Risk Management the Coach's Responsibility

Many coaches find it difficult to come up with a complete risk management plan for their team.  For some it may be that they don't understand the importance of one or not feel it is their responsibility, for others it is not knowing where to start or what all comprises of a complete plan.  As a coach you are the decision maker for your team, you need to make safety and risk management a priority as it can be the difference between success and failure or life and death. 

Risk management is an ongoing process that must begin prior to the season beginning and does not end until after the season is over. 

So what all does a coach need to do? We will discuss the basics of a risk management program for sport teams. 

Emergency Action Plan (EAP) - the EAP is designed to make sure all the proper steps are taken when an injury occurs and that specific people have a designated roles/jobs so that all are prepared.  Basic EAPs consist of 3 roles, the charge person who is attending to the injured athlete, the call person who contacts EMS and the control person who maintains order among the crowd, opposing team and liaises with the facility.  

Have First Aid and CPR - it is all great that you have an EAP but if you don't have basic injury management skills such as first aid and CPR, what are you going to do if something occurs?  You can not rely on always having a trainer, athletic therapist on your staff or that each year you will have parents who are doctors, nurses or paramedics.  These are added bonuses not sure things.  

Take an Injury Management Seminar - First aid and CPR only get you so far in the world of sports.  You need to understand the types of injuries that will occur in sports and how to apply the knowledge you gained in first aid and CPR to those situations.  A good seminar will not only discuss sports injuries but go in-depth on risk management, injury prevention and return to activity. 

Carry a First Aid Kit - each team should carry an individualized first aid kit for their sport and the knowledge of those who will be using it.  Sports require more than just few pieces of gauze and band-aids but unless you are trained to do so you don't need a stitch kit. 

Do Risk Assessments - at practices and games.  Know what the areas of risk are in your sport and at each facility you are at.  By doing so you can implement prevention strategies and be more prepared for situations that are specific to each activity. 

By no means is this a complete list of everything that comprises a risk management program.  After each practice, game or competition you will tweek your plan based on what occurred.  Rely on past experiences as well to help form your full plan.  Risk management is about creating a safe environment for your athletes, your staff as well as the other team and spectators.  Though when you first start working on your plan it is a lot of work, the benefits pay off throughout the seasons.  When injuries do occur, because you were prepared they will take less energy and focus at that time than if you did not have an effective risk management plan. 

For more information on risk management, EAPs and the coaches role please visit our website at www.eliteinjury.com  and follow us on Twitter @EliteInjuryMgmt 

Preparing for the Upcoming Season as a Coach

Many sports are beginning to start preparations for the upcoming fall and winter seasons.  Depending on your role in sports be it coach, athletes, or parent how you prepare for the season will differ.  In a three part series we will discuss some of the keys to preparing for the season so that everyone can find success. 

For many coaches there is no off season or down time. Once the season ends they are going over how to improve for next year.  By half way through they are ordering supplies, uniforms and planning their practice and game schedule.  All of this may seem very easy and very routine after a couple of years of coaching, but complacency can be one of the greatest threats to safety. 

When ordering supplies it is important to take into account any changes in equipment policy and regulation.  Equipment manufacturers are great for making something new and improved, however does that new and improved model meet your league and governing body regulations?  Are the new improvements actually for the better or will they cause more harm to your athletes?  Did they remove padding to make the item lighter, leaving your athletes more prone to injury?  These are some of the questions that need to be asked to either your equipment manager or equipment representative.

Another aspect of ordering supplies is restocking your first aid and medical kit.  Replacing all used and expired items.  Keeping your first aid kit up to date with appropriate supplies to your sport and personal qualifications, is a major step in your risk management program.  

Scheduling practices and games is very time consuming and at times very frustrating.  Keeping a good practice to game ratio is very important to avoid physical and mental development and to promote proper skill acquisition.  A minimum ratio of 2:1 would be nice.  For those coaching/teaching sports that do not involve games, keeping the number of hours of practice down is equally as important.  Look at the schedule from a monthly and yearly perspective as this will give you a better indication of what is actually going on, not just a week to week basis.  

As a coach/instructor preparing your athletes for all aspects of life, not just the given sport is the greatest task you will be given.  Mike Babcock has said it is a "great opportunity to make a difference", he is truly right.  You may not realize that not matter the age, you will be an influence on your athletes.  Being prepared to instil life skills and educate them on basics other than sports skills and tactics, will help you create better all round athletes, both on the playing surface and in life.  

I have met many coaches who feel they need to be an expert at everything and be able to do it all.  As the coach you are the captain of the ship.  You need to ensure you have everything taken care of to guide your ship straight.  Being prepared before the season starts will set you on the right course, but no matter what you will face some turbulent seas and need to adjust course.  Having a group of experts to help you right the course will set you apart from the rest. 

Follow us on Twitter @EliteInjuryMgmt and check out our services at EliteInjury.com 

A Cog on the Wheel

I spent the past weekend at a conference where the speakers and attendees ranged from coaches to sport medicine physicians.  I gained lots of things from the weekend in regards to lower body injuries, what I gained the most was how each profession in the world of sports medicine is just a cog on the wheel. 

Our speakers included a registered massage therapist, registered dietician, physical therapist, physical therapist with a PhD and an athletic therapist with a PhD in sports medicine and biomechanics.  They all pointed out how each profession plays a role in all aspects of sports. 

 Though many of our professions overlap in terms of scope, we need to work together to as part of a team to help our athletes and patients achieve their success.  

Everyone from coaches, parents, teachers, exercise therapists, kinesiologists, strength and conditioning coaches, chiropractors, massage therapists, athletic therapists, physical therapists, and sport medicine physicians all are part of the athletes support team.  Remember all of our goals are the same, to keep the athletes playing and achieving their goals. 

Follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

Emergency Action Plan

An athlete goes down, they are hurt and not getting back up.  What do you do?

Well no matter if you are an Athletic Therapist/Trainer or coach the most important thing that you have already done is have your Emergency Action Plan (EAP).  The EAP is simply the plan that you as an association, club or team have set out in case an emergent situation may occur.  It is important to remember that not all emergent situations may be an injury.  An athlete may have a medical episode as well as someone in the stands.

It is really simple to think that if an emergency does occur everything will fall into place and there will be no complications.  However during an emergent situation, there is chaos.  No matter the level, no matter the expertise of the medical staff or coaching staff, everything going on is chaos.  If you check back to any of the videos from the post Athletic Therapists/Trainers in Action  even though all the ATs are working in the professional ranks, what goes on around them is chaos.  The biggest thing to notice is that it is organized chaos.  Each person knew their role and that by completing their role, that was what would guarantee the athlete getting the best, quickest care possible.

It is very important to note that if as a coach you are unable to have an Athletic Therapist on staff you still need to have an EAP and may find it more important as you will be taking control and charge of the situation.  You as a coach need to have this written plan that you share with your coaching staff and inform your parent group that you have one.  This will help with efficiency in care and will ease any concerns that your parent group will have in case something were to happen to their child.

So what makes up a good EAP.  There are three major roles.  Charge Person, Call Person, Control Person.  The focus will be on if you do not have an AT on staff and will be managing the emergency as a member of the coaching staff.  Time is of the essence during an emergency, so making sure that everyone knows what to do is very important.

The Charge Person's only concern is the care of the injured athlete.  They are to decide whether or not further care is needed beyond what they are trained to do.  This can include finding someone more qualified in the stands and activating EMS.  It is recommended that this person does possess some level of first aid and CPR training that way they have the knowledge base to know if more care is needed and can do some basic interventions.

The Call Person has at times the most simple job, they need to discuss with the charge person what the extent of the players injury is and if they want EMS contacted.  Never rely on a cell phone during this time as depending on the location service may be intermittent.  The call person should know the location of a land line or pay phone at the venue and have the address for each.  They should also know the best location for the ambulance to come to to ensure adequate access, the closer the ambulance can get to the playing field can at times be critical.

The Control Person can be likened to the bouncer.  They must ensure only the people needed to help with the emergency have access to the athlete.  As much as spectators and parents feel they will be of assistance, the more bodies in the way can impede the care of the injured athlete.

So how does all this start.  Once the charge person enters either the competitive surface, both the call and control person need to be at the ready.  A simple set of easily identifiable signals can get the ball rolling.  You can choose which signals work best for you and your EAP team, but some standard rules should apply.  The signal for activating EMS should be one handed, as your other hand could be stabilizing the head and neck.  All signals should be large ie. arm straight up in the air, hand on the head ect.  That way someone on the sidelines or stands can easily distinguish what is going on.  You can have a signal not only to activate EMS, but to ask for assistance from the sidelines.

Depending on the EAP sample you look at, it can be either the call person or control persons job to talk to the facility staff.  The facility staff are a huge asset during this time.  They know the layout of the venue and will assist in ensuring the ambulance can get to the athlete quickly and uninhibited.  You can also decide who will retrieve the Automated External Defibrillator (AED), it can be the call or control person or you can designate someone who's job is solely to do that.  As soon as the charge person shows the need to activate EMS the AED needs to be retrieved.

Use the officials of the game or event, they can help greatly in dealing with crowd control including the other team.  Once they charge person has decided that EMS needs to be activated they can assist the control person and facility staff in ensuring quick access to the athlete.

Time is of the essence during an emergency, be it your athlete or a spectator or even an athlete from another team, you want to ensure they get the quickest access to advanced medical care.  In rural areas your average time for an ambulance to arrive can be upwards of half an hour, even in the city you may be looking at a wait of ten minutes or more.  The sooner that you as the charge person decide that is what is needed, the sooner that ambulance is on its way.  Never assume that someone else more qualified will be there to make that determination and know that unlike professional sports Paramedics are not waiting in the wings to take over.  A well organized EAP runs smoothly like a well choreographed dance, each person moves independently of each other but all working towards the same goal.  This goal is the safety of the athletes and having an EAP is one of the first steps in ensuring that for them.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

So Your the One who Runs Onto the Ice?

First of all I don't run onto the ice, that isn't safe, I walk quickly.  You may be thinking that all our concentration is on not falling, even though that may be part of what is going on in our head, we are already starting assessing the scene.

When you are working on the bench or the sideline as an Athletic Therapist you are always at the ready.  I have heard coaches say it is like we have eyes in the back of our heads we can know something is wrong even if we are not looking at the playing surface.  Adam Oates commented that when he started as a coach in the NHL he noticed one of his players was hurt and turned to Athletic Trainer Greg Smith to point it out and Smith was already moving down towards the end of the bench the player was coming off at.  This is a typical reaction for any AT working with a team.

I have been asked what we do while on the bench.  When working lacrosse and hockey I did work the gate but for me that just helped me see the ice and floor better, it also helped me get to know my athletes.  You could tell what they were like coming off from each shift, what was normal and what wasn't.  You would also be amazed at what they will tell you while you are both standing there.

So a player goes down.  You get an initial shot of adrenaline, I have told coaches who do not have access to ATs on their bench that the first thing you need to do when entering the playing surface is to take a deep breath and calm down, it is because that is what I do. As I am on my way to the injured athlete, many things are running through my head.  I am assessing what position they are in, are they lying still or rolling around in apparent agony?  I am going over what I saw the last few seconds of the play, based on this I already have an idea of what body part might be injured.  I quickly run through their medical history, was that the same knee that they had surgery on two seasons ago?  I may talk to another player or official to see if the noticed anything.

Once I arrive at the athletes side, the hands on work begins.  Always start with A, B, C - Airway, Breathing, Circulation.  Hopefully the athlete is talking to you and that solves A & B, you still need to check their heart rate.  Have them take some deep breaths before you start to assess, what is wrong, what hurts, what happened?  What I saw might not be what they are complaining of, however when I start my physical assessment I am going to make sure we both aren't right.  As long as it is not a suspected spinal injury, a quick physical assessment occurs and once the athlete is ready we move the athlete safely.

The pressure that is on during the on field assessment is huge.  Deciding if it is safe to move the athlete and how to do so.  Officials, other players are over your shoulder trying to help and wanting to get the game moving.  The coaches are wanting you to find out what is wrong so they know if they have lost a player or not.  Then there is the fans.  Parents, grandparents, family, friends, scouts, everyone is watching your every move, at times if feels like they are waiting for you to mess up.

I may not have eyes in the back of my head, but I do use my senses during injury assessment.  Initial injury assessment begins on the sideline, by watching and listening to the game or sport.  Once the physical assessment begins we add the sense of touch but always continue with my eyes and ears.  The use of the 6th sense is almost the most important, however that is a whole other post in itself.

So yes I am the one that goes onto the ice or field, but my job doesn't start or end there.  I've been watching to make sure if anything happens, making sure any of the prevention techniques used are doing their job, checking in with athletes as to their status of a healing injury.  When an athlete does get hurt, getting them off to the sidelines safely is just the start, a further assessment and decision about care must occur prior to anything else.  No matter what the safety of the athlete is key.  Getting them back to play is the goal, that is why we do what we do.

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com