Health/fitness facility standards and guidelines for risk management and emergency policies

This is an excerpt from ACSM's Health/Fitness Facility Standards and Guidelines-4th Edition by American College of Sports Medicine.

Risk management refers to the practices and systems that businesses put in place to reduce or limit their exposure to potential liability and financial loss. In the fitness and health club industry, risk management refers to the practices, procedures, and systems by which the club reduces its risk of having an employee, member, or user experience an event that could result in harm (injury or death) to the individual (employee, member, or user) and perhaps later to the business entity itself. Risk management covers practices that range from those that are preventive in nature (such as pre-activity screening and properly caring for equipment) to those practices that are considered a reaction or a recovery-and-response system to untoward events (such as emergency response systems).

This chapter presents standards and guidelines for the risk management and emergency procedures that health/fitness facilities need to consider in order to provide a safe physical activity environment for its employees, members, and users. Some of the standards and guidelines that might otherwise be considered risk management practices, such as pre-activity screening and other operational practices, are addressed in other chapters of this book. Table 3.1 lists the eight required standards for risk management and emergency policies; whereas table 3.3 details the six recommended guidelines for risk management and emergency policies. Table 3.2 contains a listing of the states that have enacted AED legislation.

Having an emergency response system is critical to providing a safe environment for members, users, and staff, as well as being a sound practice in risk management. For health/fitness facilities, emergency response systems must be developed in order to provide the highest reasonable level of safety for members and users. Emergency policies, procedures, and practices for health/fitness facilities, as presented and discussed in this chapter, are derived from recommendations published jointly in 1998 and 2002 by ACSM and AHA. (Refer to appendixes H and I.)

Many of these recommendations are identified and discussed in this chapter in the context of standards for health/fitness facilities in 2011 and beyond. However, it is acknowledged that the types of health/fitness facilities vary markedly, from facilities that are unsupervised to medically supervised clinical exercise centers. Such facilities often serve different aims and clientele, may or may not have organized program offerings, and may or may not have qualified staff. Thus, beyond the standards offered in this chapter, facilities needing assistance in matters of preparing emergency policies, procedures, and practices relevant to their setting will find the contents of the 1998 and 2002 ACSM/AHA publications to be helpful resources. Among the more crucial elements attendant to incorporating emergency response systems in a facility are the following:

Facility operators should use local healthcare or medical personnel to help them develop their emergency response program. Most local emergency medical services (EMS) will assist a facility in developing its response program. Facilities can also pay for the services of a physician, registered nurse, or certified emergency medical technician to guide the development of their emergency response program.
The emergency response system must address the major emergency situations that might occur. Among those situations that might arise are those medical emergencies that are reasonably foreseeable with the onset of moderate or more intense exercise, such as hypoglycemia, sudden cardiac arrest, heart attack, stroke, and heat illness, and those injuries that are orthopedic in nature. The response system must also address other foreseeable emergencies not necessarily associated with physical activity, such as fires, chemical accidents, and natural disasters.
The emergency response system must provide explicit steps or instructions on how each emergency situation will be handled and the roles that should be played by first, second, and third responders to an emergency. In addition, the emergency response system needs to provide locations for all emergency equipment (e.g., telephone for 911 or other contact information for EMS, the location for all emergency exits, and the most favorable access ways for EMS personnel) as well as the steps necessary for contacting the local EMS.
The emergency response system must be fully documented (i.e., staff training, emergency instructions), and pertinent information must be kept in an area that can be easily accessed by the club staff. In addition, the emergency response system needs to be reviewed with facility staff on a regular basis.
The emergency response system must be physically rehearsed at least two times per year, with notations maintained in a log that indicate when the rehearsals were performed and who participated.
The emergency response system must address the availability of first-aid kits and other medical equipment within the facility.
The emergency response system should identify a local coordinator (e.g., a staff person who is responsible for a facility's overall level of emergency readiness).

It is critical that facility operators remain aware of conditions within their facility that could pose an increased risk to their employees, members, and users. To this end, it is critical that facility operators develop an audit and/or inspection process that allows them to regularly check the safety of their facility. This audit process can be as simple as a checklist of the critical safety practices that must be in place, which allows the staff to verify that all the proper safety practices are being followed. The goal is for the operator to establish a schedule for inspecting the facility to determine adherence to the specific safety practices that the facility has put in place to protect the employees, members, and users. In all cases, the result of each inspection or audit should be maintained on file by the facility operator for a period of at least three years.