Emergency Action Plan

Once this form is submitted, you will be able to download a PDF of the Emergency Action Plan to save and print.

Athletic Directors and/or Athletic Trainers, should create a unique Emergency Action Plan for each athletic facility/venue in which you will hold practice or competition.

"*" indicates required fields

Venue Information

High School*

Venue*

Administrator Name*

First Last

Administrator Cell Phone*

Step 1- 911

Call 911

EMS Access Point- Practice*

EMS Access Point- Events*

Street Intersection- Practice*

Street Intersection- Events*

Meet EMS

Meet Ambulance at EMS Access Point. Take to victim.

Entry Door/Gate Location- Practice*

Entry Door/Gate Location- Events*

Contacts

School contacts to call in an emergency event.

Athletic Trainer (if applicable)

First Last

Athletic Trainer Cell Phone (if applicable)

Athletic Director*

First Last

Athletic Director Cell Phone*

Step 2- CPR

Begin CPR

1. Certified individuals begin CPR.
2. Take turns with other certified individuals as needed until EMS arrives.

Step 3- Retrieve AED

*When AED arrives, turn it on and follow voice prompts

1. Remove clothing from chest.
2. Attach electrode pads as directed by voice prompts.
3. Stand clear while AED analyzes heart rhythm.
4. Keep area clear if AED advises a shock.
5. Follow device prompts for further action.
6. Continue use until EMS arrives.

AED Location- Practice*

AED Location- Events*

Athletic Trainer- Typical Location (if applicable)

Heat Stroke

Locate Supplies

Tub should be prepared daily.
1. Remove equipment/excess clothing. Move to shade.
2. Immerse athlete into cold ice water tub, stir water. (If no tub, recommend wrapping athlete in tarp with ice and water.
In absence of tub or tarp, recommend cold shower or rotating cold, wet towels over the entire body.)
3. Monitor vital signs.
4. Cool First, Transport Second.
5. Cool until EMS arrives.

Tub/Tarp Location*

Water Source Location*

Ice Location*