Transcript

0:11

And we're great to have, doctor Karen Straub Stanton. Doctor Stanton, how are you doing this morning? Got you on mute, Rodney. You're on you're still on mute.

0:24

Sorry. Good, sir. How are you?

0:25

Great. I'm fantastic. So this talk and we'll go through, briefly just a couple of the slides and where we're moving through, and we'll open up to the video only. And then we're gonna change gears in an area that we don't think of, but I think it has incredible it's not a it's it's a large it's a large sport in terms of what worldwide, and it's equestrian competitions. And we have a number of, athletic trainers, other providers who provide medical care across the country.

0:54

Karen has, has done this for a long time. I'm not sure how many at least at least 2 years, at least, I know, or a little bit more than that. I've known Karen for a long time. But, anyway, we, thinking about this as being unique to what may happen for other sports and these things, we're just trying to show that and through the questions we're gonna talk about today or what are these common themes that we see, not just in equestrian, but in other sports as well. There's tremendous parallels, the uniqueness of it, or we talk about international competition as well.

1:29

So, with that, doctor Stanton has no conflicts of interest, and I'm gonna let her we'll talk a little bit give her a quick intro in in just a second, and let her tell her a little bit about herself if you've not heard her, present with us before. And the main things are think about essential equipment for this learning objective specific to equestrians, understand their protocols for availability during competition. And there's some uniqueness even with the EAP when you're thinking about with horse you know, having horses, it's it's not on solid ground. It's on dirt. And, that creates an issue of how to move potential injuries that can occur.

2:07

Then also channel environmental considerations. Think about the typical rider injuries and how we how you prepare for catastrophic injuries, including, on the field management. So, you know, I I visited with doctor Stanton by 2 year 2 years ago. I was over there for an event in the area and had a chance to visit and see their facilities, where she works. And it was just, the emergency care equipment, the preparation.

2:30

It was during the competition. So I was I was, you know, still different than any other competition. So that we that we're encountered with. So, with that, doctor Stanton, how are you doing this morning?

2:42

I'm good.

2:44

Excellent. Excellent. Let me drop this down for a second. I've gotta get to where I need to get to on this as well. So if you would just give a little bit of background for, intro and, your background and, and and especially towards equestrian, area as well.

2:60

Okay. Well, my background, is kind of extensive. Most of before I got to equestrian, most of my experience was in football, baseball, and softball. I've worked at division 1 and division 2 institutions. So, you know, when you're in the collegiate setting, you cover all sports as necessary.

3:19

So I've kind of covered all of those, but those are my primary. I got moved into equestrian, because we had some significant injuries in this area, and we were having some management issues with those. Also, I I knew the coach, quite frankly. Great guy. Love to work with him.

3:36

So when we got together, he was winning championships before, but we won a lot together. I know that's not the focus of this, but we're pretty proud of that. So from there, I just started diving into what this sport is like. It's not a mainstream sport, so I had to learn it from the ground up, including how they do what they do, what it takes to do it, the little nuances that go with it, and then the things that happen, and how to manage those. So I've just kind of learned that along the way.

4:05

Okay. Well, thank you again for being here. So starting out, we're gonna talk about a couple of different key areas, throughout, the short time we have and then open up for q and a as well. So what is first off, let's talk let's look at, the venue specific EAPs. Okay.

4:25

How is your different how is your EAP is your is your EAP different than what you would see at football or basketball on your campus or tennis or any other sports? And then what's the uniqueness or any uniqueness you have to take into consideration that or enhance versus a typical, like, collision sport?

4:48

Okay. The organization of our e EAPs from administrative level is consistent across all of our facilities here, and that's pretty consistent across our conference. I see a couple other people from our conference on here. So we maintain that level of consistency as far as positions on-site and maybe all of those types of things. The unique aspects of this sport and thinking about the facilities in our conference and across our nation that we've been to is they are not well crowd controlled.

5:16

There's a lot of public access through spaces that can become deemed important for emergency management, so you really have to work with your event management staff. Your medical time out is essential at every event, communicating with who you have on-site, where they're gonna be located, how we're gonna manage an access. For our facility here, we have the standard ambulances, EMTs on-site. We also have police officers on-site that are part of our plan to execute and move, and I really have to rely strongly on event management, to assist the medical staff in crowd control. That has been one thing that did take a little bit of getting used to.

5:54

When you're at, a football game or a basketball game, there's a lot of referees and officials around the control crowd entering spaces. In equestrian, because of the layout of the facilities, you're talking about several rings outdoors, that are open from all angles, so you've gotta really rely on those other people. The second thing to consider with controlling emergencies and equestrian is that you are not alone in the ring as a competitor. So if there is an injury that occurs in the ring, knock on wood, let's say somebody is thrown, falls off, something like that, there is a very large animal who is probably not happy that we need to consider controlling. So seeing safety and entering those facilities during competition is essential.

6:39

We have to make sure we have the appropriate personnel on-site to control, we call it the equipment sometimes, but it's not, to control the horse. The horse has continued along its path even if it's dropped the rider. Now it's not guided, and it is essentially moving through the space. So we have to have a personnel there to make sure that is controlled, so that we can enter the ring safely, and attend to the injured app.

7:03

So the one thing I I guess I I I've been to your venue before, your your host venue. So the one of the things I that look at okay. You have parking is I guess, the the issue is having ambulance coming on-site. You have typically dirt a dirt a hard surface dirt road. Mhmm.

7:23

When it rains like it does here in the south, it rains at least. That's not a shower. And how do you account for that that type of because you're already in a in the the the the arena is already dirt. So you don't have a lot of hard surface. How do you all account for that?

7:39

Are you seeing that in other is that become a, using multi using, the the the carts emergency care carts, all terrain carts as an alternative?

7:50

All terrain carts are definitely an alternative. At our facility too, we bring our EMS crew, our coordinator coverage coordinator on-site to review the facility every year, and we have him actually drive through the spaces, to make sure that those are passable. If they're not, we obviously have to fix those before anything goes on. In a weather situation, the terrain does change, and so we talk about that from moving the ambulance around the rings in addition to move the ambulance in the rings. When, and interestingly enough, between the two disciplines, so we have what's called jumping seat and western.

8:24

Between those two disciplines, the surface within the ring is different. The, quote, the dirt is different. So you have to account for that when you're planning on moving ambulances in and out. The other interesting thing that we never like to talk about is if we and we do with our emergency staff. If we had to land a helicopter out here in this area for that type of support, that is an option because we have all this open land.

8:47

The special consideration in that is a lot of times that open land is a pasture, and there may be horses in that pasture. So we have to work. We have to preplan. We have to have preseason meetings to review how we're gonna handle all of those things. With rain, the surface does change in traction and ability to move.

9:08

So as we enter that space, we're working with our local professionals who specialize in the terrain, in the types of dirt. We review when they become unsafe. Some of our ambulances may not be able to enter if the rings have become very soaked. However, most of the times, if they're not passable by ambulance, we wouldn't have people competing in them.

9:28

So what are, we mentioned you've you've talked about some of this in in general, but what are some specific injuries that you typically see by riders during equestrian events? And, also, what is the I guess, what's the atypical, but maybe more than more serious side that you have encountered?

9:51

Riders typically we are kind of fortunate at least at this level. Our riders when they fall, we say they kind of fall well. So there's a way and method in order to do that. So when they are unexpectedly dismounted from horses, a lot of times that is basically resulting in bruises, contusions. SI malalignment is one I see a lot of.

10:15

I have seen shoulder dislocations from that falling on the outstretched arm, fractures from falling on the outstretched arm, as they try to roll through that fall. So those are some common ones from a traumatic standpoint. Fortunately, in a question a question is not a mainstream sport, so a lot of what we're doing is preventative, which I I enjoy. So we're trying to teach them how to do that, prepare them for how to do that, and then make them overall more fit, more strong, more flexible so that they can handle some of those things better. Other than that, the a lot of the injuries I see, a lot of the harder injuries I see are from not competition.

10:54

You can have a horse may become agitated or upset, and it's pulling on the reins. The person's holding on, and we've got a dislocated shoulder from that before. So we have those types of things.

11:07

So and what we're looking at is you're you're really, the other thing about is is high impact

11:12

Mhmm.

11:13

Potentially fall these are not just high impact or high velocity injuries. These are potentially compression injuries with if you have a, a disrupt you know, the horse is now becoming, if they go in the path of the horse going forward. Are there other, like, from a height that takes a whole different level of consideration. Now you're getting more potentially into the upward the torso, head, neck, falling outstretched arms, things like that as well. So good.

11:43

That's it's so it can the the those are probably more. Those are common. That's the common mechanism than it would be just I'm just gonna go run into someone. So we may see with the basketball basketball or otherwise. So let's shift gears a minute, and I wanna ask you about, like, just your collaboration.

12:02

So from a standpoint, obviously, you have to have a high level you've already discussed the level of collaboration and communication you have with your coaches, with the other the event staff, other organizers. How about when you travel I know, with to go into another venue and or you're coming in another team is coming in with, their athletic training and their medical staff. What any considerations or there are there certain horse like, do they know the horses or I know there's a whole another area because they don't they don't get to choose their horses. Right? They get to eat one's worth other, but just from a communication standpoint, what goes on?

12:45

So when a so if we're hosting an event, another another team is coming in here. Upon arrival, I'll reach out to the medical staff, which is typically the athletic trainer. From that point, we do the usual courtesy check ins and kind of explaining, hey. This is where everything is. This is what we have access to, those types of things.

13:02

Soon as EMS arrives on-site, which is typically right about that same time, I organize a medical time out between the athletic trainer and the ambulance personnel. We go over all of that. Events and coaches are brought in. The visiting team coaches are also present in that, so they have understanding of services, responsibilities, and plan. They're given time to ask questions.

13:25

Any follow ups or additional needs are done at that time.

13:28

K. Are there any, training or drills that you conduct that I mean, y'all do, but how how many are brought in? I mean, you talked about having EMS coming to do a walk through. Are you doing an annual since you were the the medical staff person, do y'all walk through or do a full, scenario walk through, or something along those lines where you're working on tabletop exercises, or how, typically, how often do y'all do those during a given year?

13:55

We review our emergency action plans with our medical staff, including any of our physicians that may cover an EMTs on an annual basis. As far as walk throughs, because of our rotating physician staff here, and the people who are on-site for coverage because EMS can rotate. We've had some EMS here locally, and I'm sure other people are experiencing this. It may not always be the same EMS personnel showing up. So once everyone is on-site together, we're gonna run through verbally what's gonna happen.

14:24

If there's any incident that occurs of any nature, then we do what I call kind of a medical debriefing after the fact to see if there's been any changes to what we need to do. If anyone on-site sees something that they have questions or concerns about, could we do it a different way? We talk about all those before the event happens so that everyone is on the same page. That's really important with all the different moving parts around these types of events. Everyone has to be on the same page.

14:51

Everyone has to know how to access emergency personnel. Everyone has to know where everyone's location is and how to reach everyone.

14:58

So with all those lines, I guess, think about how the it's medicine's evolved, and you all are evolving over you've been at your institution for how many years now?

15:09

19.

15:10

19. And how many championships have you won?

15:12

In this sport, I have more rings than fingers.

15:16

Okay. That's good. That's good to know. So, you you're doing well then, like you've mentioned as well. So, with that.

15:23

So one of the things that when I know when I came to we visit about a year or so ago, just looking at all the, you know, the advance we're seeing what's happening in the in sports medicine, what we're doing other than the, you know, structure, the basic the the emergency care equipment, are there any, equipment or advances that you all do that may that we may not have may not utilize in the typical like, we think of, you know, emergency medicine for football or otherwise that we okay. Here's how we do this or planning to a unique case that may may translate over to other areas.

16:07

As far as, like, the emergency management stuff, the one thing that has come up recently that's kind of been getting a lot of buzz, is the safety vest. So I don't know if anyone is aware of these. They essentially are pneumatic vest. They have air canisters. They are attached, to the front part of the saddle by a strap is what I'm gonna call it.

16:28

It is designed to deploy if the student athlete in jumping seat is essentially thrown or dislodged from their seat, it will then inflate to protect them as they fall. So this is a newer thing. It's it's been big in Europe for years from an industry standpoint. Problems or concerns that I have from an emergency management standpoint is there is no consistency in these vests. There is no one certification of this vest.

16:60

So I can have an athlete, who has some type of agreement or access to a state of the art, very well done vest, but I can also have some I've seen in smaller competitions, not ours, or in camps and clinics that I've visited that look like old spider straps that we put under football pads years ago. The problem that brings in is the way that they deflate, first of all. They have been known to prevent injuries. They have been known to cause injuries across the world. They can and have deflated prematurely.

17:36

They can and have deflated inconsistently. Sometimes those straps don't work. So the concern is, 1, an inconsistent piece of equipment that someone has. The fact that I may have a certain piece of equipment here or a certain type and someone else may have another. When EMS comes on-site, we are always reviewing that we don't have a consistent vest.

18:00

I do ask visiting personnel if they have any athletes wearing these vest, and if so, we can take a look at them to see them so that if any tragic or catastrophic situation occurred where spine boarding transport, all of those things, access to the chest was necessary, we could go over to the best of our ability what type they had and how to address a catastrophic emergency or cardiac situation with someone with a deployed vest on. Currently, like I said, to my knowledge and I've checked with my coaching staff in the federation, there has not been a certification standard. So I go back to my football days when I say the health plan has to be this certified. That doesn't exist for this fest, and so it's new. It's just one thing that's becoming a challenge that we're having a lot of discussions about how to manage.

18:47

The best way I found so far because, again, you can't tell in this sport, they can wear it if they want to. So finding out what type they have, what it looks like, how it's gonna deploy, and making sure that all the emergency medical personnel know that so that we have a plan prior to how to remove if necessary, how to deflate those types of things.

19:07

That becomes very problematic. I think just from a standpoint, I did not know that was that's a newer thing. And I've seen it in rodeo, and, you know, I wish I'd had that growing up because I grew up on a farm raising cattle. And I can't tell you how many times I was thrown off the front of the horse. But, also, you know, you can take that for what it's worth.

19:26

So it probably, brain damage otherwise. So, but any with that, though, you have to be thinking about how am I going not just how do you have the right equipment to do the removal, axe you mentioned access.

19:39

Mhmm.

19:39

And then also how you're going to stabilize a potential Mhmm. Head and neck injury. Right. So what with we we practice this with football and lacrosse, but also how to you know, having, a multi person, lift to get access to remove equipment as well. That's a whole different aspect as well.

19:60

20:00

And if it were If it were something like football pads and football helmet that is consistent and standard, then we can practice with that personnel. But since it's it's not a consistent it's not a consistent piece of equipment, we we can practice, we talk about, but the chances of some showing up with possibly a variation of that equipment is pretty high. We also have to make sure that EMS understands that the helmets, that jumping seat, so the smaller saddle, that jumping seat wears, those are certified by an agency, at least in Collegiate. So there is standard there, which is nice. But I need to make sure that my EMS personnel understands helmet for equestrian is not like helmet for football.

20:41

So we have to talk about the fact that it's fitted, how it goes on, making sure that they're comfortable with the potential for helmet no vest and helmet and vest in that side. In the western side, and I feel like I've ignored them a little bit, they don't have any protective headgear for the purpose of riding. They have a cowboy hat, and that is essentially part of a uniform or the aesthetic part of it. It's in no way a protective piece of equipment. There's been a lot of discussion about putting the western rider in a protective helmet, but thus far, the industry and the governing bodies have not made that call.

21:16

Put a helmet and put the big king big big hat. You know? It it'd be a lot bigger. But, yeah, it's okay.

21:22

So many ideas about how to do that, but, again, it's all discussion. And right now, the industry is not on board with that. Yeah.

21:29

I think the last thing we just want the the the the thing that popped to mind is, okay, you now you have a like, the going back to the vest and the helmet. Now you have it it expands, and now you have a different position of the head. You know? And then what happens if that is it, I guess, if it foam fills or whatever, it's solid or not, then you have to be thinking about what's how that's gonna happen if you puncture it, if it changes the neck position. So, that's a yeah.

21:56

That's yeah. That'd be that'd be a fun, session just to go through how to play with those. That would be just from a scenario standpoint. So

22:03

It is. And like I said, I can't say communication is important enough. That medical time out for us, I don't wanna say it's more essential, but because of all these weird little nuances, we really have to make sure every day before we start putting people in in the field of play that we all understand the parts that are involved.

22:21

Yeah. Wow. That's we went through a lot of questions here and got got a lot covered in the, 15 minutes or so, a little bit then some. So, I'm gonna throw if there's any other questions, I'm gonna have a quick, shout out to the audience. If you have any questions, go ahead and post those.

22:37

Or if you wanna raise your hand, we'll ask a question to, doctor Stanton, and then we will, we'll we're gonna move on to our last session for the day. So while we're waiting for this, what is the what's the injury or condition? I'm asked the doctor, Albert this. What's this I I guess, I would say, what's the what's something you can't make up? Like, in terms of you've seen in terms of an injury in the field that's, like, more of a it's a one off of did the somebody in this audience get injured or, like, an official or something that's very unique in terms of what you're dealing with around law you know, your your instrument, so to speak, but it's your it's the horse.

23:20

It's part of your equal participant.

23:23

They are an equal participant, and they are athletes. And so they have their own sports medicine team, which is very interesting. People may appreciate this. They're more sometimes the masters type athlete, the older type athlete. A lot of the horses that come into this field, that come into collegiate western have retired from their professional life, so they're not young.

23:43

So they have their own nuances. Weird injuries that happen, people get kicked. People in the crowds, if they're not where they're supposed to be, a 100% will get kicked. They will get bitten. There's all kinds of different pieces, and that's where communicating and controlling that space is such a fun challenge to keep them out.

23:60

Weird injuries that happen, and usually they happen because people aren't paying attention, which I think is is the main thing. You have a large animal there that has its own opinions about life. And one of our worst injuries in it, we've fallen out, stretched arm, broken arm, as we were leaving for nationals that day. She simply was playing around. She took the crop that they use, and she swung it too far forward, and the horse saw it.

24:25

And it was a sideways run and just threw her off. So we had, you know, we had concussion. We had fracture. We had surgery. We had all kinds of things going down, transport.

24:36

And that luckily happened at 6 AM in the morning when everyone was super fresh and ready to go. So, that was a little unique. I I think if people most of the injuries can be avoided if people are just intelligent about the fact that this is a living, breathing piece of equipment.

24:52

Yep. So, real quick is, the I have a question I'll text you 2 questions from the audience. Okay. Is do you keep spine boarding, scoop, stretcher, splints, and medical kits on the MTV or, your a ATV if you have an injury on the course?

25:09

Yes. We have we have AED spine board splints. I'm trying to get a spine board splints, crutches, extra splitting material, first aid equipment. We are moving into things like we have stuff like pulse oxes and all of those things to monitor vital signs. We have all those right there.

25:26

I say court side. It's ringside for us, and it is on, like, a Kubota, a t that type of thing, so it can easily move around the facility.

25:36

Alright. So here's, I'm a throw one last question. We'll move on. Is is there any difference in treating a horse bite versus other bite that we might you might encounter?

25:44

Strangely enough, I have the most animal bites, in in in our staff's history. One of them happened at football, but that's a different story. The ones in equestrian, you have to manage them just like you would any other animal bite. The fortunate thing is we tend to know the medical history of the aggressor or the, of the force in this situation. So we have that health.

26:08

We have to go through all the things that you do for any of our animal body. You do the first aid. You make sure you, you know, you check safety, make sure the controlled bleeding, all of those emergency action things. The lovely thing is then you have to do all the paperwork, because these are animal bites, so they are reportable. These are university properties, so you have to make sure people know about that.

26:27

A lot of time, risk management has to have a form. It's it's super exciting when someone gets bit around here. Nothing has ever been open to the point of requiring stitches, fortunately. Typically, their skin breaks and then just a ton of bruising. But I do like to let people know a horse will bite you anywhere it can reach.

26:47

So keep that in mind when you're moving around them. It's not just fingers and arms that these these horses are going after. Okay. They're going after. That's not fair.

26:56

I say it just happens by accident.

26:58

So the wrap up question. Sorry. Have you ever have you ever been kicked by a horse?

27:02

Me? No. I'm too smart.

27:04

Okay. You ever been thrown by the horse?

27:07

Not since I was 20 in Sweden. So I've never been thrown by a horse here.

27:11

Okay. And have you been bitten by the horse before?

27:14

No. I have not. But I can tell you a neat thing a unique thing for return to play for significant injury out here is I make them do what's almost like an old FCE type approach. They have to be able to bend, squat, and move from out from under the horse before we let the return to play.

27:31

And with that, just know that if you're around horses, don't turn your back because they will bite you in the back. That that is that is just words of advice, and Karen pointed that as knowing that as well. So that's just, they're they're wonderful animals and, and, but, also, they can also be dangerous as well. So

27:50

And and I just wanna say, horses are mostly nice. Bites don't occur as much as you think. Our people do a great job of controlling that. It's typically a spectator or someone who's not paying attention or who's aggravating the animal.

28:04

It does. So don't aggravate a horse. So that's that's that's the moral of the story. So, doctor Stanton, thank you so much. It's always great to have you, talk with you.

28:15

You brought you know, I'm I'm looking forward to having you back again, from the last time and this time, and now it would do down the line in the future. So, again, thank you so much, and I hope you have a great, summer as well.

28:27

You too, sir. Happy to be here. Thank you everybody for attending.

28:31

Great. Thank you so much. Okay.