The National Center for Catastrophic Sports Injury Research has recorded more than 3,000 catastrophic sport-related injuries among high school and collegiate athletes since 1982.
High-profile medical emergencies in youth, collegiate and professional sports have highlighted the importance of emergency care at sporting events.
Rapid recognition of potentially catastrophic injury in athletes and activation of an emergency action plan (EAP) are vital to ensure timely emergency response and reduce morbidity and mortality. The EAP identifies the process for prehospital care of an injured athlete and recognizes potential environmental factors that impact athlete safety.
Pediatricians, particularly sports medicine pediatricians, are well-suited to serve in team/sideline physician roles for youth and collegiate sports and lead the creation and implementation of the EAP.
Elements of EAPs
The EAP is a step-by-step guide for the prehospital care of an injured athlete. It should define the roles of all personnel, list available equipment and its location, and outline procedures for emergency transport to the hospital.
An effective EAP should be specific to the site (every practice and competition location), widely available, reviewed and rehearsed prior to each event, and updated annually. For events with pediatric patients, transport to a facility with pediatric services must be clear.
An EAP should address environmental considerations such as heat/cold illness, lightning, natural disasters and altitude.
Heat illness
Exertional heat illness, ranging from exertional heat exhaustion to life-threatening exertional heat stroke, represents a leading cause of death resulting from sport participation.
Studies show that prepubescent age, inadequate hydration, inadequate acclimatization, and medications and supplements, particularly those affecting the nervous or cardiovascular systems (see table 1), predispose young athletes to exertional heat illness.
The risk for exertional heat illness due to inadequate acclimatization also is increased by rising average daily temperature and relative humidity seen with climate change, particularly during summer months.
To minimize morbidity and mortality, it is vital to recognize signs of heat illness early (see table 2) and initiate onsite cooling immediately while facilitating transport of the athlete to a hospital.
Other weather events
Outdoor sports also are subject to cold and natural disasters. An EAP should consider lightning, precipitation, wind, earthquakes and wildfires. Sideline physicians and emergency personnel should be aware of local, regional and league guidelines for delaying, rescheduling or canceling an event or moving it indoors.
Events taking place at altitude, whether indoors or outdoors, require knowledge of acute physiological changes of exercise at high altitude, including increased ventilatory demand, increased cardiac output, vasodilation and diuresis. Athletes who are not acclimatized to altitude are at greater risk of altitude illness, and those with sickle cell anemia are at risk for sickle cell crisis. An EAP covering an athletic event taking place at altitude should account for these unique risks.
Pediatricians serving as sideline physicians are not only present for sideline assessment of injured athletes but also play a key role in the development and activation of the site-specific EAP.
Dr. Lang and Dr. Walter are members of the AAP Council on Sports Medicine and Fitness Executive Committee.
