insurance policy. Please practice it. Please update it. Please distribute it. No two EAPs are exactly the same. I cover St. Thomas University, which has over 20 sports and over 1,000 athletes. It's an NAIA school. The EAP for all the sports is eight pages. The Miami Dolphins, which have 60-some players on the roster, less than 100 total, is 33 pages. A lot of that represents the complexity of what happens in the NFL versus an NAIA school, but that doesn't change the fact that each one has what they need for each school. So yours does not have to be the same as another person. The equipment and supplies are extremely important. A lot of the failures are not because an EAP wasn't there, but because the equipment was not readily available, wasn't, you know, was broken. You open the bag and something's missing. I like this slide. Dr. Friedman wrote a nice article in the American College of Cardiology on the how-to for an EAP a couple years ago. I suggest you check that out. But it's a circle. Okay. It is not a one-point timeline. You have your plan, you have your training, you have your review, and you do it all over again all the time. The AED is extremely important. Just having an athletic trainer on middle school and high school fields can be very, very helpful at preventing sudden cardiac death. Having an AED available is very, very helpful. I mean, you see the numbers. 89% survival. You see what it is right now in middle school. You see what it is at the D2, D3 level. The NFL, if you saw a release last week, there's the Smart Heart Sports Coalition. It's a combination of a lot of sports groups who are trying to accomplish three things in all 50 states. Make sure every sports team has an EAP, has an AED, and has training. You will not be there. If you are the medical provider, physician, athletic trainer, physical therapist, you should all be trained. But you're not always going to be there, and you should have all the coaches and staff trained. Make them comfortable with this. So this is a very worthwhile goal, and I believe there are grants coming in the future. I don't know if anyone here will need them, but please be aware and maybe distribute to some of your local high schools. Remember that this is a team approach. You're sitting there, and you've come up with a plan, but if you haven't talked to everybody, it is not going to be an effective plan. Who are your first responders? In each situation, who's going to be in charge? What are the hand signals you're going to use if the radios don't work? How are you going to communicate the EAP to the officials, to the coaches? When everything goes down, everyone wants the information immediately. Again, you saw in the DeMar Hamlin case how the reporting went with the officials and NFL officials. And I'm not getting into specifics, but just because you're not on an NFL sideline doesn't mean you won't be under that exact same pressure with everyone asking you, university president, the parents. Everyone wants to know, and they want to know now, and you need to be ready to respond. I talked a lot about the heart. This is a longer slide. It's not meant to be comprehensive. It's meant to have you think that there are other things other than cardiac that should go into your EAP. It should start with your pre-participation exams. Figure out who your risky patients are. Look at your environment, where you play, where you practice, what things can come up. Here's some more specifics you might have in your EAP. So now you say, okay, this is our spine protocol. How are you going to do it? Are you doing the log roll? Are you pausing when you go up? I'm not saying one of these is any better than the other, but you need to decide what you're going to do, practice it, and then put it down on paper. What about equipment? Does your local emergency department know how to take off football pads and helmet? Are you going to do it? Is someone from your team going to go with them to the emergency department to do it later? What is going to be the best practice for you? Write it down, practice it. And this is a living document. So if you do one thing one year and say, you know what, that's not going to work for us anymore. You update your EAP, retrain and continue. Nancy talked a lot about the cold tub, but that's another example in your EAP where you put down exactly what you're going to do. Make it easy on yourself. So in a crisis, you have that EAP. If you don't have it memorized, you have it, everyone's aware, and you do it. We all play football. There's two teams required. One is going to be home, one is away. Now you may be in a situation where you share stadiums like in high schools, and they're very familiar with the scenario and the situation, or you may be traveling. The away team is going to be at your mercy. If you do not prepare them for the complexities and intricacies of your EAP, you will have failed them, and that's not right. So please make sure you have clear maps, locations, discussions, and you can email them. You can call them. You can Zoom them, whichever you want to do or you two mutually agree to do, but there should be adequate communication prior to the event. We practice our EAP using a third party. I know that may be costly, and if that's not in the budget, then find a doc that's a community doc or an EMT that teaches ACLS and other life-saving measures, and have someone who's not running the EAP run the practice and simulation for you. It is very helpful to have someone else do it and challenge you to get better. Keep you on task. This is the time where you go over your roles. This is the best time. Empty your bag out. Look at it. Do you like the eye gel that's in there? Do you like the curved to-do intubations? Does the light work? What is in your bag? Are you comfortable with using it? Is anything expired or doesn't look right? Because this will be your best opportunity to make sure you have what you need should a disaster come, and remember, this is very venue-specific. So if doctors aren't traditionally on your sideline at practice, they should not be participating in the EAP training for practice. They can be there to observe and help, but you should be aware of what you normally have, and that's how you practice. In the NFL, we have a 60-minute medical meeting. Very, very challenging to try and get all the medical staffs together an hour before game time away from our locker room. Initially, there was a lot of pushback. It's very difficult, but it is actually very helpful for us to meet with the game day officials, go over the EAP, discuss, introduce everyone that will be involved, whose role is what. We go over where everything is, where we transport. In the end, it's probably around a six-minute meeting, but in that six minutes, we're able to accomplish something that can be very helpful should an emergency arise. In fact, it's been so effective that they're adding a 90-minute meeting for just the emergency personnel to meet and go over everything again. This is my last slide. So these are the crucial points. You need to assess the risk of who you have on your team. You need to identify who you're going to use in an EAP, train them, make sure all the equipment is there, make sure you know how to communicate when things happen, and you need to practice this over and over again. You come to these events, these CME courses, you go to NATA, AOSSM, AMSSM, and they go over something and you say, wow, I think we should add that. Go home, add it to your plan, redistribute it. Always look for opportunities for improvement. So I'd like to thank Kyle, the Dolphins athletic trainer, and Jim Tuffy, the St. Thomas trainer for allowing me to share the EAP. Jim Ellis from the NFL Emergency Preparedness also shared several slides. There was a webinar a month or two ago that's available that had a whole long discussion on the EAP. Dr. Friedman allowed me to share some of his slides from the how-to from a cardiology perspective and of course my family for allowing me to come here today. So thank you.

Emergency Action Plan

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sudden cardiac arrest