As the number of Americans that are accessing health clubs and gyms increases, and the number of active older adults that keep exercising remains constant the gym industry is going to be in for a surprise! Traditionally gyms and health clubs have been reactive to health and medical problems, waiting until they occur to act. Up until now the standard has been first aid and CPR training and until recently the addition of AED's. But what happens when a staff member gives erroneous advice to a member having a medical issue or worse fails to initiate the emergency protocol.

The unfortunate fact is that as good as first aid / CPR training is it does not cover what will be commonly be encountered in the health club setting. Members bring all of their medical problems with them to the gym and as a result if they are not screened by the gym staff or they do not disclose what medical issues they may have it is only a matter of time before a medical emergency occurs.

Let me recount some examples so everyone understands what I mean when we say that erroneous advice or none at all is being given. Over the Past 7 years of running 911 calls two incidents stand out clearly in my mind.

I responded one Saturday morning to a large chain gym. When we arrived the front desk staff was not even aware there was a medical emergency in the facility. After looking for and eventually finding the patient we were informed by the patients 'trainer' that they were just working out and the client got dizzy and "fell out". When questioned the trainer had no knowledge of the clients medical history and had no documentation on past medical history to reference. The client / patient was basically unconscious and was unable to answer questions. Thankfully in this case it was just an issue of HYPOGLYCEMIA. The client had not eaten breakfast and the trainer had pushed a little too hard. The interesting thing is that if the trainer had asked the proper questions prior to this event a little juice or electrolyte drink would have prevented a medical emergency. The trainer was open to liability by having not followed emergency procedures and could have been held responsible if the client had fallen and sustained an injury. The gym was also liable by not implementing or following it's emergency plan.

The next call that really stands out in my mind is perfect example of why an emergency plan is so important. We responded to a gym for an unconscious patient. On arrival the desk staff escorted us to the patient. I found a female 37 years old sitting against a wall in a spinning class, she was exceptionally diaphoretic (sweaty), pale, and breathing rapidly. Her pulse was weak and irregular. The gym staff had no emergency medical information on this person and she was unable to speak clearly. Now, this could be low blood sugar, heat illness, stroke, heart attack, medication side effects etc.. Her blood pressure was very low, and now the problem arises, the patient was instructed by the gym staff and class instructor to sit up and lean against the wall, then someone gave her an energy drink with caffeine. So our poor patient was given the wrong advice by a staff member and given a beverage that could severely make her worse. She needed to lay on her back with her feet elevated so her blood pressure normalized, telling her to sit up was a major error. This woman has occasional bouts of VASOVAGAL reaction's where her blood pressure get's rapidly low, and all she needs to do is lay down, if your blood pressure drops too low unconsciousness ensues and can lead to asystole aka heart stopping.

The common thread is customer service has come to the forefront of the gym industry, but it seems than many facilities neglect to have and practice an emergency action plan. Buying an AED and having a first aid kit is not enough, the staff needs to be educated and trained on how to deal with an emergency when it happens, and specifically to not give erroneous advice that will leave the staff member and facility open to liability.

First aid and CPR certifications are necessary to have but the training needs to go further. BRADYCARDIA, TACCHYCARDIA, HYPO/HYPER-GLYCEMIA, CARDIAC DYSTHRYTHMIAS and HEAT ILLNESS are all examples of the most common gym emergencies that you will encounter but are not covered in first aid training. Lines of communication need to be clear. From the initial incident to accessing the 911 system to arrival of Emergency Medical Responders needs to be scripted and practiced at least once per quarter. Being prepared is key, knowing what to do and specifically what not to do is paramount. Do no harm but acting on behalf of the client within your knowledge base will help you and your facility excel to the forefront of the industry while hopefully reducing liability along the way.