What is the proper protocol for responding to medical emergencies at a gym?

Medical Emergency Protocol for Gyms

Gyms must have an automated external defibrillator (AED) positioned to deliver the first shock within 2 minutes of collapse, with trained staff immediately initiating high-quality CPR for any unresponsive individual, as sudden cardiac arrest is the most catastrophic emergency in athletic settings. 1

Immediate Recognition and Response

Cardiac Arrest Recognition

• Assume any unexpected collapse with unresponsiveness is sudden cardiac arrest (SCA) until proven otherwise. 1
• Do not be misled by continued breathing or open eyes—athletes in cardiac arrest may continue breathing regularly following collapse. 1
• Activate emergency medical services (EMS) immediately while simultaneously beginning resuscitation. 1

Initial Actions (First 60-90 Seconds)

• Begin high-quality chest compressions immediately at 100-120 compressions per minute with minimal interruptions. 1
• Assign one staff member to call 9-1-1 and another to retrieve the AED. 1
• If trained, provide rescue breaths; if not, perform hands-only CPR (compressions alone). 1
• The AED must be attached and ready to deliver the first shock within 2-3 minutes of collapse. 1

AED Deployment and Defibrillation Protocol

AED Use

• Apply the AED immediately upon arrival and follow device prompts. 1
• Deliver one shock per 2-minute cycle of CPR—do not deliver stacked shocks. 1
• Resume chest compressions immediately after shock delivery without waiting to check pulse. 1
• Continue CPR for 2 minutes before allowing the AED to reanalyze rhythm. 1

Shockable Rhythm Management

• If ventricular fibrillation or pulseless ventricular tachycardia persists after three shocks, continue CPR and prepare for EMS transfer. 1
• Minimize all interruptions to chest compressions—pauses should be <10 seconds. 1

Non-Shockable Rhythm Management

• Continue high-quality CPR without interruption. 1
• Maintain compressions until EMS arrives with advanced life support capabilities. 1

Facility Preparedness Requirements

Essential Equipment and Staffing

• All gyms must have at least one AED positioned to allow access within 5 minutes to any location in the facility. 1
• Larger facilities (>2,500 members) should have multiple AEDs strategically placed. 1
• Designated staff trained in CPR must be present during all hours of operation. 1
• Monthly AED checks for battery life and device integrity are mandatory. 1

Written Emergency Action Plan

• Develop and rehearse emergency protocols at least every 3 months. 1
• Include specific protocols for cardiac arrest, heat illness, head/neck injuries, asthma, diabetic emergencies, and mental health crises. 1
• Coordinate the plan with local EMS and ensure staff know the exact address and best entry point for emergency responders. 1
• Assign specific roles: who calls 9-1-1, who retrieves the AED, who begins CPR, and who meets EMS at the entrance. 1

Other Medical Emergencies

Heat-Related Illness

• For suspected heat stroke (altered mental status, core temperature >104°F/40°C), immediately remove protective equipment/clothing and begin rapid whole-body cooling while activating EMS. 1
• Cold-water or ice-water immersion is the preferred cooling method. 1
• Apply ice packs to neck, axillae, and groin if immersion unavailable. 1
• Do not delay cooling while waiting for temperature verification—treat based on clinical presentation. 1

Head Injuries and Concussion

• Remove from activity immediately for any suspected concussion. 2
• Never allow same-day return to activity, even if symptoms resolve. 2
• Activate EMS for loss of consciousness, altered mental status, repeated vomiting, severe headache, seizures, or focal neurological deficits. 2

Spinal Injuries

• Maintain cervical spine immobilization for any suspected neck injury. 1
• Do not move the individual unless location presents immediate safety concerns. 1
• Wait for EMS with spinal immobilization equipment. 1

Critical Pitfalls to Avoid

• Never delay CPR or AED application to move the victim to a different location unless there is immediate danger. 1
• Do not check for pulse before beginning CPR—this wastes critical time. 1
• Avoid prolonged interruptions in chest compressions for any reason, including rhythm checks or shock delivery. 1
• Do not use AEDs on children under 8 years of age without pediatric pads/settings. 1
• Never use exercise as punishment, as this increases risk of exertional emergencies. 1

Legal Protections

• Federal Cardiac Arrest Survival Act (CASA) and state Good Samaritan laws provide immunity from liability for lay responders using AEDs in good faith. 1
• Proper training, equipment maintenance, and coordination with local EMS further minimize legal risks. 1

Post-Event Actions

• Document all details of the emergency response. 1
• Conduct a debriefing with all involved staff within 24-48 hours. 1
• Review and update the emergency action plan based on lessons learned. 1
• Coordinate with EMS for quality improvement feedback. 1