It Can Happen to You!

April 12, 2011

Lessons learned from real-life emergencies

Julie Stoehr
IM Sports/Fitness/Recreation Coordinator and Facility Manager
Penn State Harrisburg

“Someone’s collapsed in the racquetball courts!” These are words that all fitness facility staff dread, but ones for which they must be prepared. Performing life-saving techniques is something that one prepares for through yearly CPR/AED certification, but hopes never to have to execute. Results of life-saving efforts are rather clear-cut….. life or death. There is no room for ambiguity. Regardless of the outcome however, much can be learned from emergency situations and response procedures that were implemented from beginning to end. Despite the plethora of CPR/AED/First Aid training that most fitness facility directors and staff attend, nothing quite prepares one for the actual act of performing life-saving procedures.

Fitness facilities and emergency response actions often go hand-in-hand. This is especially true in a multi-generational fitness facility such as the one on the Penn State Harrisburg campus. As an outreach to the community, Penn State Harrisburg offers fitness facility memberships to local residents. Members are required to sign a waiver of liability with their paid membership. With such memberships comes the added risk of serious injury, heart attack, and other emergencies related to the more mature fitness center user.

Over a short period of time, the Penn State Harrisburg fitness facility was the scene of two heart attack deaths. Both victims were older men who were participating in cardiovascular activities. In both instances, CPR was initiated within one minute of each victim’s collapse with the implementation of the AED shortly thereafter. A portable oxygen canister was also put into action. Two of the initial responders had advanced training in CPR/AED, so quality care was administered. EMS arrived within a reasonable amount of time.
Regardless of condition or age, these tragedies can happen and responders must be able to gather their wits and perform. As one can imagine, it is very upsetting to be administering CPR and AED while seeing the victim’s skin color turning blue and the release of trapped air in the lungs (which is easily mistaken for a breath). Even when EMS arrives, it is a frantic situation comprised of intubation and IV drip insertion, so the initial first responders may be asked to continue to operate the AED. First responders should not assume that their jobs are done once EMS arrives. AED operators will still be required to follow all commands of the AED including the announcements to clear and to shock. EMTs need to hear those announcements loud and clear because they are preoccupied with their hands-on rescue of the victim.
Once EMS leaves with the victim, responders must deal with a multitude of issues, such as keeping the area isolated until proper clean-up procedures for blood-borne pathogens are completed, answering questions, and confronting their own feelings of success or failure. For those involved in the Penn State Harrisburg fitness facility deaths, it was beneficial to have a de-briefing meeting a few days after the incident. This de-briefing was conducted by a certified counsellor from Student Assistance, and it was attended by everyone involved in the incident, no matter how small the involvement.

Other lessons learned from the urgent situations at Penn State Harrisburg include the following:

• Student workers who are not first responders can be utilized to get the AED; provide victim symptoms to the person on the phone to 911; flag down the ambulance; isolate the area of occurrence; gather the victim’s information (name, age, emergency contact, etc.) for police and EMS; and be the “gopher” for anything else needed at the scene.

• Gather as much help as possible on the way to the scene.

• Everyone not directly involved with lifesaving procedures should clear the area. People tend to stand in place and watch and end up becoming an obstacle rather than a help.

• Rather than have a kit with a rescue mask and gloves, it is one less thing to remember to grab if all staff wear a belly bag or fanny pack containing those items.

• Make sure that there are scissors in the AED in order to cut away clothing.

• EMS techs will detach the initial AED (the one from the facility) and will attach their own AED. However, the AED pads remain in place, so when EMS transports the victim, those pads will need to be replaced in the AED belonging to the facility. Often, the EMS crew will supply the replacement pads.

• Anyone who performs any mouth-to-mouth resuscitation without a barrier should go to the emergency room or doctor for evaluation as soon as possible. Sometimes a tetanus and/or hepatitis shot are given in these instances.

• Follow through with a de-briefing even if it means paying a certified counsellor to conduct it.

Other items to consider before an emergency situation occurs include:

• If possible, keep the CPR manikins in the fitness facility so that employees have easy access to them in order to practice whenever there is some “down time.”

• Devise and train all staff in your own facility’s specific emergency response plan.

• Designate someone to look at the AED every day. The flashing light that indicates a low or dead battery is not easily visible on some AEDs. Of course, all other maintenance concerning the AED should be checked monthly.

• Institute realistic unannounced mock emergency situations to which staff will respond. This will give personnel a feel for their reactions, emotions, and ability with life-saving procedures. Until it truly happens, it is difficult to know how one will react, thus the surprise scenarios can provide that reality factor.

It is certainly a nerve-wracking experience to respond to an emergency and to perform life-saving techniques under the stress of the moment. These are occurrences that every fitness facility manager fears and for which we strive to prepare. There is no such thing as “too much training.” Realizing that everything that could be done was done makes these difficult situations easier to reconcile for all parties involved. Don’t wait! Train your staff today!