Article Text

Download PDFPDF
Pre-event ‘medical time out’
  1. Ron Courson1,
  2. Glenn Henry1,
  3. Kyle Borque2,
  4. Douglas J Casa3,
  5. Micki S Collins4,
  6. Christianne Eason3,
  7. Greg Elkins5,
  8. Jim Ellis6,
  9. Warne Fitch7,
  10. Richard Hunt8,
  11. James Kyle9,
  12. Lawrence J Lemak10,
  13. Bert Mandelbaum11,
  14. Kevin Morley12,
  15. Catherine S O'Neal4,
  16. Robb S Rehberg6,
  17. Fred Reifsteck13,
  18. Samantha E Scarneo-Miller14,
  19. Allen Sills6
  1. 1Athletic, University of Georgia, Athens, Georgia, USA
  2. 2Houston Methodist Hospital, Houston, Texas, USA
  3. 3Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
  4. 4LSU, Baton Rouge, Louisiana, USA
  5. 5Southern West Virginia Health System, Hamlin, West Virginia, USA
  6. 6NFL, New York, New York, USA
  7. 7Vanderbilt University, Nashville, Tennessee, USA
  8. 8HHS, Washington, District of Columbia, USA
  9. 9The Kyle Group, Lewisburg, West Virginia, USA
  10. 10Lemak Health, Birmingham, Alabama, USA
  11. 11Santa Monica Orthopaedic and Sports Med Group, Santa Monica, UK
  12. 12Nashville Predators, Nashville, Tennessee, USA
  13. 13University of Georgia, Athens, Georgia, USA
  14. 14Division of Athletic Training, West Virginia University, Morgantown, West Virginia, USA
  1. Correspondence to Ron Courson, Athletic, University of Georgia, Athens, Georgia, USA; rcourson{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Medical emergencies are an inherent risk in any sport, transcending boundaries and impacting athletes globally. From a cervical spine injury on the (American) football field to a sudden cardiac arrest (SCA) on the soccer pitch or an exertional heat stroke during a high school track meet, the potential for emergencies underscores the importance of preparedness and vigilance at every level and in all sport settings. Despite their varying contexts and levels of medical resources, sports share a common vulnerability to emergencies, emphasising the critical need for proactive measures to safeguard the health and well-being of athletes. Indeed, preparedness is paramount for handling medical emergencies effectively.

To enhance athlete safety at sporting events, we propose the implementation of a pre-event medical meeting, referred to as the ‘medical time out’ (MTO). The objective of the MTO is to gather sports medicine and emergency care personnel prior to a game or competition to review the emergency action plan (EAP) and enhance coordination before an emergency occurs. The aim of this commentary is to highlight key elements of MTO and promote its adoption throughout sport.

Key considerations for an MTO

Given the unpredictable nature of medical emergencies during sport, facilitating a rapid and efficient response is essential to deliver optimal care.1–3 The MTO should be conducted prior to each sporting event and functions as a comprehensive checklist review of the venue’s EAP. Home and visiting team medical staff (athletic trainers, physiotherapists and team physicians), venue medical staff and on-site emergency medical personnel should be present for the MTO.

The National Athletic Trainers’ Association endorsed the MTO in 2012,4 and it has gained increasing recognition and application over the past 12 years. The term ‘time out’ is familiar in both sports and medicine. In sports, it is used for strategic discussions or play calls, while in medicine, presurgical …

View Full Text


  • X @mickiscollins

  • Deceased This editorial is dedicated to Greg Elkins (12 May 1962 – 17 March 2024)

  • Correction notice This article has been corrected since it published Online First. The affiliations for Christianne Eason and Douglas Casa have been updated.

  • Contributors All authors made substantial contributions to the conception or design of the manuscript, assisted in drafting the manuscript or revising it critically for important intellectual content, approved of the final version of the manuscript to be published and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note This editorial is dedicated to Greg Elkins, MD (May 12, 1962 - March 17, 2024).

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.