THE MEDICAL EMERGENCY MANAGEMENT BAG

1 May

Medical practitioners working in sport need a fit-for-purpose medical emergency management bag designed with the athlete’s care needs in mind. The bag should contain all the essential, appropriate contents that facilitate the optimal emergency management of athletes and be immediately accessible in training, competition and hotel environments, and when travelling to and from competition venues. The contents should enable the management of life-threatening medical emergencies, e.g. extreme haemorrhage, sudden cardiac arrest, anaphylaxis and asthma.

Bag Design

The bag should have the following features:

a size and weight that is portable and easy to carry
a robust weatherproof, easily-cleaned exterior
a capacity that is capable of containing all the essential single-use, disposable, ‘consumable’ items, sterilisable items, diagnostic equipment and intravenous fluids
be ergonomic with readily identifiable (colour-coded / labelled), sealable, transparent compartments with dedicated sections which allow easy, immediate location and access to the contents in stressful situations
a dedicated section for an automated external defibrillator, carrying case and accessories
a dedicated small section for the emergency medications (which can be separated from the main bag)
a dedicated small section for wound closure materials (which can be removed from the main bag)
capable of allowing the bag and pockets to be secured with tamper-proof, single-use plastic security tags.

Bag Contents

The contents should reflect:

the requirements of the athlete(s) with a life-threatening medical conditions (and age-appropriate)
the minimum level of care that needs to be provided and predicated on evidence-based protocols
the sport the athlete is engaged in (the medical conditions and injuries which are likely to be encountered)
the competencies of the practitioner who is going to be using the contents
the sport’s governing body regulations (a defined minimum standard list).

The bag should be packed and organised with consideration to the prioritised sequence in which the contents are likely to be needed in a medical emergency (catastrophic bleeding, airway, breathing, circulation, dysfunction, everything else). There should be no need to empty the various sections of the bag to locate the required item in what may be a very challenging emergency situation. Items which are not going to be used in the immediate management of a medical emergency do not need not be carried.

All users should be wholly familiar with the contents. If only one person is going to use the bag, it may be personalised to include a practitioner’s preferences. However, if several individuals are going to be using the bag the contents should be more generic. The bag should also include an inventory which lists the contents, the quantities, their location, and, where applicable, a date of expiry. It will ensure that all who use the bag will know where each piece of equipment is located. This inventory can be used as a ‘challenge and response’ checklist to verify the contents are present, and ensure consistency when performing the all-important pre-event check prior to deployment and when maintaining and restocking the bag. If any diagnostic device is battery-powered, the ‘battery level’ of should also be checked (spare batteries should be carried for all items which use a battery). This inventory also serves as a single source of reference during cross-border travel when the items that are being carried may need to be verified. See Appendix 1.

Medications

There are several medications which should be immediately accessible for the management of cardiac arrest (in commercially available pre-filled syringes), anaphylaxis (in an ‘auto-injector’), asthma, hypoglycaemia, seizure, vomiting and pain. All the medications should be labelled correctly, immediately identifiable and managed within an appropriate regulatory framework. The medications should only be carried, prescribed and administered by an authorised health care professional. Medications that will not need to be dispensed urgently, e.g. antibiotics, do not be need to be carried in the medical emergency management bag (the medications should be available for use when required). A replenishment process should exist for any medications used in the emergency management of an athlete. See Appendix 2.

Intravenous Fluids

Intravenous fluids are integral to the emergency management of hypovolaemia and restoration of an athlete’s circulating volume. Isotonic crystalloid solutions, ’normal saline’ (0.9% sodium chloride) and lactated Ringer's solution (or Hartmann’s solution), a fluid with an electrolyte composition more similar to blood plasma than normal saline, are normally carried.

Documents

Putting the following laminated enclosures within the bag may be useful (particularly during demanding situations):

A spinal injury ‘clearance’ tool (SICT)
A sport concussion assessment tool (SCAT)
A drug dosage aide-memoire
An up-to-date list of the contact numbers for the (i) event doctors, (ii) nearest major trauma centre (MTC), and (iii) condition-specific local hospitals, e.g. cardio-thoracic centre (CTC)
An inventory which lists the contents of the bag, the quantities, their location, and, where applicable, a date of expiry.

Bag Storage

The bag should be stored in suitable cool, dry place. If the medications are to remain within the bag, the bag should be stored securely to avoid unsolicited access. A process should be in place for disposal of any sharps containers and disposable material contaminated during the emergency management of the athlete.

Medical Gases

Supplementary oxygen is an important resource in the management of medical emergencies. A separate dedicated bag enclosing a CD-size oxygen cylinder and the required accessories, i.e. bag-valve-mask, non-rebreathing mask, nebuliser mask, oxygen tubing, should be available. Nitrous oxide is also carried in a CD-size cylinder and used for analgesic purposes. There should be a dedicated bag for this cylinder and accessories, e.g. mouthpiece/filter and hose. Using separate bags for these cylinders optimises the space available in the medical emergency management bag, and keeps them separated from the other contents when the transportation of cylinders containing pressurised gases is not permissible, e.g. on an aircraft.

Large Equipment

In addition to the resources available within the medical emergency management bag, a number of larger items of equipment are needed to manage an athlete on the ‘field of play’ and facilitate their subsequent evacuation. A plan should also be in place to recover any large (and expensive) item of equipment that is used when they are evacuated to a medical facility. An effective process should exist to ensure the maintenance and serviceability of the larger items to prevent equipment failure when they are most needed.

See Appendix 3.

Purchasing a Medical Emergency Management Bag and Contents

Rather than purchase a pre-filled bag with a range of generic basic contents, it is advised that practitioners acquire their own preferred style of empty medical emergency management bag (a ‘rucksack-style’ bag that folds out to lay flat when open is recommended) from a recognised supplier of emergency medical supplies, and stock it with appropriate ‘consumable’ supplies and specific high-quality items and diagnostic equipment applicable to their needs.

Appendix 1

THE MEDICAL EMERGENCY MANAGEMENT BAG

The Risk of Using Chewing Gum Whilst Participating In Sports Activities

Sports ER Ltd