Injury Surveillance: What We Can All Learn From The NFL and Team USA Swimming

Green and seasoned athletic trainers, alike, know the visceral feeling that the scream of “TRAINER!” elicits.  Within a matter of seconds, the scream elicits emotions that range from   confusion, panic, and anger to incompetence. Why incompetence? Because the athletic training profession is all about being able to manage athletic injuries and conditions better than any other, so why should anyone have to yell to alert an athletic trainer that their skills are needed?  The correct answer is that they should never have to yell for an athletic trainer. But, coaches will ALWAYS scream “TRAINER!” for everything; such is the nature of things.  The best athletic trainers will already know and be responding when the scream goes out because their emergency action plans provide for on-going injury surveillance.  This issue of the SEC Digest looks specifically how athletic trainers can adopt injury surveillance strategies used by the NFL and Team USA Swimming to help ensure injuries do not go unrecognized.

An event or venue specific injury surveillance plan is an essential EAP element that is often overlooked.  An injury surveillance plan involves the assignment of individuals to observe for injuries within a specific area or zone.  Lifeguards are famous for their very elaborate surveillance plans to ensure that all areas of a pool and pool deck are under constant surveillance. USA Swimming lifeguards employ a zone based system with overlapping coverage that accounts for a complete zone scan every 10s and a plan to respond to injuries in the zone within 20s. The NFL uses game day injury spotters to ensure the field of play is under constant watch.  Located in the replay booth, the NFL assigns an injury spotter to both the home and visiting team. Injury spotters monitor the field for potential injuries and alert the team’s medical staff to any concerns. Injury spotters also provide crucial information obtained via video replay to medical teams during on-field management through direct radio communication.    

Injury surveillance plans are vital for every sports medicine team to ensure that the competition area is under constant surveillance even when medical team members might be busy caring for athletes on the sideline.  A best practice surveillance plan will account for timely scanning of the sideline and areas of the venue away from current activity to ensure rapid response to onset of injuries/conditions involving athletes and non-athletes alike.

Don’t waste time reinventing the wheel as you begin developing an injury surveillance plan  Cheat a little by stealing from Team USA Swimming and the NFL. Begin by breaking the venue into zones.  Develop a strategy that provides for zone scanning every 10s and the ability to respond to an identified injury with 20s.  Here we provide two examples of how a zone based surveillance plan might look.

Example 1: High School Football Game

The athletic trainer follows the line of scrimmage watching over each play.  After a play is complete the athletic trainer scans the entire playing field, accounting for athletes, referees, coaches, and others.   The athletic trainer also watches all players coming to the sideline before finally scanning the sideline and bench. This process is repeated with the conclusion of each play.  A scan of the opposition’s sideline may also be warranted. Plan to complete each scan within 10s, or by the time the ball is set by the referee.

Assign an intern, assistant, or assistant coach that is in the coaches box to be an injury spotter.  This individual serves as an extra set of eyes, watching over the competition area, particularly when the athletic trainer is pre-occupied caring for injuries on the sideline.  The injury spotter can communicate with the athletic trainer via headset, two-way radio, text, or cell phone call. The injury spotter may also provide valuable injury information to the athletic trainer by reviewing video of the play during which the injury occurred.  The injury spotter may also be assigned the role of weather spotter as well to ensure that inclement weather doesn’t go unrecognized.

When a team physician is available, the team physician attends to athletes requiring assessment while the athletic trainer continue surveillance.  If specific athletic training skills are required, the team physician should provide back-up surveillance coverage while the athletic trainer attends to the athlete.

Example 2:  High School Basketball Game

The athletic trainer keeps watch over the court during play.  During pauses in play the athletic trainer scans the entire court, both benches, and all player substitutions.  Plan to complete the scan prior to the resumption of play. Assign an intern, assistant, or assistant coach that is on the bench or video-taping from the stands to be an injury spotter.

Injury surveillance is not a complicated process, but taking the time to establish a surveillance and injury response plan using long standing lifeguarding techniques and NFL injury spotting concepts will help ensure that athletic trainers are already providing the profession’s high standard of care before the sirens sound.