Author: Carina M. Nasrallah, MSAT, ATC, CISSN 

He was only 18 years old - healthy, strong and a beautiful performer. It was just a typical day of class and rehearsals. Everything seemed normal. No one knew that he had a congenital heart condition that would cause his heart to stop unexpectedly in the middle of rehearsal. He simply collapsed. 

Catastrophic injuries and life-threatening medical emergencies are not common in the dance studio or theater. Ankle sprains, bruised toenails and sore backs are more the “bread and butter” of dancers’ woes, and as a result it is easy to develop a false sense of security - the mentality that “it would never happen to us”. But it is critical to remember that dancers are elite athletes and not immune to catastrophic injury. Therefore, having a plan for handling emergency situations is not a recommendation - it is necessity. 

What is an emergency action plan (EAP)?

An emergency action plan (EAP) is a written document that outlines how medical emergencies will be managed within a dance institution or performance venue. The plan should be clear, comprehensive, and adaptable to a variety of scenarios. Many facilities may already have a barebones EAP - a paragraph or two discussing what to do in the case of fire, flood, medical emergency, etc. But a detailed and comprehensive EAP should read more like the choreography notes for a Balanchine ballet. The reader should be able to visualize how the scene would unfold, which characters will emerge from the wings, the sequence of steps, and the location of props. 

Who should be involved?

In the case of an emergency roles need to be delegated and the parties should know their responsibilities in advance. Instructors, staff, administrators, any on-site or off-site medical personnel (i.e. athletic trainers, physical therapists, attending physicians), and the local EMS team should be familiar with the venue-specific EAP. The plan should answer the following: Who will call EMS? Perform the initial evaluation? Retrieve the emergency contact card? Fetch emergency equipment? Escort EMS into the facility? Keep in mind qualifications, location, and availability. When working with minors a staff member needs to be designated to accompany the child to the emergency department and/or make treatment decisions if a guardian is not present. A list of key administrative and medical personnel along with contact information should be included in the EAP. Clear lines of communication should be established along with any special instructions (i.e. dialing “9” first from a landline, information to given to EMS, name/address of the receiving emergency facility, etc). 

Plan, prepare, and plot it out

Often a qualified medical professional may not be available to perform the initial evaluation in a medical emergency. Therefore the EAP should outline scenarios in which EMS needs to be activated and when it is unsafe to move an injured dancer depending on level of consciousness, type and location of injury, etc. A healthcare professional trained in emergency care services should assist with developing these guidelines using easily understood language and terminology. Additionally all instructors and staff should be trained in automatic external defibrillation (AED) use, cardiopulmonary resuscitation (CPR), and first aid. Emergency contact cards for each dancer should always include a “consent to treat” signed by the dancer or parent/guardian (if a minor). 

Locating and setting up emergency equipment can cost precious minutes in situations when seconds can mean the difference of life or death. Automated external defibrillators are a life-saving investment that all companies and studios should consider making. They can be easily mounted on a wall in a studio or carried on tour without even requiring a “per diem”! The EAP should include a detailed description of the location of automated external defibrillators (AEDs) and first aid kits. Someone not familiar with the facility’s layout should be able to locate any emergency equipment by following the EAP. Similarly, the plan should establish an entry and route for emergency care personnel to approach the venue and access the injured person quickly. Floor plans or diagrams may be beneficial for clearly designating routes and locations of emergency equipment. These should be specific to each venue. 

The performance should never be a rehearsal

As any dance patron knows, seeing a show that has never been rehearsed is not worth paying for. Similarly, implementing the action plan in an emergency situation should never be the first time it is rehearsed. This only invites disaster. An EAP should be reviewed and revised as needed at least once a year with staff, administrators, and medical personnel. Practicing scenarios to drill the EAP is the best way to reinforce the action steps. Then when the unthinkable happens and the adrenaline kicks in chaos does not ensue. A well-designed and rehearsed EAP will reduce time-costly errors and ensures that communication and order are maintained in an emergency situation. Being unprepared could cost everything. 

So returning to the young dancer above - what was the end of his story?
That is for you to determine. What is your plan? 

Additional Resources

1. Andersen J, Courson RW, Kleiner DM, McLoda TA. National Athletic Trainers' Association Position Statement: Emergency Planning in Athletics. J Athl Train. 2002 Mar;37(1):99-104. PubMed PMID: 12937447; PubMed Central PMCID: PMC164314. 

2. Emergency action plan (template). National Institute for Occupational Safety & Health. October 2003. 

3. Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, McDermott BP, Miller MG, Stearns RL, Swartz EE, Walsh KM. National Athletic Trainers' Association Position Statement: Preventing Sudden Death in Sports. J Athl Train 2012 Jan-Feb 47(1):96-118. 

4. Gates R. Be Prepared for Disaster. Occupational Health & Safety. May