Introduction. A significant number of preventable catastrophic injuries occur in secondary school athletics. Compliance to Emergency Action Plan (EAP) recommendations is not well documented. The purpose of this systematic review was to identify compliance to EAP recommendations, access to an athletic trainer (AT) and automated external defibrillator (AED), and current legislative mandates in school-based athletics. Methods. Electronic databases were searched to identify articles that met criteria for inclusion. Studies in English that focused on adoption, implementation, or compliance with EAPs or other national guidelines pertaining to athlete health were eligible for inclusion. Quality and validity were examined in each article and data were grouped based on outcome measures. Results. Of 12,906 studies, 21 met the criteria for inclusion and full text review. Nine studies demonstrated EAP adoption rates ranging from 55% - 100%. Five studies found that EAPs were rehearsed and reviewed annually in 18.2% - 91.6% of schools that have an EAP. At total of 9.9% of schools were compliant with all 12 National Athletic Trainers Association (NATA) EAP guidelines. A total of 2.5% - 27.5% of schools followed NATA exertional heat illness guidelines and 50% - 81% of schools had access to an Athletic Trainer. In addition, 61% - 94.4% of schools had an AED available at their athletic venues. Four of 51 state high school athletic association member schools were required to meet best practice standards for EAP implementation, 7 of 51 for AED access, 8 of 51 for heat acclimation, and 3 of 51 for concussion management. Conclusions. There was a wide range of EAP adoption and a low rate of compliance to EAP guidelines in U.S. schools. Barriers to EAP adoption and compliance were not well documented and additional research should aim to identify impeding and facilitating factors.

INTRODUCTION. Current evidence shows a variable rate of emergency action plan (EAP) implementation and a low rate of compliance to EAP guidelines in United States secondary schools. Compliance to emergency action plan recommendations in Kansas high schools is not known. The purpose of this study was to identify the emergency preparedness of public high school athletics in the state of Kansas and identify prevailing characteristics of schools that correlate with decreased compliance of an EAP. METHODS. Athletic directors for public high schools in the state of Kansas were asked to participate in a web-based questionnaire that was emailed to each athletic director. The questionnaire identified demographics of the study population, EAP implementation rates, compliance to national EAP guidelines, access to certified medical personnel, and training received by athletics personnel. Descriptive statistics were then compiled and reported. RESULTS. The response rate for the survey was 96% (341/355). A total of 94.1% (320/340) of schools have an EAP, 81.4% (276/339) of schools have an automated external defibrillator (AED) at all athletic venues, and 51.8% (176/340) of schools had an athletic trainer (AT) on staff. Urban schools were significantly more likely than rural schools to have an AT on staff (OR=11.10, 95% CI=[6.42, 19.18], p<0.0001), have an EAP (OR=3.69, 95% CI=[1.05, 13.02], p=0.0303), require additional training for coaches (OR=2.69, 95% CI=[1.42, 5.08], p =0.0017), and have an AED on-site for some events (OR=2.18, 95% CI=[1.24, 3.81], p=0.0057). CONCLUSIONS. Most Kansas high schools have an EAP in place and have at least 1 AED. Emergency planning should be improved through venue specific EAPs, access to early defibrillation, and additional training. Rural and low division schools have lower AT staffing and consequently are more significantly impacted by these factors. Rural and low division schools are more significantly impacted than urban and high division schools and this should be taken into account in future improvement strategies.

Objectives: Current evidence shows a variable rate of emergency action plan (EAP) implementation and a low rate of compliance to EAP guidelines in United States secondary schools. There is limited data on emergency preparedness of schools without access to an athletic trainer (AT). The purpose of this study was to identify the emergency preparedness of public high school athletics in the United States. Methods: A web-based questionnaire was developed to perform a cross-sectional analysis of the emergency preparedness of high schools. The questionnaire included 24 questions focused on demographics of the study population, EAP adoption, compliance to national EAP guidelines, access to certified medical personnel, and training received by athletics personnel. The questionnaire was delivered electronically through email by each State High School Athletics Association (SHSAA) to athletic trainers, athletic directors, and coaches of recipient schools. Results: Schools with a larger number of students enrolled were significantly associated with greater proportions of having an EAP (p<.0001), having an AT on staff (p<.0001), requiring additional training for coaches (p = .0003), and having an AED on-site for all events (p = .0021). Urban districts (OR=3.514, 95% CI=[2.242, 5.507], p <.0001) and suburban districts (OR=4.950, 95% CI=[3.287, 7.454], p <.0001) were more likely than rural districts to have an athletic trainer on staff. Rural districts were more likely than suburban districts to report financial barriers (OR=1.867, 95% CI=[1.051, 3.318], p=.0321). Rural districts were more likely than both urban (OR=1.901, 95% CI=[1.104, 3.268], p=.0192) and suburban (OR= 2.825, 95% CI=[1.770, 4.505], p<.0001) to report that additional funding would help meet NATA EAP best practice standards. High poverty districts (96 urban, 69 suburban and 157 rural) were less likely to have an AED for all athletic venues (OR=.660, 95% CI=[.452, .964], p=.0311) and less likely to have an EAP (OR=.511, 95% CI=[.306, .853], p=.0092). Among districts that were impoverished, rural districts were less likely than urban (OR=.268, 95% CI=[.153, .469], p<.0001) and suburban (OR=.121, 95% CI=[.056, .260], p <.0001) to have an AT on staff, more likely than suburban districts to report financial barriers (OR=1.867, 95% CI=[1.051, 3.318], p=.0321), and more likely to report barriers related to access to medical providers than urban (OR=3.403, 95% CI=[1.666, 6.949], p=.0005) and suburban (OR=3.900, 95% CI=[1.664, 9.144], p=.0010). Conclusions: The results of this study suggest that lower enrollment, high poverty and rural schools are less prepared for athletic emergencies than their higher enrollment, low poverty and suburban counterparts given the fact that these schools are generally less likely to have an AT on staff, less AEDs available at sporting events, lor to have EAPs implemented and less likely to provide additional training. Among these classifications, rural status may be the most important indicator, given that a comparison of impoverished schools demonstrates that rural schools were less likely to have ATs on staff and more likely to report financial barriers and barriers related to access to medical providers compared to poor urban and suburban schools. Financial barriers likely underly many of the findings in this study, as well as barriers related to access to medical professionals. Future improvement strategies should seek to identify ways to overcome these barriers and encourage compliance with NATA recommendations.