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Prepare Staff for a Death at Your Fitness Center

Even if a death occurs at your fitness center, proper training for both during and after such an event can help prepare you and your staff members, and help you retain members who may be scared off by the tragedy.

The benefits of regular physical exercise for the prevention of cardiovascular disease are well-known. However, even presumably fit people can die. And, unfortunately, they can die in your fitness center. Even though the incidence of death during exercise in the general population is very low, fitness facilities need to be prepared. Each year, approximately 0.75 and 0.13 per 100,000 young men and women, and six per 100,000 middle-aged men die during exercise.1

Paul Brown, a 20-year industry veteran and CEO of Face to Face consulting, encountered this tragedy early in his career when a member died while running on a treadmill. Despite this, Brown is still positive about the fitness industry. "Our industry has saved far more lives through regular exercise than we have lost," he says. Your members need to know this when faced with a tragic event at your facility. They need to feel safe and secure, and know that you have everything under control. Without safety and emergency guidelines in place, your retention numbers can suffer if a tragic event occurs.

It can happen at any time

How would you react as an owner, a manager, a leader - and, most importantly, a human being - after dealing with such a traumatic event? And, it is not just the event. The aftermath and member reaction can also be harrowing.

Over my 30 years in the fitness industry, I have experienced only two fitness-related member deaths. The first was early in my career when a 48-year-old, lean, muscular and experienced runner died while he was running in a local park. Because this happened off-site, it seemed somewhat removed from the facility's operations. There was also, it appeared to me, no one to blame. There was little anybody could do to help save the victim, except for his jogging partner, who, in those pre-cell phone days, rushed into a nearby shop to call an ambulance.

I must have been a naïve young employee, because I was stunned when my manager told me that he had received nasty anonymous phone calls "abusing [him] for promoting stupid exercise." My manager also faced some accusatory questions like, "Why didn't you know he had a heart problem?"

Wind the clock forward some 25 years, and I faced a similar situation. I am the manager of two large facilities that have more than 4,000 members. During peak hours, a member collapsed after running on a treadmill. Despite our best efforts using an AED (automated external defibrillator), and the arrival of nurses, doctors and emergency services within 10 minutes, the member was pronounced dead on arrival at the hospital.

Worst-case scenarios

Fortunately, the facilities I manage have wonderful support networks. Medical staff, psychological counselors and a supportive human resource department helped ease the psychological burden. Not every person facing this type of situation is as fortunate as I am.

One fitness professional, who prefers to remain anonymous, endured the same situation with no support from other staff members or his employers. He was the only staff member on site who was first-aid trained when the incident occurred; three other staff members simply froze. There was no AED available and no emergency procedure in place, and it all happened in an inaccessible facility that emergency services took more than 20 minutes to find.

After the tragedy, the only support he received from the company was a phone call from the corporate office saying, "You can take the rest of the day off." The next day, it was business as usual. He is still traumatized from these events, and suffers from regular panic attacks.

In addition to this employee, think about the other members who witnessed the event. Aside from the obvious shock of a member dying in the facility, how did the other members view the fitness staff? All respect and credibility was lost.

Other colleagues have told me similar stories of untrained staff members who don't know basic CPR, of AEDs being present but "lost" and staff ineptitude confounding an already tragic situation.

Scenario-based training

How do you give the member who is being rescued the best chance possible to survive, and assure other members that your staff members are properly trained to deal with emergency situations? And, in a worst-case scenario, how do you deal with a member actually dying on your premises?

Matt Streich, a CPR and first aid instructor with the American Heart Association for the past 20 years, has taught CPR to more than 30,000 people, including beginners, fitness center staff and even certified cardiologists. "Realistic, practical training is essential," he says. "Studies show that the more trained a person is, the more appropriately they will handle an emergency situation."

Streich says that it is important to be honest to students. "Television shows where patients automatically recover from CPR efforts nearly every time are totally unrealistic," he says. "This has a lot to do with the general public's misconception about rescue efforts." Figures from the American Heart Association indicate that as few as 2 percent of people are saved with manual CPR. "The chances definitely go up with the use of an AED, but there is no guarantee the rescue will be successful," says Streich.

Training scenarios for your staff members should include situations where a rescue is not successful. "Practicing how you handle a tragedy like this will give you a reference point for the future in how you respond in supporting your team, and how you face and answer difficult questions from members," says Streich. "This is not a movie or TV show. The victim does not always survive."

Reactions and recovery

Dr. Richard Kennedy is a Washington, D.C.-based internist with 25 years of experience in emergency response settings. "Psychological counseling is a must for first responders," he says. "If you do not have access to trained counselors, it is incumbent on the owner/manager to support the team and find a trained counselor in the community."

Even if the victim survives, there are still emotions left to deal with. "After an event like this, it is natural for the first responders to feel some degree of guilt," Kennedy explains. "Some may have recalled their initial hesitation, panic and feeling of helplessness. They will ask themselves questions: 'Could I have done more?' 'Did I do anything wrong?' All of these types of questions surface."

Even the most prepared individuals may not be entirely in control of their reactions when dealing with the sudden death of a member. "People's reactions during the attempted rescue can range from dumbing down or freezing, to frenetic panicking," says Kennedy. "It is natural for people to freeze when faced with traumatic situations. Animals play dead to survive, and recent studies indicate that this could also be a factor in human reactions to tragedy. A type of 'ignore it and it will go away' approach."

To help mitigate this natural response, Kennedy encourages regular scenario training. "By practicing response skills, you can make yourself aware of your human reactions," he says.

Member reaction

Part of the cycle of grief are members' questions regarding your and your staff members' competence. In my experience, most members will be supportive, but you may also face questions like, "How often are you guys trained?" and "Why wasn't the AED put on straight away?" These questions are common, and to be expected.

"[People] are often looking for someone to blame, particularly if the person who died was close to them and seemingly fit and healthy," says Streich. "People want an explanation for something they feel, right at that moment, is unbelievable."

As a human being, your reactions to these questions can be to freeze and not say anything, or to blow up in anger. As a first responder, you can find yourself sensitive to any perceived suggestion of incompetence. Brown recommends being confident in your approach, with statements at the ready, like, "Sir/madam, we did the very best we could, and I have every confidence that our team acted appropriately. Please respect our emotions at this time because we are grieving, as well."

In my situation, I adopted a similar, albeit more assertive, approach. While I was not loud or aggressive, I was quite firm in my answer to one member who, I felt, was being offensive. Looking back, I have no regrets about my retort to this member. I was confident we did the best we could, and would gladly say it again.

How you respond is a matter of judgment. There is no right or wrong response. Again, a scenario-based training session - even if it is held just once per year - will help provide you and your staff members with some awareness of what you may encounter.

Best practices

Here are some steps to take so you and your staff can feel satisfied you did the best you could under the most trying conditions you will possibly ever face.

During the rescue attempt, do the following:
  • Cover the basics. Require first aid training, along with CPR and AED training, for all facility staff - not just fitness staff.
  • Get real. Training should be realistic and scenario-based, with a clear emergency plan in place.
  • Manage the rescue scene. Good management of the rescue scene includes crowd control and timeline reporting of main events. Have one person cordon off the area to keep people away. If you are fortunate to work in a place that has building security, ask them to assist you. If possible, have one staff person act as a reporter, noting the exact time the emergency occurred, when an ambulance was called, when it arrived, how long the person was treated before being taken away and any other relevant details. This is invaluable when asked to recall specific events for legal and insurance purposes.
  • Don't diagnose. Most importantly, leave the diagnosis to the medical specialists.
During the aftermath, do the following:
  • Script responses. Scenario training should explore scripted responses to offer members in the event of a tragedy.
  • Accept the inevitable. Familiarize staff with normal human responses, such as freezing or panicking. By being aware, and having regular training, hopefully you can overcome these responses.
  • Provide counseling. Psychological counseling for all staff involved is essential.
  • Grow a thick skin. Understand that members' perceptions may lead them to ask insensitive questions. Train staff to be aware of this, and to have appropriate responses ready.

Prepare and prevail

Even though exercise-related death is a rare occurrence, you should be ready in the event that this does happen in your facility. These guidelines for training during the rescue and after the event will help you and your staff react appropriately in the event a death or serious injury does occur. With a safe and appropriate reaction, no matter what the consequence, you can help your members feel safe in your facility, and keep them coming back.

References
1. Topol, E.J. Textbook of Cardiovascular Medicine, second edition., p.85. Lippincott, Williams & Wilkins: Baltimore, Md., 2002.
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