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.

Weather decision maker: ____________________________

Weather watcher: __________________________________

Lightning

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.

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.

Tornadoes

If a tornado watch or warning

is issued, practices or matches

will be canceled immediately.

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.

Hail

During a hail storm all athletes,

spectators, and staff must

immediately go to a covered shelter.

Hot Weather Conditions

Hot weather conditions could produce

heat cramps, heat exhaustion, and

heat stroke, which can be life

threatening.

During hot weather conditions,

coaches will provide for frequent rest

periods (preferably in shaded areas)

and water breaks.

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.

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 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.

Safety is NO Accident

Be Prepared

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: (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

Conditions that require immediate medical attention: • 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.

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: _________________

Site Specific Planner

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

Penlight

Petroleum jelly

Plastic bags for crushed ice

Prewrap—underwrap for tape (for taping)

Rectal thermometer (for use in cases of

suspected heat illness)

Rescue breathing or CPR face mask

Safety glasses—for first aiders

Safety pins

Saline solution for eyes

Sterile gauze pads—three-inch and four-

inch squares (preferably nonstick)

Sterile gauze rolls

Sunscreen—sun protection factor

(SPF) 30 or greater

Tape adherent and tape remover

Tongue depressors

Tooth saver kit

Triangular bandages

Tweezers

Antibacterial soap or wipes

Arm sling

Athletic tape—one and a half inch

Bandage scissors

Bandage strips—assorted sizes

Blood spill kit

Cell phone

Contact lens case

Cotton swabs

Elastic wraps—three inch, four inch, and six

inch

Emergency blanket

Examination gloves—latex free

Eye patch

First aid cream or antibacterial ointment

Foam rubber—one-eighth inch, one-fourth

inch, and one-half inch

Insect sting kit

List of emergency phone numbers

Mirror

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: Last Name:________________________________________________________ Date of Birth:_______/_______/________ Age: Sex: Phone: ____________________________________________ Emergency Contact: Relationship: 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, Doctor’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.

Examining Physician’s Signature_________________________________________ Date_________________

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

No _____

_____

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

Yes _____

_____

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

Details (if answered yes) _____________________________________

_____________________________________

__________________________________________________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ __________________________________________________________________________ _____________________________________ _____________________________________ _____________________________________

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 Result: _____________________________________________

PUSH-UP Result: _____________________________________________

TRUNK LIFT Result: _____________________________________________

BACK-SAVER SIT AND REACH; SHOULDER STRETCH: Measure flexibility.

• Objective: for the sit and reach, testing one leg at a time, sit with one knee bent and one leg straight against a box

and reach forward; for the shoulder stretch, with one arm over the shoulder and one arm tucked under behind the

back, students try to touch their fingers and then alternate arms

BACK-SAVER SIT AND STRETCH Result: _____________________________________________

SHOULDER STRETCH Result: _____________________________________________

BODY MASS INDEX (BMI): Measures body composition.

• Objective: Provides an indication of the appropriateness of a child’s weight relative to height.

RESULT Weight: _______________________ Height: ____________________________ BMI: ______________________