Transcript
Everyone, and welcome to session 2 of the Sports Merchant Care symposium 1.0.
Right?
Castle into I'm the presenter today, and I apologize for the last minute changeover.
We had doctor Kyle scheduled for today.
He had to make a last minute modification schedule, so he will be on Wednesday slot, and I'm filling in last minute as well for this.
So Couple housekeeping notes, those of you who attended the previous session with Doctor Rod Walters, it was a fantastic presentation.
Just a great introductory session to sports emergency care and or the symposium and, especially, EAP gaps.
This will follow in on off of his, and I think this will he said a lot of great had a lot of great messages and and also a fantastic questions to those who were on the last call or last webinar with him.
So Couple quick last quick items.
One is just jump in the chat.
Let me know where you're from.
And also the other attendees or what setting you're in.
Wanna wanna hear where you're from.
And then also, when we get to asking questions, feel free.
To drop any questions you have in on the q and a session.
And at the end, we'll make sure those are answered.
And then if for some reason, we have time that runs out with then we'll follow back I'll thought we'll make sure we follow back up with those questions.
So all the attendees get those, as well.
So we have a lot of questions that are dropping in.
We have a number of folks who are jumping on board right now.
So we'll we'll go I'm gonna give me a second.
I'm gonna get loaded up with my presentation, and we'll go ahead and get started for the day.
Okay.
So we can get screen going here.
And, again, like, any any questions you have, feel free to reach out.
Oops.
Sorry.
Got some wrong slot here.
So today, this session is a follow-up on, you know, one of the things we think about.
We talk about causes.
We talk about the, you know, injuries and how we treat those.
But, really, it'll take a we're gonna take a deep dive into sudden cardiac arrest and looking at where are the fail points.
And as you see, we have have several cases.
We're gonna look into this, but, well, this is what this will address, and this should I I feel very good that what what Doctor Walters presented earlier in the in the symposium is a is just a carryover, but just a different context for different condition as well.
So first off, I need to provide my disclosures as well.
I'll let you read those for a second.
What those are.
And then as far as disclaimers or or any conflicts of interest as well, that's what those are.
So as we got as I mentioned in this presentation, again, thanks again for joining on and and ask any questions throughout, we'll get to the end.
Is first thing I wanted to look at is so we understand what sudden cardiac arrest and death really need to this talk about some of the epidemiological data, really what goes on behind this and what are driving track, because we know it exists, and we know that's going to happen, but we think of when it's going to happened as well.
Look at the contemporary opponents of emergency action plans.
And in these several cases, we'll outline I'll outline today we will discuss is that there are key failure points that have occurred that are really simple things to fix, but they're not fixed or they're not performed until after the fact, which is most times very tragic and very simple things that could have been avoided.
Again, the failure points, addressing those and sudden cardiac death or the the slight lesser version is they have a permanent injury but they do survive the sudden cardiac event.
Then also think about what the role the the late person, like the person running out of the stands, or who can use an assisting in your various settings, use as opportunity to assist in cardiac death or I'm sorry, sudden, preventing sudden cardiac death, which or having sudden cardiac arrest.
So this is a phrase that I came across or at least I'm I mean, I made.
I was thinking about a presentation a couple weeks ago for symposium, and it just was very appropriate when we're thinking about what is the AED?
We talk about, you know, different things being the clutch player.
So, you know, if you think about that, we see them sitting around the wall.
We don't think much of them.
They're in airports, wherever.
But they're always waiting for that chance to go in, and they're going to work.
They're they are the Michael Jordan's, the the Serena Williams.
They're gonna make that hit.
You know, whatever it it may be at the game or they're winning the catch, etcetera.
That's what they're designed to do.
That's what they will do.
But if you don't put them in the game or or our coach doesn't put them in the game, or just the late person recognizing that when they need it, they will never ever chance they will never win that game, which is ultimately the sudden cardiac death.
And and they're still sitting there watching to see another loss, which is very tragic.
So, you know, this, you know, out of hospital cardiac arrest, what we do know statistically in in hands and has here's a great article to look up.
But if we apply an AED within in within the 1st 2 minutes, You have a 7 fold increase of survivability.
Within 2 to 5 minutes, it's 4 fold increase.
And what I wanna show you here is an example of a case where the the there was a rapid response, not just from the with the training but the school for a volleyball athlete.
So let's get this started here for a second.
Horrible.
A senior suddenly collapses.
You can actually hear the thud as she hits the hardwood floor.
She lies there.
Life says everyone runs to her side.
The teen is in full cardiac arrest.
One coach
Hope you're able to hear that.
Are, but it's not worth
the video.
It's looking grim for seventeen year old Claire Crawford.
Then somebody rushes in with a defibrillator.
There it is.
It's in the black box.
Sure enough, you can see Claire's body jolt from the electric charge.
Julie Sermons is the quick thinking school administrator who used the defibrillator.
Life started to come back.
In her, and it was it was wonderful to see.
And this is Claire today.
It's a miracle.
Players says she was feeling fine during the volleyball play.
Just seconds before she passed out, the ball came away and she gives it a good whack.
But then something goes wrong.
She's in distress and clutches her heart, then collapses.
Can you tell us what your symptoms were?
So you can look that up for Claire Crawford, but I wanna emphasize that the administrator, it wasn't in the what they were to portray on the media and on this article is it was not a miracle.
It was a deliberate response.
They had the training.
The administrator knew what to do They had that action plan in place with the medical staff there, immediate action having a team concept.
And that's the thing that most people or if we don't think about is this is easily done in how they did that emergency response.
Which had a very good outcome.
So when we think about, you know, let's take a look at what what do we know about sudden cardiac arrest and death, It's an excellent study by Peterson and colleagues that that analyzed the data from the National Center for catastrophic sports injury research.
What they found in high school and college athletes was that there were 331 cases over that period, and there were 173 fatalities.
Of those, you look at those numbers, that's a pretty, you know, 77, 76 0 7% were in middle in high school.
It doesn't happen that often in college and professional, but it does could still occur.
The majority were male, They were basketball or they played American football, and then also the highest incidents in was or about players in division 1 basketball, or African American males.
Those just under it's good to understand this data from a perspective of understanding what may happen or the potential likely that can happen at any given time.
We know that, but what that looks like.
When we look at this in terms of also carrying forward with this is looking to study, is where you see what the cases were and what the outcome was survival or death, and they're looking at the various reports of how that occurred when we're looking at medical records and also as well.
Again, it goes back to rapid response and what occurred.
This is sudden cardiac arrest, you don't survive it luckily.
This is a you may survive being lucky, but At the end of the day, it requires a deliberate response in being in being having a knowledgeable plan in place a deliberate plan at schools with that may occur.
Again, this gives into the study also you look at the at the spectrum of various cardiac conditions that can occur, and you're looking at, you know, as we know about hypertrophic cardiomyopathy, It's relatively the son of one of us left undetected.
But most of them, if they're going through a thorough physical exam, it will be detected at some point of time.
And judge and whether they can evaluating whether they can participate or continue to participate in in sports.
And that's that's one of the common reasons for cardiac arrest and death.
Here you see another kind of continuation in the study and where this separates out in terms of high school on the left, and then NCAA Sports, and you're seeing this the the the numbers in various sports as well versus male and female, and as it moves on through an incidence of for college athletes as well, look at what those statistical data means.
Doesn't mean we don't provide the same level of care.
It just means we need to have a heightened awareness.
They'll know that we may see that more often than others.
So we know that a a high incidence occurs in young athletes, but what what can we do better?
And this is Doctor Dresner and colleagues also did some of similar study with the those cases as well as a review cases in parent heartwatch database.
And again, it's a fairly complex, 70, almost 80%, and the age, you know, the average age was 16.7.
So we look at the the pediatric case point or case cases or the population, high school, junior high, etcetera, that's where we're gonna see those or potential likelihood where training in is really necessity and then also having a deliberate plan for the EAP and how you activate EMS.
In the absence of a trained medical provider.
In these cases, 89% survived when an AED was applied.
And I wanna emphasize that, having the training to CPR and AED is is critical in this case.
So we'll talk briefly just for a minute.
Don't wanna go in too much detail about Demar Hamlin.
We've seen that.
It was sudden cardiac arrest.
This was the lightning bolt events.
And I used that phrase as something that I was at a conference this weekend and had the opportunity to listen to Rick Bilt, Workhalter, Kansas City, and also Denny Kellington, who's with Buffalo Bills.
And that was the exact point.
It was a lightning bolt.
It was not Commodore Cortez as much as the everyone wanted to speculate the media speculated throughout.
That's been that's been confirmed earlier in the week.
What made this successful is that development and implementation of a comprehensive EAP, and it created that response.
You have a deliberate response with that.
And when we think about what that looks like, we look at that and, yes, they have 30 plus providers on the field.
They have EMS.
They have those things.
But all the components that that an NFL team has, it it mirrors what a high school has.
Or junior high hats.
You have to you may not have the the volume of numbers of people, but you still have the same components and it still easily be easily attainable at all levels of activity.
And again, this was a that what happened in NFL when everyone observed was it's a venue specific emergency action plan response.
It is not the EAP, and that is a really important part that that a venue specific response plan it's part of and protocols are part the protocols are part of the policy procedures document.
It's not by itself, and definitely not the venue specific plans.
It's one small it's one sheet of paper that builds the whole for all of the venues and for that act for what that organization where there's practices, games, etcetera.
So briefly talking about the timeline for when we look at Demar Hamlin, and I and I show these these next couple slides is understanding that there's a deliberate response and where the importance of a protocol comes into play.
The reason he was not transferred initially was because their protocol.
And again, if you have a protocol and you follow it, it puts into place and also lean on EMS For those of your health care providers talk to local EMS because they have protocols and they make it very easily from a transition of care.
Is what that looks like is that that athlete was not moved off the field until he had they they had recovered, excuse me, had a return of spontaneous circulation.
They had a they had a pulse again.
So that's where that that that time block is there, then they let them otherwise, they probably would have done that for about 30 minutes.
And that's a typical time frame they're gonna run through the cycles to convert someone before they put them into a unit because it's more difficult to manage the patient with even 1 or 2 riding in the back of the unit.
Those of you who have done that.
Here again, this supports from this, this is simple simple protocol.
It came out of the Cincinnati area.
With what with the EMS systems.
And this is the what's this what they have given?
This is their protocol for all providers.
They're there.
Given time sensitive nature, they know it's urgent, but it's best perform on scene.
And then they're gonna then emergency care transport to the hospital should be to delay whenever possible.
So this is something I think a lot of people have heard before, and I like to emphasize this because I think it's it's just Uber important is that we do share a professional legal and ethical responsibility in writing.
And not just by words, but in what we say, but in writing.
That puts it to it that puts it to pen and paper, puts it to it's almost a contract in implementing a comprehensive plan that will effectively provide the care.
And it's really important we have those things in place because if it's not in writing, it wasn't there's no continuity that was done consistently.
So what are the implications for all athletic settings related to the EAP?
And I just provide these briefly.
You have a a great success story where Roland and then you have a very tragic story and I'm gonna talk about more about was Matthew Magnini, who was a in Kentucky and had a soccer player who died.
Very tragic because this could have been avoided.
So these are just a couple of quick questions or components of the EAP.
Are your personnel trained or their qualifications?
What are your role in EAP?
And do you have it in writing?
Can you sit can can someone come to you right now and say, hey.
What's your training and what's your calling off of the coaches or anyone else, and can you show that?
And you should be able to pull a document out.
This is what it is.
What does steep what does your feedback What is your rehearsals and reviews?
Do you have the appropriate medical care equipment supplies?
And are those married up with your training and the protocol.
It's not just enough to have just the AED or the splint.
It needs to be appropriate, and you can implement those when it's need needed most for any regardless of the situation.
What's your communication plans?
What does that how are your radios or backups?
Are you using other types of forms of communication, including hand signals, something to keep in mind for events?
What are your what's your medical time out Do you do it before and after practices?
What if you have a change in menu?
These are little things or things can be done on a regular basis and have it.
It's a checklist.
So to speak, as you go down, and everyone knows what that means and and how it's performed on a regular and planned basis.
What's what is your journal documentation document, all aspects, and then also the the tail side of this is what happens after the event in terms of critical incident response.
And knowing who's not only we know that if you're a health care provider, you're taking care of the provider, but who's gonna take care of you after a significant event?
In from a from a wellness standpoint.
So when we think about this, we think about, you know, a sudden cardiac arrest, in order to be successful, you have to have a deliberate action plan if you're going to have an outcome.
We know that patient may not succumb to that, but we want to the goal is to give that patient a chance to survive and live.
And that may mean doing the initial things where it does require doing the initial things on-site immediately as soon as possible, and then that successful transfer to a hospital for and hopefully for effective outcomes.
So one of the things we think about kind of shift gears a little bit and think about inaction.
And people think that, you know, and we see this all over the place is in different areas of sports medicine.
That assuming someone else is going to do it or otherwise, in this case, the legislators, as you see this, they're this regardless of the state, they it is very they're in action in applying appropriate policies.
They they at times, we know that the legislative branches can overstep and was it's intended good, but it does if you have a end up having after the fact but waiting to happen is the hardest thing to look at.
If you've not looked at this article by Stephanie Kuzadim, the Louisville Courier Journal.
It just came out this week in USA Today.
It is a fantastic series, and it talks about the problems that we are facing in this country in terms of health and safety.
In this case though, you have New York State, you have Lewis Acampora, with a lacrosse player, had Columbus headquarters hitting the chess with the ball.
It took 22 years of diligent lobby lobbying the the at that level, before the high school it was mandated high school and colleges were required to wear chest protectors 22 years.
Here's a successful case, and let and start emphasizing, what are these key factors for success?
And, you know, the Chaminade high school player is He had a seventeen year old PJ Kellechan had a seizure in SCA during practice.
They have an Aflac trainer coaches or to they immediately initiated CPR and the AD immediately.
The key factor is here.
As you read through some this arc through through this history on this case, They had staff training.
They had a EAP activation.
They had the equipment.
Actually, they have an 11, at the time, had 11 AEDs throughout their athletic facilities.
Which means they were prepared to handle that regardless of the situation, in regards of the activity.
Here's another successful case.
When we think about the key factors that this young athlete is able to go home after a hospital visit.
Brennan Connell, who's a pitcher on the mound during a game, actually had he had one athletic trainer, had a coach, and also had a Bostoner who happened to be he was a mother who happened to be in the stands watching her son as senior night, another another athlete.
That'll be a physician.
She also came on this on the field as well to assist.
They had initiated CPR and AED and had the EAP activation.
Again, simple things, training.
You have to have an EAP and has to be that deliberate plan or that script that you have to have in place.
AED is on-site, just like the other one.
You have a late person assistance.
This is someone in knowing that that person may come in and with that as well.
Another critical case for the what what's very effective.
So let's change gears for a second and talk about Matthew Magnini.
And this is just the case of inaction.
And this is so very, very tragic And what happened with this young man is this was definitely an avoidable event.
This was the lawsuit was finally saw, was it was the lawsuit was settled a couple of months ago.
So there was an AT and Aflac trainer and coaches on-site.
The from what reports were seen in there.
And there was an AD available at the facility However, it wasn't an AD wasn't used until 12 minutes later until EMS arrived.
There was no specific plan in place.
So you have no venue.
You have no you have no map or model.
To that's being there was no model to show how this is being done and how it is done.
Whether it's a protocol, I'm gonna ask if there was, it wasn't followed.
Or at least it would be the intention of that by looking at this because of the delay in care.
And then also questionable, you know, for more as the training for all of those involved around that.
Very tragic case that could have been avoided.
Let's just get a pulse, for example, with Zeke Upshaw.
This was a athlete in the NBA, Grand Rapids Glee.
He's a guard forward.
Collapse during the game, it was non contact.
And what was unique about this is that apparently from what the re what where I was able to research on this was the athlete collapsed.
And but they initially thought it may have been or at least the intention may have been a head injury, but he had no direct contact with any when he with any player Prior to that, what do you think may be coming to a court is?
What end up result of this, you have trained staff on-site We have EM and rescue equipment, and then you have ink the the kicker point with this was an in was there an incomplete initial assessment?
Of recognizing just taking a pulse, do the do the trend at this do the additional assessment, identify those trending vitals, to make that determination that there is a significant issue with this young athlete.
It's very tragic.
So here's what's very unique in the fact of where I'm just gonna ask you, where is the EAP?
This is one of the kicker points of this with Alan Harris with a sixteen year old football player.
During summer conditioning collapsed after several splints.
This is not this is a very first start of practice, but, you know, probably 4 or 5 sprints in of the activity, had had seizure activity or demonstrated seizure activity.
You have 3 coaches on-site.
1 made the initial eval and activated 911, but there's there was no u there was no AED on-site at the practice but there was one in the gym.
And from all accounts, there's probably easily 30 seconds away less than minute away.
You have an out they what is unique about this is that they had an outside provider who had developed the EEP for the school but it had not been provided to the provide the coaches as well.
They'd already been creative, but it was not provided.
Which there goes into there's a problematic process as well.
Questionable whether a CPR and AED coaches or self and safety training for coaches.
And then, also, it took 10 minutes over 10 minutes for CPR and AED was initiated and with and with EMS arrived.
So this the failed points again These are very consistent when you look at these cases are the what is their training?
You it's not just having that initial, having training something Do you go through that training?
And is there a practice or deliberate practice and rehearsal that it constitutes training for just journal readiness?
What is on-site equipment?
And what whether that there was there was I would all accounts, there was no EAP.
That was and they that was a $5000,000,000 lawsuit.
So moving forward with some of you saw some of the consistent things we're seeing in several cases.
And just recently several week or so ago, the NFL has announced with partner organizations in initiating the start the Smart Heart Sports Coalition.
And this truly identified publicly what are some of the items that are that are really critical and we think about high school athletes.
And because that is the greatest and that middle school, the greatest amount of risk with cardiac related incidents, and we see that as well.
So one of the things they did, they they have they've already issued a letter out to 43 governors.
And those if you're in one of those states that they're in green, fantastic work if you're health in in advocating for health and safety at schools or for athletes.
The yellow you're getting there Orange and orange and red.
We've got a lot of work to do.
And those are some things that we're actively working on different groups are as well.
But what they're finding and what they what this coalition is advocating for are 3 critical areas.
And and if you go back to the cases we looked at, well, to successful in those that were not successful that I've already alluded to, is did they have an emergency action plan in place?
It's venue specific.
It's distributed, posted, rehearsed, and updated annually.
That's so e as easy as it gets.
Do you have an AED on on location?
And it's or and it's or It's within 1 to 3 minutes of each venue.
In one case, demonstrated it was less than a minute away, but it was never activated.
1 was on there.
Another one having a trained healthcare provider.
It was not utilized.
So those are those are two areas that are are really critical.
And then also, because coaches are gonna be at every activity.
It's strength coaches.
It's the you know, strength condition coaches.
It's assistant coaches, head coaches.
Whereas a significant gap in in states that do not require CPR and AED training and education.
That is a paramount must in in order to give someone a chance to survive.
So let's revisit the comprehensive EAP.
So what is that comprehensive EAP?
And we I alluded to it earlier, but I wanna talk about it again from a standpoint of These are questions you're asking.
These are action oriented questions, and you should be able to say if you're if you're working at a school setting or organization is Yes.
All my all personnel including myself are trained and appropriately qualified, and we all understand our respective roles in their emergency care at a given situation.
That could be whether it's a coach on-site or, I mean, a a physician.
If you have physical therapist assist you or contractors, other providers, everybody knows their roles and responsibilities, and it's documented.
You we can put it in writing and say, this is what I'm trained to do and what I'm and what someone is trained or not trained to do.
Do you do that regular rehearsals and reviews?
And typically, There's no set number that says it late.
We typically do once a year, some or twice a year.
Think of it as an ongoing process, especially after if you had a had a significant incident, maybe a good time to go back and support those tabletop exercises and review that as well.
You have the appropriate medical care equipment supplies.
It's been already they've been matched to the personnel training skills.
There's also are they Are they is it current?
Are they not expired?
Are they operational beforehand?
Kinda think of doing a systems check.
So when you go when you go on to a field every day, it should be a If you have an AED there, you should have an AED, it's there.
It should be a simple turn on and turn off.
And, yes, I've documented it works.
And the batteries are in check, etcetera.
What are communication plans in the backup?
Do you you we have that in place.
And think about what these others are, and we'll talk about these in more detail, have the EAP.
We have a pre practice in moving document documentation trails that account for those things and have a deliberate plan.
So what we wanna do is talk a little bit more about each of those and what that looks like for the major part of this session.
And again, I encourage you to have any questions, please do so in the in the q and a, and we'll get to those at the very end.
This is an example of what a table contents would look like for an organization's EAP.
And you see there are different there are different appendices and other things as well.
They have different things down.
What's the equipment location?
If a coach has a kit, what this looks like, and this is one I had the opportunity to assist with couple years ago is in a review process, and this is a very comprehensive document.
This takes time to build, but it doesn't cost it doesn't you don't have to pay a a subscription fee.
You have to get people together.
For that.
So let's talk about number 1 and which is the personnel training and qualifications.
If you're not trained, you definitely can't do anything.
And with that as well and what the qualifications are and knowing what that looks like is think about what the skills, their abilities, what the limitations, all the personnel, we they have to reasonably execute the plan within their abilities.
And then, also, based on what the the setting is, recognizing what public and laid by standard utilization.
That also includes, we have, you know, for example, schools we have individuals who come out and wanna volunteer.
And that is fantastic.
You you want that type of engagement, whether it be from local fire like, the volunteer fire department or just have parent who wants to help, but they have to be if they're going to do that, there needs to be some training or verification that they're if they're there, this is what you can they will they're Canon will do.
Also, think about performance assessment, looking at confidence and readiness.
And because someone may know how to do CPR, but there doesn't mean they they can perform that effectively in the actual situation or scenarios.
That does take some it takes time and effort to go through the scenario training.
When we and moving with that, know, from a feedback standpoint, what does that protocol look like?
What I mean, what's the EAP look like?
Who needs to see it and review it?
Anyone who's involved in that process or including locking the gates administrators, they need to be a part of that review.
And so, yes, I understand what these are.
And and but also tabletop exercises are excellent.
Part of this process if it's more difficult to get a large number of people together at one time.
Having that regular and planned basis looking at the road skill, moving forward with a skill within a protocol, can the person perform those together?
Are are they by themselves?
Do you do lab scenarios, doing a debrief after?
Not just a practice, but also an incident is very critical in that process to help improve health and safety.
And then can you do simulations as well?
There are a number of agencies out there, and I include agencies, including Fire and EMS, the local law enforcement.
You have other resource officers at various organizations.
You have athletic training programs across the country, they they are they are geared to help and do these type of simulations, encourage you to reach out to them, or have them come to you based on your resources or working on different avenues to help improve that type type of simulation training.
I can tell you from a public safety standpoint that public safety officials want this to occur on a regular basis.
It just provides for streamlined care and efficiency during critical incidents.
About equipment and access to equipment, are they what's the location?
Is it accessible?
What's the quantity?
Or is it operational?
Do is it expired or not?
And or the battery working.
Not in a support to note that important that not every personnel needs access to all the equipment.
They just need to have access to the equipment that they're trained in.
And and then having delineation of those skilled equipment needs for each personnel make sure it's clearly labeled, etcetera.
My my equipment needs may be different or yours may be also education and training.
Undue credentials at EMT and as an athletic trainer.
So within the spectrum of full care, I need to be able to do my job within my training, I need to have, you know, the supraglotic airways and other types of equipment that we need.
But I may not need that.
If it's a paramedic, where I'm gonna have license to do medication emergency medicines, that paramedic may have that.
I don't have x I don't need access to that law.
I can't have access to that by by state practice act again.
Build up protocols, practice guidelines, and and the loss of what your state practice act will allow.
As far as a communication plan, this is this is the most important part.
Other things that failure to communicate or lack of communication or breakdown is very critical.
So when when you're looking at your EAP, it needs to be listed on there what that what are your local regional accepting facilities, what the capabilities are.
It's important that you know what that is, but also you're articulating information to a family member or parent and knowing why they may pass a hospital 10 minutes down the road to one that's 25 minutes down the road based on that facilities capabilities in the in their in what the patient is presenting with as well.
Whether or not you have AirMed or other areas as well.
Think about the communication plan.
Some have hand signals during an event.
You have radio, but what if radio doesn't work, you need a backup plan.
I've used you know, these are a couple examples.
You may use a group me for larger groups or use Zello.
It's almost like a walkie talkie one example.
Not promoting that those 2 specifically, but there are many different types out there.
Using something that's consistent, it's been tried and and tested within your system, and you and everyone knows how to activate that and utilize that.
Here's an example of a venue specific emergency action plan in response.
You see on the right hand side, it has a map.
It shows where to go.
It gives instructions for the person who's calling 911 and how they are to what's gonna happen during that call.
So you can basically get to in tell anyone to go activate that or hand them a sheet of paper.
There's also the local area of septon facilities as well.
And what that looks like.
So it's really important what capabilities are and how to handle that and how that's merged with your in merge your local emergency services.
It is the extension again, the protocol, it's extension of the EAP.
We it standardizes a situation standard situation and the delivery of care.
We want to think of this as a 3 60 degree approach in how we deliver those the the health care itself.
And how we can evaluate it as well.
It's about continual process improvement.
Also, we think about what's a medical timeout look out in games.
Let's look at this for a second.
Here's those who attending Doctor Jim Kyle, who actually created the Friday night medical time out.
He's presenting on Wednesday, And this is gonna be a fantastic presentation of how we document the it it's the it's communication before and during any critical event that saves lives.
It it it makes things more efficient.
On the left is something we have here in Louisiana.
Which the the high school association actually mandated several years ago had the opportunity to be involved in in helping develop this doc initial document We did some research on that is looking at where, what the who is involved in this, and then what needs to take place.
And the different main areas that are there, and they utilize that.
And what they found, which was what we found some of the studies data, I don't have it on here, but it was that while it was initially mandated for football the 1st the 1st year, other sports were already using this already.
And then they made it watch they made it mandated and rolled it out just for football, get based on the timing of when it was rolled out.
And then the other sports.
Now it's mandated throughout.
So excellent.
It's very simple, but at least it goes through the process as well.
Other things in terms of documentation.
So if it's not documented, it did not happen.
It's just like a patient record.
Just keep that in mind of what that looks like as well is keeping track of when training occurred.
Make sure it's signed.
It's a paper trail.
In in today's world, we may have a digital but making sure you're having some digital sign offs within that, checking equipment on a regular and plan by maybe once a month.
You have a you have a trauma kit.
Make sure those are other things to do on the daily equipment, and make sure it's followed.
And again, part of this is if something if someone in your organization is required to do something and they're not doing it, you have to document that and address that as a significant deficit in your organizational processes.
Also important having debriefings and after action reports and have a chance to talk about those serious incidents in a in a non bias manner in how things were done well.
And the unfortunate thing with medicine is that we can do everything in our cases where everything was done was possible to save a life or have a good outcome, but it just ends up not having a a a a not so positive outcome or a very negative outcome, which could be death.
Those are those are unfortunate cases, but it's important that we process through those processes, all health care providers and coaches, anyone that may involve to know that you did everything you could do versus you're wondering if you did or did not do.
Don't look back on it like that, but looking at it as This is what we did, and this is all things and given the situation, this was the best course of treatment, and it was validated by multiple, some speak, eyes on that situation.
Lastly, again, taking care of those involved, it could be athletes, it could be The provider, others involved.
We see this now.
There's excellent resources for an athlete trainer.
We have AT cares.
It's just regards it could be, you know, it could be some someone having a heart attack or other cases as well.
But, again, we have to take care of ourselves in that in that process have a mechanism of who is going to take care of us and others.
If we're not able to actually do that, and we would be expected to be in that role already to handle that as well.
So in closing, so we've got some time here.
We've got about I want to leave plenty of time for q and a.
And again, think about any questions you have, ask you to just go ahead and answer those and we'll start rolling down the questions in the q and a, you feel free to address those.
So in in closing this up is number 1, sudden cardiac arrest is winable.
We can win this.
And it has a high degree of winning.
You know?
And some of this researchers showed about 8, you know, 89% as a matter of fact, when AED was used, it was survival.
We know it may not have happened, but we have to we have to be in a position to give the athlete a chance to live versus do something that's truly detrimental.
We have to have an EAP.
If you don't know where to know where to start, then ask someone and ask one.
Where do you start start simple, and it just takes time to build.
It's not something that's gonna be built overnight, but you can start the foundational processes and have a deliberate plan okay, we're gonna look at this and this month and this month and this month and pretty soon you have the case around.
There's a lot people wanna help others because this is impactful.
1, because if I'm if I'm well, I was traveling with the team and I'm coming to visit you.
Yes.
I have if I have an EAP, or or had, you know, based similar to your setting, they they're gonna help people bounce ideas off.
If you don't if an organization doesn't keep providing AEDs and training, then, you know, this is kind of a common thought process, and I'm just it's more of my opinion.
But if they they can if they don't have the AEDs and training, and require training, then they shouldn't have athletics because this is a supervision issue.
This is something that's definitely preventable in one of those cases.
They have a core or the essential emergency care equipment that give give providers such as athletic trainers and physicians are on-site give them the tools that they can to do their job.
And that's what that's what's most paramount.
You know, one thing I is a I'm a very have a strong opinion on is CPR AD training must be in the job description, not just required by law, but it needs to be used in the job description.
It's required to supervise activities period.
That's a, you know, health care providers are already trained in basic life support, but there's no reason why this should be a job description versus You hear cases of being an unfunded mandate where that gets hung up on that standpoint as well.
Another one is the is medical have a medical time out before before practices and events.
That's also to have that quick take 30, 40 minutes.
Now the NFL is moving this upcoming year.
They're gonna have a 90 minute have a year of 60 minute medical time out.
They're gonna have a 90 minute as well.
They'll have officials to do some other things new this upcoming year.
And then the last two things are kind of a part of number 7.
Think of us 7 is are those 2 together equaling 7 is, you know, what is your cardiac care?
Is it provided?
Is it current inefficient?
What's your plan?
Is are you doing the things that are contemporary?
And then also, you know, how did you and your staff or your organization responded as as rest of resiliency.
It it helps you to rebound and move through that process as well in in evaluating what you did with appropriate given the circumstances, and if anything could have been made more efficient or improve moving forward for the for the future, which may mean that you've done everything you've done, and there's no need to change anything, but you don't know that unless that's evaluated.
So I just wanted with those as well.
And last thing I like to use is a quote.
The one this is one of the quotes from a famous Navy Seal.
I'll let you read that for a minute, and then we'll jump right into questions.
Thank you very much.
Let's go ahead and get to the questions.
We've got a little bit of time here about 10 or 15 minutes as well.
So Thanks, Suzanna.
So first one I'm I'm reading here and is I know this may be a a setting dependence from Sierra Reid.
But how do you start the process of attaining an AED?
It's a fantastic question.
One is, there are some foundations or nonprofit that are there.
If you don't, I guess, with that, Sarah, you know, I'm getting the chat area as well, is based on your setting, is also look at there are startup grants.
There are now looking at federal government.
They may have that as well.
The NFL was part of the smart heart coalition.
They're offering they have monies available that were used in helping schools to purchase AEDs, So I would encourage you to start looking at that vigorously as well.
And I think the what a side of it is they you can it doesn't have to be the top of the line.
It has to be an AED.
So you can buy some of the 3, you know, 35100, the Cadillac version, or you can have a basic one that maybe run less than a 1000.
For myself, you know, in my company, I I have some that have they're about 6 to $700.
About about 7.50, I think, is a little cut to go back.
I have 5.
I'm not buying.
I need the type.
I need a small portable.
I need it to turn on, put the pads on, and it works.
And they do, which we will check on them as well.
So that's the first part.
It's looking cost effectiveness and just make that part of a from a risk management standpoint, that's the other side of that is go to your organization.
If you're to high school, just address that as a problem.
You need this.
This is a standard of care.
This is it's hard to say standard of care, but think about where a normal accepted care is being accessible within 1 to 3 minutes, can you get that to anywhere in your facility within 1 to 3 minutes?
Someone easily getting that.
So I hope that answered that question.
Anthony Panera, ask the medical time out.
Do you have a template of what one might look like to form on your own.
I think the oh, we have a number of different templates out there, and I think you have one.
I think the the Friday night lights at Doctor Kyle has, and I know he'll have that.
I'll I'll get with him to make sure we share that out with with everyone who's attending the symposium.
Think it's just a good start point.
There are different ones that they look at and really think about what the checklist or what that conversation will look like.
On your own.
So there are a number of different forms out there.
What that looks like is more of a checklist to what that looks like for myself.
I have I have number like, I have events.
I have PRN people coming different events.
I have a simple checklist of make sure you do this.
Make sure the equipment's checked.
Make sure you ask the the officials who other key personnel are, where where certain equipment is, so everybody knows what it is, but also knows what you do as well, and I do a lot of different types of events.
So that does vary as well.
Sean asked, is it better to transport to southern cardiac, to trauma center over local ER, even to further away, or just trust EMS transport decision?
So one is they're going to transport where that's determined by their pro protocol and and their their STEMI protocols.
If you're having a cardiac arrest.
Just so we don't have you won't have decision.
If you get into a like a like a a level or a status 3 or 4 where it's not life threatening, they'll allow you it'll say, okay.
Where do you wanna go to Versa, that's a cardiac event.
It runs under a specific protocol, and they're moving through that as well.
That that progression as well.
The one thing I would say along those lines and and this is another great question is that it's really important.
I only emphasize that initial assessment of telling the or reporting to EMS what that is, what the what the case is, and articulating those signs and symptoms that this is the problem.
And one of the things that maybe overlooked is if you're recognized as a provider, or if you're a coach online here.
Or otherwise, if you're recognizing a seizure, then you also need to be thinking cardiac arrest.
It's it's goes hand in hand.
Because cardiac arrest may actually present itself and it does present itself in seizure activity or seizure from a visualization standpoint.
So we think of seizure and you're not doing something versus you gotta take vital signs and progressing that on.
They may be having they are most likely having some type of cardiac event, especially in a younger population.
So just to be aware of that is that's but that's also a conversation that you need to have with your EMS director, with EMS services.
We have different ones there.
I think just have that conversation and understand what they go what what facilities they will go to.
Because you if you call, for example, you may have a air air med.
Air med is not conducive because it's gonna take several minutes before they even go they even leave the ground, and you have to land as well.
There's certain protocol they go with as well.
But also think about how with the care that you provide, Think about what that looks like in terms of transition.
And in the previous presentation by Doctor Walters, He hit on the fact of, you know, having that and you'll also hear this from Edstrap on Friday, and I'll tell you the same thing.
Haven't if I had more time to talk about the importance of that this that transfer report.
When when we're giving if I'm receiving information in in my with EMS, then I need just a 32nd transition report.
I don't need to know, you know, what what they had to eat 5 days ago.
I need to know what they're what the what's their presenting with?
What are their vital signs?
What have you done in terms of interventions?
That's it.
How long has been going on?
Have trending vape vital signs data?
That can be done in 30 seconds or less.
One of the way to give you an example of this, one of the examples when I was I was riding with EMS, the first time I the first time I rode, they we went we took a call into the hospital, and they were like, okay.
You need to make the and and I've never been trained on how to make a call into the you have to make that call several minutes out.
Give them a status report, and that's about 30 seconds.
And they just told me kinda scared me to death.
It's like, okay.
If you take more than 45 seconds, they're just gonna hang up on you.
And I'm like, what is that?
And I don't understand that.
What do you mean why they're gonna hang up when they have calling in from the unit, there is Will.
So and with that, it was a I'm really glad they did that.
Because it really pushed me when I'm not or it's not on the unit is making that quick call being very efficient in my value in my report, but also when they show up on-site is I'm just not handing it over to EMS.
You, as a provider, have control unless it's a certain the situation by state is dictated by state laws that as a as a no number of your athletic trainers here, you have control of that patient.
We assume we're gonna give it over to a paramedic.
You have to make sure that patient, especially in heat another conversation, heat stroke, but there's no heat stroke.
You have you have control of that patient beforehand turning it over.
So there's something to think about.
So I hope I did answer that question for you, Sean.
Ben Velasquez, what's your opinion regarding shared AEDs between Sports 1 AD for 2 or 3 filter venue.
Well, I think that ideally, I think we know that Ideally, in the same event, you wanna have this you wanna have one for each each venue.
However, one AED is better than no AED.
And knowing that it has it.
But you have to take in consideration that if you're applying an AED for 1, do you pull it off and go to someone else.
That's not something you wanna be in that position for.
It would not that would not that's the worst case scenario in if you're dealing with youth sports, that's a very likely situation.
It may occur.
So especially for context sports.
So I wouldn't as far as sharing an AED, I'm not I I've definitely not want a proponent of that because you the more you have, the better.
But but also recognizing that there are some budgetary confines there.
The the next best, if you don't have that, you start the hey.
You start CPR as soon as possible.
And in the case, if you had multiple cases at one time, then you still you still need to have the training and go back to training with a lack of that as well.
But I would not that's the one thing I would tell you.
Doctor.
Lasquez is not to promote that is they need to and that's something probably from a school or a organization standpoint, look at a risk a risk management standpoint, they'll probably tell you you need to have one of every filter venue as well.
Jeff Banacci, What are key talking points when meeting EMS at the start of an athletic event if you're meeting them for the first time?
That's a fantastic question.
And We've done that so many times, and probably one of the the the neat things I did earlier one of my first rides, I was covering a high school where there were athletic trainers on both sides.
And it was nice to hear that, hey.
I'm so and so.
I'm an athletic trainer, and I just sat by like, wow.
This is great.
For me, even doing dual credential, I'm like, okay.
Can we could sit back.
We're not gonna relax, but definitely know we're we have good hands that are already there with that.
So you have no idea the meaning of that when someone I mean, if if you haven't had that done before, it's really it's a wonderful experience for having any provider come up to you as well.
I think just tell them who you are.
You're here on-site.
Do you have a minute we wanna talk to you?
What what do you what's your plans.
And the first thing you wanna ask if they're at an athletic event is, okay.
Are you are you deadlines?
Are you here for the whole event?
Are you on standby?
Because Some of you've seen this, you don't know this, at least drop off, we're getting a call.
And so they just need to know what you need to know what that is.
And start that conversation, and it's really it's really easy.
I think just ask them if they have any questions.
I hope they have a hope they have a great day because we all want everybody to have a great day.
And then the same thing as well.
And then you you just tell them where you are or what your capabilities are if it's the first time and move forward with that.
That typically works well for me.
It doesn't it doesn't require a 15 minute meeting per se because they may be coming in they're they're they're driving in hot, so to speak, into that area.
So just something to be aware of is to start that conversation with them, and then you have a checkpoint, but also making sure you're checking with the coaches on on, you know, administrators on both sides who has access especially if you're walking in for the first time in an event knowing who who who has who has control of the keys, who's gonna you know, his police are gonna be there, are they who's gonna control the crowd, etcetera, because one of the biggest problems you may encounter is actually having someone come in from another stands like a parent, etcetera.
And that creates a very chaotic situation.
So, again, practicing with intention, going through that process, having somebody help control it, and delegating what that made is part of that process as well.
Eric has or at least have 5 or multiple paths, yes.
That can that's a good point right there as well.
Having multiple paths for a single AED, which can be cheaper.
So if you have to because once you use 1, it's not usable.
And that's that's probably the the best option.
You'll go back to what Doctor.
Blasquez has had as far as a question on there.
Anything else?
Any other questions?
We've got a couple minutes left.
If we wanna ask 1 or 2 other questions, more than glad to stay on here, but if I don't, we'll we'll go ahead and wrap this up a little bit early.
And one thing I didn't add, I think I asked from your beginning, but if you if you would just kinda you don't mind taking a minute to share where you're from, on the chat area.
So just like to see where some of you were from.
See Ronnie Harper, not too far from here, and Eric's up in Kentucky.
Couple other areas.
Jeff, it was great to see you this past weekend as well.
Great to see people around the country coming in.
I hope this has been very helpful from, you know, from Indianapolis to other parts in Lancaster, Pennsylvania.
Hillary, thanks for joining as well.
So With that being said, I'm a go ahead and sign off now.
I'll see other questions coming through.
Hope you enjoyed this session.
And, okay, I do have a question real quick from Russell.
So, Russell, please go ahead and feel free to ask your I'll wait for you to ask your question.
Okay.
Well, in case you did the thumb and and wave as well.
So and and, again, thank you again for joining us.
We're gonna these recordings are These these sessions are being recorded.
Later in the week, we'll give you instructions on how to gain once we get these all accessed, are accessible online for that as well.
Larry, thank you.
I know you had some issues trying to get logged in.
Appreciate it from Washington signing in a little bit earlier in the morning as well.
So, again, thank you again, and we look for more information for our next sessions.
We'll start tomorrow again at 10:30.
We have another fantastic lineup of presenters for tomorrow.
Thank you very much.
Case Report Reviews: EAP Gaps Revealed in Sudden Cardiac Arrest (SCA) in Athletics
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Updated Jan 22, 2024
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