Sickle Cell Trait (SCT): Standard Operating Procedures

Personnel/Chain of command

1. Team MD, DO, Fellow

2. Certified Athletic Trainer

3. Athletic Training Student

4. Coaches

5. Athletic Director

6. School Officials

Procedures

Screening measures should be done prior to participation and usually includes bloodwork done at birth; however, some individuals may not know they have SCT. Documentation of newborn screening results should be recorded during the Pre-Participation Exam (PPE) for health care providers and administrators to be aware. SCT screening should be considered for all athletes who are participating in intense activity with football being the highest risk sport, however, no individual with SCT should be denied sports participation.

Athletes with SCT should have their own training progression, allowed to set their own pace, have longer periods or rest and recovery; activity should stop if the individual experiences muscle ‘cramping’, pain, swelling, weakness, tenderness, inability to catch their breath, or fatigue. Additionally, an individual can become more prepared for in-season activities by participating in preseason strength and conditioning programs that target the individual’s needs, goals, abilities, and sport-specific demands. Athletes who perform repetitive high-speed sprints and/or interval training should have extended periods of recovery. However, it should be warned that even with this preparation, they should refrain from performance tests such as mile runs and serial sprints as death has been frequently reported.

Educate coaches and players frequently around a player with SCT to recognize symptoms assumed to be sickling: fatigue, difficulty breathing, leg/low back pain, or leg/low back cramping. Environmental heat stress, dehydration, asthma, illness, and altitude can predispose an individual for a crisis.

Sickling Collapse vs. Heat Cramps

· Pain: SCT is characterized with diffuse pain

· Physical: SCT will lie still, not yelling in pain, with muscles that look and feel normal

· SCT will usually occur within the first 30 minutes of activity, and core temperature is not greatly elevated

· SCT will not have muscle twinges or “locked-up” muscles

· SCT collapses due to weak muscles

Emergency Procedures

· First on chain of command delegate lower personnel to call 911 and stay on the line, and treat as a medical emergency

o Inform 911 of suspected Sickle Cell emergency and to expect explosive rhabdomyolysis and metabolic complications

o Give address (listed below) and meet EMS at the gate

· First chain of command delegate another lower personnel to grab golf cart for transporting to ATR and to grab AED

· First chain of command check and monitor vital signs

o Heart rate

o Breath rate

o Blood oxygen saturation levels

o Blood pressure

· Give 15 1pm oxygen (if available) with non-rebreather face mask

· Cool athlete if environmental heat stress is suspected

o Submerge in cold tank

o Grab 4 other personnel on the chain of command for the TACO method

· If vital signs decline …

o Attach AED and start an IV (if available)

· Have remaining personnel call parents and get ready for EMS transportation

· If a parent is not present when EMS arrives, a coach or member of the health care team should ride with the student athlete

Address: 5601 Clegg Drive, Toledo, OH 43613

Directions: Turn onto Whitmer Drive from Alexis Rd or Tremainsville, then to Edgar Street between the Whitmer Football Stadium and Jefferson Junior High. Access gate is across from Jefferson Junior High next to concessions.

Equipment

· Fingertip pulse oximeter: in tan supply box inside ATR

· Cold tank: in ATR at southwest corner of Football Stadium

· AED: Primary: in black box on sideline or back of golf cart

Secondary: in ATR at southwest corner of Football Stadium

· Landline phone: in athletics/coaches office, ATR office

· Golf cart: on track/football sidelines or the infield for track meets

· 15 1pm oxygen with non-rebreather face mask

· Saline IV

Implementation

Each health care staff should know which student athletes have SCT as well as each athlete’s coach. At the beginning of each season, the health care team should review which athletes have SCT, signs and symptoms of SCT, and the EAP specific for the site that those individuals practice/play at (i.e. Fieldhouse, Wrestling Room, ice rink, etc.).

At the beginning of each year, the pulse oximeter, AED, landline phones, and golf cart (and oxygen/IV for proper readings and expiration if available) should be checked for proper function. Rehearsal/practice should be done with a coach or volunteer student who is briefed beforehand on what to say or act and to “collapse” at a random time of their choosing. During this time, the health care staff should debrief on what went well and what could be improved as well as an overview of the evaluation/assessment.

Documentation

First to the scene should relay to the certified athletic trainers what they saw as well as any first steps taken. The ATCs should ask coaching staff what particular drills were being done and at what time in practice for documentation of the type of exertion as well as if the player asked to rest or reported any typical signs and symptoms. All procedures done by the health care staff, coaches, and officials should be recorded within 24 hours to retain reliability of events for future review. The ATCs should contact the parent/guardian the next day following a hospital visit.

Walker_SCT_SOP.pdf

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