Transcript
Hello, everyone.
This is Ray Castle, and I'm the moderator today for the 2nd session of the Sports And Emergency Care symposium.
And I'm I'm pleased to have Ron Kors at University of Georgia, who will be this presenting this session this as his time.
Couple housekeeping notes Before we get started, we got we get some fantastic information coming to you.
And in this presentation, it's a great follow-up to Doctor.
Horodyski where we're gonna talk more about the evidence and and what as far as when to make those decisions and should drive your protocols and practice as well.
So couple quick housekeeping notes again.
One is jump in the chat and let us know where you're from.
We really enjoy having being able to see where the difference in the settings you're from.
It's for as we move through the presentation, please do go into the q and a button and you can ask your questions or if something comes up during the middle of presentation, go ahead and ask it.
And then we will at the end, we do have a live q and or have a q and a session.
We can answer those questions.
To make sure those during this session.
And if for some reason, we we have more questions and we can answer during the time frame, then we're we're gonna come back and get those make sure you'll get those questions answered after the symposium to everyone.
So it's a tremendous pleasure to have Ron, not as a friend, but also as a respected colleague.
Good morning good afternoon, Ron.
How are you doing?
Thanks, Ray.
It's a Christmas beater today.
Oh, great.
I I appreciate you taking time out of your schedule to join us on the symposium.
So Real brief, you go to website.
You can see Ron's a compliment.
Ron is truly the the driving force in the sports medicine world related to emergency medical care.
He's been doing that for he's been doing it for a number of years, and he has been at the since number of universities, but more several universities, but since 1995, they're serving the director of rehabilitation, sports medicine, or and or at I'm sorry.
At I think we got the dates wrong right there as well, so at University of Georgia.
He has been world renowned in his work in Emergency Medicine.
He's been involved with the u s Olympic Committee, with a team.
He's worked with the 98 Soul Games.
Work with Atlanta Olympic Planning Committee as well.
He's been he's also previously served on the NCAA competitive safeguards and medical aspects of sports committee as well as past president of Southeastern Conference Sports Medicine Committee and also currently serves as some of the highlights is is he is on a member of currently serves as NFL Health And Safety Committee.
And he's been well accomplished in number of his awards and what he does.
He's a expert on number of different areas in terms of protocols.
And this is one area that he's been published in or being a lead in this and with that.
So with the Mercy Care and Spine Board injury.
So or spine injuries and medical care.
So, Ron, I'm gonna give it over to you.
And it's, again, it's a pleasure to have you here today.
Hey.
Thank you, Ray.
Today, we're gonna talk about current concepts of mastocyspine injuries and quid removal.
It's a privilege to be here.
I don't think I'm live on the screen share for advanced slide.
May to try to click on the on your screen.
It should be you shouldn't you shouldn't have access.
Okay.
There you
go.
There it is.
From a disclosure standpoint, I didn't have any financial conflicts.
I did was the coach here of the Unit TA Spineers' support group back in 2019, 2020.
And that's what we're gonna discuss today.
This was group we put together back in 2019.
We actually had 25 different medical professionals.
A wide variety of people from physicians in emergency medicine, orthopedic surgery, neurosurgery, primary care sports medicine, athletrans from wide variety backgrounds, from the clinical setting to high school, to collegiate different levels and professional.
And what we try to do is to put together an evidence based paper on the maximum spine injuries.
We did a modified Delphi study, and At this time, there were some changing standards in EMS, so we really wanna talk about health care options.
And that's what I left us today.
There's not a right or wrong to do this.
One of those options.
And there can be some variability here based upon what the city you're at, what type of EMS response you have, and what type of equipment train you have available.
Now we know there's enormous impact associated with the catastrophic spine injury, and now with the physical, with the person involved, financial some devastating financial costs and emotional.
And, again, not only would the athlete involved but family, friends, teammates, and coaches, American tackle football has the highest number of catch up and spot injuries among all the sports players in the United States.
And there was a epidemiological study done a few years ago that showed the direct contact issues represent almost 91% of all spine injuries.
Keep in mind that even though we have a sizeable number of spine injuries, and are qualified, there may be much larger than majors that are expected and may require some final precautions prior to having definitive diagnosis.
Now there's some differences between the student f and football degenerative population.
Number 1, they're typically younger.
They have good bone health.
There's less comorbidities.
Many times in a a motor vehicle accident or violence, you may have public trauma.
When in sports situation, you may have isolated spine injury and maybe a common head injury as well, but with some heat challenge environments that too, particularly with the helmet shoulder pads.
We're talking about equipment to support with football, They serve a purpose for protection where they could be a treatment barrier when we have an injury.
So that was really the primary reason this test was commissioned and funded is to try to take a critical look at equipment laden sports with respect to spine injury, how to best treat those.
Again, we had 25 healthcare providers.
I had the opportunity to co chair this along with Jim Ellis.
Who is the Mercy Michael Cassello from NFL, the medical director, USFL.
Instead of hearing, who's a a long time team position with the CLC Hawks, and he was still watching.
We started out first with a pretty extensive lit review.
We actually looked over 1500 articles that were peer reviewed related to spine injury, and then we did a modified Delphi study We had a face to face meeting Atlanta towards in 2019 at the shipper center with all the the members involved.
And we actually came out with 3 initiatives First, we had an evidence based paper with sort criteria under appropriate care of the Spanish athlete.
And then we actually published that multiple times in the animals emergency medicine trying to target emergency repositions.
Inclinic sports medicine, tried to target, you know, athlete trainers and department care physicians.
The journal athlete training, targeted specifically athlete trainers, and the last journal of University of Medical Services, Targeting EMS.
We also had a best practice of curbside paper, which are really a Dylan team more today.
And we had an educational video.
If you haven't had the opportunity to see the video, I strongly encourage you to do it.
It's available for free on the entertainment website.
If you go to n a t a dot org, you go the response section.
And this is a 15 minute video put together in the University of Washington And it's really targeted to all healthcare providers, not just health trainers, EMS physicians, and something can be used from an educational standpoint of health training rooms.
Educational settings that help avoid hospital personnel, equipment removal, and also EMS.
Just a quick review of spinal cord in that knee.
You know, the spinal cord is encased and the spinal canal.
It's very well protected from a phony standpoint.
But if you have a fracture instability of the cervical spine, you can have an impact on the spinal cord.
Particularly wanna be aware of a printed nerve is interlace C35 that fix the diaphragm muscle can have respiratory compromised.
The other thing to think about is not just a primary effects of a spinal injury, but the second and tertiary effects.
If you think about the closed box system, we also form the brain, If we have a brain injury source to swell, it can spin to a certain point, and then the skull is rigid with bone.
It can't span anymore.
We can hit secondary cup complications.
We can have the same thing with spine injury.
If we have an injury, then the spinal cord itself is evidence here, the spinal cord is gonna start to swell.
Reduce the point where we can't expand anymore, we can have tissue ischemia and has secondary complications.
So we wanna try to try to minimize it as much as we can and that's where all the field care becomes so important.
Now, we can have although centric, we can Casa Alfentry was sudden death, and the risk increases when it involves the upper circle spine.
So the first critical step is recognition.
Anything in immersing medicine, we can't treat to or recognize specifically what we have.
Once we recognize it, we have prop treatment in the prehospital setting, and we will have Tommy identification treatment.
The biggest thing is cause no harm.
Wanna find a way to get a quick diagnosis, package that person appropriately, and then the definitive care facility without doing it for the harm.
And that's our biggest is emergency medicine.
We had some changes back in But 2015, 2016, when the American Council, Mercy Messen, came out and chased EMS upon standards.
And the first thing that they tried was that it limerick term spiral mobilization, which is a a valid point.
The reality is that we have a nice stable spine with injury, no matter how we package that, we can't really immobilize it.
So he moved the term for mobilization to his final most restriction.
And then they came out with some certain criteria for defining when we should immobilize or spiral most restrict someone.
In the past from an EMS standpoint, and I've been EMT for a number of years, Anytime we respond to the scene, had complaints of spod pain, it was automatically mobilization at that time.
So what they're talking about now is taking a critical look at criteria and determining who and if needs to be spun the most nutrition.
And they basically broke it out of 2 categories.
And from a pure epic standpoint, it will listen to change what we do, where if we respond to a situation we have a a spinal injury, if they have normal level counts, and that's really important because we have to have level counts to be able to do a a thorough assessment.
Where they have normal level castes, nose mount tinnitus, no atomic abnormality, and no level of findings is not necessary and necessarily restrict that movement.
However, if we think about an athlete mechanism like a football player with an hexagonal mechanism, we get blood trauma, we get also go for cashness, We've got spinal pain receptors.
We have nerves like a plate.
We may have an atopic dermatitis and injury.
Any of those criteria indicate that we need to do a spinal most restriction now.
There's a wide variety of variables that we had to be aware of.
And the first one is known in your state and your local protocols.
If I called 911, it had to be an EMS.
When they arrived, EMS or all health care providers just like health trainers, and they're working on the the direct supervision of a of a medical director or a physician.
So just like we are probably in to follow our team position, they're probably they're following medical control.
So they may have a set protocol that they have to follow.
If we have a deviation for more protocol than theirs, that's where we create a conflict.
So it's really important on the front end to know as a provider, Why does the local protocol for spine injury my locale?
And what's the state protocol for that?
The next thing to think about is what emergency equipments available.
And this change would would be changed in ASAP.
There's actually a couple of states in the United States right now.
Michigan, New Hampshire, in particular, that no one would carry richest mobiles and ambulances.
So if you're able to trade in those states and you wanna have a rich responder board, you have to make arrangements to have that in your inventory on your facility.
So no one else equipment is available.
The next one is really critical.
It's a number of personnel assigned.
And this one we talked about options.
There's a wide variety different moving things we can do, moving from the the lift in slide or the multi person lift, the law rule and read those a detail about how many trained personnel you have on-site.
Positioning the athlete is athlete prone, is a FTC pawn.
If they're prone, as they're hitting the initial position, many times, particularly in football with a face mask.
If they're prone, the face by someone may kick in the side and the lower rotation flexion.
So what's the position you have to eat?
Are there space restrictions?
For example, it was a heavily handle facility, maybe tackling this wall, or deep into the sideline, and it gets a bench of defense or equity system.
It was minimize the number of riskiers and location around them.
And the last is seeing safety and seeing control.
Now from a background standpoint, there may be a variety of healthcare professionals involved.
We have a spine injury on the field.
It can range from physicians and various specialties to athlete trainers, student led trainers, EMS, and your EMS may raise as well from a paramedic to advance to a basic.
So it's important to make sure that everybody understands it has a well coordinated plan.
And we're working together to have some guidelines so we can face management.
And that was with the person's paper to try to develop some standardized guidelines as well as terminology.
It goes back to preparation teamwork.
What makes a great team?
We work together, put our egos aside, and we have a common goal.
And understand that everybody has different roles.
There's a quarterback.
There's a wide receiver.
There's blockers.
Everybody has a specific role they have to play.
The same thing with sports medicine.
And and the same thing by that matter, not only are coordinated roles, but there's specific tasks that we have to do It's just like a football team practice every day, almost tasks, we have to as well.
The techniques we're gonna talk about are motor honing skills, and you can't not do them on a regular basis, expected to be proficient in how much time arise.
So we have to work together, and we have to practice and rehearse, scenario, basically, as well.
I worked a number of years for doctor Andrew's Jim Andrew's says, well, we're now working serves, and he always says saying, there's no such thing as always.
And never messing.
We like to think that many things are black and white, but particularly inspired, we have a lot of gray issues.
And one thing we wanna think about is every emergency situation is unique and every patient is different.
So that's why you talk about options as body care.
We wanna be familiar with all the techniques And based upon that specific situation and that specific patient, we apply the techniques that we need to do.
So the bottom line is into this circumstance should dictate appropriate actions in all cases.
Teamwork and communication.
Again, we have a life threatening situation.
This is not the time to discuss inside on what we wanna do.
What the recommendations with the task force was that every organization come out with a spine injury protocol.
Many of the if you hear if you're an ECA amplifier, severity goes to NCIC mandated that we had to have a written contested protocol.
And our person thought it was one of the best things we did because it helps put all your health care providers on the same page.
Again, you can decide what's best for your scenario, but then you know your athlete trainers, your doctors on the same page.
Just like this, and it gets a little even more advanced than the concussion protocol because now we're involving different players such as EMS.
So we actually recommend that you have a a written cease by protocol It talks about medical direction, Houston Sharks, has been reviewed by your medical director, your neurosurgeon, North Kakes surgeon.
EMS, athletic trainers.
So again, we have the situation.
We've already set an appropriate treatment, and we're all the same page.
We need to have an emergency action plan and needs to be written and approved by the team physicians.
Again, going back, we're working in a middle direction, we wanna make sure our team is just signed off on it.
And, also, it's been involved in EMS.
This, I think, was one of the definitive parts that come out with the papers, making sure that we have a written Spanish Jamaican protocol.
And that's considered now best practice of developers in support call.
Having a transportation plan you know, what's our primary hospital?
And it's not necessarily the closest hospital or what's the definitive hospital takes somebody with potential spinal cord injury.
If we have access to it and again we have to understand this not ever said and if we have access to a trauma center, they're really more designed to take care of a Spanish or athlete had definitive care right there.
And we wanna think about having a hospital protocol for equipment removal.
Think about inserts on a record basis with the hospital staff to make sure if you transport someone there that has equipment at home, that the physician, the ED, the wardlies, the nurses are familiar with the equipment, and they know how to remove it.
And we also wanna think about referral to a spinal rehab facility.
If we have a gastroenterologist, they're gonna be stabilized and managed in the 1st hospital, and it can be transferred to rehab facility.
Do we have one in mind that we would like to use in the enforced situation happens?
A big thing is what we call the medical time out.
This was coined about 10 years ago in 2013 by the NTA.
And the real thing is one of the most significant things we've done.
It's the same concept as when we have a time out in surgery and we have an athlete time out.
We try to get organized because miscommunication can lead to some potential catastrophic errors.
So before the game starts, before the practice starts, We want to get all the health care providers together and talk about what's our EAP?
What are emergency protocols?
What equipment do we have on-site?
Where's it located at?
In 1 of our care options, we offer a macro personnel.
And this is a really critical concept.
In work's assessment, Again, recognize the key, we can't treat what we have in value it properly.
So it starts first with recognition for potential, and then our emergency assessment.
Really three parts, my seat size up.
As an athlete trader, blessed me to have to be on the field and see the Maker's Venture.
So if we saw the difference in back of one receiver come in on the collision and the difference in back hit the head lower down with a hexagonal mechanism impacting the crowd of the head, I think as I go out there, there was a potential for a spine and also a head injury.
Do they appear to me moving when I go out of the motionless?
It's a peer senior, pretty safe and sink control when I get under my primary survey, and we we change now to make, circulates my primary component, circulation away breathing.
Was it levocarcus?
Levocarcus turned by aptitude?
Are they alert?
If not, they respond to verbal.
If not, they respond to pain, if now they are responsive.
So Velocast is by appu, and then my signer survey, a detailed signer assessment, vital signs in my sample medical history.
Sync Control.
It's been said sometimes that commas contagious and that's really important.
As a healthcare professional, in a tense scene like that, we need to exude confidence.
If we're calm, everybody rest will remain calm.
But the same point, panic is contagious.
So we set the tone and how we act and how we control the scene.
Remember, Boston is making very well intention, but they can cause distractions.
So that's part of the medical time out before the game.
Get with the game official.
Hey, Mister official.
We have a history on the field.
Can you help keep the team back in the box?
We use our student athletic trainers.
We actually use a chaplain.
He does a great job.
We have an Israel in the field.
He gets a team together.
And says a prayer.
But again, making sure that we keep the sink controlled and it makes easy access for the ambulance and mercy card to get an equipment it keeps the noise down so we can communicate well.
But here, we wanna eliminate distractions.
In this example, the night control scene, and again, These people may be well intentioned, but they're in the way.
So when you're here, there's a lot of noise around.
It's hard to communicate.
It's hard to get the carbon equipment in.
And you have space considerations.
So again, failure to maintain a buffer zone between the initial person and the number of personnel didn't allow appropriate space to work.
Again, think about sync control.
Circum spine in any situation or suspected spine injury, the first thing is cspine stabilization.
Also think about who's your first responder?
And who you want to take this?
As the HIPAA trainer, retro sports master, and I purposely wanna keep my hands free for evaluation.
So I'm on the field of play, and we have a potential injury, is we're going out there must have no.
You know, I'm gonna keep my hands free.
So the first one out there besides me gonna be the one to get cease my sexualization.
If we have to transfer techniques between me and the rescuer, we'll talk about the cement and we're doing quick removal, we had to have clear effect of communication.
The big question that we talked about this is when should protective equipment be removed?
It has been removed at some point.
It's been removed on-site by the hospital ED, and there's not a right or wrong answer.
The one thing we need to keep in mind is regardless, we need to have access to airway prior to transport.
The worst thing can happen is we decide to leave the equipment in place.
When we put the I have to leave the back of the ambulance with 1 paramedic, and they may be in in good respiratory conditions at that point.
But somewhere in transport, if they go on the respiratory compromised or respiratory arrest, Now you get a situation where they have one person back there that's gonna have access to airway, and they're willing to know how they can move equipment by themselves.
So when we transport regardless of where we stand, so one or 2 things.
Make sure we remove the face mask or remove the helmet shoulder panels so we have access to airway.
And that's critical concept.
And that is done regardless of whether we move the equipment off-site or the hospital ED.
Now there's some advances on moving the equipment on-site.
If we do that, it it still takes sufficient evaluation when they arrive, if it still takes diagnostic testing.
And from a packing standpoint, it actually makes it easier, and we can do a better job of packaging them.
We can get a sulfur colored home.
Which we can't do a hemoglobin plate.
And with the pads off, we get the strapping system closer to the body and secure them to the board better.
Protect the equipment removal regardless of worsening requires trained and experienced rescuers.
And again, that doesn't matter if it's on the field of play or send the EV training experience rescuers.
These are motor skills as we practice on regular basis.
First, we wanna be familiar with face mask removal.
And this goes back to knowing what type of helmets we have, how to read the face mask or the quick release clips.
There's different types of those.
We wanna think about having the combined tool approach whether it's a cord screwdriver or cutting device.
We gotta be familiar with the type of helmets, and there's a wide variety of helmets right now, and each of them have their own different nuances.
It's really important that we're familiar with those.
The same thing with the shoulder pass.
Shoulder pass had changed dramatically in the past years.
Traditionally, all the shoulder pass at lacing system up front.
It was easily cut or untie, and you could open expose a chest.
Now you're seeing a wide variety of shoulder pads ever fall in the fry.
And some of these have material that is very difficult to not impossible to cut with paramedics shares.
So how do we take those off?
We also have the the Rodel Wip Court, which is a quick release made specific emergencies.
So we'll be familiar with my types of shoulder pads and my type of helmets.
Equipment removal, regardless of what's done, it should be done by those at the hospital with training.
One of the reason we started thinking about the possibility of doing on the field If you think about the reality is we typically have more people trained equipment removal on the field of play in a worse situation than we do in the hospital.
How many times have you all may have had this happen in the audience where you're the athlete trained on the field of play, and you have a suspected spot injury.
You do sponsor most restriction.
You practice them.
You put them back in handouts.
You lead the same.
You travel back in handouts when you're shooting athlete.
Are you out with the hospital ED?
You come in, you're the only athlete trainer there.
And maybe the physician comes in as a a quick evaluation, says, hey, Ron, Let's go and get equipment off, and I'll come and take a look at it.
We'll do some diagnostic tests.
Well, now you're in a situation where you may be the only one in the hospital familiar with that, take equipment off.
And he may have some physicians and nurses of what is in a well meaning, but they don't know how to do it.
So that may not be the safe situation.
So a couple of things we can resolve as number 1, we can take the kickoff and fill the play.
We have more trained personnel.
Are number 2, we can take steps in advance to train people in the hospital to know how to use equipment.
Now regardless again of where we take it off, it's on the fill of play or it's in the hospital to take the helicorder pass it off, it requires transfer the cspondylolization.
Now, the PARAMENTIC here, RESUROR 1, Rob, the FLATRAINER, RESUROR 2, Right now, the paramedics can see spot control.
Rob is gonna come in and take seat spot control from the front because the paramedics here is the best to take the helmet off.
We have to transfer control.
So we're ops gonna come in here with what we call an enter, poster technique.
He's gonna take his left hand right here, he's ingress a chin.
He's take his right hand to come underneath here and grasp the the back of the the spine, and the posterior spine, the back of the the skull.
He's got, like, a pitch grip here.
He has a control.
The nice thing about the stool, we can control rotation.
Supposed to meet a ladder technique.
We don't have to go on either side of the head, so not to meet the cheek pads.
Once Rob has control, he's gonna say, I have seized my control.
If you can release And now the pyramid can take the steps and cut the the champagne straps and go and take the helmet off.
But, again, it requires a transition with clear communication and clear coordination.
Once the helmet solar pads are removed, we can put a rigid circle simulation device on And again, we can get try to immobilize the simple smile as best we can.
Now, current recommendations or the mobilize head and neck in a neutral moment, and this goes back to anatomy in a closed box system.
By getting the spinal cord is contained with the spinal canal, Spotter cows, Bonnie, and rigid.
Once I have my primary insult to my injury, it starts to swell.
Now it continues to swell.
It's gonna reach a point where he's the borders of the spinal canal and can't swim anymore.
So I wanna make sure that I try to keep them in a neutral position.
If I'm flexed, if I'm extended, if I'm mildly flex rotated, my spondylosis.
I'm at the WiSpan Canal diameter, we're in the initial position.
So we can with a cost of further harm.
We wanna do that at the time we package them.
Best concept of mutual alignment.
Now I wanna be careful if if I reach a point where where I feel like they don't wanna go.
I don't wanna try to actually nip with the spine.
I wanna try to bring in an intro, but if I meet resistance, I'm gonna mobilize some position around.
But if we can safely, we wanna bring the neutral position in the mobile system there.
Again, we can't complete a muscle response.
We used to turn a spinal motion restriction, and the premise of this is reduce myelomos as much as we can and prevent further harm to spinal cord.
The first step is endless stabilization.
So as the infiltrator go on the field, I see the mechanism of injury, I go out, Again, my responder here, and this goes viral.
Most restrictions.
I'm gonna take my hands here, and I want my thumbs, the key concept, isthumbs toward the face.
And this regards toward the athlete's prime.
You see in the slide here, the shoe prime comes toward the face.
They're prone here and get them toward the face.
And the reason that it's important as we roll him over, I don't wanna have to change my hand position.
Now one thing to think about here is this picture really illustrates as well.
As a young athlete trainer, I used to worry about having pro athlete because it does complicate things.
When it goes back to how do you look at things as a positive or negative.
From a negative standpoint, they're prone and they don't have as much access to their face and maybe a little more difficult in the eval.
But from a positive standpoint, if they're stable, if they're circulation airbag, whether they're intact or stable, I can go and take my time before I immediately rolled them over, I take my paramedics shares.
I can cut them back in Jersey.
I cut them back in pads.
And once I roll them over, it's easy to bobble over the passing front and take them off.
Actually, it's an advantage.
But the first thing I want to think about in my stabilization, I'm just putting my hands on medial outer side of their of their head.
I'm not trying to plot traction just to keep your head nice and still.
Then I want to think about spondylosis friction.
There's a wide variety of things that we see used throughout the country now.
Again, the gold standard is typically the richest spot board.
You may see the script stretcher Now many times this is actually carried more from a hip standpoint, like somebody who hit fracture this location, where this is an exit tool that can be used where the supine athlete is not effective on a pro athlete.
The guardian, many states now are simply due on, like, a multi person left.
And picking the athlete up and putting them on the gurney.
Subtype, particularly motorway Lexus, we may see the kindergarten education adviser KD This is a half spine board.
It's really designed for someone in a car when they're seated in a position.
Their pelvis in their backs is in that degree angle.
But this is actually really nice too.
It's nice coming to football, but say, for example, I'm covering gymnastics and I haven't had to leave the phone yet.
May tells you in the Sydney position.
Maybe I haven't had to they came off the pole lock pit, and they're on the ground to see position.
This is actually a nice device.
And then vacuum mobilization, It's not Tom.
We found the US as more standard care in Europe, but we may still see it from Tom Tom.
We won't be aware of this option.
Again, there's a wide variability.
And part of this, you can know what may be in the ATLAS or EMS unit, Kevin.
The big thing was selecting my device be aware of my local and state EMS protocols, and that goes back again in advance finding out what my locale does for my EMS.
They may have, for example, a protocol for a medical director says we'll always use a rich responder board.
So that's what they're gonna use because just like AmpliTraders working in our doctors, to work in a medical discretion, a medical direction.
For this consideration, the injury mechanism, the athlete size, for example, again, if I have a 350 pounder, Even through soup pod, the soup structure may not be appropriate device for them because it's just too small for new size.
The equipment will be athletes And, again, the big factor, number of skill out of the people of the sports medicine team.
Again, a number of things have changed regarding guidelines.
We will be familiar with the email system policy, and we wanna think about, you know, the the best way they should take them from the scene.
Now what we're seeing more and more in the house is bullet point.
They made the paramedics may educate the person, they place them on the recent device, Once you have a little stretch, they may remove the device.
That was actually our protocol here in Hackenska Park County, and we simply went to medical direction and said, We'd like to keep it on the board from the time we immobilize them till the time we get in the hospital.
With the rationale, we're gonna have to transfer them to the gurney to another gurney in the hospital.
They may have to go with MRI until we have a defend diagnosis.
We'd like to keep them as restrictive as we can, and the medical director was fine with that.
But again, communicate that beforehand having the plans of critical importance.
And historically, going back, Regional mobilization has been really successful.
There was some pushback, and one of the reasons they said made the changes.
It can be some deleterious effects.
With a prolonged mobilization.
And by prolonged, we're talking several hours.
We do wanna try to get them off the board as quickly as possible, and our goal is to do it in less than 30 minutes here and a half is from the time we put them on the board to the time we get the hospital and evaluate.
Now one thing you can't de minimise discomfort.
And if you read a mobiles on board, it's a couple of your bunny promises, your scapula, your PSIS, and your pelvis, your heels, the back of your head if the hell is removed.
So we can help mitigate the having a padded board.
Now right now, they don't make a commercially padded oversized board.
You can buy padded normal boards.
So what you actually do with an oversized boards, we take adhesive foam padding is applied to there.
There is also a commercially available vacuum pad that you can put on top of the spine where it's just flat, that you can hold through the f this body.
But there are some techniques we can use to try to mitigate discomfort for prolonged mobilization.
Now there's different ways we can do this from a transfer technique.
And again, as we talked about before, every situation is different.
So listen to those circumstances and picking sheets are more appropriate.
Now, law rule is a more common one is consider the standard of care in EMS.
It can be used for both supine proton athletes.
The scoop stretcher can only be used for supine athletes.
The multi person lift can only use subsequent athletes.
And, also, now there's some variations in road commands, hand position, board angle steering techniques.
Really, that's more of your own particular protocol.
There's not a right or wrong about, if you say 123 or 321, If you do a regular hand position cross hands, it's what is coupled to your protocol in what you practice a horse and familiar with on a regular basis.
With the 2 most common techniques we see are the long rope and the multi person lift, and he we won't be fishing with both of these.
The multi person left in a previously, we had the crustace for Ameribirth Ordyski.
He's really got some ground working research universe in Florida, and she's shown it in multiple clever studies.
The multi person lift has less circle motion.
That doesn't mean I'm always gonna do with multiple person lift.
Now, for example, in my situation, I may have in University of Georgia, a number of voicemail technicians and physicians, and have a transcriptions today, and I have the numbers to do that.
In the high school situation, my my only provider, and I bring into paramedics with EMS, there's no other people do it.
I have to have a minimum of eight people in the multi person left.
Also, I can only do it in a super athlete.
So, again, it goes back to be familiar with all techniques and pick the most appropriate one based on what we have.
In the multi person left, I've got rescue or one here at the head, and the person ahead is always gonna have the commands in in big Make the calls.
I've got rescue here with the smile we're signing in.
I've got 3 rescuers on the left, 3 rescuers on the right.
Knows all positioned the same way, everyone on their knees spaced out appropriately.
I wanna make sure that I don't have, like, one person on knees.
One person squatting down, one person on one foot and one knee.
Also, I wanna think about the size of my rescuers.
If I have smaller rescuers that need better at the bottom by the feet, who are my larger stronger rescuers here at the top with some more weight with the body.
Again, I've got my rescuers positioned on the the count of 3.
We're gonna pick that up for the approximate 6 inches, 123 in unison.
When you're up in the air, risk your raise is gonna slide the board underneath.
With the voice of position, we have the command to lower.
The logo technique is still by far the most company less maneuvering EMS.
Actually, I've been a long time EMS instructor in in the vast majority of EMS textbooks.
The multi person lift is still not talked about.
Because, again, if you think about from me as a standpoint, how often do you have any for our risk agreements people there?
So, again, the goal center right now in the US is real local technique.
It's the one they're most familiar with.
The local technique typically requires 5 rescuers.
You have one at the head.
You have one at the board and 2 to 3 rescuers here on the side.
Rescue 1 is positioned ahead.
Restaurants here are gonna roll the athlete on the board.
And again, it's it's it can be a very efficient technique.
One advantage of this is they have to never lease contact with the ground, with the multi person air, or whether you're up in the air.
Now with the pro technique, there's 2 they're actually done, quote they make, and to push that dig.
Both have their advantages.
The pool technique is just the one that was always taught in the past.
You have the rescuers on one side, the boards between them.
Now from a negative standpoint, this puts it the riskiers of Bob McAllen Advantage from a backward looking standpoint.
It's hard to reach over the board.
The other thing, once you roll them over, The weight of the athlete's body is on the board, push down your legs, you have to sort of scoot it out.
But the advanced pull technique, if you're in a space confined situation like we have here where the ethic went down against the wall, this may be the only viable alternative.
The push techniques a little bit more efficient, it's easy to push athlete from a biomechanical standpoint.
The thing we wanna think about is when we push at the tipping point, we wanna stop and just hand position lower than down.
So, again, to push and pull that into your most viable options, pick based on your protocol, and also based on space configurations.
The pro technique again requires 4 rescuers.
My rescuer here, the heads and charts.
We have my three people on the board here.
We're gonna put the board between our our knees and the rescuer, roll them over.
Which technique, again, we've discussed already.
Now another common thing is thinking about centering on the spine board In the past, we used this to the diagonal slide, the visual slide.
Again, this goes back to some of the resource in Meredith Ward.
I see the University of Florida.
We actually found that the straight lateral horizontal slide has least bond movement.
So we're tipping and taking half the And this is a great example on the multi person list.
Many times, they're all the more exactly we want them.
On the law world, very rarely, or the position of the board exactly we want them.
So that's where we have to sit and revive and get them on the board so we can package them.
The skip stretch technique again can be used with the coupon athlete, requesting rescuers, we have one to head.
Key point before we break the the board in two pieces, we're gonna measure it.
It's just like adjusting the crutch.
Measure the athlete.
Adjust them both sides, then break it half.
We're gonna put the the small water heater side of them, then we're gonna do like an a frame.
We're gonna take the part of the head, put it together first, and we're gonna come here at the bottom of the tension together.
A couple of things to be aware of.
It's just nuances with the scoop structure.
Number 1, When we put the skip structure together at the joint here, it's right at the head and neck, and we wanna be very careful that we don't inadvertently hit the rest of those hands, maintain c spot.
That thing is we can see if we pitch this together, something that's potentially caught on the back of the pads and mash and put together.
The vacuum mattress.
Again, the vacuum mattress is not very frequently used in the US.
It's more the standard care in Europe.
The nice thing about it is a little bit more couple.
It's not it's hard as a rigid board, and it actually accommodates you you can fill the space with the the foam basin there to the lumbar spine and the different contours of of the body.
The dismemberment is is this is not a rich reward.
If for any reason you have a depressurization, you have lost all stabilization.
It's the same thing as a rep and mobilizer's plant.
They're great.
But if we have a terror hole in there and you have penetration, and you use your air, you lost all stability.
So one thing we recommend, if you're gonna use this, you may wanna use it in conjunction with the board.
And once your mobiles have, pick them up and put them on top of Regions bond board.
We also wanna think about sales strapping technique.
Now once we put them on the board, how do we secure them to the board?
One thing from a sequence standpoint, we always wanna secure the body first and the head last.
The body first and the head last And why is it important?
Let's say, for example, we have a patient that has a concomitant head and spine injury.
And sometimes what we see with the head injury, when they increase cranial pressure, there may be vomiting.
Let's say we have this exact situation.
We're in the process of packaging them, and they vomit.
Now we have to take them on the side to clear their airway.
If I strap their head down first and get their body free, That's a potential move their spine.
Their head is relatively light.
Their body's heavy.
Conversely, if I secure their body first, it's easy for me to the control of the head.
If it's not secure with my hands, we still work them on the side.
So, again, from practicing technique and securing body first, head last.
Another concept is keeping the arms free.
1, if I put the straps around the arms, the straps are further away from the chest and the thorax, and not secure as well.
But 2, if I secure the arms down, once I get to the back of Hamlet, I won't access the arms.
The paramedics may wanna start an IV for hydration and med control.
We may wanna do serial neurovascular checks.
We may wanna be able to access the arms for vital size of blood pressure pulse.
So keep the arm free, and we can take just some paraflex, to acetate, or elastic band, and we can secure the hands together so they won't flop.
Then once we get them to the ambulance unit, we can let them go and give them access to the arms.
If we do decide to take the helmet filter pass off product transport, we can go and put a properly fitted soap color at that top.
Now one thing thing about patching against, traditionally EMS and fire risk involves use of 3 strep technique and strep around the chest.
Strap around the pelvis and strap around the legs.
Now think about this, and that's all I did secure them, and then I have I hit them all besides advice with passing the side.
I've got tape across the chin, tape across the board, or tape across the contact, and I put them in the back of the hammers.
My head is very recently secured, and I've just got 3 straps on the body.
Perhaps it's gonna stop and start.
Stop and start.
As a hit, stop signs, red lights, and so forth.
What happens to the body is they can twist them back and forth.
As we talked about before, when we did the Delphi study, we actually reviewed our 1500 articles, and surprisingly, there's only been one published peer review article mostrapping technique, and it was done by 2 paramedics back in nineties in LA, our manics in Mehluvsky.
And they replicated an extra technique And with this, what happens is you take one strap across the shoulder, and go to opposite axelon, and then we x across another side.
And what this does secures the body to the board, in case it's transitioning from a AP standpoint.
So we actually recommend the x technique, and this can be done with speed clip systems, or can also be done with the Velcro systems.
A variety.
Hemalization adviser available.
You can pickages and one that works best for you.
Now we do advocate needs to be a lightweight block of roll in the past.
Weighted blocks like sandbags were used.
They really captured it again.
If I have an athlete, and vomits, and we have risk from compromised, we have to roll them over the side, and we have a weighted block, it can cause a head to move.
We also wanna think about tape with 2 points of contact going across the eyebrows.
If you go up on the forehead, it has a potential slip off.
And do the same thing across the chin.
And we'll move a concept.
Wanna think about as a unit, if we take the helmet off, the show pass came off as well.
The primary reason being, if I take the helmet off, the show pass is still alone, add the potential for the neck to drop back into extension position and going about the cause of neutral alignment.
If they go about extension, it closes the diamond, the spinal canal, and there's less space for the swelling to go.
From a sequence standpoint, if I take both off, the helmet always comes off first, follow the shoulder pads.
The first thing I want to think about is cut the jersey.
To remove the jersey, I want to cut it from my t cut technique.
So my rescue right here is gonna take my paramedics shares.
Dave has got a seat spun right here.
Drew here on the side.
He's gonna take his shares.
He can't go to sleep.
And the first part of the t and this is gonna cut down.
I always wanna cut away from the neck, not toward it.
So I'll take out here and then take it down.
Once I do that, I'm gonna spread the jersey apart.
I'm gonna cut the shoulder pads.
And once I cut the shoulder pads here now, I'll just spread the shoulder pads apart.
This is gonna come in from the front.
She can see spot technique we talked about.
Again, we're moving away from medial lateral a couple of disadvantage of needle out technique placed in his hands on side of the head, one cheek basket in the way, and it says cheek pad removal.
With the new helmets now, with the cheap bad contours, it's really necessary to take the cheap pads off.
We also read them in in the first to get a hands in there.
But if we do the AP technique, we won't have the front and won't have the back.
I don't want to do that.
The other thing that ends with this is I have a hand behind the head I'm basically cupping the back of the circle spine and the the base of the skull.
If you think about it, they've been exercising head of sweaty sweat, we start our hands in, we're squeezing from the side, and when the helmet comes off, it appears it would have the drop down, that AP technique helps secure the right.
This is gonna come in.
Take C Spine Control.
She's gonna get a nice grasp with the picture technique with AP.
I have control.
You can release So now we're on a screen to take the helmet off.
And, again, this is the closer of the eight piece seborosignae drew here has to handle the chin.
I like this too because you can throw rotation, which is hard to do with the middle left technique.
His other hand's coming at the bottom and he's simply kept in the back of the upper circle spine and the poster store.
Sort of had to remove the several big techniques, and let's talk about the nuances of each one.
The multi person lift is affected technique if I had the programmatic rescuers there.
Again, it requires non rescuers.
I've got my one at the head here.
I've got my one at the board here to either side.
We're gonna decide upfront and we're gonna take the equipment off.
So before we get ready for the movement, we're gonna go ahead, do the t cut on the jersey, cut the pads, take the helmet off, and now my pads are cut and ready to drop off.
Once I pick the athlete up, the pads just simply fall off.
The key point is make sure I cut everything.
The effing addition to shoulder pads may have a back plate may have rip pads.
Make sure I've got cut everything before picking up an air.
Worst thing you can have is have them up in the air and realize we'll have to get together back pads and have to be messing with that while they're actually up in the air in a really unstable position.
So what we're gonna do here is the same technique.
The only difference is we're gonna pick them a little bit higher.
We're gonna pick them up 12 inches loud space in the passive ball.
So we picked them up on his command.
What's in the air?
My naturalist here is right here.
She's been reaching carefully, take the pass, guide them out, paths are clear, and then we can do a lowering command.
The elevator torso is one that was typically done for many years in the emergency room.
Basically, it's like a modified supercrutch.
We're bringing over about 30 degrees, clearing their skeptical off the the ground to allow the pads to come off.
One thing to think about this, this does involve lumbar thoracic movement.
So if we suspect this, if they're having lumbar thoracic pain, and we can't rule out a chem common injury there, this technique is contraindicated.
But, basically, what you're gonna do is my my rescuer here If the head, we're gonna pass control.
TELIZRA here.
She I have Sizzie, but Joe, he can release the paramedics here.
So I just told you you can pick them up.
And now, David, you can take the pass and carefully slide him over at the top.
It's called the LA torso or the tilt technique.
This is a newer technique, and this was actually really advocated by Eric Schwartz when he did some really nice research up in New University of Hampshire.
It's called the flat torso technique and the flat drag.
It requires 2 different rescuers.
So, again, we transfer technique here John here at the front is taking seats spun over.
I have seats spun.
You can release.
They've already taken the helmet over and taken it off.
Now the passer cut, they're simply gonna take a risk on either side and slowly carefully just drag the passer.
The nice thing about this, there's no river whatsoever.
It's supposed to work personally after the the tilt.
They're on the ground.
They're not moving at all.
It's a very safe technique.
It's easy using the mushroom as well.
The law rule requires multiple rescuers with the law rule, what you're trying to do is incorporate this into your mobilist technique.
So for example, if they're prone, as we talked about before, if they're stable and they're circulation or breathing in control, I'm not in a hurry.
Take my time and take that few extra seconds and go ahead before I roll them, cut the back of the jersey, cut the back of the pads, then we roll them all over the board, we can cut the front of the pads, It's gonna be Bob Belton and take them off.
And we have the option if we wanna take it off from the field of play or we just want to leave it intact and packs them that way they'll also give the EV with the position.
We can take them off there.
If we have a super athlete, what we wanna do is pause and actually inspect them back.
This is one thing we talked about in evaluation.
You guys wanna look at the back.
So if I'm doing the logo typical super athlete, I'm gonna bring them over.
I'm gonna pause them right here.
My rescue of the board says he can take his shares, cut them back in the jersey, get them back in the pads, actually inspect them back, and then we can roll them back down.
So we can incorporate this with the log rule.
Quickly shorter paths, we talked about the RODEL system.
And right now, this is a patented technique, so it's only available on RODEL paths.
Requires through rescuers, we kept the front of the pads, and then we pulled this rip cord and zippers the back of the pads, and we can simply bob out them.
Sorter pan removal over the head.
Now this comes in handy.
If you have a path, it can't be cut.
We're seeing a lot of paths now.
They're very rigid in the front.
For example, the quarterback pass, protect their sternum.
And from a safety standpoint, they're great protection, but they can't be cut.
So how do we get these off?
We'll use a modified tilt technique that we talked about for the elevate torso.
Dave here at Seaspan Control.
This is gonna reach underneath the pads, and take cease by control.
So who's included transfer, communicate, day by seat by control, you can release, they can take the helmet off, And now we're gonna do days here.
We still got seatbelt control list.
The paramedics and her counter are gonna come up.
On the 3 count 123.
They're gonna elevate the position, and waist up there.
They just gonna take the pads off.
Then the key here is Liz has to reach underneath the pads and have that control.
Other considerations when I think about peripheral collars, rip pads, back pads, or pass or difficult to cut, and it goes back in to be familiar with the type of helmets and shoulder grass that we have.
If feasible, we wanna transport them back with a facility that can provide definitive care, And again, communicate ideally the athlete trainer wants to go with the athlete and and and give a brief description of what happened to make his injury how we treat them with filler play, what their vials have done, how they've responded, telecastes has changed, and he can't treat with the semester.
And again, if we let the equipment out and have the athletic trainer connect as a lead to guide EMS and physicians and nurses who have to take the equipment out best.
I guess, best choice to think about what we do, we have to come back to athlete.
And this is very common sometime.
You may have an interesting athlete.
And halfway through the packs and prices start to wake up and make the combative.
How do we handle that?
We won't discuss that in front.
How do we deal with the combined space issues like we talked about before?
CPR and a great example of this is the more handling case, and actually was the case a couple of weeks ago with Utah State.
Where they also have an atherosclerotic arrest with the wrong hormone.
In this case, we move from a concern about spine, concern about life support with cardio, pulmonary resuscitation, and the gear has to come off.
What's the protocol for that?
The first thing again going back to recognition.
If we have a unconscious athlete, there are pulseless to prove otherwise.
So we have to assess circulation, airway breathing.
As soon as the AD is available, we wanna stop on the plat pads.
If we short CPR stop at that point, Don't delay.
It's just the eighties available.
We wanna shock right then.
And if we're doing a c draw, we wanna minimize interruption depressions.
So the first thing step by step Step 1, we wanna recognize.
Activate e EAP if EMS is now assigned to 911, we treat my voice equipment.
I wanna cut my jersey shoulder pads in front to access chest.
The ticket we talked about before.
As soon as I spread the pads, I can start compresses right then.
We can worry about the helmet and take it to pass off the other rescuers.
But ideally, in 5 to 10 seconds, I wanna access the chest and start compresses right then.
As soon as the aide gets there, stop by compressions, apply it, and shock.
As soon as we shock, we wanna, you know, immediately go by the compressions, knowing the subtop, Even we convert them, it may take 20 or 30 seconds to see a response.
So we wanna continue compressions, and we'll stop the signs of life.
But the big key with this is recognition, and also to understand that we can do effective compressions through shoulder pads, the John Delica, though Rossi's done some multinational research on this and showed definitively in a couple of peer reviewed public research studies that compresses over short of passing not effective.
So we have to do the direct do the chest, and then I'll also cut the jersey, and cut the paths.
Take home points.
Preparation, develop an emergency action plan for spine, develop a spine protocol, communicate to everyone.
This is not to force medicine thing.
We wanna make sure we involve EMS as well.
The big thing options.
We are factors to make a clinical decision on what's best was into this situation.
Practice and review scenario based training.
And what we try to do in preseason, is do this with my athletic trainers, and they also do with my athletic trainers and position EMS that we were having to gain.
And create different situations.
Practice with the supine athlete.
Practice with the pro athlete.
Practice with the head turned in a non neutral position.
Pax in the confined space, do a scenario where in the middle of practicing the athlete's arrest, and we have to go straight to the CPR.
Or that he starts to bomb me at the terminal side to clear the airway, but scenario based training helps us have the best result and the team cast and make sure we're working together.
From resource standpoint, if you haven't accessed these, I encourage you to go to the mata.org, the slide page, and all these papers in the video are available.
The video was a great teaching tool.
What we exited in Athens, Gore County, We took this to a hospital, and they put it on the human resource website.
So every year, everyone at ED, doctors, nurse and world is required to go in, and reviews video tape, and that way they can actually document 1, they have tops in that, and they everybody's been compliant with that.
And then addition to that, we actually take our team in and start a year, and we take some scenarios and view that in the ED.
But this is a great teaching tool for hospitals, for EMS.
And with that way, I'll end and take any questions we may have.
Swings up back on here again.
So, yes, definitely, Ron.
Thank you so much.
It was this fantastic information, I think, to the audience if you were on the the previous presentation about the Hordiski.
Definitely, you're seeing different aspects where the where the efficacy of the long roll, multi person lift, lateral transfer, all those techniques as well.
Do have a couple of questions that are coming in and go ahead and get to the first one real quick is when we have time is One question is, how does equipment removal look lot look different for other equipment heavy sports like hockey or lacrosse?
That's that's a great point.
The cross is different.
Mostly, the cross helmets are vivid, you know, face face mask.
So the face mask can't be removed.
It has to be taken off.
One thing to think about with the cross paths, they're they're much less constructed.
They're not nearly as big in bulky shoulder pads.
You can sit and cut them and do a flat drag.
You would do the same concept.
Helmet comes off first.
Past second.
So we did the transfer with the c spine, cut the the chest strap, take the helmet straight off, and then do a flat torso drag.
And take the the pass off.
And again, from a construct standpoint, they're not bulky, they raise the drag off.
Great.
Great.
Great question there.
So I wanna have you while we spend a little bit of time earlier in the presentation, you mentioned for transporting the patient to the to to the emergency department on a hard spine board.
And, obviously, that's a not that's not the same as probably a typical protocol that they have.
Did you go did you all go through their EMS director with EMS and get an exception, and you can just kinda talk brief about how that's done because I think that's something that most applicants may not be aware of in their in their jurisdiction.
Yes.
That's a great point, Ray.
I think it's really important to to have good communication with the EMS director.
And I found many times it helps to start physician to physician, EMS to EMS.
One of the advantages I've been a long time EMT, so sometimes makes a little bit usually communicate.
But what we did, we actually took this information.
And we've got a nice peer reviewed article.
We got Best Practice article, and we took the medical director.
And we said in our case, we've already got them immobilized.
Who had secured with he had them over his device, secured the board.
It doesn't make sense to go and keep them all there.
The transport time is short.
Is is they're gonna be transferred from the EMS Gurnee to the hospital Gurnee anyway and passing in Ohio.
It just made sense that they agreed The same thing like EHI, and we talked about the Cool Forest Transport 2nd.
When they came out of their peer review article in a prehospital emergency care, that was simply to go to EMS and say, hey.
We've got a nice peer review article, and they bought into that.
So I think if you could communicate beforehand and make sure on the same page, it makes a big difference.
And the voice of confrontation we have for Downtown.
Great.
Thank you very much.
Here's another quick question.
Do we know specifically the steps that we're taking to remove equipment start care for the more handling?
I I do, but I I can't really comment specifically on that.
I will say, Some of that may come out down the road, but from a Kelsey's early standpoint, it's not been Lisa's point, but they did an outstanding job on the field of play.
And he goes back again, the recognition key.
You know, if you saw that, you know, you had a contact situation there and retails where they have to collapse, it could have been confused with a possible spine injury.
They were able to differentiate that and realize that it wasn't fun.
It was cardiac, and that quick recognition made by the difference in safety was live.
I I don't wanna add to that, Ron, you made a made a good point excellent point on doing early vital sign assessment I know I was doing a talk one of the talks I did yesterday, my cardiac failed points at EAP was that vital signs were not taken on-site, and there was a differentiation between a head injury versus a cardiac it was actually cardiac or a fatal cardiac arrest that occurred.
So, again, that critical core assessment you take in the first couple of seconds is is is vital.
One quick last question and we'll jump off here is, are you aware of of a scoop structure wider than 17 inches, which is a standard from a ferno or as an example, or for a wider athlete?
Right now, to my knowledge, they only have one size of your stretcher, and that's what the disadvantages with a with a large athlete, it's it's really difficult to use.
You know?
And if I have a 3 a half £50 nosegorn, and I put the script stretcher on.
It's disappeared.
And I and I can't see the handles.
It's hard for me to do the strapping concept.
So at this point, they really don't make an oversized script stretcher.
Now they do actually have there's one company that makes a skip stretcher.
They rather have the break points that the the head and the foot your angle on the sides.
And, yeah, I do like the concept because one of the problems with the scoop, when you're trying to put together the top, you're gonna be really careful not to hit the hands of the person.
Doing Seaspan Control and this in case that.
Excellent.
Another excellent question.
So, Ron, we're at
the we're at our end of our time, and audience as well.
Thank you so much for your time and expertise and and what you shared today, Ron.
Thank you.
Thank you, Ray.
Appreciate the opportunity.
Right.
So everyone briefly, there's one last question about where can we find the video.
You show the show the ER.
What I will do is I when I send the email out for it to you'll it'll be tomorrow.
It's kind of a wrap up.
I'll show the NADA link the video that Ron alluded to.
I'll put that in with so you have that as a resource as well, and as we start doing this throughout the week as well.
Finally, make sure you fill out your evaluations, if you would, and be look on look out tomorrow morning for our next several emails that'll go out on tomorrow's presentations.
Thank you again, Ron, and audience for participating.
You all have a great day.
Thank you.
Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete
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Updated Jan 22, 2024
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