Transcript
It's a pleasure to be here.
We're on day 3 of the Sports Merchant Care symposium.
We have another fantastic lineup coming to you today as well.
We've had 4 fantastic presentations already.
Yesterday, we unveiled a lot of information about The the spine injury management, best practices with from Doctor.
Marybeth Hordisky and Ron Courson, And today, we have Doctor James Kyle and Doctor David Heath.
So without further ado.
I'm gonna go ahead and get started, Doctor.
Kyle, welcome this morning.
Hello, Doctor.
Castle.
Good to talk to you.
Now great to always see you in person as well.
Couple housekeeping notes as we get started.
I see a number of folks that have been here already returning as well.
Good to see.
I've got some master athletic training students from University of Omaha.
I mean, from University of Nebraska at Omaha.
Welcome to see you all again.
Dale over in Georgetown, Lindsay in in North Carolina.
We've got Brad.
Good to see you good to see you on here today.
Stevens up in Quincy, high school in Massachusetts, and many others are here as well.
So great to have you here.
So Without further ado, couple quick items.
If you're in the chat area, make sure you have it set to everyone unless you have something specific you wanna send to sent to me or Doctor Kyle, just a back end message, but definitely listening to see.
And, also, I'm a say hello to Sierra.
Congrats on your soon to graduating in up up a little bit north of us as well.
So with that being said, in the q and a session, you'll see that button on your Zoom link.
Make sure you are typing that in.
And send your questions in at any time.
If you have a question comes up, go ahead and send it in.
It may sit there in the queue for a little while, but we're gonna get to it at the end.
Also, at the end of the q and a and when we get to the q and a session, at the end of the session, feel free if you'd like to to actually have a open your audio up, and we'll open that up.
If you wanna ask requesting up a column person, do that.
Otherwise, we can do that by texting.
So just let us know when you type your question.
So that's all I have for right now.
And, again, make sure you fill out their evaluations after the course where you're always good to get your feedback.
So without further ado, doctor doctor Kyle, I've had the pleasure of work with him over the last several years as various Mercia Care workshops, but He has been a true game changer in sports medicine, emergency care world.
He's at 3535 plus years.
In the emergency and sports medicine position.
He currently serves the executive director of the Cowen Group, regional medical director for EMS in Southern West Virginia, and medical director of the paramedic program in NRXCTC.
He has done a tremendous amount of work.
He is and this is his bread and butter, the medical time out.
And I say that because he started he created the Friday night time out, medical time out, which is now not just for Friday nights, but it's for Mondays Sundays Saturday mornings and and then before practice her game.
And it's become a staple part and essential part of the emergency action plan process.
Okay.
He is in With that, I am I could go on and on.
But, Doctor Kyle, I'm a give it over to you, and we've got some as we get right to the part of this, which is the medical time out.
Well, Ray, thank you again for inviting me to join the sports emergency care symposium with Action Medical Consultants.
It's very nice to be included I I don't really appreciate the fact that you put me after I have to follow-up Mary Beth and Ron.
2 outstanding presenters, and they do very good on these remote broadcasts.
Used to looking at the audience.
And frequently, I leave the podium with a portable speaker and wander around and And so I'm not as good, nearly as good as you and others in this sort of format, but I'll do my best today.
Well, hopefully, the good thing is we have a chance for and again to the audience, if we'll we'll be able to turn the audio on for you if you just raise your hand once ready for q and a.
So you can actually talk to the audience.
So that's one thing we're doing a little bit different here.
So If you wanna talk to Doctor.
Kyle directly on this web at the end for q and a session, just we'll we'll get to that.
So let's go ahead and get started.
You can kill your screen up in full presentation mode, and I'm gonna jump off here.
I'll be watching the background.
Okay.
Here we go.
Well, the topic again today is the Friday night medical time out.
Regain checklist or safe sports play.
I I don't have any any disclosures other than to tell you that the Friday night medical time out is a is is available to all of you for no charge.
You can go to our website, the Kyle Group, and order a copy.
The 2023 PDF fillable portion Also, we have a partner in Cory Stringer Institute, KSI, and you can access their website and work through to emergency action plans in the Friday night medical time out their versions there for you.
Alright.
Quite simply with the Friday night, meta time out is to make sure that everybody knows the emergency action play on Friday night, visiting team, EMS, share all the details with the focus on head and neck, as you learned yesterday, with communication to EMS, should you need them?
Also some discussions and equipment needs for athlete collapse.
Sudden cardiac arrest, everybody has been talking about about the last few months.
Exercise collapse associated with sickle.
Cell trait, which is not a sudden cardiac arrest, but a delayed cardiac arrest format.
And, of course, exertional heat stroke, and you're gonna learn more about that, I think, from Doctor Heath today.
And in addition, in small town USA, Who's gonna be covering a cheerleader injury?
Sideline, medical staff, or EMS.
How about spectator?
And band coverage go through all those things.
And and and the key point of this, when we started it, I'll tell you a few minutes ago, and small town USA in Southern Western Virginia over 10 years ago.
You've got to get to the EMS at the game out of the truck, and on the track.
That includes allows you to have good visibility.
Equipment's all there ready to go.
And the spectators and cheerleaders and band are covered.
Excuse me, Doctor.
Kyle, if you don't mind, go to the If you don't want to go to presentation mode, the screen may be a little smaller for some folks.
It's not since it's not in full screen mode.
Okay.
Hi.
Do you go to president?
Go go down to the bottom of your menu menu bar and go over where it says notes, and you'll see about the 4th icon over.
It looks like a presentation screen.
Okay.
Let's do it.
Go bring your mouse down to the bottom of your screen.
Uh-huh.
Let's see.
Actually, go up to let's see.
I'll say go up to the main menu.
So where it says slideshow.
Sort of that.
Okay.
It should be able to from current from current slot over to the left.
You can hit that one and that should do it right there.
There we go.
Is that better?
Yes, sir.
Thank you.
Good.
Do we need to go back at all or continue?
You're good.
Keep going.
So who should be there?
Obviously, EMS, FA trainers, the team positions, but other notable entities, the game officials.
It'd be great if the WhiteHat referee could be there.
School officials and law enforcement law enforcement.
This is a photograph of the 2013 medical time out occurring in Woodrow Wilson High in Southern Western Union, you can see all the players there including the state police ready to be involved.
Now, as I mentioned, this Friday night medical time out is celebrating its its 10th birthday.
It's been around a bit.
It's been tried.
Tested, revamped, and it's matured a good bit.
I will tell you that we started The process for this in 2012 at Concord University in Athens, West Virginia, my hometown, actually.
My dad was athletic director there as I grew up.
But we started it with a division to collegiate program to field tests the process.
And and then in 2013, we took it to 16 high schools in Southern West Virginia.
And Ray, it's worth noting that only 2 of those had certified athletic trainers.
Many of the schools had provisional trainers, either nurses, EMTs, physical therapist helping, but only 2 certified athletic trainers.
And and what we what we'd learned in the 1st couple of years, particularly in 2012, that that there was a bit of disconnect between the EMS talent and the athletic training talent.
And they're ability to work well together.
That's not new.
It's been a it's been an issue even in both of these entities, EMS and athletic trainers have been around 40, 50 years, but they'd never seem to work together unless you massage it a bit.
So what we came up with was a partnership with Doctor Jim Andrews and his Andrews Institute in Pensacola Gulf Breeze and filmed a video called VitalSign trending in sports drama.
And we use this format as sort of a a common language between the the 2 groups.
And it seemed to work.
1 of the one of the key points of this vital sign trending video was discussing what to do with the downed athlete, and we came up with a concept called the rule of 100.
The rule of 100 is pretty straightforward and easy to obtain.
If you have a down to athlete, go to this patient's side, check to see if there's a radial pulse, the pulse at the wrist, and put on your o two sat monitor and do a quick tympanic temp in 30 seconds, you can determine all these vital signs.
If you can palpate the radial pulse, that means the blood pressure is at least 90 systolic.
Listen to say for simple.
It's at least a 100.
And you can do a 6 second count, multiply by 10 to get to pulse rate.
And, of course, the tympanic temperature, we read very, very quickly.
So simply said, if the downed athlete has a pulse that's less than 100.
They're not tachycardic.
If they have a radial pulse, their systolic blood pressure is above 100, They're not hypotensive.
And if their temps blow on during their o two set is nearly 100, They're not gonna die today.
Those are all good numbers.
On the other hand, if they're tacking away at 1:40, and they've got a a temp of 101.
You begin the vital sign trending with serial vital signs for the next 30 minutes, monitoring heart rate, BP, and temp.
And see how they respond to these interventions, rest hydration, and make the determination where they go to the ER or whether it can be returned to the training room seen by the team physician.
So that rule 100, the rest of the vital sign training is still available.
It's on our website.
If you click on our icon, the the call group tree under Sports Medicine, you'll find that video.
And I can't tell you Ray that Ron Courson, who you heard from yesterday, and I, along with the Andrews Institute, are probably gonna redo that that that vital sign trending video this summer.
That should be a nice addition and sort of catch everybody up.
After the success, in Southern Western Virginia, we had a lot of good feedback from principals and coaches and physicians.
In 2014, we took it to Atlanta and seen them work in BigTown USA.
We work closely with Atlanta.
Public schools, 8 high schools, and and and the greater Atlanta area.
And it also seem to have great benefit was easy to to implement.
Then again, in 2017, we had a chance to present at the Andrews Institute on the the growth of the medical time out.
And from there, we had the opportunity to partner with Allen High School in Dallas, Texas.
That's the largest high school in Texas in perennial winner of state championships.
And gave us the idea of what's neat in your town.
The small town USA, as well as Allan's dating him at seats.
Over almost 30,000 cost of 60,000,000 to bill, and there are 800 members of the band on a hot, late August, Friday night.
With heat and all those things associated with.
That other entity that happened back in 2016 to continue to get to make sure that we had common lines of communication of our state office of EMS, and I'm the regional director for the southern part of the state, put together a protocol, special ops protocol 9205.
Sports venue coverage, EMS guidelines for the medical time out.
And you can't really read the print there, but the leads off with the concept that high school sporting events are high profile community events.
With an inherent risk of of injury or illness.
And to being prepared for that, we wanted to add on some information about heat stress.
I think we were the 1st state in the in the country to introduce a concept of cool prior to transport with exertional heat stroke.
We also talked to a good bit about athletic, sudden cardiac arrest with that.
And made sure that we included the concept that early recognition was key Since many athletes go down and experience seizure like activity called the sensual seizure, and or agonal respirations at the time of the collapse.
I might mention, we also include the concept of laid cardiac arrest with pulseless electrical activity in the sickle cell.
Trait exertional collapse phenomena.
So the Friday night benefit time out is intended for EMS to minimize chaos and confusion and be familiar with the venue's emergency action plan.
Why is this important?
Well, the president of the call group, Missus Call calling this race because sporting events are fishbowl, arrangements.
You can guarantee it if you have a catastrophic injury it's gonna be videoed and put on FaceTime and social media before the ambulance ever gets to the hospital.
It's a different to cover an event and a resuscitation at a high school sporting venue that it is in the private home.
This this ball ring is something to keep to keep in mind.
Our partnership with the NFL started in 2000 18 when Doctor Allan Stills requested that we participated in the NFL youth sports safety Saint Dink in June of of 18 in New York City.
And this was a chance for us to really get some some some timely feedback on the effectiveness as well as the utility of the time out in different sports venues.
One of those entities participate in that conference was a Correus Ringer Institute, which I'm sure most of you are aware of, and their leader, Doctor Doug Casa.
And from that association in 2019, the Corey Stringer Institute adopted their version of the Friday night medical time out and put it on their web page.
And here you can see the the generates are front.
So as you haven't seen this before, It's a laminated front and back page format.
And on the top, left hand corner of the front page is is or the checkboxes, that are sort of the heart and soul of the beginning of the time out.
EMS is there.
There's any home teams.
I mean, you're gonna go through equipment list and things that you make sure you want on the sidelines.
So just go through that.
Do you have ACLS capabilities on your truck that's that's there, or if the truck's not there, how do you get a hold of it?
Is there an AED on the sidelines?
And right after the AD, are you aware that many athletes that go down with a sudden track arrest might have?
Seizure like activity or agonal respirations.
That's assigned to get the AD on not to worry about a head injury.
Or breathing problem.
And I might mention, Ray, that we we've got around the most part of the southeast for the last several years giving workshops on the time out.
And frequently, we give a pretest and a post test to measure knowledge base, and it's not uncommon.
That even now 15 years after the sentinel seizure was described physicians aren't aware of.
Avway trainers, some are aware.
EMS.
So the symptom seizure concept is is It's still a teaching point we need to consider continue to focus on.
Backboard, this is 2019 that's changed in some of the 2022 versions, face mask removal tool.
She's fine protocol.
I'm sure you heard a lot about this yesterday with with Ron and Mary Beth, but Preparation for this, determining who's gonna have control that sees by him with Hellman and Hands placed versus who's gonna be the leader of the assessment and back boarding procedure.
He knows who's gonna do what?
Not wait till the time that you have to actually board somebody.
And as you would expect with Corey Streeter, the environmental risk status has been highlighted cool prior to transport.
The lightning fan as well as stop the bleed awareness with hemorrhage control again.
That's the front page, and every we we encourage every school system or state to put together their top 10 checkboxes in this upper left hand corner and we modified it for many.
But that's pretty much the the 2019 pre pandemic list that most people chose.
The rest of the information at the top of that front pages, self explanatory is getting names and numbers of EMS, game administrator, ER number if you have to send the patient home and visiting team physicians and athletic trainers.
Now on the back page, this is the bottom back of the query stringer.
On the left hand side is the multi person lift.
I'm sure you heard a lot about that from Mary Beth yesterday for those of you who weren't able to attend.
This is a proven research proven entity using cadaveric studies for motion at C4C5 with standard law rule versus the multi person lift.
And doctor Marybeth is has shown that you can really lower the degree of any motion during the multi person lift, but has to be done the right way.
And it has to be it has to be practice.
As you can expect, a yellow box for the query stringers there for environmental risk status.
Water breaks for extreme heat, heat using the wet bulb measurement tool for those in Michigan.
Wisconsin, maybe some warm breaks for extreme cold, and make sure you designate where you go and what to do with lightning.
If you notice there's also the the SCAT 5 symptom evaluation checklist on that And and the purpose of that is to to create a a longitudinal evaluation of the athlete through the 1st 2 or 3 days if they had a concussion while you're taking them to the emergency department in the truck get the total symptom score.
Hand off that sheet to the charged nurse in the ER.
Make sure that he or she repeats out at discharge, hands it off to the parents, and they do it the next morning, That's all sets it up.
So when they see their primary care physician or sports medicine physician, we've got clear guidelines or clear understanding of the symptom progression or regression in the 1st few days.
Now just to show you a couple of the other 2019 checklist, We we form a relationship with the Texas Association of Private and Broke Hill Schools.
2019, and they had the same top left little go different order.
As Corey Streeter, but they added the game official, the WhiteHat guy, the referee, as a person involved in that pregame checklist.
Very good idea.
Ray, do we have anybody here from Texas?
And I noticed you had some Nebraska
Yes.
We have several from Texas, from Latin Air Force Base, from Dallas, Couple other Somerset, Texas, Georgetown, Texas, got a couple of ones, Garland ISD.
Good.
We also added the DC Sports Medicine athlet Trainer Association in 2019.
In 2020, during the 1st year of the pandemic, The West Virginia ATA changed theirs to include an infection control piece due to COVID focusing on event hydration planning as well as sideline, PPE, and sanitizers.
And a community update.
Back in 2017, something happened at the Andrew's meeting, injuries in football that really had a big impact.
That meeting, Doctor Allen Sills was the brand new chief medical officer for the NFL, getting ready to go to New York for next week to begin his work.
And doctor Andrews asked us to present the Friday night medical time out and updates that meeting.
Doctor Sills was in attendance and Doctor Andrews came up with a quote about preparedness for all emergencies This starts here.
This starts with us.
That was the mandate.
And sure enough, it worked.
Doctor Sills went back to New York and worked all summer on so that in Falls, 2017, the NFL had the 60 minute meeting.
The 60 minute meeting mandatory hosted by the WhiteHat guy, the referee, to go through all the what ifs, and make decisions on who responds to what problem.
And just in the last 2 years, he's even added to this by adding Doctor Jim Ellis.
Jim was a a as an ER physician out of Atlanta now in in Greenville, South Carolina, who was team physician for Atlanta falcons for many years.
The NFL Super Bowl emergency preparedness team that went in a week before the Super Bowl to make everything make sure everything was a okay and ready to go.
And he he has several phrases.
He talks about the fact that know what your role is not if it happens, but when it happens.
Now he's the emergency medicine emergency preparedness consultant for the NFL.
I'm working all the teams.
That vision played off big benefits back in January because Last year in 2022, Doctor Ellis recommended during this 60 minute meeting that with 30 medical professionals present at a at a typical NFL game that the the physician who would be in charge in the case of a sudden cardiac arrest would be named and that person would be the lead.
And sure enough that happened in Cincinnati, regards to you know about the cardiac concussion, the commotion, and the successful resuscitation.
All this pretty straightforward Make sure you're prepared.
Think about the what is and when they're gonna happen.
Great success story there.
Another success piece that Doctor Sills added with the NFL was the airway emergency sign hands collapsed overhead.
And he added, I think, in the 2019 season, every every NFL venue had to have a airway physician either emergency medicine doctor or an anesthesiologist with a paramedic and a respiratory therapist present at all games.
That certainly came in handy also in Cincinnati.
Good thinking.
So now we'll move to the 2022 checklist.
After the pandemic, we put together some of the leaders in the early morning of the Friday night met at the time of and asked for their input into how we should design the 2022 versions.
And I think Rave Castle, Doctor Castle was involved in that group with about a half a dozen others.
And you're seeing now what we put together on the top left hand side, we we remove some things.
And add some things.
And the thing we added was sideline EpiPen and rescue inhaler.
Of course, we kept the sideline AD in Sentinel seizure ag or respiration, hemorrhage control, face mask, and equipment removal tool, cspine motion restriction equipment.
Beth replaced the backboard.
You recall that from your discussions yesterday.
I'm sure environmental risk status is still there and gained a special circumstances.
We gained a special circumstances.
We were still coming out of COVID, so wraps.
We had COVID in the in the community, changes in the venue, with obstacles and destruction, sort of wide open category.
And then on the right hand side, we had incident designee.
The incident designee is a term to say that if something bad happens, If you have a serious injury, who is the lead person or persons?
To notify the parents, to reach out to a behavioral medicine specialist pastors who's gonna put together the response to this catastrophic injury and and think about the other parts and the and the runoff from it.
So that was a term I think you're gonna hear from Lovey.
Tiburon on Friday, the University of Georgia now with Atlanta Falcon's, and that was her term And her suggestion is we added the mental health component to the Friday night medical time out.
Ray, would this be a good time to stop and ask for some questions, or do you wanna Let's
go ahead and go on to the end.
If you would by if you would, please.
Just go ahead and finish up, and we'll we'll have a time.
Just remind everybody.
Just go ahead and put your questions in.
The q and a is we're moving along, and we're gonna get to those at the very end.
Okay?
So if you you know, I think all of us agree that if you're gonna have a football game, you need to have a pre game checklist.
You're gonna have a high school basketball.
You need to have a pre game checklist.
Let's just look at football where we are right now.
The NFL being the model.
We've got their several ATCs, several team docs, ACLS at the field.
They do the 60 minute meeting.
Rapidly well, it has to do a yes, teammatic yes of airway specialty.
And let's go to the division 1.
They had some of those, but Not all.
Most have the MTO.
I'm not sure they really have the the white hat.
At the regain medic meeting, and not many have a team paramedic.
I mean, that's a medic on the sidelines as opposed to the in the truck.
If the division 2 and 3 level, ACLS is usually there.
We got one team dot probably a couple of trainer.
Urban high schools have the trainer of the dock.
A lot have an ACR's truck there, but in metropolitan areas, sometimes The truck's not present, but ready to be called.
Some have an MTO.
In rural high schools, small town USA almost always have ACLS there and frequently have multiple trucks.
Because they're high profile community events.
Everybody wants to be there.
They might not have a trainer, serve a trainer or a doc, but they've got very talented EMS.
And moving through the 10 year experience of the MTO, One of the hiccups has become that urban high school because the ACLS is present at the game.
But many times, the first time those talented ACLS providers, it could be ACLS of paramedics with special training called critical care medics.
It's the first time they've met the Sports Medicine staff of the of the home team.
And and that sort of moves to my recommendations.
What what do we do next?
That preseason EMS answers I think, is crucial.
You've gotta meet the guys and gals.
They're gonna be covering the game during the month of August.
Maybe go through the multi person left with him or goes through some other protocols or scenarios so that everybody knows what the other group is thinking about.
I'm also a big advocate for the WhiteHat being required for the formal MTO.
While the whistle, 15 minutes prior to the game, home team come over, does any team come over, EMS, get out of the truck and on the track.
Let's go through our checklist.
Sidelot of Paramedic, Glenn Henry, that the University of Georgia has been on the sidelines with Ron Courson for over 20 years.
Very valuable resource.
Here you go.
Glenn Henry, UGA team medic.
Nice to have there.
For sea spine control, open long bone fractures, bee sting, asthma, all those things that curse airway emergency and sudden.
Cardiac arrest.
And finally, In closing, Ray, I'd like to go through a little bit of the sudden cardiac arrest awareness on the field with the engine of Demar Hamlin in January the idea of AEDs of supporting venues, everybody ready and rehearsed to make a difference in the case of a sudden cardiac arrest in an athlete, has received a big shot of penicillin.
Here you can see the the the principle of the 5 piece proper preparation prevents poor performance.
This is at the University of Georgia indoor facility where we're going through this scenario, of a down sudden cracker as a athlete and what to do and how to do it in what order.
As a cow group, we've come up with concept of the first 5 and y is 5.
This is a document in evolution.
It's not ready to be it's not ready to be cited is the way to do things, but it's a group effort determine in small town USA, where as opposed to the NFL with 30 medical professionals, small town USA may be one team physician or not.
Maybe an athletic trainer or not.
Coach is for sure.
What to do in the first five and the wise 5.
The first 5 or the first 5 minutes.
And those first 5 minutes wanna make sure that three things happen.
Number 1, you recognize it's a cardiac arrest quickly.
Can be tricky.
Sometimes when they go down, They'll continue to actually breathe those agonal respirations because they've been exerting themselves.
Eyes will be rolled back.
Sometimes, hand movements like the seizure like activity.
Early recognition.
2nd, early compressions.
Get to the chest, start compressions as soon as you establish.
There's no pulse and unresponsive nature.
And then early AED.
And what we're trying to push on this is that after you've gone through 2 cycles, and 2 attempted shocks.
Hopefully, 90% of the time were more wanna be successful.
If you're not successful, By the way, chest compressions are done as soon as you can get your hands on the chest.
In the case, if you've got a equipment leg and athlete, you're having trouble with shoulder pad removal, even before.
But expose the chest, cut away the jersey, while before in chest impression, open shoulder pads expose the chest or CPR and AED.
You notice there's no mention of this of rescue breathing in the first five.
In the wise five, it's what you wanna do if not successful in the first 5 minutes.
This includes lots of different things, but ACLS is there, but what we're trying to teach is the concept of utilizing a rhythm strip replacing the AD pads with the monitor pads and seeing what's actually rhythm in.
Is it V fib, which you want it to be?
Or something else.
Is it pulses electrical activity?
Is it the tac?
And so what do you wanna do about it?
And one of the things we wanna mention is the concept of entitled c 02, the capital e, little TC 02 is a measurement of the carbon dioxide coming out of the airway.
That's helpful information.
Because early in a cardiac arrest, the normal entitled CO2 of a roughly 35 is down in the low teens.
As you effectively do compressions, more blood circulates and that end title will go up to baby 20.
As you're doing effective compressions, the end title should stay in that range.
If you become fatigued, the number will drop.
And another point is, when the entitle suddenly jumps from 15 to 25, it means you have gotten successful return to spontaneous circulation even if you can't locate a pulse.
So in tile is a concept we wanna teach.
Another concept is cost of social activity, whether the QRS complex is near or wide, a lot of information can be obtained from that.
But if you've got a pretty good intel CO2 and a PE PA rhythm, it might be that you have return to spontaneous circulation.
That's time for another talk.
In the past, months or so, we've become more and more aware of the Lucas device made by Striker Corporation.
They have material CPR device and how effective the compressions can be maintained and getting hands free using this device.
SIMLabs in Michigan, SIMLabs in Albany, New York with the NFL, and and we our SIMLabs here at our New River Community Technical College with paramedics didn't show clearly that this is the way to go, and every NFL team now has access to these Lucas devices or another brand name, mechanical CBR devices.
And it's gonna be the wave of the future.
So that's another thing to think about as we move forward.
And finally, just wanna call your attention to what came out last month of the seminar put together by Doctor Sills in the NFL, announcing the smart, hard sports coalition, which basically says you gotta have 3 things at your high school in order to have safe sports play.
Emergency action plans for each high school venue.
Number 1.
Number 2.
It's really hard.
AED locations.
Number 3.
CPR and AED, sir, education for coaches, the smart heart sports coalition.
How are we going?
And this is an issue from the NFL to write a letter to the governor of every state saying we would like to see legislation in place at your state.
Level to make sure this is happening.
And this is the breakdown as of March 27th.
Green.
I think there's something there.
Texas.
All you guys shout out there.
The green states have all those in place.
Yellow has 2 policies.
Red no policy.
Who for thought?
Once again, thanks for the time.
I think we're gonna have about 15 minutes for questions and answers, Ray.
Mark Cobb, our president of the Calgary, wanted to make sure that We appreciate you sharing the passion behind the mission of preparedness.
Thank you very much,
Kyle.
Yes.
It's fantastic.
Really great information.
I mean, you you I think one I know that you you've already self invited yourself to do a talk on capnography.
So and and time to see you too.
So we'll definitely touch base with you on that.
So already got a couple of comments that come in, and I'm gonna share these where you're reading these, I believe.
But I just wanna if you wanna comment on them, the first one is from Megan over in Houston, and she put in the comment as a comment as I think it's reported to bring up the importance of these for the PRN athletic trainer.
So many work you know, as you know, AT's work PRN events and do not have the thorough EAPs skilled or educated individuals to assist or even know anyone working for either team.
And and on her personal note, She thinks it's the less the less resources the medical staff has, excuse me, for have our pregame or match MTO has been more important.
So the patient ATR is stuck in the middle of an emergent incident.
So definitely you wanna comment on that or just add to that what she just said.
Yeah.
Point.
That's a great that's a great point, Megan.
Let me tell you.
You don't need a whole lot of talent.
To have a, say, Friday night sports play.
You just need to know what talent you have.
If race in an event and I'm in an event, We don't need a whole lot of other people.
But on the other hand, if there there's nobody there that's a certified trainer, you don't have a team physician, You wanna know that so you can think about the what is or something happened.
It it doesn't mean that you have to have an empty bin in your bag.
Just know that you don't have one.
It's just information sharing so that you know what's available, and who's gonna play when the time comes.
Yeah.
I think to add to that briefly, I think up.
When on Monday, we had Rod Walters.
Doctor Rod Walters speak on the EAP failures or case points with even card with heatstroke.
And one thing's he how he brings it out is having that deliberate protocol or that model.
You have to this is a model for how you're going to respond and just what the example you said about the EpiPen is is not so much that you know you have it, is know that what you're going to do when you don't have it and how you interact with that.
And I think that's hoping that one of the things we're reinforcing this week is knowing what you have available, you know, even the spine boarding like Doctor Wurdisky you know, you may not have access to 6 people to do a multi person lift, so you need to practice the long road.
It's still accepted in EMS.
And for simple reason, because you may have 2 in the unit, and they have to do an airway, you know, 1 sec stabilization of the spot seat of the head, and then roll that person over rapidly for rapid trauma assessment, etcetera.
So this this more reinforces that those various concepts.
Right.
Let me interrupt just a second.
A lot of people that are presenting this, we won't agree with me on this.
But after just thinking about what we said, coaches, AEDs, CPR, coaches, eight person lift.
I really think.
I really think.
Very best lift is is the best.
And there's a reluctant say, well, we don't I don't have one student trainer, me.
We can't do that.
Yes, you can.
You got coaches.
And others know that coaches aren't, quote, trained in backboarding.
So There's a liability inherent in it.
I disagree.
I think if you include the coaches in that piece of the emergency action plan, you get buy in for other pieces of
Yeah.
I think to add to that, while this is very different very common on the extreme side, I went to cert to Soleil.
They actually trained their athletes how to go up, you know, 40, 50 feet up or however far it is when they're scaffolding, etcetera, in case they have a a serious injury where athletes stuck up there because it's gonna be even hard for even EMS and fire to get up there.
So they're trained extraction as well.
So something's they can be done based on the setting.
Excellent point there, Doctor Cowell.
Again, so, Mike, Hopper has in asking this is how can we scale the MTO concept for days other than Friday nights?
So we often so often we talk about Boston Football, but what about the freshman basketball game on a Monday afternoon?
Good question, Mike.
Where where's Mike from?
From the Dallas area.
Yeah.
Well, the if you think of of the Friday night metaphor time out, I like to call it your emergency action plan for the football venue on steerings.
It's gone up to a different level.
Of course, you know, in terms of high school football, that's a frequent injury in a in a big in a big venue.
As you switch, though, that It just gives you the all the baseline knowledge and information to switch it to the soccer venue.
To the baseball and softball venue, I would probably put at the top of my softball, I'd write in there, commercial, cordless awareness.
And the AED.
The same thing from the cross.
For basketball, just add pieces to the top of it on the left hand side and the rest of it is the same.
Things that you might expect to happen And, of course, in a lot of basketball games, EMS is not gonna be there.
So emphasis on how to get them there quickly and what to do in the case of of of of hemorrhage control would probably be pretty important.
Thank you.
And Mike, thanks for that question.
Mandy has this question.
You mentioned the fishbowl for any sporting event.
For an S or SCA event, how do you recommend shielding the spectators and other teammates from this, and it's very traumatic for everyone involved.
The NFL event with Demar was handled very nicely where you couldn't see what they were doing with him.
Where's Mandy from?
Mandy, where
are you from?
And she's asking this, Mandy, because she's from a high school setting.
But, Mandy, if you wouldn't mind sharing as Doctor Kahl.
She's from Ohio.
Okay.
Well, that's that's a tough question.
At the bottom right front page of the of the dime out, it has a a check mark for who's in charge of of incident control.
And the basic principle is to get the athletes back to the sideline using a coach or a chaplain or something like that and let the e m let the your merger response team do their job on the field to play free of any visual obstructions.
So they can summons the truck on the fill or they can use their hand signals to to guide the resuscitation.
So as opposed to standing around and blocking their resuscitation effort.
So the Fishbowl arena It's a matter it's a matter of of you gotta accept that challenge if you decide to provide coverage from the EMS as well as the athletic training physician, team position.
It's a it's a it's a tough job.
It's a tough job for an ER doctor to do his job or her job on the field of play, but necessary part.
I don't know if I answer that pretty well for you, Mandy, but I would disagree that the the NFL with all those surrounding players, that's something where I would have scripted.
Yep.
The some I'll I'll add maybe something maybe just a thought is as part of your when your your EAP activate, you're working through your training, and you work with your coaches, and others there, is one thing you could do is actually just assign them and go to this scenario.
So if you happen to be the one providing care, they would be trained in okay, athletes come around, just turn away, just put a circle around from a on that standpoint, you you'll limit the number of people we're viewing.
You're not gonna prevent that at all, but at least you have somebody who can actually direct and manage the people around our our crowd control, so to speak.
And so that does help to it may eliminate some of that, the, you know, the the issues that you brought up because it does occur.
And then you also have other people coming on the field who may not, you know, a parent, etcetera, which is which can add to the chaos.
So, again, think of yourself as as the your quarterback and not and the quarterback doesn't necessarily or the the the you're the head coach of a critical incident.
It's not about putting your hands on somebody.
It's about controlling the scene.
And I know doctor Kyle has a lot of experience in that work with EMS.
He's seen control and critical incident.
It's not so much about putting your hands on somebody doing the rendering care.
It's having somebody who can do that, and you're stepping making a step back to the deliberate process to to help them in direct traffic of what needs to happen.
And that may be it could be the physician here, the physician on the sideline who's working with you.
That that's their role to direct traffic, and I think and I only I think that was part of what they had, you know, part of their plan, you may have seen them win that football.
You have care providers and one positions on one side, but another position.
They're having to have somebody who's helping direct traffic as well.
So Excellent question.
Any other questions?
We still have a very good answer.
I'm not sure we gave a good answer for Randy, but scene control is important, and EMS is used to that.
They need it.
They're correct.
They've gotta have scene control in order to do their job.
Yeah.
Well, I think the part of this, Doctor.
Kyle, is, you know, we're these are some excellent questions, and it's it just starts to we're starting the conversation.
Mean, we've gotta have conversations as opposed to the you know, this you bring forth a lot of great information and and not just it's useful because we do it all the time.
But it's also helping the other, you know, the around us, I mean, to understand that.
I know that I'll I'll share from Louisiana perspective several years ago, they implemented the required what now requires a medical time out.
And it was called a pregame administrative conference.
And it's a very simple sheet.
It's like a 1, you know, doesn't have to check sheets on it, but it does tell what the things to look for.
From security, from weather, give everybody I think the thing that you see is that a lot across the country, and this is not a This is not a slide on officials and the head official, but there there's a sometimes I think there's a disconnect, and we've we've seen this that at a high school level, the officials think they're in charge.
They are in charge of the field, but the actually, the host of the organization who's hosting the event, they are ultimately in charge of the overall venue, which gets into a medical response.
I think it goes to what Mike your other your comment was about, you know, not having having more of the meetings, and I'm a read part of this.
You all you all should be able to see this as well.
Is you're covering games at one of the stadiums and EMS is in the tunnel.
Games throughout the day and there's only one time where they actually had a pregame time out for a medical meeting, and that's one with Mike is saying he went to versus the other they did not.
So having some mandates down the line are very simple things, not having a detailed form.
We're just having them get together as part of that process.
Just snows, you know, who's on first and what's on second and all that and then so.
Yeah.
Your rate your your points are very well, and I'm we're we're short.
Preaching the choir here because they're attending this.
You don't have to have the Friday night pivotal time out, and it's your pregame checklist.
But you do need to have a pregame checklist.
Yep.
And you can design it specific for you.
You don't need to include everything we've got on ours.
But after hearing this, if you would like to personalize your own MTO using the Friday night concept, our group would be happy.
Send your logo over with an email to me.
Doctorjimcall@gmail.com.
Doctor Jim Collins, dr Jim Collins, gmail.com.
With your school logo, we'll plaster it up there so that you'll have your logo right on the top of the MTO is like KSI or or caps.
And we I just I I shared everybody with your website at the very beginning.
It's on with on the chat area, so they could go to that directly as well.
Last question, I know we've got we're running out on time, and this is another excellent question from Larry is our gamer nounchers informed about providing caution about crowd control.
That's a good another one.
I think that these stifel do.
Their game announcer are in their pregame checklist.
I forgot to mention that.
Yeah.
And then that probably Larry, that's something we ought to work on and maybe include on the mass your MTO to have the game announcer there because that would be a great great addition.
I don't know why I forgotten about that.
Where's Larry from?
From Seattle, I believe, if I'm correct.
Yeah.
Yeah.
I think Rafe Castle would love to reach out to you, Larry, and and work on that as a special project.
Well, I think I mean, the the inter interesting part of that question is that you know, you need this is gets into critical incident management messaging that you have to that announcer is gonna help control, you know, seeing control, if you had something a very catastrophic incident.
And I think the thing is you're you have to be very deliberate in what that looks like.
And and when that would be when you would roll that message out.
That's the other side of that as well.
They have to close again for weather.
You have a standardized message.
If you have a lightning, You need to kinda roll through that those various scenarios, but you have to have a it's like having a cancellation, what that means, or what they're gonna do, and how they do that.
Think that's something definitely worth having a conversation with your school's risk management and how they would how they handle that or if it's a district issue and working to collaborate that.
Doctor Kyle, if you would, what is your email?
I'm a send I'm a push this right now.
What is your email you to send to is doctor jimkyle@gmail?
Little b littlearjim ky0e@gmail.
Okay.
I just sent everybody right there.
So, again, we're out we're out of time right now.
Thanks, everybody.
For the fantastic questions and the discussion, Doctor.
Kyle as well and and being available to present today definitely this is something we could hear, you know, 4 days a month out of the year and something that and everybody bring a discussion to it in a conversation point.
So, again, thank you again.
Everybody else for attending today, Remember that the evaluation sessions the emails are on the form.
Look forward to a in about 30 minutes.
We got the next Doctor Heath is coming on board to talk about the next topic.
Again, everyone, thanks again, Doctor.
Kyle.
Appreciate your time today and your expertise.
God bless Ray.
God bless all attendees.
Have a great day.
The Medical TimeOut
General Course Information
Learning Material
Bookmarks
1955 Cherokee Street
Baton Rouge, LA 70806
United States
Baton Rouge, LA 70806
United States
Copyright © 2024 Action Medicine Consultants, LLC
___MESSAGE___
___MESSAGE___