Sideline Preparedness and Emergencies

General Principles

  • Sideline preparedness is the recognition and formation of medical services in order to promote athletic participation, provide exemplary medical care, and reduce risk of injury.

  • It is achieved by having a unified system with qualified medical staff, pre-event planning, game-day preparation, and post-event evaluation.

  • Many factors influence the type of injuries and emergencies that may occur, and it is critical that the director of medical services is knowledgeable about the competition.

  • Medical services will vary widely when covering a multiday competition, a 1-day Ironman race, an American football game, or a gymnastics meet.

  • During any sporting event, availability of medical services for participants, volunteers, and spectators is vital. The extent of services is often part of a signed contractual agreement.

  • The medical team may consist of a single physician or athletic trainer or may include several different healthcare professionals with varying levels of knowledge, degrees, specialties, and experience. The medical staff may be paid for their services, provided in-kind services, or unpaid volunteers.

  • Pre-event planning and practice are imperative to improve safety measures, reduce risks to athletes and spectators during the event, and provide appropriate medical care.

  • Game-day preparation is essential, as it streamlines medical care for those injured on-site.

  • Post-event evaluation is critical in order to provide continuing care for the injured and to provide strategic information for improvement in future events.

Medical Staff

  • Director of medical services

    • Is usually a physician (a qualified MD or DO with an unrestricted medical license along with training and certification in sports medicine), but may be a certified athletic trainer or other healthcare provider.

    • Responsibilities include:

      • Making decisions regarding the health of all players.

      • Assembling medical staff.

      • Creating and rehearsing an emergency activation plan (EAP) and chain of command for practice and game environments.

      • Being available at all times and having back-up coverage when not available.

      • Coordinating care among others associated with the team.

      • Organizing medical transfers of injured and/or ill athletes.

      • Clearing athletes to play.

      • Safety assessment of the practice facility, event environment, and playing conditions.

      • Providing appropriate documentation of medical care.

      • Possible involvement in development of drug testing protocols, treatment, and prevention programs.

      • Communication with athletes, parents, administrators, coaches, athletic directors, general managers, owners, media, sports agents, legal experts, and others regarding any health issues related to sports participation.

  • Associate physicians

    • May include orthopedic surgeons and primary care physicians with an interest and training in sports medicine.

  • Additional physicians

    • May be required by league rules and can include trauma surgeons, neurologists, neurosurgeons, cardiologists, plastic surgeons, ophthalmologists, maxillofacial surgeons, dentists, dermatologists, and others.

  • Head athletic trainer

    • Should be certified with an unrestricted license.

    • Works closely with the team physicians.

    • Provides all aspects of medical care.

  • Other key members who may be included are assistant athletic trainers, exercise physiologists, strength and conditioning coaches, physical therapists, nurses, psychologists, dietitians, chiropractors, massage therapists, paramedics, and emergency medical technicians (EMTs).

Medical Equipment

  • Medical equipment needs are substantially variable and dependent on many factors, including the type of medical personnel in attendance; timing, duration, and location of the event; number of participants and spectators; access to medical facilities; and league policy.

  • Pre-event communication among medical providers will better ensure that all equipment needs are met and unnecessary duplication of equipment is minimized.

  • The medical director needs to know what supplies are available on-site and what is available at local medical facilities.

  • On-site supplies may be provided by the physician, athletic trainer or physical therapist, organization or team, and/or paramedic or EMT squad.

  • Required and/or essential and recommended and/or desirable supplies are listed in Table 4.1 .

    Table 4.1
    Medical Equipment
    Required and/or Essential Recommended and/or Desirable
    Medical Bag General

    • Alcohol/betadine

    • Scissors

    • Bandages

    • D50W/instant glucose

    • Salt tabs

    • Disinfectant

    • Gloves

    • Angiocatheters

    • Local anesthetics

    • Needles/syringes

    • Pen and paper

    • Sharps box

    • Suture kit

    • Surgical adhesive

    • Wound irrigation

    • Thermometer


    • Airway and mask

    • Blood pressure cuff

    • Stethoscope

    • Cricothyrotomy kit

    • Epinephrine 1:1000

    • Beta-agonist inhaler

    Head and Neck

    • Dental kit

    • Eye kit

    • Ophthalmoscope/otoscope

    • Pen light

    • Pin/sharp object

    • Reflex hammer

    • Benzoin

    • Blister care

    • Contact lens solution

    • Cautery

    • Postinjury instruction sheets

    • Emergency phone numbers

    • Mirror

    • Nail clippers

    • Nasal tampons

    • Paper bag

    • Rx pad

    • Razor and cream

    • Rectal thermometer

    • Scalpel

    • Skin lubricant

    • Skin stapler

    • Tongue depressor

    • Topical antibiotics

    • Preferred medications

    • ACLS medications

    • IV fluids kit

    Medical Supplies
    • AED/defibrillator

    • Extremity splints

    • Cervical collar

    • Radio/phone access

    • Spine board

    • Sling and swathe

    • Ice

    • Oral fluids

    • Plastic bags

    • Face mask removal equipment

    • Medical waste bags

    • Blanket

    • Mylar sheets

    • Crutches

    • Mouth guards

    • Sling psychrometer

    • Tape cutter

    • Concussion assessment tools

    • Glucometer

    • I-Stat


  • The medical staff should be aware of common injuries and illnesses that may occur during the planned sporting event. This may be accomplished by reviewing epidemiologic data, reports from previous similar events, published research, sports medicine textbooks and literature, and previous personal experiences. This knowledge will assist the medical staff in the creation of strategies and policies to promote athlete health, optimize medical care, and prevent injuries.

  • The medical staff may need to clear athletes with medical disorders and identify those at risk of health issues related to participation.

  • The medical staff should visit the course/venue to inspect for safety risks, location of training rooms and medical treatment facilities, optimum positioning of medical staff during the event, and ambulance/emergency access routes.

  • The event EAP and injury protocols must be written, rehearsed, and practiced with all members of the healthcare team. Everyone should have a clear understanding of their roles and responsibilities in the event of a medical emergency.

  • Successful care during a sideline emergency is achieved through regular practice drills of emergency situations.

Day of Event

  • Game-day responsibilities will vary with the type of sporting event being covered and the venue where it is being held.

  • The medical staff should arrive early, at least an hour before the start of the event. This will allow time to meet with other members of the medical staff, coaches, and administrators, opposing team’s medical personnel and administrators, game officials, paramedics/EMTs, security and law enforcement members, and other volunteers.

  • Dress appropriately for the event and ensure all staff have appropriate, all-access medical credentials. Standardized clothing will allow for easy identification of the medical team.

  • Every member of the medical team must understand their roles in case of an emergency. Allow time to rehearse and review the EAP.

  • The medical team should meet with the opposing team’s medical staff to ensure that they have adequate medical coverage, know how to activate the EAP, and to review injury and illness scenarios.

  • Determine who will be the first providers for an injured or ill athlete and the means of communicating with other staff to assist with care. Also determine who will be providing care to spectators, officials, coaches, volunteers, and others in attendance.

  • Physician expertise and experience have an impact on game-day decisions on return to play. The physician must consider if the disorder may be worsened by participation, predispose the athlete to other health risks, or place others at an increased risk of injury or illness.


  • Review injuries and illnesses that occurred during the event, follow-up with participants who required emergency transportation, replenish medical supplies, and determine and correct deficiencies.

  • Communicate, if necessary, with appropriate nonmedical individuals and organizations such as parents, teachers, teammates, coaches, athletic directors, general managers, security staff, player agents, event sponsor, and the media.

  • Health Insurance Portability and Accountability Act (HIPAA) rules must be followed with regard to athlete privacy. However, these are often superseded by collective bargaining agreements, player contracts, scholarship rules, and other legal positions. Nevertheless, it is critical to discuss medical issues and recommendations with the athlete first and foremost before communicating with others.

Sideline Emergencies

  • Perform a quick overall assessment to determine whether an injury or illness is life-threatening (e.g., cardiac event) or limb-threatening (e.g., joint dislocation with neurovascular compromise).

  • Determine whether there are other injured or ill athletes that require triage.

  • Ensure the safety of medical staff tending to injured or ill participants.

  • Decide on the safest method to remove the athlete from the playing field, where the athlete will be further assessed (i.e., sideline, training room, or emergency room), and the best means and timing of transportation if necessary.

  • If the athlete does not require emergent transportation, a decision must be made as to whether it is safe for the athlete to return to play.

Cardiopulmonary Arrest

  • Check for responsiveness. If not responsive, then activate the EAP.

  • Check airway for spontaneous breathing, ensure that athlete has a patent airway, and maintain cervical spine stability in neutral position, particularly if there is concern for head and neck injury.

  • Remove face mask, if present, to gain access to and secure the oral airway.

  • Check pulse; if absent, remove clothing and protective gear and start chest compressions at a depth of ≥2″ and a rate of 100–120 compressions/minute. If the patient is in ventricular fibrillation or unstable ventricular tachycardia, early defibrillation is necessary to restore normal electrical cardiac activity. Each minute of delay decreases the chance of survival by approximately 10%.

  • Administer oxygen (O 2 ), secure intravenous (IV) access, and follow advanced cardiac life support (ACLS) protocols while awaiting ambulance transport to a medical facility.

Exercise-Associated Collapse (EAC)

  • Defined as the inability to stand or walk unassisted during or after the completion of an exertional event.

  • Collapse during or after exercise can be due to numerous disorders. The medical staff must be able to provide prompt and accurate on-site evaluation and treatment.

  • Collapse before the finish line suggests a more serious disorder.

  • The most common causes of EAC are postural hypotension, muscle cramps, dehydration, heat illness, hypoglycemia, hypothermia, and hyponatremia.

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