Transcript

0:14

Yes. Good morning.

0:16

Good morning. So, I wanna try to give me bear with me one second as we, get the presentation, squared away. And if not, we're gonna go I'm a try a different mode here for today, for the here we go. Let's see. This should be able to let's see if I can, share.

0:38

Here we go. We're gonna go to plan b on the slideshow here for a minute, and hope you all can see that and for that. So, yeah. Great. You.

0:52

Apologize about that. So this is gonna run ahead. I'll get this to run ahead. There we go. So our first presentation today, and I and, again, I mentioned before, apologize being running in late, getting some of the technology stuff squared away.

1:07

We're there's gonna be rapid fire presentations. And the, first with the 3 presentations, how we're gonna do these is do ask some specific questions and to the to our panelists, and then we're gonna open it up for q and a. And just remember that, we encourage you to raise your hand. We will if you wanna ask the question yourself, we will turn your mic on. So, with that, I'm gonna go and do a quick introduction for our first panelist.

1:37

And this is very, doctor Stephanie Aldrete is on the clinical faculty, and, also, she is the lead excuse me. For as many different titles, in addition to being at the the universe I mean, Edward Via College of Medicine in Monroe, where she is the I'm correcting correct me correct. You're the lead for family medicine. Is that correct?

2:01

Yes.

2:02

And then, also, among other things, she's been a team physician with UL or as with UL Monroe. Also, where her some of her area of expertise is is in lies in terms of travel abroad. And so where she has extensive work with, the USA Gymnastics and traveling overseas and had the opportunity to work with doctor Haldred about a week and a half ago. I guess it's kinda time's flat time's flown a little bit, at the Sunbelt Conference track and field championships. And, this was some of the conversations we were having, about travel abroad and just travel and things like that and working working with them.

2:42

And, also, not to mention that her husband is an athletic trainer as well. So with that, doctor Aldrete, thank you so much, for being here today.

2:52

Thank you for having me. I was really honored whenever you asked me to be a part of this whenever we were covering Sunbelt track and thought I was gonna get to spend some more time with you, covering the junior college national championship track and field, but was called for a gymnastics trip to go to South America. So which was very pertinent to what we're talking about today. Right?

3:15

Yes. It is. And we're gonna talk you know, first off, before we get started, I know that, just from a disclosure standpoint, doctor Robert has no conflicts of interest. And if she does mention anything in this presentation, will be for demonstration, not for any endorsement. So before we get started, the last thing I'm gonna mention is what our learning objectives are for this presentation is, as you can see here, we're gonna talk about the unique challenges and considerations of emergency medical care, for international competitions.

3:43

And and and the reality is it it really occurs for anywhere we travel, but it's just a different context here being in the states and where we're used to. Also, like medical protocols, emergency response strategies, we'll talk during that q and a. And then also think about how to prepare and adapt for emergency medical plans, to the diverse, health care systems and regulations. So with that, I'm gonna turn the screen off, and we're just gonna have this, have the just the easy conversation today and and, moving on. So if you would, doctor Albert, briefly, just talk a little bit about where your, like, your background is, and you just probably a little bit more information about what your, expertise is in, and and, we'll go ahead and get started with some questions.

4:27

Well, I started off going the internship route as a student athletic trainer way back in the day. And, and so that's where sports medicine has always been in the forefront of anything that I've wanted to do that, had had ended up I'm married and athletic trainer, so he encouraged me to take the MCAT instead of the BOC. And, and so that's where my route has gone this direction. But, always end up holding the athletic trainers near and dear to everything that I do that, I wouldn't necessarily end up traveling and doing the things that I do if there wasn't an athletic trainer with me. Now I'm currently at, VCOM Louisiana in Monroe, Louisiana.

5:12

So went up north that, tier for family medicine, osteopathic, neuromusculoskeletal medicine, and sports medicine. And, that it's nice being in an academic position right now because it does give me the opportunity to where I have a practice that's only athletes. That, my only clinical responsibilities right now are with the University of Louisiana Monroe in the athletic training room and then, also with USA Gymnastics trampoline, and tumbling.

5:40

Great. So you were I know that we were talking last a week or so ago. It's been kind of a blur because I was the following I came back up and working the, coordinating, with our company, the National Junior College Track and Field Championships, which, has its own unique had its own uniqueness for from, the more so from athletes traveling from around the country. So okay. So you traveled overseas.

6:03

You went to Peru. Correct? And that event what was that event again?

6:08

So I went to Peru for the Pan AM trampoline championships, and it had juniors, it had seniors, and it had club competition in it. So it was 3 competitions and 1.

6:19

Okay. So first off, the but the thing I wanna talk about one of the part of the things are venue specific EAPs. And, obviously, you did not develop the venue specific EAP, or thinking about some of the things excuse me. What are some things you think you have to take into consideration just from a from a, your approach into the EA into a venue that you're walking into from overseas?

6:45

So with each one of these events that I cover for USA Gymnastics for the trampoline and tumbling side, I don't do anything with artistic, but just the TNT that, each one of these are International Federation of Gymnastics sponsored events. And so there ends up being work plans that are already set before coming in. That with that, that there are certain minimums that the countries have to have in order to have the event, and part of that's gonna be having some medical on-site. Now they may say that they have a doctor on-site. They may say that they have physios on-site and everything, but you never really know what the level of training is or what they've ended up experiencing before until you get there.

7:25

So it's seeking out that local medical to be able to see what things are what they have set up. And so, they had a doctor. She did look like she was about 12. And so that, she was there. She was on the competition floor the entire time that, and was the one that was kind of covering the event with a paramedic or nurse that, now again, that not really sure what that level of training is that goes along with it.

7:55

But their triage station for anything was a table that had an AED on it, and then it had, a a like, a cooler with, reusable ice packs in it. And there were some gauze and some anti inflammatories, and that was about it. That, they did have a wheelchair. They did have a scoop and a, spine board there as well. And so their whole plan was that, okay, they will either scoop spine board or spine board or use the wheelchair to get them off the field of play and get them into the back of the ambulance and then figure out what to do with them after that.

8:32

So we pretty much whenever we travel, we bring our mobile like triage with us and stuff with primary care things to be able to work with, SAM splints, traction splints, all sorts of things, and just hope that they have the basics. But as Americans, whenever we're on these trips, sometimes we'll end up being bullies for our athletes and not really bullies. It's just a matter of these are our athletes that we're not gonna spine board certain things, but we're also going to push the spine board other things that maybe they don't end up doing.

9:09

I think you brought a great point that you've gotta be an advocate for your team and your but also walking into that situation that you just mentioned. You have to know what they anticipated what you're walking into, and you don't know really what that looks like. I've traveled overseas before. I traveled with some, Olympic teams as well, and that's just you you're you know what you're covering. But if you've never gone there, you really know what to expect.

9:35

So you're from that consideration there as well, which leads into you're traveling you you're coming in. You're traveling with other profess like, athletic trainers with those teams or other, providers as well and maybe physical therapists, other ones as well. So what is the from an athlete training perspective, what is the what would be the 1 or 2 key things or takeaways that you would say is, hey. I need to help with this. I'm working with the physician.

10:02

What can I make this the best possible scenario? Walking in, not knowing what's gonna happen.

10:09

So for both of it that usually, it ends up being those timeouts ahead of time of just kind of delineating roles, but also knowing that, you know, we're we're cross covering for everything. And so typically with my athletic trainers that it's a matter of I'm not gonna have any, preventative equipment so much within my kit that I end up bringing, that I'm not gonna end up having any tape. That, if I can fit in a Theragun or a lacrosse ball or or anything else from that standpoint, I will, but usually, it's it's not. And, the athletes really wanna end up seeing the athletic trainers for those warm ups too. That, that typically we end up getting split up to where I end up staying back in the warm up area, and that ends up being a kind of med hub for us, where athletes can end up coming through and then making then having my my athletic trainer be the one that's on the field of play.

11:03

And that if they need me, then we end up making sure that we've got our communication devices of how we can end up doing how we can end up him notifying me or them notifying me if I need to come out to the field of play. Okay. Typically, we only have one transferable that gets one medical provider out there on that sale to play, and I really push for that to be the athletic trainer every time because y'all are the specific emergency medical responders for athletic events. And I don't really like for our physical therapist or other ones that travel with us to be the ones in there because I know my athletic trainers are gonna keep their stuff together if something happens.

11:41

Okay. So with that, what are just briefly, knowing not knowing what like, for the gymnastics, if you've never traveled or artistic gymnastics or the trampoline, what are the most common injuries or medical issues you encounter during international competitions and how you're preemptively managing them?

12:02

Well, that's all gonna be sports specific. For ours, it's gonna be a lot of foot and ankle injuries that can end up occurring. And if we end up having our double mini trampoline and tumbling there too, that then that ends up opening up a whole another realm. The big bad scary stuff that we're worried about from the trampoline standpoint is if they end up going between the springs or hitting the frames. Because typically with the heights that they're end up jumping in and the force in which they come down, that, we have multiple open fib fractures, that can end up occurring that luckily the past couple of competitions, it has not been our countries and everything.

12:39

I mean, feeling bad from the Mexico standpoint and everything because they had a real bad one in Colombia, which was the whole thing that triggered me to end up coming on to this trip and everything. That, also in Colombia, they had another country athlete that bounced so far off the trampoline that landed on his feet on the wood floor and, had, I think, an open calcaneal fracture too. So we end up getting some gnarly things that we end up watching for and and being ready to respond to that, the the other big thing that we're, has or not hesitant about, but that's always kind of out there is that if they go through the springs, they can end up having femoral fractures, open femoral fractures with that. And so knowing that that was potential risk for the sport, that I actually have a couple of tourniquets and blood stop within my, within my, kit as well that I'll travel with. And I will move that into a sling along with Sam's Splints, lots of gauze, gloves, and, and even then ace wraps and everything from the sideline coverage if I'm out there for it too.

13:51

So Okay.

13:52

Well, that was gonna I was gonna ask about protocols, but that really gets to the specific merge emergency protocols. You you know that these may happen just by the nature of the sport or the likelihood of it. And, hopefully, that your athletes don't have that, encounter, but it can happen. So it's, with that. So let let's change gears a second.

14:12

And probably the one of the more like, so I know that I've traveled or even when we travel stateside, you're getting into from if you go to from here in Louisiana, if I'm traveling to Oregon or vice versa or, you know, as well as what the cultural differences and we say it just from how the culture of the medicine is in general. I know we see that some degree in within, the states. But when you go overseas, if you just kinda elaborate a little bit on the, cultural differences in medical practice and how that impacts what you're able to do in overseas.

14:47

Well, overseas that, we're we're lucky in the sense from the country that we come from that they may end up looking at us for help in certain state or circumstances too. So continuing to have a team based mindset of where medical across all countries and everything that we're all there for the good of the athlete and for a good outcome with that too. And so being able to help, but then also taking on those context clues of when to back off, from that too to render aid, but not get in the way. That, and they've all been open, to us being able to help in certain ways where and even then, expect us to step in at different times to do things. So the the language barrier, very big, that especially whenever we were in Peru, not a whole lot of English speakers there, and my Spanish is not so great.

15:37

So Google Translate was fantastic, that if there's other translations, subscriptions and stuff, whatever, but Google was the one that all of us were using from that standpoint. And, that there's certain protocols that are kind of universal across medicine and everything with that as well, of where stabilizing and transporting that our ABCs, everything else from that. And so it's just where you can see where we're similarly trained in certain protocols and everything, but little variations. But those variations aren't life threatening or anything else.

16:18

So in other words, be nice. Well, I know that that then I mean, we talk about that all the time, but be nice and you continue to be and that's just gets in the upfront communication. Let them know who you are. They and vice versa. Learn who they are.

16:31

Listen to what if you're you're gonna be the visitor. And then there's a point where you I think you mentioned this is, you don't you can't be nice. You've gotta be aggressive as an advocate for that. So, that was great to to understand that. So, from the list from back with that, also kinda gets into the logistics side.

16:50

So you have to if you have an athlete's being transported I'm not transported, but you're bringing equipment supplies in. Are there any things that you have to communicate beforehand or just because of either laws or otherwise things you cannot transport in to I know there's certain things you cannot transport in for certain countries. But how do you how do you all navigate that? And then it gets into the communication or the differences in medicine, how you can accomplish things you know you will need or have access to?

17:20

That, usually comes down to medications that we can't end up transporting in, that I will end up having, some, antibiotics and, other sorts of things, like common things that we'd end up needing, from a medication standpoint that end up bringing in, that really it comes down to the controlled substances. Well, US, we can't really transport those anyway and everything with our teams. And so we know that's kind of the same for international as we are from the domestic standpoint. That, so with that, as soon as we end up showing up, they're trying to see what do they have. If they do, whenever we had a competition in Birmingham, UK back in November, it was a matter of, okay.

18:03

Well, what sort of anesthesia do you have on-site if we do have those big open tip fibs or other sorts of things to go along with it and, trying to see the differences in the drugs that were around, that ended up learning some about some new inhaled, induction agents and and pain medicines and everything from the that's available in the UK that's been outlawed in the US. And so it was just kinda one of those where we're just praying that nothing ends up happening from that standpoint. But, you know, we approach it that way anyway. Up happening from that standpoint. But, you know, we approach it that way anyway.

18:36

Then you also think have to think about doping. That's the other consideration for that. So I know that's that if you're if it's that, I guess, being approved here in the US versus not I mean, approved other others other countries but not in the US, And that's another issue itself. But the first thing is being, the health and welfare, of what's being done and have them in the medical facility and doing some, along those lines. So

19:03

And going into the pharmacies in the different countries and everything really have to to look on the boxes with some sort of translation device and everything to make sure that, that the ingredients in there is the same as what it is in the US Because you're right, the doping, that the additives or other medications that are over the counter in different countries, is not the same. And so if we end up running out of a Tylenol or Ibuprofen or even cold medicine that going into that, into that pharmacy that trying to search out those ingredients to make sure that they're not gonna flag because they had a cough or something like that. And then also really educating our athletes that just because you go into the pharmacy and you see a a label that looks familiar, you still have to end up searching out those ingredients.

19:52

Alright. So two quick questions, and we'll open it up for q and a. One is, what's the one piece of advice that you would give a person with the medical team traveling to their 1st international event?

20:08

Oh, that, talk to those that have been before. So that way, they can help you to prepare. No question is a dumb question, that really it's it's something where that that amount of preparation that you do before going in is gonna end up put you putting you at ease. And so it's a matter of, talk to those that have been before.

20:31

Okay. And here's the fun question. What's something that's happened you've seen that be like, okay. You can't make this up. It's kind of a off the grid, type of thing you would not you wouldn't expect to see.

20:46

That's very unusual in terms of the the injury other than, like, that that one you saw where flying off of the, trampoline on the ground?

20:53

Well, that, I wasn't out on the field to play for this one because I think I probably would've run towards the tramp at this is that, they had an athlete this past competition from a different country. He did his whole routine, did all 10 skills up on the tramp and everything saluted, and then dropped on the trampoline. And, and so the coach was right there, and they kept calling for the local medical and everything for it. Well, our local medical that was on the that was at the table on the competition floor, I guess, were on their phones and not understanding that the screams and yells and everything were for them to come out and respond and everything, and that it ended up taking just a little while for it. So even though there's local medical and you've talked to them and you see what they have there, does not mean that they are paying attention to the competition and, to know exactly what is going on even with something as simple as, you know, didn't fly off the tramp.

21:53

They just collapsed on it after the fact. So

21:57

yeah. Well, I'm gonna share 1 when I do my talk about the present about the track because I'm I'm sure you heard about it from your husband because of the athlete that ran across the field, and I'm just gonna leave it there. And I heard a I was dealing with another urgent issue, and I hear I'm in the process. I hear this, whoo. And I'm like, at the crowd.

22:15

So I'll talk about that the next time. So if it'll if you're on, but it involves I'll just say this. It involves a near miss, and it involves a javelin.

22:25

So gosh. Oh my gosh. So I

22:28

will. So with that, I think we've got a we've got, a list of questions, though. So I'm gonna give it over to audience side now for a minute or a couple minutes. So Laurie Vasquez asked, any issues with getting supplies to security airports? And if I travel with an AED, I generally get the TSA supervisor to let them know so they can screen me separately so not to not to cause disruption in line.

22:54

Which that you can that you have a medical I'll I know you have that for AEDs. You'd have to travel you can get a letter to travel with that. So if you could, address that question.

23:02

Did, I find that if I have a list of everything that's in my kit and then making sure that it's known ahead of time that, it's medical, all for medical purposes and everything too, that, then being able to let them know that and having the letter. Typically, having the letter of the competition, can end up being helpful too. That, and so I end up having, a letter with the official organization and everything as far as being a part of it. And I'm talking about the Federation International Gymnastics. 2, that I have my medical license, my DEA.

23:39

And, and and so I've got all of that together as I end up looking to travel, and I keep that in my carry on with it. Now, typically, I do check my medical kit. I will end up keeping a little bit of one with medications with me for and if the team's on the the plane with me to be able to dispense if needed with it. But, otherwise, I check my kit. AirTags, I put an AirTag in it.

24:04

I put an AirTag in everything in order to be able to track it to make sure that it's gonna make it to the country too with me and being able to seek it out. So those, that being able to have those letters declaring everything ahead of time ends up helping with that as well.

24:22

Okay. Great. That was a great, question. Other one other question, and we'll, move on is, Adam Young asked, you mentioned that getting medications is difficult overseas, and and I guess we'll answer that. How did you how did you or your team get other supplies overseas?

24:38

That's probably the other supply issues, like, with the other equipment. Probably

24:42

So with that, that usually we end up carrying that we end up having recovery equipment with us, NormaTec, Hypervolt, that Venoms and other things like that, that usually where we end up losing different or not losing different supplies, but if it's something for from a tape standpoint that, with these competitions that will end up being around the other athletic trainers or physios from the other countries, and sometimes we can end up doing a trade, because everybody kind of ends up being in the same sort of situation with it. That, for other games and other things that I've ended up doing that we've had to talk to the local hospitals or, even then talking with the local, medical that they may be able to get supplies for us. In. And that's kind of part of them being the local medical and the local organizing committee for this is that there's many things that that they will end up reaching out to their hospital systems or other physios if that's, the the structure that they end up having to do it. Otherwise, this is one of the things that I always think athletic trainers are great great for is that you just find a way.

25:53

You just rig it, that you repurpose anything and everything to go along with it, and it's kind of that ingenuity that you'll have as sports medicine professionals for it.

26:04

Well, great. Doctor Robert, thank you for, a note for the athletic trainers, the, the the shout out you gave to them and and for us and all we do as well. So and at the end of the day, it's a team effort. So we're all working we're rowing the same boat and trying to move together and, with that. So, with that, I know that, we've probably got well, past a couple minutes past this.

26:24

Not taking your time up, but I hope you'll come back on again with us, sometime in the near future. So you I know you have some good stories and and then some as well when now that you get back from being jet lagged from, overseas. So thank you so much for being here today.

26:39

Appreciate it very much. Thank you. And I've enjoyed seeing some familiar names in there. Shout out to Kevin Schroeder. It's been a while, man.

26:46

So thank you.

26:48

Yep. Great. And I'll I'll get to I hope to get to work with you again soon. A little bit longer than we had, up at the, Sunbelt Conference track championship. So with that as well.

26:56

So thank you again.

26:58

Thank you. Good