Understanding emergency procedures in fitness environment

An emergency response system is crucial for ensuring a safe environment for members, users, and staff, as well as being a very sound practice for managing risk. With health and fitness facilities, an emergency response system must be established to offer the highest reasonable safety level for users and staff.

Emergency gym procedures are the established plans that are instigated if an emergency occurs. It may be simply a power outage, or more seriously a medical emergency, a fire or even a weather-related scenario. Gyms must have an emergency action plan (EAP) in place so that all the occupants at the time will be able to act effectively if required.

What Would You Do?

If a gym clients is seriously injured, or worse, dies in front of you while they have been exercising. What would you do? The question usually comes as a complete surprise to existing and new instructors. Unfortunately, the notion of folks dying or being injured while in an exercise environment is rarely addressed by the gym management, or by employees. Therefore, when it does happens, which it will one day, the gym is in chaos as basically nobody knows what procedures to follow.

Gym Emergency: Typical Scenario

This is what usually happens when procedures are obscure.

• The gym staff are not clear about what to do, panic may ensue.
• The front desk operator telephones 911 (or the police).
• The gym management may performs CPR/AED.
• Members are afraid to help or do not wish to be involved.

While this scenario is generally what happens, it is that the instructor/trainers not knowing that is particularly disturbing when seconds and minutes are crucial and can save a life.

The reasoning here is that on the whole the gym staff do not know a gym’s emergency procedures, regarding say, a heart attack. Even if they do know the procedure, how many instructors are CRP/AED certified?

Why Many Gym Managements Don’t Know EAP?

• It is assumed that instructors who are CPR/AED certified already know what to do.
• They do not want to scare away new instructors.
• The gym has no procedures in place for emergencies (other than “call 911″).
• It has not occurred to the manager/owner that clients may experience heart attacks there.

Chain of Command

Every gym should have a chain of responsibility which is deployed during an emergency. Emergencies can happen at any moment. There will be occasions when the person in overall charge will not be in the premises. That is why a chain of responsibility is essential, as the next person becomes in charge of the emergency.

Activation of EAP

The individual in charge at the time should make the call to activate an EAP. If a medical emergency has occurred, then those who are trained in CPR and emergency aid must remain with the patient. The person in charge at the time will coordinate the staff and gym personnel as to what they must do while the plan is in activation.

Location of Equipment

All gyms should have emergency equipment to hand. This must include a first aid kit, a telephone, fire extinguisher/s and sometimes an automated external defibrillator (AED). Every person that works in the gym must know where this equipment is available.

Posting of Emergency Procedure

Gyms should have an EAP poster in a visible position in order that all the information is easily available in case of an emergency. This should list the chain of command, the location of emergency equipment, and other relevant information. People do not really think clearly in an emergency, and having an EAP poster with all relevant information can save a lives when time matters most.

Managing the Risks

The management of risk refers to those practices and systems that gyms should establish to limit their exposure to any potential liability or financial loss. In the health club and fitness industry, risk management refers to the practices, systems and procedures by which a gym can reduce the risk of an employee or a client coming to harm (injury or death). Risk management involves practices that are preventive (such as pre-activity screening and correctly maintaining equipment) to practices that can be considered a reaction to unexpected events (such as emergency response systems).

It must be acknowledged that the various types of health and fitness facilities do markedly vary, from the unsupervised to medically supervised clinical exercise centers.

• Gyms and exercise facilities often serve varied aims and clients, they do or don’t have organized programs, and also may or may not employ staff that are qualified.
• Management should use the local medical personnel or healthcare professionals to help develop an emergency response program.
• Local emergency medical services (EMS) can help a facility to develop a response program.
• Gyms and facilities can also engage the services of a physician, a registered nurse, or a certified emergency medical technician to assist in the development of their response program.

An emergency response system should consider any emergency situations that may occur.

• Among these are medical emergencies that can be foreseen in regard to moderate or more intense workouts, such as hypoglycemia, a heart attack, a stroke, cardiac arrest or heat illness, and injuries that are in nature orthopedic.
• The response system should also consider other potential emergencies not specifically caused by physical activity, such a chemical accident, fire, and a range of weather and natural disaster events.
• An emergency response plan should consider explicit steps and instructions on how the emergency situation must be dealt with and including the roles that 1
  
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  responders to an emergency will play.
• Additionally, an emergency response plan must indicate clearly the locations of emergency equipment (e.g., telephone for 911 and contact info for EMS, locations of the emergency exits, and the access points for EMS personnel), and also the steps needed to contact local EMS.

It is preferable to physically rehearse the emergency response system at least twice per year.

Medical Emergencies at the Gym

Exercise brings so many health benefits, and moreover is beneficial to people with many medical conditions that include heart disease and Myocardial infarction (heart attack).

The risk of a sudden medical emergency is ever present, and medical emergencies may occur before, during and after exercise. For vulnerable people, exercise may precipitate an emergency at the gym which can emanate from many different medical conditions like diabetes or high blood pressure, heart disease, and also a poor physical condition, or obesity and so on. For example, if an individual experiences pressure of the chest during or after an exercise session, they must call an ambulance to ride to the hospital irrespective of whether the person is on medication for blood pressure or has had three prior heart attacks, if they are 22 years of age, or seemingly fit and healthy.

What to do in an Emergency

Let us assume that you are an instructor in a gym which has no clearly visible emergency procedure, or none that you are of. Perhaps one day you will hear a PA system announcement asking: “Is there a doctor or nurse in the building?” that is usually a sign that something quite bad has happened. You might or might not hear those words over the PA. All clubs are different.

If you feel that an emergency is occurring, whatever you may be doing, should be dropped and then head to the emergency location to assess the situation. Do not assume that someone else will do it. If you are instructing at the time, make excuses and go yourself.

After arriving, these basic steps should be followed.

• If a person collapses, then immediately inform emergency medical services and also care for the person according to the guidelines of the American Heart Association CPR or similar authority.
• If there is an automated external defibrillator (AED) available, then utilise it.
• Every instructor or trainer and gym management personnel are encouraged to at attend a basic CPR course.
• CPR techniques are easy to learn and they carry a very low risk of transmission of any disease to a provider if hands-only CPR is used or one of other modern protocols that de-emphasize giving rescue breaths mouth-to-mouth.
• The training will help to prepare one to deal with a clear medical emergency such as collapse and in particular, the loss of pulse.

Many medical emergencies begin with much less clear signs or symptoms.

Chest pain is perhaps the most prevalent symptom of a cardiac emergency, although people often describe what they are feeling as tightness or pressure. Discomfort or sensations in the jaw or neck, the arms, the upper abdomen or back, may also be linked to a cardiac event.

Even without any chest discomfort, a shortness of breath, may well be a heart attack symptom or other medical emergency. This is a common feeling at a gym even for healthy individuals during or immediately following exercise. The thing to watch for is whether the shortness of breath seems dis-proportionate to the situation or if it is lasting longer than normal.

Unfortunately, several other possible causes may be associated with a cardiac event such as, lightheadedness, nausea and sweating amongst them. Again, the rule of thumb is to look for what may seem out of the ordinary under the circumstances.

Strokes are also a medical emergency which requires immediate response. While strokes are less usually thought of as being associated with exercising, the symptoms and signs of a stroke include:

• a sudden headache,
• difficulty with finding words
• language comprehension
• confusion
• speech is slurred
• un – coordinated movement and numbness
• a tingling or a weakness particularly on one side of the body or face.

What actually constitutes a real medical emergency is often a challenging judgment call, and if one is in doubt then it’s better to send the person immediately to an emergency department and let the professionals assess. Occasionally, people might prefer to visit an urgent care or their doctor’s office, but those facilities will usually not have the necessary resources to assess or manage a real emergency and so should be consulted for routine health care and what are clearly minor issues.

Some may wish to avoid the expense or drama of calling an ambulance. Bear in mind that if a person is really having a heart attack or a stroke, the minutes count, and the time elapsing from the start of the event to treatment will determine the extent of damage to heart muscle or to the brain – elapsing time can dramatically alter outcomes.

If CPR is Necessary

• Keep calm
• Perform CPR /use the AED (if you are CPR/AED certified)
• Have a staff member call 911 and also contact the gym manager/owner, regarding the incident
• Perform CPR ( or AED) until the paramedics arrive
• Instruct a staff member to get the member’s club file to give to the paramedics on their arrival (this file should contain contact info, the medications of the person and such like, important info for paramedics).
• Assign a member of staff to wait outside the premises, to escort the paramedics inside and to the emergency location on their arrival. File an incident report

Common Gym Related Emergencies

Occasionally an athlete may experience a potentially life changing injury, such as to the head or a severe neck injury, eye injuries, or similar. However the majority of sports-related injuries will be bone and soft tissue injuries like strains, sprains, dislocations and knee injuries. Most of these injuries will absolutely require treatment, but it may not be necessary to call for an emergency response.

On the whole, apart from the very serious health emergencies which may never even happen in your presence, most injuries that are gym and exercise related are avoidable. Remember the golden rules to follow, and hopefully almost all injuries will not occur on your watch.

• Warm –up
• Stretching (both pre- and post-exercise )
• Hydration
• Nutrition
• Rest

Bear in mind that a body operates like a machine, yet it requires diligent maintenance such as correct nutrition, stretching and rest. Too much of a good thing, or overworking the body is always inadvisable and regularly leads to negative results. Remember to know your own limits and also those of the clients, meaning listen to your body and hopefully the incidence of injury will be greatly diminished.