MRFC-Youth Emergency Plan and Procedures by Miami Rugby Youth

Miami Rugby Football Club Youth Division Emergency Plan and Procedures

Introduction Below you will find weather and medical emergency plans, as well as multiple forms. All adults that work with our athletes, including coaches, non-coaching staff, and parents that are very involved, are expected to review and be familiar with this entire packet, especially with the emergency plans.

Some basic guidelines to follow with the forms: Injury Report: completed by the first responder or person that provides primary care. This is to be placed in the child’s file after completion. Medical History Questionnaire: completed by parent(s) prior to child practicing; placed in child’s file. Medical Examination Form for Rugby: completed by a physician prior to practice; placed in child’s file. Emergency Information and Informed Consent Form: completed by parent prior to first practice; this will be carried by coaches to all practices and matches AND a minimum of 2 copies will be kept in the child’s file. Pre-season Fitness Screening: completed by strength and conditioning coach or athletic trainer prior to the first practice, then multiple times during the season; this will be kept in file by the head coach and/or strength and conditioning coach/athletic trainer.

Weather Emergency Plan A weather emergency plan is essential for all sports, especially those played outdoors. We must be prepared for weather events including, but not limited to, lightning, hail, tornadoes, extreme temperatures, and hurricanes. Weather emergencies can create chaos and injuries to athletes, staff and spectators but these can be minimized or completely eliminated if a plan is set in place and followed. Whenever possible, parents will be notified of a practice or match that has been canceled due to a weather event at least an hour in advance. In the event of a cancellation of a practice or match that has already started, at least one coach is required to stay until the last athlete is picked up by an adult.

Lightning

Hot Weather Conditions

Tornadoes

We will follow the rules of the park if there is a lightning alarm. Otherwise, the "30-30 Rule" applies. This states that when you see lightning, count the time until you hear thunder. If this time is 30 seconds or less, go immediately to a safer place. If you can't see the lightning, just hearing the thunder means lightning is likely within striking range.

Hot weather conditions could produce heat cramps, heat exhaustion, and heat stroke, which can be life threatening.

If a tornado watch or warning is issued, practices or matches will be canceled immediately.

A safer place is a closed building (not sheds or bleachers). If a closed building is not available, athletes, spectators, and staff should go inside cars with closed windows. Wait for the park’s alarm to return to the field OR wait 30 minutes or more after hearing the last thunder before leaving the safer location.

During hot weather conditions, coaches will provide for frequent rest periods (preferably in shaded areas) and water breaks.

Hail During a hail storm all athletes, spectators, and staff must immediately go to a covered shelter.

Cold Weather Conditions Coaches should monitor athletes during practices and games when temperatures are between 32° F and 60° F, especially during wet and raining weather.

Weather decision maker: ____________________________ Weather watcher: __________________________________

If a tornado is approaching the practice or match area, athletes, spectators, and staff will seek shelter in a closed building. If this is not available all athletes and staff should lie flat as far away from trees as possible.

Hurricanes Hurricane watch: we will follow the local school board’s decision of canceling practice/matches. Hurricane warning: all practices and matches are canceled until further notice.

911 Script

Safety is NO Accident Be Prepared

This is (caller). The address of my emergency is (address) and the phone number I am calling from is (phone number). There are (number of participating) athletes present, and one of our athletes has injured their (injury) and needs an ambulance. They are currently (condition of the injured athlete). We have begun (what treatment). We are located in the (give specifics), we are sending (person) to meet the emergency personnel. Stay on the line and answer any questions the dispatcher may have and until they instruct you to hang up. You should have an established primary and secondary communication system such as cell phones. When using cell phones call your local direct EMS number to insure there is no delay in emergency response.

Emergency situations and/or life threatening conditions may arise at any time during athletic events and quick action must be taken in order to provide the athlete with the best possible care. Developing and implementing an emergency plan will assure that these situations are handled appropriately. Injuries are an inherent risk in sports, despite pre-participation physical exams, adequate medical coverage, safe practice and training techniques, and sports medicine teams. The ONLY way to effectively respond to an emergency is to be prepared. To be adequately prepared requires: an emergency plan, proper event coverage, proper training of personnel, maintenance of appropriate medical equipment, utilization of appropriate medical equipment, adequate means of communication, and continuing education in emergency medicine for all personnel.

Conditions considered to be life or death emergencies:

Conditions that require immediate medical attention:

(911 should be called as soon as possible.) • Unconscious athlete • Suspected C-spine injury • Hemorrhage (serious bleeding) • Heat stroke • Shock • Absence of pulse/breathing • Diabetic shock or coma • Seizures

• Eye injuries • Fractures • Dislocations • Dental injuries • Severe sprain • Concussion In the event of a life or death emergency, seconds could make the difference in the outcome.

Emergency care cards, first aid kit and quick access to ice shall be the standard for each practice and event. At least one coach should be a trained emergency first aid responder or one shall be within easy contact to provide care. Certification in CPR, AED, first aid, and prevention of disease transmission, is recommended for all athletics personnel associated with practices, competitions, skills instruction and strength and conditioning. Review of the emergency plan is required by ALL ADULTS, including non-coaches, which work with our athletes.

Site Specific Planner

Assign Roles:

Primary:

Secondary:

First responder: Primary care giver: Call EMS: Notify parents: Manage team during: Document injuries/report: Immediate follow up with parents: Open gates, or doors: Meet EMS: Travel with injured athlete: Ongoing follow up with parents:

Location: Emergency cards: ___________________________________________ Emergency facility: ___________________________________________ First aid kit: ___________________________________________ AED (if available): ___________________________________________ Phone to be used: ___________________________________________ Emergency air transportation available: ____________________________________________ Response time in minutes: ___________________________________________

Telephone Numbers: Local EMS: ______________________________ Certified Athletic Trainer: _______________ Emergency Care Facility: ___________________ Athletic Administrator: _________________

First Aid Kit Checklist A well-stocked first aid kit includes the following items: Antibacterial soap or wipes

Penlight

Arm sling

Petroleum jelly

Athletic tape—one and a half inch

Plastic bags for crushed ice

Bandage scissors

Prewrap—underwrap for tape (for taping)

Bandage strips—assorted sizes

Rectal thermometer (for use in cases of

Blood spill kit

suspected heat illness)

Cell phone

Rescue breathing or CPR face mask

Contact lens case

Safety glasses—for first aiders

Cotton swabs

Safety pins

Elastic wraps—three inch, four inch, and six

Saline solution for eyes

inch

Sterile gauze pads—three-inch and four-

Emergency blanket

inch squares (preferably nonstick)

Examination gloves—latex free

Sterile gauze rolls

Eye patch

Sunscreen—sun protection factor

First aid cream or antibacterial ointment

(SPF) 30 or greater

Foam rubber—one-eighth inch, one-fourth

Tape adherent and tape remover

inch, and one-half inch

Tongue depressors

Insect sting kit

Tooth saver kit

List of emergency phone numbers

Triangular bandages

Mirror

Tweezers

Moleskin Nail clippers Oral thermometer (to determine if an athlete has a fever due to illness)

Injury Report Name of athlete ________________________________________________________ Date ________________________________ Time ___________________________ First aider (name) ______________________________________________________ Mechanism of injury _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Type of injury __________________________________________________________ Anatomical area involved ________________________________________________ Extent of injury ________________________________________________________ First aid administered ___________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Other treatment administered _____________________________________________ _____________________________________________________________________ Referral action _________________________________________________________ _____________________________________________________________________ First aider (signature)

Medical History Questionnare Player Information: First Name: Date of Birth:_______/_______/________ Age: Emergency Contact:

Last Name:________________________________________________________ Sex: Relationship:

Phone: ____________________________________________ Phone: __________________________

PLEASE CIRCLE YES OR NO AND LIST DETAILS AS REQUESTED. ALL INFORMATION WILL REMAIN CONFIDENTIAL AND APPLIED ONLY TO EMERGENCY CARE SITUATIONS 1. Are there currently any injuries requiring medical attention? Yes No Please List: _________________________________________________________________________ _____________________________________ 2. Are you currently under the care of a doctor? Yes No If so, Doctorâ&#x20AC;&#x2122;s Name/Number/Emergency Contact___________________________________________________________________ 3. Do you have any allergies? (Bee stings, Foods, Medication, Etc.) Yes No Please List: __________________________________________________________________________ ___________________________ 4. Do you regularly take any over the counter and/or prescription medication? Yes No Please List: _________________________________________________________________________ _____________________________________ 5. Have you experienced any major surgeries? Yes No Please List: _________________________________________________________________________ _____________________________________ 6. Are you current on all immunizations? Yes No List Special Considerations: ____________________________________________________________________________________________ 7. Have you ever been diagnosed with any major diseases or conditions? (Seizures, Diabetes, Epilepsy, Heart Disease, Etc.) Yes No Please List: _________________________________________________________________________ _____________________________________ 8. Have you ever been told you have (had) asthma, exercise induced asthma, or use an inhaler? Yes No List medications: ________________________________________________________________________________________________________ 9. Do you have or have you ever had a hernia or rupture? Yes No List Dates if repaired: ___________________________________________________________________________________________________ 10. Have you ever been knocked out, had a concussion, and/or other closed head injury? Yes No Please List: _________________________________________________________________________ _____________________________________ 11. Have you ever injured the bones, ligaments, nerves or discs or your neck and back that disabled you for a week or longer? Yes No List injuries/dates: ______________________________________________________________________________________________________ 12. Have you ever had a broken bone or fracture? Yes No List bones/dates/right or left: _________________________________________________________________________________________ 13. Have you ever had a shoulder/elbow or wrist injury that disabled you for a week or longer? Yes No List injuries/dates/right or left: _______________________________________________________________________________________ 14. Have you ever injured the ligaments in your knee? Yes No List injuries/dates/right or left: _______________________________________________________________________________________

15. Have you ever had an ankle injury that disabled you for a week or longer? (Dislocation, Sprain, Separation, Etc.) Yes No List injuries/dates/right or left: ________________________________________________________________________________________ 16. Do you presently have a rod, pin, screw or plate anywhere in your body or use a medical support device? Yes No List injury and/or location: _____________________________________________________________________________________________ 17. Do you wear contact lenses or removable dental appliances? Yes No List items: ________________________________________________________________________________________________________________ 18. Do you have any other conditions you wish to make us aware of? Yes No Please specify and give details: _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ THE ABOVE QUESTIONS HAVE BEEN ANSWERED COMPLETELY AND TRUTHFULLY TO THE BEST OF MY KNOWLEDGE. SIGNING THIS DOCUMENT RELEASES ALL INFORMATION TO ASSIST IN THE APPLICATION OF NECESSARY EMERGENCY CARE. ___________________________________________________ PRINT PLAYERS NAME

_____________________________________________________ SIGNATURE

_____________________________ DATE

___________________________________________________ PRINT PARENT/GUARDIANS NAME

_____________________________________________________ SIGNATURE

_____________________________ DATE

Medical Examination Form for Rugby Name _____________________________________________________ Age _________ Birth Date ______________________ Address ________________________________________________________________ Phone ____________________________ (street) (city) (zip) Instructions: All questions must be answered by a certified physician. Failure to disclose pertinent medical information may invalidate your insurance coverage and may cancel your eligibility to participate in the sport. Any further health problems must be discussed with the physician at the time of this examination. Medical History: Have you ever had any of the following? If “yes,” give details to the examining doctor. No Yes Details (if answered yes) 1. Head injury or concussion 2. Bone or joint disorders, fractures, dislocations, trick joints, arthritis, or back pain 3. Eye or ear problems (disease or surgery) 4. Heat illness 5. Dizzy spells 6. Tuberculosis, pneumonia, or bronchitis 7. Heart trouble or rheumatic fever 8. High or low blood pressure 9. Anemia, leukemia, or bleeding disorder 10. Diabetes, hepatitis or jaundice 11. Ulcers, other stomach trouble, or colitis 12. Kidney or bladder problems 13. Hernia (rupture) 14. Mental illness or nervous breakdown 15. Addiction to drugs or alcohol 16. Surgery or be advised to have surgery 17. Taking medication regularly 18. Allergies or skin problems 19. Menstrual problems; LMP 20. Asthma

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_____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________

Examining Physician’s Signature_________________________________________ Date_________________

Emergency Information and Informed Consent Form Athlete’s name ___________________________________________________________ Age _________ Primary Phone ________________________________ Secondary Phone __________________________ Address _______________________________________________________________________________________ List two persons to contact in case of emergency: Parent’s or guardian’s name __________________________________________________________ Primary Phone ________________________________ Address ________________________________________________________________________________ Secondary Phone ________________________________ Second person’s name and relationship ________________________________________________________ Primary Phone ________________________ Address ________________________________________________________________________________ Secondary Phone ________________________________ Insurance co. ________________________________________________________

Policy no. ____________________________________________________

Physician’s name ___________________________________________________________

Phone _______________________________

Are you allergic to any drugs? ____________ If so, what? ________________________________________________________________________________ Do you have any allergies (e.g., bee stings or dust)? __________________________________________________________________________________ Do you have __________ asthma, __________ diabetes, or __________ epilepsy? (Check any that apply) Do you take any medications? ____________ If so, what? ________________________________________________________________________________ Do you wear contact lenses? _______ Other ____________________________________________________________________________________________

I hereby give my permission for _______________________________________________________________ to participate in rugby during the season beginning in______________________. Further, in case of any injury or illness my child may experience (please select one): I authorize the staff to provide emergency treatment and call 911 if necessary I prefer 911 be called immediately and that no Miami Rugby Youth staff perform emergency medical treatment This authorization is granted only if I cannot be reached and a reasonable effort has been made to do so.

My child and I are aware that participating in _____________________________ is a potentially hazardous activity. We assume all risks associated with participation in this sport, including, but not limited to, falls, contact with other participants, the effects of the weather, traffic, and other reasonable risk conditions associated with the sport. All such risks to my child are known and appreciated by my child and me. We understand this informed consent form and agree to its conditions. Child's signature________________________________________________

Date __________________________

Parent's or guardian's signature__________________________________

Date _________________________

Pre- Season Fitness Screening The fitness level of all players 10 years of age and above will be assessed using the Fitnessgram physical fitness test standards. There will be a pre-test administered prior to the start of the season followed by identical tests during the season to compare development. Using these results, the coaches will implement a physical training program to facilitate and promote all players’ fitness levels.

Athlete’s Name: ________________________________________ Head Coach: ___________________________ Test date/Test number: ______________________ Evaluating Coach: _______________________________

MULTI-STAGE FITNESS TEST (BEEP TEST): Measures cardiovascular endurance. • Objective: Run as long as possible back and forth across a 20-meter space at a specified pace that gets faster each minute. Result: _____________________________________________

CURL-UP, PUSH -UP, and TRUNK LIFT: Measure muscular strength and endurance. • Objectives: Complete as many curl-ups as possible (up to a maximum of 75) at a specified pace, complete as many push-ups as possible at a rhythmic pace, and lift the upper body off the floor using the muscles of the back and hold the position to allow for measurement. CURL-UP