The Cramer Red Bag and Your EAP
By Jane Steger, First Aider Staff
Today’s unpredictable world requires all of us to be prepared for the worst, both on and off the court, field, track or pool. We all know that lives have been saved when an Emergency Action Plan (EAP) is successfully executed; but have you created, communicated, practiced and / or updated your EAP? And what tools does your plan incorporate? We spoke with Ray Castle, PhD, ATC, LAT at Louisiana State University and Chase Paulson, MS, ATC at Diamond Bar High School in California about EAP’s and tools.
“EAPs are not new, but effective plans need to be in an organized format for communication and response to a variety of situations in light of the increased demand for medical care at athletic events and the complexities we now face in today's world,” Dr. Castle stated. “We are seeing a paradigm shift. While it is an athletic event, there's a potential for a mass casualty incident with an athletic component, whether it is stands collapsing, multiple on-field injuries with a collision, or spectator-initiated incidents.”
Paulson said, “One of the things that I live by is the motto, ‘Failure to prepare is preparing to fail.’ [quote by Mike Murdock]. And as a secondary school athletic trainer, you have to be prepared for everything. We might have 450 athletes competing at one time across our campus and we're the only person who has medical training. One of my friends said recently, ‘You even have to be prepared for a plane to fall out of the sky’. He was using this as a metaphor for a worst-case scenario, but if that does happen, you have to be prepared to respond.”
“Thanks to a bill just signed by our California Governor, effective July 1, 2019 emergency action plans will be required in every high school that elects to offer athletics. This is a monumental change. Prior to this action, EAP’s were of course highly recommended by the BOC and the NATA, but not required. Emergency action plans are the number one thing that prevent deaths,” continued Paulson.
What follows is some great practical advice from these two athletic trainers, presented in sections that align with the National Athletic Trainers Association’s (NATA) outline of an EAP.
The NATA’s website provides an outline for the components of a comprehensive EAP, starting with the identification of emergency personnel involved and role delineation.
“When I started my current position at Diamond Bar, my first priority was to establish an Emergency Action Plan. It took some time to identify all the resources, personnel and what allies you have to help you in the process,” said Paulson. “You have to recognize that not everyone is open to change, and you're not in this alone. Even though you might be the only athletic trainer that's employed by your high school, you’re not the first athletic trainer in your state or local area working on an EAP. Often athletic trainers fail to reach out for help. You’re not re-creating the wheel; you’re taking something that has already been proven to work somewhere and modifying it for your specific location.
“When you're creating an EAP you have to consider all the individuals who come into contact with the athletes on any given competition day or any given practice day,” continued Paulson. “Obviously that would include their program's coach, but there are likely others that are not so obvious. For example, our baseball program employs a strength and conditioning coach. He needs to be included in the emergency action plan because if an athlete has a weight fall on them and gets injured, he needs know what to do and who to contact.”
Dr. Castle added, “My personal belief is if you're offering an athletic program, you need to have appropriate emergency care resources. The question is, ‘Is it possible to have an athletic trainer at every high school in the country?’ No. The numbers aren't there to move forward with that, but it doesn't mean they can't have dedicated EMS personnel there. To help to provide the best care possible, we use an interdisciplinary approach.”
Another component of the NATA’s EAP outline is the communication system and protocol.
“You not only need a plan, you need to actively review the plan and practice,” Dr. Castle says. “On a yearly basis our medical staff practices multiple situations, for example, how to stabilize a fracture; how to control bleeding; how to employ airway management; how to address heat stroke, just to name a few. I refer to it as ‘sharpening the saw’. It also helps to create different scenarios or incidents that may occur and how you will respond to those.”
“To get my EAP plan widely accepted, I illustrated how it plays into the simplicity of keeping kids healthy and safe,” commented Paulson. “The coaches accepted the plan when they realized that as long as they act according to the plan and the scope of their training, they stay out of hot water. However, I knew I couldn’t give the coaches an encyclopedia to read; the plan had to be short, sweet and to the point.
“I talked to a couple of veteran coaches and they said, ‘If I'm not seeing it in one page, I'm not following it.’So I re-worked the plan and finally got it down to five steps. It's five simple steps to make sure that no matter if I'm present or not, the coach has the information to ensure the athlete is taken care of, because that's the number one goal.”
Dr. Castle added, “You must have the training and communications skill, but you can't wait until five minutes before an event. Training and communication must take place well in advance. Utilize the medical timeout process before every athletic event, which is really an important process to go through. If you're hosting an athletic event, you should meet with the officials and medical team on the other side before any action takes place to ensure everyone is working from the same plan.”
Necessary emergency equipment and the location of the equipment is another critical component of an EAP.
“We utilize our Cramer® Red Bag every single day,” said Paulson. “Going back to our emergency plan, one thing we do is a daily equipment check to see if things are in proper working order and if we need to restock or remove a piece because it's damaged and needs to be repaired or replaced. That starts with the Cramer Red Bag because it serves all of our first aid situations like broken bones, all the way up to situations where CPR may be needed. That Red Bag is our go to bag.”
Dr. Castle added, “The real advantage of the Cramer vacuum splints is you can use them in a variety of situations. We practice this with having simulated fractures on a pole vault pit or in the field, and with the athlete in different positions. They are conformable to the body part, and work well for a dislocation or an angulated fracture where it’s really critical to stabilize in place. That's when the vacuum splint becomes an emergency modality. Your emergency bag should obviously have all rescue medications that one is appropriately trained to administer, i.e., epi-pens, as well as wound care supplies, airway adjuncts, tourniquets and hemostastic agents to control mass hemorrhage, and an AED (automatic external defibrillator). Think of it as an infield trauma unit.”
Site specific instructions for each venue and directions for EMS to access all facilities must be included in an EAP that will save lives.
“As I said, we have a one page EAP plan for each venue,” said Paulson. “So our soccer stadium has a one-page plan, our gym has a one-page plan, our wrestling room has a one-page plan, etc. The full EAP document is about 31 pages long because of the rationale and the legal language that we need to have in terms of chain of command and available equipment, directions for EMS, facility access, etc. We take a little snippet out of the entire plan because if you're at the pool, you don't really need to know about how to get to the softball field. You just want to know how to get the ambulance to the pool or to get somebody to that athlete.
And finally, an EAP, according to the NATA, must include a section on Responsibility for Documentation that captures the actions taken during emergency and evaluation of emergency response.
“You need to really think out of the box in terms of the types of situations that you may encounter,” said Dr. Castle. “Be appropriately trained. Practice what you've learned. Rehearse, review, re-evaluate, especially when it comes to emergency response in situations that do occur. Have a communication plan in place. That communication plan starts well before the event, through the event and afterwards…what worked well? What did not work well? How can we improve? What will make things better the next time around? Emergency care is a very relevant topic and one of the core skills that we do as an athletic trainer on a daily basis, regardless of the setting.”
Paulson added, “I review our 5 step plans every year. I go back with the best practices, the information that we're supposed to follow from the NATA, and make revisions and then act it out. If it works, then we’re good. And when you’re just getting started on writing your EAP, seek out some help. Like I said, you're not reinventing the wheel. Find another school that's close to your size and demographics and see what they have. And see if you can use it. You may feel like you're the only one doing it, but you're not doing it alone. Reach outside of your network and see what you can find."
Bios:
Chase Paulson, MS, ATC
Chase Paulson achieved his BS in Kinesiology from California Baptist University in 2009. After this, Chase began working on his Master’s Degree in Athletic Training, also at California Baptist University, graduating in 2011 and earning his certification shortly thereafter.
Chase is currently employed at Diamond Bar High School, in Diamond Bar, CA, as the Head Athletic Trainer; and through the East San Gabriel Valley ROP as Diamond Bar’s CTE Instructor for their Health Science Pathway, encompassing courses related to the field of Health and Medicine. Chase is also the Advisor for the Diamond Bar HOSA – Future Health Professional chapter, which he founded in 2013.
He has been an active participant on the CATA Governmental Affairs Committee's Legislative Action Team since 2012, and joined the CATA Secondary Schools Committee in 2015. In 2014 Chase was selected to be a member of the CIF Southern Section Athletic Trainers Advisory Committee, and in 2015 was selected to assume the role of Head State Master Assessor for the CIF’s Wrestling Weight Management Program. Chase was selected as the NATA District 8 Chair of the Secondary Schools Committee in June 2016, where he represents all secondary school athletic trainers in California, Hawaii, and Nevada. Chase recently received the CIF-SS Jim Staunton Champion for Character award, being one of only two athletic trainers to receive the award.
Ray Castle, PhD, ATC, LAT
Dr. Castle is a BOC Certified Athletic Trainer (since 1991), LSBME credentialed athletic trainer (LAT since 1994), and is an American Red Cross Instructor (since 2005). Dr. Castle has an extensive background in education, clinical practice, and professional service spanning over 27 years. Dr. Castle's clinical practice background has included experiences at the high school, college, and internationallevels (1996 Atlanta Olympic Games; USOC Sports Medicine Staff for 2003 Pan American Games; and 2004 US Women's Bobsled).
Dr. Castle is a highly active member of the athletic training profession, having made more than 50 presentations at the local, state, national and international levels, numerous publications, as well as serving on various organization committees at state, district, and national levels. Dr. Castle served as Vice President (2013-16) of the Louisiana Athletic Trainers Association. At the national level, he has served as chair of the NATA Educational Multimedia Committee (2004-08), a member of the NATA's Education Council Executive Committee (2004-08), board member of NATA Research and Education Foundation (2010-12), and board member on Commission on Accreditation for Athletic Training Education (2011-2017).
Dr. Castle has been recognized for his service efforts in the athletic training profession, and has been the recipient of the following honors including:NATA Most Distinguished Athletic Trainer Award (2017); SEATA Hall of Fame (2014); NATA Athletic Trainer Service Award (2007); SEATA District Award (2005); and Athletic Trainers’ Association of Florida (ATAF) College/University Athletic Trainer of the Year Award (2001).
Dr. Castle is the owner of Action Medicine Consultants, LLC. His company provides sports medicine coverage, sports medicine consulting, and related services for organizations and events. He currently serves as medical coordinator for several large-scale events, including the RiverRoux Triathlon, Tiger 10K, Mississippi Gulf Coast Marathon, and the Louisiana Marathon.