Transcript
Alright.
Today, we'll be, addressing a unique setting in emergency medicine, and that includes track and field.
I think everybody on here has worked some form of track and field.
And as Ray has said to me before, it is either really good or it's either really bad when you go to a track meet.
Doctor Castle will be sharing his insights on the preparedness of an emergency action plan and how to be as efficient as possible during, track meets.
Next slide, Ray.
Snow conflicts of interest.
Any products device identified is used for demonstration endorsements.
So right.
Going to talk about the common emergencies, specifically in track and field, the role of the rapid assessment and initial management, as well as explore the coordinated efforts of a medical team.
That covers the event along with the, individuals that are on-site.
So, doctor Castle, welcome.
And, this, this large scale track event is a different beast than your local average track event where you are the athletic trainer and you know your setting, you know your your area.
What we're talking about is going in with athletic training services into large scale track events, which we had the luxury of covering here recently and learned a lot about our process of doing that.
You were the medical coordinator of that large event.
Just give us a general in in introduction because we're gonna be referring to this large event quite often.
Give us an introduction about this event that I'm referring to.
Well, the one we had I had actually 2 back to back events.
1, I was assisting coverage for the Sunbelt Conference track and field championships at University of Louisiana Monroe.
That was about a week and a or 2 weeks ago.
Had the opportunity to go up and assist with that.
And that which also afforded an opportunity to come back in to have, get, you know, eyes on and really see how the the the venue functioned in, slightly different manner, different some different setups for the National Junior College Track and Field Championships as a d one.
With outdoor we had this, last week.
It was over 3 days, including a practice day.
So all those, all the event days were Thursday, Friday, and Saturday.
So, you know, we have that.
We got I get to see that a little bit different with different perspectives.
So when we when, obviously, Ronnie and I and our team going in to run this, it was a little different perspective.
These are things that we need to really shore up.
And, really, it helped us really from a venue standpoint of, okay.
It rained had a heavy rain during this during that previous conference.
And so we're able to see where areas it it it it modified where we actually were gonna put our medical, operations, but also how we access or EMS accesses the course.
And, actually, in a couple of times, this came up in conversation.
Even though the ground was drier, we had to encounter this during 2 or one specific, situation.
So, for that.
Cool.
So you have to assist in 1 and lead the other in the same venue, so you really got 2 different perspectives that really, really was unique.
So let's just talk about emergency action planning when it comes to you being the coordinator.
What would you say are the top three elements that come to mind, when planning for this this event as a coordinator?
Let me preface that.
I probably should've said beforehand.
The diff probably the difference with that event is that we we have one one, group who's who is accustomed to running track meets.
And then the next week, it was a separate entity, and now but they had not they had officials there, everything else there, but they have not they had not, coordinated from an event organizer standpoint a large scale track meet, much less a track meet.
So that creates a little bit of a difference in terms of how some of the approach and having to emphasize some of the things.
So back in the question again was the 3 What
what are the 3 big things when you were approaching that meet?
The big three things from an emergency action planning standpoint that you said I have to try to really focus on a lot?
1st off oh, yeah.
1st off is having the that that having identifying what our, public safety resources are gonna be throughout the event.
That is spot in this case, we had Monroe Fire and EMS and also to Acadian Ambulance.
So they were both fantastic.
All those crews over 3 days.
That's the 4 one identifying that we have.
Number 2 is having ample resources physical resources outside of that, actually, on the course, athletic trainers, other medical support that are there, and then just identifying the communication modes.
That's really the the track meets are pretty straightforward.
I knew that, you know, what the venue looked like and but we had to really shore up in making sure everybody's on the same page from a communication standpoint.
So doctor Auger talked about trampoline, and my brain was like, okay.
Somebody collapsed on a trampoline.
Like, I'm trying to figure out, like, how I would be prepared for that.
Then we talked about horses, and that was unique because you have to account for this huge animal in the middle of it.
And now we get to track and feel, and it's different.
Like, it has its own weirdness or unique challenges.
What are those challenges in track and field that you see from an emergency action planning standpoint?
Probably the the bigger things you think about are 1 is is have to be you have to think about crowd control always.
That's then that was that's always something based on a new meeting of where they're not having access, where you can see what's going on, but also from other things, people coming in and interjecting, when they should not be in interjecting.
That's that's always a potential we see it with any sport.
You have to think about, like, for example, the the the pole vault and the triple jump, those type of injuries, you know, pole the poles crack or break, which we had a couple of it that were but it's about happened.
It happened during the week, probably.
I think Ronnie would, like, 3 or 4 poles during the, comp various competition, something like that.
Oh.
Then you think with fractures or other injuries, high high, falls, so to speak, that could be greater than 10:10 feet, which is now you have other and having other injuries.
And then you're thinking about, you know, obviously, the typical cardiac arrest, but also heat related illnesses.
Now with that being said, that's some of the things that the that the event officials mitigated on they moved out on one race, the 10 10000 move it to 7 o'clock in the morning for the women's and then back of the men's.
There were still issues with that.
Now keep in mind, it was in the it was around 70 or 71 degrees at 8 o'clock in the morning and still having a, have we had we had a heat related illness, or exertional heat stroke and have some other things that go on.
So you said we think about what that was in having right have the right equipment, have all that stuff staged up ready to to move throughout.
Yeah.
When covering this event, outside of my typical job that I sort of grew up in, which was high school sports, I'm always challenged to look at it through a different lens, and you're exactly right.
You know, pole snapping is not necessarily something that I saw at my track meet simply because the the level of energy that is generated in these poles.
Once you get up to a national level, there's a lot more forces being generated in all capacities, and that was definitely one that caught me off guard.
But let's just talk about now about, running a local track meet versus a national or international track meet?
In this case, it was a national one.
What makes the national one most unique?
You know, because it's national.
I mean, you have less and I think the thing to keep in mind is your setup would be we're gonna use the same the same philosophy, the same approach running we just wanna have as much as much as many assets or availability there.
You know?
So I know that we work indoor track meets, and that's a that's a little different confined space.
And I've worked high school outdoor meets and other ones as well.
It really depends on what you have available to manage those situations.
And if you don't have it, then you've gotta have that plan in place to what's gonna happen, you know, using bystanders, using coaches, other things as well.
So I think the the one thing is you're probably going to have you're gonna have less athletes.
Or I think the the numbers to this national championship were, I think, right under 900 total, give or take, which is pretty small considering, you know, that all the events are those are in qualifying events.
Number 2 is the level of competition is now streamlined down, so you're gonna have less You're you're gonna probably be defined in terms of the that not as many type of injuries you may see.
That's knock on wood.
But because they're better condition, they have other things going on versus in youth sports.
And there you know, there's adults versus youth.
We see the differences there.
So I think that standpoint having resources available, but, also, you have to really ensure you have those resources there.
I think, you know, we go back and look.
We had tremendous resources throughout, but we would probably still say now that we've done an event.
Okay.
We're this this type of event at that venue, how we can plan to make it even more efficient and do better as well.
So it was really cool to get to meet people from all over the United States and just strike up conversations because track meets are long, and you get to talk to a lot of people because you just have a lot of downtime.
And so we started meeting people, from Southern Idaho and Salt Lake City and these these just different environmental type of conditions.
Talk to me about, like, what were our expectations of bringing people from different climate cultures in the South Louisiana?
Well, I think the the the the typical thing is I know that I can run-in.
You would you had this conversation before, is that we know this is going something is going to happen.
We we know that.
And but we also know that something probably unique is gonna happen as well.
So you have to plan you have to know that that's going to happen.
There is always a if if it if it has happened before, more likely it can happen again.
In this case, we have environment, and it's you know, the temperature is very is is it is it's warm down here, to say the least, in in, you know, this time of year in May.
So that heat related illnesses was our was probably the number one concern going into the event, how we're going to manage this because we have athletes from, not just from, you know, lower elevation, but we're most part, we're at 0 ground level, you know, for the most part, versus you have athletes from, maybe from, out west that have, you know, from Utah or Idaho.
They're coming in, you know, 5 out 4000, 5000 feet change in elevation, and they're changing up so the the incidents but it can happen anywhere.
And so we didn't really think of it as there.
We just have to have make sure we we know it's going to happen.
So we didn't really we couldn't change anything different other than they change the event officials changed the 10,000 too early in the morning, which was tremendous.
It's actually a really good day that day in terms of temperature from ours from what we evaluated as.
But we still had to have everything multiple tanks be ready.
We have tarps to add on top of that.
We had ample ice.
We already staged that.
We have, you know, be prepared for heatstroke.
We also did the medical time out, which is really crucial in terms of talking with bar and EMS because they have not seen that's not their protocol.
So they were seeing this in real time, you know, how to effectively transport.
And I think the one thing that I emphasize to them is our job this weekend.
We're working with you.
It's our job as we don't want to use you.
We wanna do the things we can you know, we want you to have an easy day.
Because if we're working hard we're doing something extra, that means it's coming on as well.
So we had to, and they and I think they appreciated that.
That was a they were like, okay.
Great.
They we're on the same page, and we went through how we're gonna handle the like, a heat stroke or other condition coming in the medical tent.
And when we also mitigate we talked about because of the ground, where we different areas is wet, how we get we'd already talked through how we're going to get a gurney onto the medical area and how we need to, an alternate for that.
Like, we have litter patient litters that we use.
So
So let's keep talking about this medical time out a little bit more, because when you go into a new environment and like you said, you're trying to make connections with layers of emergency medicine resources, and they arrive at different times.
They they show up with different personnels on different days, and then they come in with their own personal backgrounds, their own personal protocols.
And, the track meet is is is often running.
Like like, talk to me about how do you pull that together to make it as efficient as possible with all of the busyness that goes around us at that time?
Well, one of the things we had, we had shift changes.
So we would go in you know, if you if you know that when this is gonna occur, then you have not just one person or big event.
You have to do 2 people.
You have to be be as concise as you can.
There's upfront communication.
We weren't sure who's gonna be there on-site, but we, you know, we preface that all we, per se.
You know, we were able to communicate some with the with the and we and and they know what we're going to do.
So, we went through a very brief process every day.
We had them there before the events began, and we walked through a very deliberate process.
This is what we're going to do, and this is how we need to handle the specifically for heat stroke because they're not accustomed to seeing that.
And we we showed them the equipment.
We showed them, you know, where or they they were in the medical tent area.
This is how we're gonna bring them in.
We need someone to be a to be a scribe and record the information, and then we're moving on with that.
So the medical time out talks about all the conditions.
It talks about what equipment we have available, what equipment we have on the field, but call and we have medical kits that we that all of our staff if you're on the field, you had Ronnie Ronnie.
We had probably 5 kits out on the track that were out there at any given or 5 or depending on how many we had are where where where they were based on the events at any given time.
We have we're having our full, trauma response kits that have AED, splints, airways, the full, you know, BLS, response.
So they need to know and we showed them that so they know what they see on-site as well before even though they're bringing their own equipment out or if they have to one goes out in advance, like, for example, fire and EMS may come out without equipment.
We could tell them beforehand what communication standpoint versus EMS bringing their whole gurney out with equipment.
So we worked, track meets at another venue in January February.
We worked 2 or 3 of them.
And then we came back, and now we're in May, and we're working at another venue.
And each one of them is different.
And they all I think of track similar to the oddness of wrestling and crowd control and managing around people and managing around different flows of traffic.
And so this one was no different than any other.
They had their own crowd control issues and working around people that were coming and going.
And talk to me about how we had to adjust or how you have to adjust when you go to venues that don't follow the patterns that you typically are used to to people around you.
Well, for starters, we have very our our clothing, everybody had the same clothing.
We knew how we you know, not just a lanyard, but we have red shirt with the medical.
We have hats.
We have those things that we can clearly identify who they are.
Oh, and by the way, we have these kits that are next to us as well.
So kinda stick out like a sore thumb.
But the the big thing is just trying to consistently work if there's not a consistent plan.
It's just to work with folks to get look.
We need to get these folks out of this area.
And there was one point in time where we went to the officials.
I'm like, look.
They they've gotta move out of this area, period.
This there was actually a well, I'll just say it.
We had an issue with an athlete, and we've seen this before.
We've always seen this twice.
We saw one where there was athlete got hit in the, in the throat chest area with the shot put, and we're still and I and trying to figure out what it's glanced off out of the area.
But then we also had this one injury where where an athlete was injured.
And this one time, and they I mentioned this earlier, is they decide to break through all the other stuff, and a teammate, whoever, decides to run across the the infield.
Well, we have areas blocked off, but, you know, when you have that and then you have the javelin going on, and then I'm I don't see this, but I hear this.
I'm dealing with another urgent issue going on, so I'm not paying attention to the infield track of the opposite side.
I knew there was an injury on the side.
But knowing that, and I hear this oh, and I'm I just recall that, and I come back with, did you see that?
Well, there's always person almost get hit by a javelin.
So that just like, it's in the land of you can't make this up.
And Yeah.
You know, so, that's a whole another story itself.
But did not get hit.
Thank goodness.
But you have to you have to plan for the unexpected.
And, you know, you you know things can happen.
You're prepared for those things.
And and, like, I like I've heard, you know, Ed Strath talk about this before.
Like, you plan for the I can't remember how he says it, but it's just planning for the unexpected.
But you have to be prepared for anything that happens in any given time, but knowing that typical that's just something atypical.
So, security is really big And that and that any large scale event, you have to have a security component even around the finish line.
And we had, you know, people at the finish line.
They're trying to get up in the the where the photographers are.
Like, you need to clear out this area.
We have to be active.
Just know that as a health care provider, you this is advocacy as well.
You have to be active and move people out of an area.
Like, if they're running down the street, you don't want them to run into a a photographer or something along those lines.
Well, it reminded me that you can't make any assumptions that the administration is is putting things in place that they've seen.
In a we have to take more aggressive approach to manage the crowd.
Even though it's not technically our responsibility, it is when it comes to safety.
You gotta speak up and not just sit back and and hope that they see what you're seeing.
And And I think the one thing it's you know, the the event the event we had, they were the the organizers were fantastic.
They they put things in place.
They were good.
They, I mean, they they were fantastic to work with.
It was just little gaps that they're that that that that got that throughout the event may have gotten exposed, and and we addressed it proactively.
So that's the one thing to keep in mind is the event staff is on board with it.
You're on board with it.
And just being aware it's just communication is, you know, helping getting officials know what was going on as well.
Alright.
Last question I have, and everybody's welcome to either open your mic or chat in with, Ray.
And my last question is, Ray, somebody else is going to try to do this, covered event, large scale national event at a venue that's not theirs.
And what would be your advice, to anybody that try to tackle something like this?
What what what do you say they need to start thinking about?
You know, I I think that the number one thing is is just ask.
You know, there are folks who want to there are folks who want any there who want you to succeed.
And that's one thing that something I've done over the years is I've gone like, I never covered, you know, triathlons or marathons, and then I started doing that with my with the company.
And I just started asking questions, start looking at data.
What are typical things that occur knowing that, hey.
You have this situation, that you have this.
I think the one thing that you, you know, don't listen to everything you hear, But, you know, I would tell you, you know, like, you're a high school athletic trainer, and you've been to an event like you like, at a local college and how they do it, and they have and you know they have x y z number of color coverage, then you map that out and say, hey.
I need to get to that point as best I can.
And if I can't, how do we handle this?
That's like, I do this for merit.
We've done this for marathons for a number of years.
I've good friend of mine's, Chris Torano's, the Boston Marathon.
And I look at those numbers and what's done there, and I'm not gonna meet those numbers for 26.2 miles.
But because I don't have the number of athletes.
But still, we've started looking at how we the comparative numbers, the the injury epidemiology, what what statistically, what's gonna happen in injury or casualty rates with the equipment you have, all those things.
And when you scale it down, then you have a similar process.
So it's still in in its scale its scalability.
Again, everything you're doing, you have to have the essential equipment and supplies.
Give people the tools to be successful having all the essential medical equipment, which means, you know, where your medical tent is.
That's for this event, you've gotta be near the finish line.
And if someone says tells you I need to be a far end, that just doesn't make sense because everybody's coming to right where you need to be.
And you need to be there because that's where most things happen.
You know, contrary to what you may think, whatever, with injuries and stuff like that, whether you're by yourself or not, that you need to be in that position to be most successful.
Because when they're sprinting, that's when they're they're most exertion at the very tail end.
That's where they fall.
That's where they your hurdles.
It's all where that area is versus being on the far side, out of the way when you can't can't be there.
Now granted, you know, like, it depends on the venue, but you need to be you need to be visible.
And b, doesn't mean you have to be there all the time, but you have to be able to help get help to help move people off the track and so on and so forth.
So there's no different verse on this.
It's the same you know, at the end of the day, track meets track meet.
So, you know, run straight, turn left, jump high, jump far, throw really far, don't get hurt.
It's kind you know, that's kind of the similar it that's the same for high school, college, International Olympics, you name it.
It's kinda this has some different, area things to think about.
So Chad asked a great question.
How did you come up with how much staff you need to cover in VIN?
What's your what's your formula?
What's your thoughts on that?
Well, the at the at the rope level, you need to think about, okay.
Look at the schedule of events.
So, like, for example, you have, you know, you have a track that's running around.
On one side, it's typically gonna have or an area is gonna have, like, a pole vault and long jump.
So what we do is you need to have somebody near where that where they are because there's gonna a jump at entry as well.
So it's no different than football practice.
If you have football practice at a college and somebody's over in the far field, are you gonna have somebody there?
Yes.
You're gonna so thinking applies.
It's it's a potential for entry.
So they're covering we'd have a person who would cover, that near the back straight area.
And we but typically divide a track up into quarters.
Like, you know, the the the first the first 100 meters, second 100, 3rd, or you can do it in thirds.
You know?
However, we would do that.
Basically, we have more resources.
We have somebody at the very end of the track because we need to be responsive to there, and then we have the finish line, and then we have are are these the the back the the final stretch and then the finish line area.
If there's someone in other venue, you gotta have it over there.
We had we had that case with a venue that's probably 200 meters from the track.
There's a throwing area, but had to have somebody over there.
Not that more than likely, they're throwing nothing's gonna happen.
The odds of it nothing happening, but the odd the odds are it's gonna happen.
So it still can happen.
So, you wanna think about where those are and then more having or you're adjusting to have the increased flow when you have a problem.
And you also have somebody like the medical multiple people with medical tint.
So that's where you have a flow, typical flow if you have more.
I like to work, you know, and Ronnie knows this.
We talk about it all the time is working in teams.
If you have teams, it works better.
But if you don't have teams, you gotta be able to function around that as well.
So and or we're moving and and but have that communication to shift.
And we have this in one particular case where there's athlete who is in a distance run.
We were already seeing noticing it.
We were communicating already, and then the the run run the the medical staff on the backside was just kinda moving forward and trying to address the problem before it address it, efficiently.
So
No.
For this track meet, we had anywhere between 45 in October 8 when I first saw that number.
Like, you sure we need this many?
And then when we got there, I was like, we need more.
Thank goodness we have all
the We we communicate with medical staff.
We had a core of core.
We had a core of 5 that was working consistently.
So and then we had brought in 6 person, then we had other folks coming in.
Plus, we have EMS and staff.
So that's where we you know, that was a and, again, that was a first run.
We had a relatively short time to plan for this from a budget standpoint, things like that.
But we also had, you know, utilizing local resources like, we use BCOM, the via college of osteopathic medicine.
So they had staff come in.
They had their students come in.
So that was that's that was the that helped tremendously.
But even after if we if you said we had this number, I'd probably go back and say we would probably would have you know, probably, we could we could double it easily just to work in teams, to work in shifts, and things like that as well.
So, that's the thing to keep in mind.
I think this you you learn from this and grow, based on the number of and and the schedule was, pretty straightforward, but we were able to you know, we we accomplished it.
But, also, there there's times when you need folks just to we were doing fluids as well so that, you know, I would doubt if we didn't have to do that, that probably would have said been a little bit different, I think, is having folks just dedicated just to doing fluid replacement versus us doing that.
So Libby asked a question about the medical tent, and I'm gonna kinda tag onto this a little bit more to her question.
And that is, I put my medical tent on the infield, and I put my medical tent off the infield.
But you said close to the finish line is a no brainer, but talk about the pros and cons of putting it in the infill versus out out of the infill.
Yeah.
Well, for this this last event we did, the issue was it rained.
And we were we I've been it was before it was dry, and it got wet.
So you it was a kind of a mosh pit.
So we moved it up into a higher elevation area, and it's still we had 3 temps.
It was still but we put tarps down just because and we left tarps there.
So because it would get muddy, but made it manageable to walk around and do the things we need to do around the tent.
I think that here are the advantages and disadvantages.
If you're inside the tent based on what the what events are going on, you have an access issue for athletes that come in.
They're there.
It does limit the number because you're pushing athletes to move out.
So they're coming to see you.
You're visible.
But the problem is if you have an event going on and you have an emergency and you have to get EMS into that tent, that becomes a problem as not continuing the the vent itself.
You know, if it's wet, you gotta have axe they meant to have a gurney, get access to it.
On the outside of the tent, it was it and it wasn't at the finish line.
It was probably, what, probably 30.
It was, like, 30 at the end of the quite 30 meters or so.
So if you need something, they know they're definitely gonna go there.
It's still visible, but we could still move back and forth.
And we're knowing it's more of an emergent issue, but also close for EMS access.
The problem with that area still was we it was rain.
It was elevated.
It was still wet, and we still couldn't you know, we had to think about having to transport or having a gurney move into the area when it was still wet.
So you have to have that backup plan of how you're gonna move it, and that came up as a conversation.
We wanna use a litter to move the athlete over to a gurney or just go because the ground was still wet.
So Yeah.
We're soft.
Excellent excellent questions.
We passed our time today, and, definitely appreciate this.
This has been very, it's been very good, Ray.
I love I love this format.
I hope everybody else enjoyed it.
And as we do more of these, hopefully, you will, feel free to join in the conversation because that's what we would like for you to do.
And so any last closing thoughts, Ray, as we wrap up these these three
Yeah.
I just wanna ask one thing.
It's it's not you know, Chad has this question about consideration of turning number of ATCs.
I'm gonna set I'm gonna throw this back and say, you have to have trained medical personnel at an event, and it works together.
You may not have the luxury of having you know, we think of having these athletic trainers.
We can't think in that mindset we have to have EMS.
And whenever you have the opportunity, if you have resources, and I've seen this on post before on social media, is it the question would be how many access do you have.
Never turn down the opportunity to have EMS or or fire EMS there.
That's that's a that's an it's additional hands on deck.
It's additional folks not to assume that we and to think that we cannot do something without fire and EMS is just not, it's not providing good care.
And, you know, and we I would like to not have to, you know but I just tell them, you know, they work, and we if worst case scenario but for that case, they're managing crowd control.
I mean, that's number 1 I want them there because with you know, within a practice standpoint, I don't need to go we don't need to go up in the stands when we have events going on.
So just make sure you can do the things you can do for any event.
It doesn't diminish what, any particular provider does.
It only enhances the the level of coverage.
And, just continue to that and ask questions.
Ask you know, reach out to us.
Reach out to anyone you have if you're trying to do an event for the first time, because you're gonna, you know, you're gonna learn from your mistakes, and that's called review.
It's called debrief.
It's called you know, those the how you get better every single time.
So hope that's the probably the one thing I would say is, my kind of a passing, or ending comment there.
I mean, thank you for the opportunity to, listen today.
You had a great audience here today and participation.
On Your Mark, Get Set, Respond: Emergency Preparedness for Large-Scale Track & Field Meets
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Updated May 30, 2024
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