ATC To The Rescue

At many events, the athletic trainer is the person with the most medical training on site. What happens when that expertise is needed by a spectator?

By Greg Scholand

Greg Scholand is an Assistant Editor at Training & Conditioning. He can be reached at: gs@MomentumMedia.com.

Training & Conditioning, 15.5, July/August 2005, http://www.momentummedia.com/articles/tc/tc1505/atcrescue.htm

As Jane Steinberg, MS, ATC, assisted a team physician working feverishly to revive a man who had stopped breathing and had no pulse, she could feel the intensity of a roaring crowd all around her. As she watched the doctor perform rescue breaths and chest compressions, thousands of voices cheered. As paramedics arrived to remove the man from the stadium, a marching band serenaded their urgent rush to the exit.

Surreal. That’s how Steinberg, now the Clinical Coordinator for Athletic Training Education at the University of South Carolina, describes her experience in graduate school helping to save the life of a spectator at a football game. She was at the event to provide athletic training services to the home team, but when an usher in the stands called to the sidelines for help, she and the team physician didn’t hesitate to jump into the crowd.

“It’s not what I expected to do when I showed up at the stadium that day,” Steinberg says, “but when we heard the yelling, we weren’t going to stand there and do nothing while waiting for the EMTs to arrive. We were there, so we jumped in to help.”

As an athletic trainer, you know why you’re on the sidelines at athletic events—to provide care for the athletes participating. But what happens when the call for help comes from behind you, not in front of you? Spectator injuries and illnesses are inevitable, and as a trained medical professional, you may be the first one people turn to for help. But is it always—or ever—your responsibility to oblige? In this article, we talk to athletic trainers who have gone to the aid of spectators and consult legal experts in a discussion of how spectator treatment fits into an athletic trainer’s sphere of duty.

Looking at the Law
In general, unless an athletic department policy expressly forbids it, there is no legal reason for an athletic trainer to refrain from assisting an injured spectator. On the other hand, under most circumstances there is no legal requirement for an athletic trainer to do so, either.

“If anyone has a legal duty to render aid, it is the host school,” says Matt Mitten, JD, ATC, Director of the National Sports Law Institute. “Spectators assume the inherent risk of injury when they attend a sporting event. But if they are paying customers who bought tickets, they are considered invitees, and in that case, the host might well have a legal duty to exercise reasonable care and to have an emergency plan in place—even something as simple as making arrangements to call 911—because it’s certainly foreseeable that a spectator could get hurt. But just because the school has some legal duty doesn’t necessarily mean it’s the athletic trainer’s responsibility.

“As a general rule, the only way that an athletic trainer would have a legal duty to go to the aid of a spectator would be if the school specified it as part of their job description,” he continues. “Therefore, the athletic trainer should have a clear understanding with the institution as to the scope of his or her duties.”

Since it’s uncommon for an athletic trainer’s job description to require caring for spectators, any aid offered is generally considered a voluntary act, and therefore in most cases is shielded from liability by “good samaritan” laws. However, these laws vary by state, and some offer more thorough protection than others. Mitten says it’s best to consult your athletic department and legal counsel to find out exactly how your state law protects you when you go into the stands rather than assume it’s alright to provide care under any circumstances.

“A typical good samaritan law might say that if you voluntarily choose to provide aid, you’re immunized from simple negligence, but not from more culpable conduct like gross negligence, recklessness, or intentional harm,” he explains. “But sometimes the good samaritan laws only apply if the actions performed are outside the scope of someone’s job duties, and there are many variations from state to state. The most important thing is for athletic trainers to consult with athletic administration officials to ensure that they know the potential scope of their duty to render aid, and any immunity that may apply.”

Melanie Herman, Executive Director of the Washington, D.C.-based Nonprofit Risk Management Center, says that as long as an athletic trainer’s actions meet a reasonable standard of care for a member of the profession, good samaritan laws will usually protect those who assist spectators. “Simple negligence, which is failing to do something a reasonable person would do or doing something a reasonable person would not do under the circumstances, is protected by most good samaritan laws. That means if you’re trying to help and you make an honest mistake, you can’t be held liable,” she explains. “And of course, the standard for what is reasonable to expect from an athletic trainer is different than for a person with no medical training. But the bottom line is that unless an athletic trainer acts in a grossly negligent way, they will be protected from liability.

“Gross negligence is basically conduct that flies in the face of accepted norms, or outrageous conduct,” Herman continues. “For instance, an athletic trainer’s education includes training on how to identify the signs of a heart attack. If an athletic trainer goes to the aid of a spectator who is suffering from a heart attack and completely ignores the obvious symptoms and doesn’t react accordingly, an attorney could try to argue that the athletic trainer acted far outside any standards of the profession.”

Put simply, then, as long as an athletic trainer performs responsibly when providing care to a spectator, he or she will typically be shielded by a good samaritan law, even if something goes wrong. (To find out about your state’s good samaritan laws and statutes, see “Good Samaritans” below.)

Mitten says that if your day-to-day job requirements put you in situations where you may need to offer care to spectators, a very simple way to protect yourself is to have the athletic department draft a policy outlining who is responsible for spectator care during an event and enumerating what is expected of the athletic trainer. “Creating a written policy gives the athletic department a chance to make sure it is aware of all liability issues, and to discuss them with the athletic trainers and counsel,” he says. “A good policy can satisfy any obligation the institution has to provide emergency medical care to spectators, make sure that unreasonable demands are not imposed on the athletic trainer, and ensure that any potential liability is minimized.”

Policy in Place
Like Jane Steinberg at South Carolina, Joe Donolli, MEd, ATC, Head Athletic Trainer at Gettysburg College, also has vivid memories of treating a spectator in need. Two years ago, he was covering a volleyball match when he was called to the aid of a parent in the stands who was suffering from a heart attack. Officials stopped the game and the man was brought to the floor of the gym, where with the help of campus medical personnel and several shocks from an AED, he was successfully revived and taken to a local hospital for emergency surgery.

Donolli didn’t have to think twice about springing into action because Gettysburg athletic trainers follow an emergency action plan that makes clear their responsibility to go to the aid of anyone in need at an athletic event—whether it’s a player, coach, official, or fan. “The college has decided that it has a responsibility to the people who attend events to provide some type of emergency medical care, and athletic trainers are part of that responsibility,” Donolli says. “In addition, all of our security people and all of our coaches are now trained as first-responders and are able to perform CPR, so they are responsible, too.”

Since Gettysburg is a small school with some events where the coaches and the athletic trainer are the only ones able to act as first-responders, the athletic trainer is often expected to be responsible for fans in need. The emergency action plan also lays out specific instructions on things like who to contact immediately for additional assistance, and the best exit route from each athletic facility on campus. Donolli says that having all this information sorted out ahead of time is a key to being prepared to handle any situation correctly.

“What building am I going to go to? How am I going to get into that building? Do I have the keys? Who is going to take care of the kids on the field if I am away? All these are questions that are best thought about in advance,” he says. “Developing a plan is just part of being proactive and prepared.”

Before it went into effect, Gettysburg’s policy, with its inclusion of athletic trainers as first-responders for spectators, was reviewed by the school’s legal counsel. Donolli also says he is satisfied that any care provided to non-athletes would be covered by his state’s good samaritan law.

At schools with larger events, spectator safety policies are more often the responsibility of event managers, who coordinate with paramedics, ambulance services, or EMTs to provide coverage. In these circumstances, the athletic training staff’s energy and resources can focus exclusively on athletes.

At the University of Southern Mississippi, for instance, athletic trainers don’t need to worry about attending to spectators, because a separate first-aid station manned by paramedics and nurses, and often an ambulance, is typically available to meet any spectator needs. “Basically, the only contact we have with the first-aid station on a game day is before the game, when we supply them with ice,” says Deborah Dunn, MEd, LAT, ATC, Assistant Athletic Trainer at USM. “They handle anything that goes on in the stands, and they’re totally separate from us.”

There are situations, however, even at a larger school like Southern Miss, where athletic trainers do become indirectly involved in spectator care. When the school hosted the Conference USA Baseball Tournament in May, an extra contingent of athletic training staff and students were on hand in case injury befell anyone at the event, including spectators. “In circumstances like the baseball tournament, our athletic trainers won’t leave the field to treat a spectator, but we will send a student who is certified in first-aid and CPR to assess the situation and inform an athletic trainer of what’s going on, and the athletic trainer then decides what action should be taken,” Dunn explains. “But in that case, we’re just making an informed judgment and telling the event staff what needs to be done.”

In The Stands
Even without a specific policy in place, many athletic trainers, particularly at the high school and small-college level, follow Gettysburg’s model of considering spectators to be within their purview during athletic events. Fortunately, the life-or-death instances are far outnumbered by much more run-of-the-mill occurrences—twisted ankles, bee stings, and stumbles over bleachers. If you find yourself heading into the stands from time to time to deal with situations like these, how can you make sure that it interferes as little as possible with your primary responsibility to the athletes on the field?

Craig Brock, ATC, Head Athletic Trainer at Canadian (Texas) High School, has treated spectators at school-sponsored athletic events on several occasions, and he says the most important thing to do is gather information before deciding whether an injury warrants leaving the field. “I’ll first try to find out exactly what happened, usually from the person who comes over to tell me about the injury,” he says. “If it’s a little kid who fell down and scraped his knee, his parent can clean it up with a paper towel and I’ll go and look at it later, maybe during halftime or after the game. If the injured person can be moved, I sometimes ask them to come down to the field so that I can take care of them without having to leave the sideline. Someone with a fractured wrist, for example, is able to walk, and they can come to me instead of me going to them.”

If the situation requires going up into the stands, some athletic trainers use a buddy system to ensure that they can focus on what’s happening around them and remain available to athletes at the same time. “Whenever I had to go into the stands or the bleachers to look at someone, I always tried to have my athletic director, some other administrator, or another coach with me, and they were my eyes on the field while my attention was on the spectator,” says Traci Jo Hubbard, ATC, former Head Athletic Trainer at Albion (Mich.) High School.

“It’s helpful to have someone who can assist you if you realize it’s an emergency and you need someone to call 911 while you provide first-aid. Most of the time you’re just doing a very quick assessment of what’s going on, but it’s a big help to have another person with you. Even if you just have to move the person out of the stands, you can do that much more quickly and get back to the team sooner if you have assistance.”

Knowing what other resources are available at an event also makes treating spectators easier. “Especially when we go on the road, I’ll try to find out beforehand where the ambulance is, what kind of staff they have, and what their level of training is,” Brock explains. “I had a case this year where there was a volunteer ambulance crew at a game and nobody in the group was trained to administer medication. Someone suffered a broken leg and needed morphine, but there was no one there who could provide it—they actually had to drive about five miles, meet a paramedic from another town on the highway, and switch ambulances to go the rest of the way to the hospital. I always try to find out in advance a little about the ambulance crew I might be working with.”

Drawing The Line
One final aspect of being available for spectator treatment is knowing when to draw the line on providing care. This can be difficult for athletic trainers, who are inclined to jump in and help whenever someone is in need. But it’s always important to remember the primary reason you’re at the event—to be available for the athletes.

“I’ve had people come up to me at a football game and say things like, ‘I’ve got a knee problem, can you take a look at it?’ I pretty much tell those people, ‘Hey, you’re going to have to make a doctor’s appointment,’” says Doug Ashton, MS, LAT, ATC, Outreach Coordinator for Freeman Sports Medicine in Joplin, Mo., a hospital-based sports-medicine program that provides athletic training services to several nearby high schools. “When people know that you can provide a service, sometimes they’ll show up thinking they can get some free advice or treatment. You just have to tell them that you’re there to provide coverage for the athletes competing on the field.”

“As an athletic trainer, I am licensed to provide service to athletes. When I am acting as a volunteer to help out a spectator, it pulls me away from the game, and that’s something I always have to think about,” adds Steinberg. “It’s partially a game-management issue, to make sure there is someplace for a fan to go for help because you have to be there for the athletes. But sometimes it’s as simple as telling someone that unless it’s an emergency, they need to visit a doctor or medical center on their own if they feel they need some kind of treatment. I want to help out as much as I possibly can, but my biggest responsibility when I’m at an event is to be on the sideline, caring for athletes.”



SIDEBAR: Good Samaritans
Virtually every state has some type of good samaritan law, though the language varies and some are more comprehensive than others. “While it’s not likely that an athletic trainer would be sued for trying to help a spectator at an event, it’s a good idea for a professional to know the liability laws in their state,” says Melanie Herman, Executive Director of the Washington, D.C.-based Nonprofit Risk Management Center. “Good samaritan laws provide a definite level of protection, but they all have exceptions.”

The Nonprofit Risk Management Center offers an excellent publication for anyone looking to understand good samaritan and volunteer protection laws and statutes in their home state. It’s called State Liability Laws for Charitable Organizations and Volunteers, and includes an easy to follow state-by-state summary of laws that affect volunteer actions, including good samaritan laws. It is available as a free download at: www94311.temp.w1.com/pubs/sll.htm.