***IN CASE OF EMERGENCY CALL 911***

Name of Building:Monsignor McCoy High School

Address: 202 8 St NE, Medicine Hat, AB

Emergency Action Plan

(Monsignor McCoy High School Main Gym:
Sr. Boys Basketball)

When a life threatening situation occurs, the charge person must take
charge of the situation. Follow the emergency protocol before each
event designate the charge, control people, and the person in charge.

Emergency Protocol Card

Ambulance Phone Number: 911 or (if 911 is not available call (403)529-8000
Type of Emergency: we have a **** year old (female/male) athlete, who is
(conscious/unconscious) and may have a **** injury.
Address of Facility and Location of Access Doors: Address: 202 8 St NE, Medicine
Hat, AB. doors will be in the back of school (breezeway in between gyms)
Other Emergency Contacts:
Team Doctor: Dr. Debakanta Jena (403)488-6666
Fire : 911
Police: 911

Pre-event Checklist:
- Locate all working phones (Cellphone, landline) ensure there are
multiple working phones.
Cellphone(parent or coach) or landline in equipment room
- Collect all athlete medical histories and information and have them
accessible and ready to send on the ambulance.
- Unlock all access doors. (EMS must enter through these) front
doors or back access door (Breezeway)
- Unlock all entrance gates. (EMS must enter through these)
- Fully stock and refresh medical kits (Have accessible)
 ***IN CASE OF EMERGENCY CALL 911***
Name of Building:Monsignor McCoy High School
Address: 202 8 St NE, Medicine Hat, AB

Jobs Who? And Supplies Description

Person in Charge (PIC)
Needed
BJ Melle Deal and treat athlete,
determine if EMS is
needed. Must fill in an
injury report form
immediately following the
incident.
* must evaluate, treat the
injury (to their capable
extent)*
Must tell call person
details of the injury and
condition of the athlete

Control Person Jim Moser Make sure no spectators

interfere with athlete

Call Person Pat Lawrence Call EMS if

(directions for EMS below) needed(indicated by PIC),
clear path for them, make
sure that all doors are
unlocked, must know
where all of the working
phones are located. Must
wait at the designated
entrance and return when
the ambulance arrives.

Phones located at:

equipment room, cell
phones (most have
them)

DIRECTIONS FOR EMS- Monsignor Mccoy High School- 202 8th st

NE, Medicine Hat, AB From Medicine Hat Regional Hospital
 ***IN CASE OF EMERGENCY CALL 911***
Name of Building:Monsignor McCoy High School
Address: 202 8 St NE, Medicine Hat, AB

1. Head East on 5th street towards 6th ave (500m)

2. Continue on AB-41A E. Take 1st street SE and Altawana Drive to
8th Street NE
3. Turn right onto 8th Street NE- Destination will be on left

ENTRANCE
1. Park in back parking lot
2. There will be two doors open to the side of the building- in a cut out
3. There is a small breezeway space and you will enter through there.
4. This space goes straight into the gym

PIC (Emergency Response)

1. Activate EAP
2. Send Call person to contact the ambulance and report back (ETA, instructions)
3. Direct the control person to keep onlookers away and assist with medical care
if necessary
4. Complete primary assessment
5. Liaise (talk) with ambulance personnel once they arrive
6. Ensure medical information card goes with the athlete to the hospital
7. Have someone accompany the athlete to the hospital
8. Complete injury report form

PIC (Non-Emergency Response)

1. Assess injury and initiate appropriate management (RICE- rest, ice, compression,
elevation)
2. Refer athlete medical personnel medical personnel for further care.
3. Complete Injury Report Form.
 ***IN CASE OF EMERGENCY CALL 911***
Name of Building:Monsignor McCoy High School
Address: 202 8 St NE, Medicine Hat, AB

Medical History Form: Athlete Medical Information

Blood Type: B+ Card:
Name: Jiminy Walt Cricket
Allergies: NO
Address: 123 Disney Way SE
Ongoing Medical Problems: NO
Telephone: (403)789-4367
Past Operations: NO
Birthdate: 07/06/01
Contact Lenses: YES
Provincial Health Care #: 456783201345
Dental appliances: NO
Insurance Plan #: 56834521
Orthopedic Braces: NO

Specify: NO

Tetanus shot: YES

Medical History Athlete Medical Information Card

Blood type: A- Name: Ron Percy Weasley

Allergies: No medical, cats, bunnies Address: 348 Willow Way SE, Medicine
Hat, AB, Canada
 ***IN CASE OF EMERGENCY CALL 911***
Name of Building:Monsignor McCoy High School
Address: 202 8 St NE, Medicine Hat, AB

Ongoing medical problems: Diabetes

Tel #: 1(403) 567-4569
Past operations: Hernia (right, lower
abdomen) Birthdate: 06/12/01

Contact Lenses : NO Provincial Health Care #: 568908765235

Dental Appliances: YES Insurance Plan #:73473110

Orthopedic Braces: NO

Specify: NO

Tetanus Shot: YES