9.1 Emergency Action Plans
Key Takeaways
- NATA 2024 (Scarneo-Miller et al., JAT 59(6):570–583): a written, venue- and sport-specific EAP covers any catastrophic injury and is not illness-specific; institutions must plan for in-season and out-of-season games, practices, conditioning, and skills sessions.
- An automated external defibrillator (AED) must be on site or retrievable for use within 3 minutes at all sport venues (NATA 2024 rec. 22, SOR B); the 2007 Inter-Association SCA consensus used a 3–5 minute collapse-to-first-shock goal and a collapse-to-CPR goal under 1 minute.
- Rehearse the EAP with hands-on scenarios at least annually with the interdisciplinary team and local EMS; document when, where, who was present, and which scenarios were run, then update the plan in the current year.
- Each venue EAP lists the exact street address, cross-streets, GPS if EMS wants it, access gates, equipment locations, radio/911 roles, and a helicopter landing zone when air medical is used.
- Multiple venues require multiple EAPs. A single generic campus PDF that is never posted or rehearsed is the classic failure, not a plan.
Quick Answer: The National Athletic Trainers’ Association (NATA) 2024 position statement (Emergency Action Plan Development and Implementation in Sport, Scarneo-Miller et al., Journal of Athletic Training 59(6):570–583) requires a written, venue- and sport-specific emergency action plan (EAP) for every sponsored activity. Post it, rehearse it at least annually with emergency medical services (EMS), and stage an automated external defibrillator (AED) so it is on site or retrievable for use within 3 minutes. One generic campus PDF is not an EAP.
Practice Analysis, 8th Edition (PA8) Domain III, task 0301, asks the athletic trainer (AT) to implement emergency action plans. The EAP is the written document that details preparations and on-site response to any catastrophic or potentially catastrophic injury in the prehospital setting. NATA is explicit: the EAP should not be injury- or illness-specific. Sudden cardiac arrest (SCA), traumatic brain injury, exertional heat stroke, spine injury, and a mental-health crisis all start with the same activation, communication, equipment, and transfer steps. Condition-specific policies and procedures (SCA protocol, heat-stroke cooling, mental-health emergency procedure) sit beside the EAP; they do not replace it.
The National Center for Catastrophic Sports Injury Research has recorded more than 3,000 high-school and collegiate catastrophic sport-related injuries since 1982–1983. Leading causes of death in sport remain SCA, traumatic brain injury, and exertional heat stroke. NATA 2024 notes that the first 10 minutes of the response are critical. You buy those minutes before the collapse—by writing, posting, stocking, and rehearsing venue plans.
Written, Venue-Specific, Sport-Specific
NATA recommendation 1: institutions that sponsor athletic events have a responsibility to develop a written EAP for all sponsored activities, including in-season and out-of-season games, practices, conditioning, and skills sessions. Recommendation 2: develop EAPs specific to each venue and each sport. The basketball coach with a medical background and the volleyball coach who is a classroom teacher in the same gym do not have the same role, the same equipment access, or the same crowd. A Friday-night football crowd of several thousand may force EMS to a different gate than a Tuesday lacrosse match in the same stadium. Each sport in that venue needs its own plan.
Multiple venues = multiple EAPs. Typical set for a secondary school or college:
| Venue | What the EAP must specify |
|---|---|
| Outdoor field (football, soccer, lacrosse, track) | Street address, cross-streets, named access gate, stretcher path across turf, helicopter landing zone if air medical is used, nearest hydrant or fire lane |
| Gymnasium | Loading-dock versus lobby entry, elevator versus stairs for a stretcher, bleacher egress, which door the ambulance actually uses |
| Weight room / strength facility | Often a basement or interior room with poor cell service; the AED cannot live only in the athletic training room 90 seconds away |
| Natatorium | Wet deck, spinal-board path, where the AED stays dry, pool-specific drowning/spinal roles, chemical-room access for staff only |
| Remote trail / cross-country / golf | GPS (latitude/longitude if local EMS wants it), mile-marker or hole number, radio channel when cell service dies, all-terrain vehicle path, nearest road intersection |
A venue- and sport-specific EAP lists, at minimum, an address, cross-streets, and recognizable landmarks. Include latitude and longitude when EMS says that helps their computer-aided dispatch. Identify air-medical landing zones when the venue is remote or when local EMS uses rotor-wing transport. Map primary and secondary EMS meeting points and primary and secondary equipment locations (NATA Table 3).
Exam trap: one generic PDF titled “Athletics Emergency Plan” in the athletic director’s drawer, covering “all campus facilities,” never posted at the trailhead or the natatorium, never rehearsed with the fire department. That document does not meet NATA 2024 and will not save an athlete at hole 12.
Equipment: The 3-Minute AED Target
NATA 2024 recommendation 22 (SOR B): an AED should be on site or retrievable for use within 3 minutes at all sport venues. Recommendation 21: emergency equipment (AED, whole-body cold-water immersion vessel, and the rest of the catastrophic kit) should be available, readily accessible, and clearly identifiable with proper signage at all athletic events.
Verify the wording against older SCA papers so you do not mix targets on the exam:
- 2007 Inter-Association Task Force on SCA in high-school and college programs (Drezner et al., JAT 42(1):143–158): target collapse-to-EMS-call and CPR initiation <1 minute, and a collapse-to-first-shock goal of less than 3 to 5 minutes.
- 2016 Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes: AEDs in the immediate vicinity (within a 3-minute walk) of high-risk sites (weight room, basketball courts, football/soccer/lacrosse/baseball/softball fields, track, indoor training).
- 2024 NATA EAP statement: tightens the operational teaching point to AED on site or retrievable for use within 3 minutes at all sport venues.
Teach <3 minutes collapse-to-shock as the athletic operational target. An AED locked in a dark athletic training room, or one “3-minute walk” that is actually 4 minutes of stairs and a keypad, fails the standard. Stage AEDs at the home bench, weight-room door, pool office, and trailhead kit, check them on the daily readiness check (NATA rec. 20), and list backup locations.
Communication, Roles, and EMS Coordination
Designate an EAP coordinator (NATA rec. 4) and a chain of command with primary and secondary liaisons for each role (rec. 6). Develop the plan with the interdisciplinary team and local emergency responders and public safety (recs. 7 and 12). Do not write it in a sports-medicine silo.
Who does what when the plan fires:
- Charge person — scene leadership and immediate care; usually the AT when present.
- Airway / CPR — opens the airway, delivers ventilations or high-quality compressions as assigned.
- AED retrieval — sprints to the posted AED, not to the office to “ask where it is.”
- Caller — the one person who calls 911 (or the campus emergency number) with a script: exact address, venue name, gate, GPS, nature of the emergency, number of patients, care already started, callback number. Stay on the line.
- Crowd control — coaches, administrators, or security keep teammates, parents, and media off the patient.
- Meet-the-ambulance — a person with a radio or vest at the named gate who walks or drives EMS to the patient; stadiums fail this step when the crew circles the wrong parking lot.
- Documentation — a designated recorder for times (collapse, CPR start, AED shock, EMS arrival).
Communication hardware belongs in the plan: two-way radios with a posted channel, a charged cell phone, a landline backup in the press box or pool office, and a note about dead zones (basement weight room, canyon trail, ice-rink compressor room). “Someone will call 911” is not a role.
Coordinate exact access: which gate is unlocked at 5:45 a.m. conditioning, whether a chain blocks the ambulance, and whether a helicopter LZ is the south lot or the practice field. Walk those routes with EMS during rehearsal, not during a code.
Post, Approve, Rehearse, Document
Occupational Safety and Health Administration (OSHA) 29 CFR 1910.38 requires a workplace emergency action plan to be in writing, kept in the workplace, and available to employees for review (employers with 10 or fewer employees may communicate that OSHA plan orally). NATA 2024 cites this posting logic for sport EAPs and goes further: recommendation 13 — make the EAP available (posted physically at all venues and available electronically). Recommendation 14 — approve the plan before implementation (administrators, athletic director, EAP coordinator, ATs, team physicians, legal counsel). Recommendation 8–9 — distribute and review at least annually and update during the current year. OSHA 1910.38 is an evacuation and workplace-alarm standard (fire, chemical release, accounting for employees). It is not a substitute for a medical, venue-specific athletic EAP. Do not hide behind “we have an OSHA binder.”
Rehearsal (rec. 10): hands-on, scenario-based practice at least annually (≥1 time per year) by the interdisciplinary health care team—and coordinate it with EMS. Tabletop slide decks do not count as rehearsal. Document (rec. 11) when, where, who was present, and which scenarios were run.
Rehearsal checklist (use this, then file it):
- Pull the venue-specific document, not the campus template.
- Run SCA (collapse, CPR, AED retrieve-and-shock clock).
- Run at least one other catastrophic scenario (spine, exertional heat stroke with tub, severe hemorrhage, or mental-health emergency).
- Time collapse-to-AED-pad at that venue; fix anything over 3 minutes.
- Walk EMS to the actual gate they will use at 6 a.m. and at 8 p.m.
- Test radios in the dead zone (weight room, trail, ice plant).
- Include a coach-only activation because ATs are not always present (NATA key point).
- Record attendance, deficiencies, and the date the plan was updated.
NATA rec. 19: discuss the EAP before competitions in a pre-event medical meeting (medical time-out). Rec. 15: a per diem AT reviews the venue EAP as part of orientation. Rec. 16–18: after activation, debrief, write an incident report, and after a catastrophic event run critical incident stress debriefing (CISD).
Weather, Lightning, and Mental-Health Addenda
Because the core EAP is not condition-specific, addenda carry the details that change by hazard.
Lightning / severe weather addendum (NATA Lightning Safety for Athletics and Recreation, Walsh et al., 2013, still the NATA lightning statement): designate a weather watcher; identify safer locations before the event (a substantial grounded building or a fully enclosed metal vehicle—not a dugout, picnic shelter, tree, or open press box); suspend activity when thunder is heard or lightning is close (flash-to-bang of about 30 seconds ≈ 6 miles; many NCAA policies notify at 8 miles and suspend at 6); wait a minimum of 30 minutes after the last thunder or flash, and reset the clock with each new strike. “When thunder roars, go indoors.” Lightning is also a scene-safety problem in 9.2: you do not become the second patient.
Mental-health emergency addendum: NATA 2024 uses mental health as the example of a policy/procedure that outlines prevention, initial recognition, and response, while the EAP still supplies who calls, where to take the person, and how EMS/crisis teams enter. List campus counseling after-hours, mobile crisis, 988, 911 when there is danger to self or others, a private location, and the rule that a suicidal athlete is not left alone. A locker-room crisis uses the same activation system as a field collapse.
Life-threatening emergencies occur with or without an AT on site. Programs must not rely solely on the health care team to write or execute the plan. Coaches, administrators, and facility staff are lay responders who need a posted, rehearsed, venue-specific EAP.
A high school stores one 12-page “campus athletics EAP” PDF in the athletic director’s office and uses it for the stadium, gym, weight room, natatorium, and a remote cross-country trail 2.4 miles from campus. The trail has no street address posted. What does the 2024 NATA EAP position statement require?
Which AED placement standard is the current operational target in the 2024 NATA EAP position statement?
Which rehearsal and documentation practice matches NATA 2024 implementation recommendations?