Tuesday, 10 April 2012 19:37

Emergency Plan Form

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 Grassroots Youth Football League 



Practice Location: _______________________________________________________


Address: _______________________________________________________________


Evacuation site in case of emergency/bad weather:




Coach #1: ____________________________ Phone: __________________________

Coach #2: ____________________________ Phone: __________________________

Coach #3: ____________________________ Phone: __________________________

Coach #4: ____________________________ Phone: __________________________

Coach/Manager Designated to be in charge in case of Emergency/Injury:



Duties of Designated Coach/Manager:

  1. Make 9-1-1 call and tell EMS where to go
  2. Give care to athlete
  3. Responsible for first aid kit and emergency cards
  4. Must have working cell phone
  5. Will call parents/guardian of injured athlete
  6. Will complete injury form
  7. Will travel with athlete/EMS to hospital

9-1-1 Call

  1. Call 9-1-1
  2. Instruct EMS (Emergency Medical Services) to report to location and meet (name of designee) at location for athlete in need of emergency medical treatment.
  3. Give address with specific location of field.
  4. Describe injury and any treatment given so far.
  5. Any other information requested by dispatcher. Do not hang up until dispatcher hangs up!
  6. Provide appropriate emergency care until arrival of EMS. Upon arrival of EMS provide athlete medical card and treatment rendered.
  7. Coach/parent should accompany athlete to hospital
  8. Notify parent(s) if not present.

On-the-Field Injury Assessment

  1. Do not remove helmet!
  2. Is athlete breathing? If not, call 9-1-1 and start CPR
  3. Is athlete bleeding? If yes, apply compression to area with gauze pad (use gloves!)
  4. Is athlete able to move? If not, determine if it is safe to move athlete. If a head/neck injury is suspected, one person must stabilize head and neck and wait for EMTs to arrive. In this case, DO NOT MOVE ATHLETE! If athlete does not have a head/neck injury, help him off field and evaluate on the sidelines.

First Aid Kit Contents

Bag, Clip board, Emergency cards, Injury Form, Gauze Pads, Gauze wraps, Band-Aids, Scissors, Hydrogen Peroxide, Antibiotic ointment, Iodine Prep pads, Gloves, Tape, Tongue depressors (to be used as finger splints)

Concussions – athlete does not have to lose consciousness to have concussion!

If a concussion is suspected, take athlete out of game/practice immediately. There is no return to play! Athlete must have medical examination and be cleared by physician!


Signs (what you see): dazed, confused, forgets, moves clumsily, mentally slow, answers questions slowly or slurs speech, unconscious, behavior/personality change


Symptoms (what athlete reports): headache, nausea, balance problems, dizziness, fuzzy vision, sensitivity to light, sluggish, foggy, confusion, memory loss (of events prior to and/or before hit)


Symptoms that indicate a medical emergency and require calling 9-1-1:

  • Decreased level of consciousness
  • Unusual drowsiness or inability to be awakened
  • Difficulty getting attention
  • Breathing difficulty
  • Severe or worsening headache
  • Persistent vomiting
  • Seizures

Heat Injuries

  1. 1.Cramping, dizziness, headache, nausea, profuse sweating, fatigue, rapid pulse, light headedness
  2. 2.Move athlete to a shaded, cooler area.
  3. 3.Elevate legs and have athlete sip cold water.
  4. 4.Place athlete in cold water bath or use ice at base of neck, groin, armpits
  5. 5.Monitor vital signs - respiration, pulse and level of consciousness. If pulse and breathing rates increase, athlete feels faint, or loses consciousness, call 9-1-1.

Wound Care (Cuts, lacerations, abrasions)

  1. Wear gloves!
  2. Clean wound with bottled water (just pour over area)
  3. Clean would with hydrogen peroxide (just pour over area)
  4. Cover lightly with gauze and tape


Stop activity. Ice area for 15 minutes. Gently compress area and elevate area. Splint or brace area if necessary. Remove ice after 15 minutes. Ice again for 15 minutes after 60 minutes with no ice.

Return to Play Guidelines

  2. Injured side must be able to do what uninjured side can do with no pain or swelling.
  3. No return to play if there is pain, swelling, bruising, blood. Must see doctor and get clearance.

Inclement weather (lightning) policy

At first sign of lightning or sound of thunder, athletes are removed from field of play and brought to emergency location. Practice suspended until 30 minutes after last sign of lightening or sound of thunder.


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