Transcript

0:10

What do you think you for y'all for y'all were bearing the man or 2 trying to get through this technology, trying to push too many buttons. It's a pleasure to have get started here with on this next session on EMS considerations for responding to the psychiatric emergency So for this session, it's actually gonna we don't do a discussion a live discussion with Woody Goffinette. So Woody is and, again, pleasure to have you here, Woody. I'm a do kind of a quick intro for those of you. No, not me, ma'am.

0:44

What he is excuse me. Currently working with Wilson Health Sports Medicine in Sydney, Ohio, and his duties include the EMS coordinator. He's also serves as a clinical instructor and tactical medic for right state universities Boon Shaft School of Emergency Medicine, and their division of Tactical Emergency Medicine. He's also a Tactical medic for city of Dayton SWAT team, Dayton narcotics division, and Sydney Pacua tactical response team in the Green County SWAT team. And, also, in earlier this year, he was presented that Stewart Service Award by the Zinnia Police Department of Rights, standing act of heroism or bravely, which involves significant risk of personal safety.

1:28

In addition to his role as an athlete trainer, he is chair of the athletic trainer's associate the Ohio athletic trainer's association, critical to the stress team. He also assists in teaching at the Ohio Police Peace Officer Training Academy. He's also recognized within the association number of awards. He's also past president of the pub the NIH's public safety athletic trainer society. And also has been a author and presenter.

1:57

So with that, Woody, it's a great to have you on the call this morning. So in the in the supposing.

2:05

No. It it's wonderful to be here. It's honorable to be here, and you know, to be able to just follow Tim, you know, Tim just brings up phenomenal points and we're gonna be able to continue to build on this platform this morning as far as giving an athlete trainer's tools to respond to psychiatric emergencies?

2:29

Yes. It's just so that this is gonna be fairly straightforward discussion. So first off, as we get started, Woody has no conflicts of interest, and and we're not introducing any product or device that she's for is for demonstration or example, but not any particular endorsement. The as as we move forward to talk about this specific topics. Again, if you have questions, we'll share those in the chat area I'm sorry, in the q and a area like we did earlier.

2:58

And If you have a question, just raise your hand, and we'll just have that conversation. I'll turn it over to you and Woody, and you can have that conversation. We encourage that during this. And this is really a unique I think it's gonna be a unique discussion. So as we talk about some of the things this morning during this session.

3:19

We're gonna have some questions, we're gonna address, but then also so that some of the key things that you heard Mister Neil talk about, this is definitely gonna come into some realistic situations or discussion points here. Again, I wanna emphasize that and and was what Mister Neil said that some of the conversations we're gonna have here are tough conversations. Just know that just be aware of that for the audience, but it is in the in the interest of patient safety and our own safety and others around us as well. So these will be some of the key things you see on the screen today. So let's go ahead and get started.

3:58

So What have you been practicing? You're if you would just kinda give a little bit of a background of where you are a little bit more detail. I know the what I described of what you currently doing your day to day engagements, an athlete trainer, is it your paramedic or and firefighter in your daily roles?

4:18

Sure. Try and keep my wife happy. Right? The you you know, the I I've always been drawn to to an athletic training. Right?

4:31

All of the want to help people. And then, you know, as as the profession had advanced this world of emergency medicine, the world of tactical emergency medicine. There are vent doors that that that open through working you know, with position, working with fellowship, transport, med docs, and working with ER docs. So You you know, I've always had, like, most of us here today always had that calling, and then, you know, And as you do this, Ray Armstrong, you see in the world of BMS, sometimes we have this disconnect between oh, I'm an athlete trainer. I handle emergencies, but now I have to call them 911.

5:22

And You know, I think, you know, Ron Porcelain, you know, Ron brought it to the NATA, I believe, in 2015, yield this medical timeout into the importance of the athlete trainer getting with EMS prior to the event. And just going through an EAP because, you know, good good lord. The the worst EAP you can ever have is is one that you don't share. So so so so I think, you know, we continued to build upon upon this interaction And, you know, you have to leave the eagle that to door. You know, at at the EMS provider, I don't care that you're an athletic trainer.

6:07

I don't care that you're a nurse. I don't care that you're a physician. I care about right now what are we doing for the patient? That it's either helping them or saving their lives because because that that's the importance of of of right now. And so so we'll go from there.

6:29

Yeah. It's a great point as we lean into this. You know, I think the the you mentioned just a simple concept of not it's not a war what the weather they have, this type of condition, or and especially, we're talking about mental health and emergency, Now they don't have this psychosis or diagnosis or who you are. It is just simply what they're presenting with and what you can do and not do. And I think the same thing applies for us as a provider.

6:54

What is your what is what are our individual skill sets? And what I can provide to the table to help the solution. That's all that needs to be done, especially with a with EMS. And so just want to I think that's a we're we're right segue as we get into some of the questions here today.

7:12

Sure. The you know, when when when when the tone drop. Right? That means someone's called 911 and we're being dispatched out. You know, if we get to the scene and no one do a CPR, person without the pulse and without the the design device, we need this start now.

7:37

Right? Where if we get to the scene and and and high quality CPR being performed, Right? The first two guys automatic, well, we can get the monitor attached. We can get drugs going based on what the monitor is telling us because Someone, we don't care who they are, but someone has already started the initial steps. And athletic trainers are there or the initial depth.

8:02

Right? The I think it's important that the athletic trainer recognized from the world of EMS psychiatric emergencies, psychiatric causes are always diagnoses of this occlusion. Right? What do I mean by them? If I say, hey, you know, here's a real life example.

8:23

We are dispatched for a fifty four year old lady to the gym She'd have been diaphoresis. She'd have been chest pains. She'd have a shortness of breath. That sound like a possible heart attack. Right?

8:38

You know, and and we get there and, you know, hey. You know, she really hasn't had the anxiety disorders. You know, this we're we're about to play the big game here. It's half time of the JV game, I think it was her mid third quarter. And and, you know, she's just having all kind of problem.

8:57

Once we started our history, it was what's different this time. And the the thing I'll never forget was she just having this stabbing pain in in our upper back, like, right between the shoulder blades. Right? And and we're like, okay. You know, we put the monitor on it.

9:15

That's, you know, elevations in in 2, 3, and a b f. And it's like, no. She's not having anxiety disorders. She's having a STEMI. And, you know, but but the coaches, you know, were like, oh, well, you know, she's just overreaction.

9:31

I think she just all worked up. And, you know, we at the EMS, we cannot you know, we don't get points for going down the wrong rabbit hole. And and at the athletic trainers, you know, you have to, you know, we know the athlete most of the time. Right? We we have a they're physical.

9:52

We we've listened to code to to other teammates. And so that, you know, it's great because, hey, it gives us a direction, but you also don't wanna just dismiss it old. They're just having one of their mood things. The because it can it it can sing it down real quick, you know, hypoglycemia. Asthma, pulmonary embolism, alcohol withdrawal are all things that are acute life threatening that to a psychiatric emergency, they can't present the same signs and symptoms.

10:28

And and and so So so so we, you know, we're responsible. That's why I say, so they the the psychiatric emergency, we have to clean whole lot of thing real quick before we can label that.

10:45

That's a great a great start off point. Just how what the approach is in that communication part is so crucial. Just how what's what's relayed especially for a meta you know, for psychiatric emergency. I've been on a couple of when I was riding with the my work with the EMS unit service here over several years. You know, you're walking into a situation.

11:08

And, yeah, I think from if you're not if take the take the perspective of the EMS professional, you're walking in and you've seen this I know Woody many times we've talked about this as well before for this presentation is, you're walking in, you're just trying to gauge what the SIP you know, you have all this stuff going on, and it comes across the call. And when you you're getting a call, it's coming across a screen. You're not getting this verbal hey, you have this fifty five year old patient with this. It's this. And they may be you're walking in and the the family is you're trying to deescalate the situation.

11:45

And and for some situations, it may be just the fact that you're wearing uniform it is very it's it's confrontational. It's not it's associated with other you know, with that. So you have to be aware of what your context is. On that other side before EMS comes in and how you're communicating that, but also the verbal non nonverbal communication is a really big key. So

12:09

but right either you're helping me or you're hurting me in a world of EMS from bystanders that are on the scene. Right? If you're helping me, you're staying in a plane, if you're hurting me, I really need to get you out of there with either, hey, we got it from here. Thank you. Or I have to get law enforcement involved.

12:28

You know, Tim brought it up. The rate you touched on it you know, the the goal isn't to have it diagnosis. Right? At the athletic trainers, we hated, you know, every athlete every athlete pairs, you know, do they have an ACL tear with this knee? Right?

12:45

You know, we're expected to provide that. We send them to the orthopedic pedic surgeon who said, oh, you have pain in your knee. You heard a pop. The we're gonna get a MRI Right? Then they'll tell you you have an ACL tear.

12:59

They won't tell you have have an ACL tear till after the MRI, but the athlete and the parents and the coaches, they wanna do right now. Well, this you know, who we are, you know, the with the psychiatric emergencies, I don't need to know the condition. Right? But what I need to do is get an idea of where am I going, what resources am I utilizing, and where it my end destination at. Right?

13:28

We're EMS. We're not the definitive care partner of invest. Right? You'll We take the tips that Tim brought as far as establishing trust with the app. We, which most athletic trainers have an abundance of and then be able to transfer that.

13:46

If you look at, right, both of us have been on a a head and neck injury on a football field, Fortunately, most of these are, hey, the abundance of precaution, and we're educating the athlete and they're as we're waiting on PMM, hey. You know, hey. This is just precautionary. You know? But this is what we're gonna do.

14:09

We're gonna you'll remove everything. We're going to, you know, roll you onto a spine board. You know, we're telling the app step by step to keep them calm. You apply the same tool in the toolbox transferring a a psychiatric patient to EMS. Hey, the guys are gonna come here.

14:30

They're gonna talk to you. They're gonna try and hate what the best, you know, worth our best avenue to go. You know, what hospital have you been to? Oh, I've been to Dean Children too. And, actually, doctor, you know, Plowski, psych rehab, you know, that's all valuable information that the athlete trainer can glean, add their weightings for us to get there, and then that transfer of care is smooth.

14:56

This smooth, the calmer, you can make it in in a psychiatric situation. The better it is for the patient, right, in that one. All of us want.

15:06

Yeah. I think it's, like, almost, like, briefly, like, I I equate this to the psychiatric emergency, how you handle this. It's no different than having a bee sting, or you if you had a drug overdose, The first thing if part of the treatment side is remove like, for a bee sting, you gotta remove the stinger out of the person when we get that in the the origin out of the way, and the same thing applies for the situation. So, you know, as we talk talk about some of the protocols you're using and moving with this next question we'll throw out to you is think about where if something is causing more of a the situation to get worse like the Allergen, or if it's not an origin, then just control simply controlling the the audience or who's around. We do that all the time anyway in games.

15:53

I think you would do a solution. So that you alluded to that as well. So along those lines, what are some things that you that are best practices that in terms of the specific things, you can the the athlete trainer or other provider, whoever audiences here can deescalate a situation involving an emergency. Anything that was really easy to do in terms of, you know, your posture or separating them out get the, you know, get other assistance, etcetera.

16:24

Right. So so if we we build off the the the excellent points that Tim made at Berge Hill, in your approach, you know, and and and this starts prior to this episode. Right? How you interact with the individual athletes, how you interact with the, you know, kids or or kids do athletes or so observant how you treat other people. Don't think they're not, and they don't need their cell phone to see how you treat both.

16:57

And, you know, and so, you know, or or athletes that we've had where we know that they have a a a psychiatric diagnosis. That's where we're getting with EMS Hey. What is our protocol? What is our protocol that send them to our local hospital versus indirect line? To to, like, stage 115 behavioral health center.

17:28

Right? Those are all thing that the athletic trainer know different than than going over other athletic emergency at the beginning of the season. We discussed the hey. You know, we have a patient with schizophrenia. You know, this is how we're going to handle this.

17:51

These are protocols. You know, I I I always laugh because it seems like healthcare providers always want EMS to break protocol and protocol to our guidance, but they're the reason behind the guidance So if you just say, hey, they're going to do ABC and we can't legally do ABC to trade in this conflict, So it is so worth having the conversation prior to the seeds and, hey, for this segment. Right? Guys, if I know if someone had a type 1 diabetes, right, I have a EAP for it. I I I keep scheduled.

18:30

Right? I keep warranties and refrigerator. It's no different with the psychiatric emergencies. Hate I know that person had these tendencies. I know what their triggers are, and I know the resources that I'm going to have that I can convey to the EMS as once again, we did get toned out for a ultra level consciousness in the wrestling room.

18:55

Right? That that's that's so we're coming into that blind. So when that bloody trainer can say, hey. This is Jimmy. Jimmy fifteen.

19:05

He just you know, his days, he had a bad day. He tried cutting home cell. I was able to look at it. Got gauze on it. We we got control bleeding.

19:17

We have a great digital pulse. The the mom All you prefer that we transport him to Dean Behavioral Health Unit. His doctor is this right oh, this is think that the kids already experienced before you're giving it an account manager, the EMS, and you are solving problem with every one of those facts that help EMS continue on that care.

19:44

Yeah. I think the one you mentioned the protocols is One is, if you're not familiar with the dealing with a psychiatric emergency, is reach out to your local EMS providers you know, understand most of those most of the protocols are in their practice guidelines are publicly available. They there's their their public entities as well. But get them to come in and show them understand what that protocol is because, you know, depending on the situation, I know when I was working with EMS, that there was a set protocol that went in place to pay if you if they had this, this, or this, or one of these, then it automatically regardless of how they're presenting. They're they could be talking.

20:26

We're talking like we are right now. But if there's been some form of potential threat for violence, otherwise, gonna be on the gurney for transport because that's that's a normal procedure they're strapped in, but they're also gonna have a full point restraint with the feet and the hands. And it's not loosened. It's not you know, I've you you you know, you've seen this before where you have if you loosen that strap, then they become a they can grab you and and it's not that they're it's, you know, when you're in the back of a unit, you're by yourself. And if you're back by yourself, then that creates a whole thing.

20:58

So you have to we have to understand what that what that situation is like. They can they're calm until they're not calm. And creating a risk for the provider as well?

21:10

Well, you know, and and you go you go down a a situation that none of us ever want to be in. But if we're involved in this situation, right, your your state d or state d are paramount to all of this, You you never make a false promise to someone having a a psychiatric episode. Right? There is first you have to understand, they're the world of different between someone that's having just a mood disorder as someone that's experiencing some, like, excited delirium. Right?

21:44

I mean, though there are 2 far ends of this spectrum, no different than, you know, grade 1, grade 3. The and and if you don't know the protocol, then then you're behind the eight ball, and and there's no reason. Right? The the the the concept of athlete trainers and EMS getting together we have long broken down the barriers. Now is it possible?

22:12

Right? I we're you know, our our fire station has 48 personnel on it. Right? And so we always know that we're gonna whenever we do in services with our local department, we're gonna do, you know, 3 days because they work 24. They're all 48.

22:30

So you got 3 crews there. And while you may not get the every one of firefighters most likely, you've you've impacted the training officer that, you know, mess director and one of the road soup road lieutenants. And so even if that EMT basic doesn't know you, just the fact that the the the senior officer is it meets you by your name or or or Greek you with respect, and you're giving them from the information says, hey. You're a health care professional, and you guys I may have not been there, but I know you guys have already been had this conversation prior to us being here today. And that just calms everyone down and calm this.

23:18

It is paramount when you're dealing with these folks. For sure.

23:24

Oh, yeah. Definitely. That's a excellent point to just having some information is better than no information and and skill training as well. So it well, all those lines, I think you've alluded to this. Like, some of the training that are you recommend, like, for athletic trainers.

23:40

We don't we don't I know that, you know, I'm working to say, we're not this is not the most prevalent condition we're dealing with, and where where have you seen the I guess, where other professionals have come together to have successful outcomes like the child you know, what look at any of any recommendations, like, what you all do with the athlete local athlete trainers. Obviously, you're dual credential, but bridging that gap between the various professions in in being able to better handle situations the psychiatric university. So

24:13

Right. It it like like all aspects of of athletic training, it it is education. Right? It's education and opportunity. You know, as Tim said, you know, monitoring at a VA, monitoring at a behavioral health, If you don't have that, those opportunities, then then it truly is is on the on the the taking advantages of opportunities like this, just the pickup key points.

24:42

Right? We're not making athletic trainers psychologists. That's not the goal. Athletic trainers. Right?

24:50

We want tools in the toolbox. And we're adding on to those. Some of those, you're just never going to know. I I give you an example 3 years ago I'm just going in with an for an athletic pressure on Thursday Thursday in the state of Ohio football team play on bright high school football team play on Friday. They're low key.

25:12

Afterwards, getting ready for volleyball, volleyball, hearing stable, Ohio plays. Manually on Tuesday, Thursday, Saturdays, and I get called into the gym, hey. I'll never forget Hey, hey, Woody. Yo. Lowell Sally got in the head again.

25:32

Well, that paints a picture. And I go out and and and and and and let me describe this. Like, the visiting team They're all frozen on the court. Our home team, they continue the warm up. I have a mom hovering over a downed athlete on the volleyball court.

25:54

I mean, she is a 9 line Chinook helicopter hovering And but but but our team, the home team, we the the group just kept continuing to warm up, hitting the volleyball. The you know, I mean, one is seen. Right? And and and I'm trying to oh my gosh. You know?

26:14

Have we called 911? She doesn't mean 911. I won't won't I she got him to head. Well, she always gets him to head, and then when she gets in the head, she collapsed. You haven't told me anything yet that had eased my mind, right, 45 minutes later.

26:31

You know? And I'm thinking of every lawyer in the state of Ohio is going to be calling me for my ineptness because this girl has psychogenic non epileptic seizures. Right? So her vital whereas stable effect, no forming a demalf and go acidosis, But by being hit by volleyball while warming up with, you know, every volleyball player will tell you that happens, this step hurt into this reoccurrent physi or pediatric crisis and it took 45 minutes for us to pull her out of this, and then she was fine. Right?

27:17

And this happened multiple times. This did that as a, you know, a billing athletic trainer. You know, had I had a chance to look at their pull up every athlete when I'm out there for a Thursday volleyball game? No. You know, the but the response.

27:34

Right? The the response of what set this apart because all of her teammates did went normal to them. You know, she had done this for 3 issues in the junior, so she had done this for 3 previous years. They were just used to her having this had the girl described it meltdowns. And then a a mom that that would would at the intensivist could be that the right treatment for her daughter was no treatment.

28:02

As friendly through EMS because she didn't wanna pay and go through all this. I'm gonna do all these test again and she'll be fine in a couple of minutes, which ended up being 45 minutes. Right? You're not expected to know what opinions is just no no different thing you're expecting. The the more complex diagnosis is You manage the situation, you best, you listen to folks that you have trust in, and you look at the scenario to start giving you clues that while this is completely abnormal, maybe it's completely normal for them.

28:39

Yeah. That that that gets into well, that's kind of a yeah. That's Mhmm. We don't know how to even that's a that's a that's one of the odd things that far. I know that I'm seeing a note a chat here The Alyssa has a I have a series of P And AS cases at my school last year that was definitely traumatic.

28:58

So Yeah.

29:01

I I think Arden, I missed that one. Yeah. But but that's that's the, you you know, Tim, I think did did a great job on the introduction this morning. That as an athletic trainer. And as EMS, I you know, EMS, we deal with psychiatric issues every day.

29:24

What the good ones look for is what's different today? What caused you to call us today that that you didn't call us yesterday for. Right? And because, like, you know, remember the psychiatric psychiatric episode, we have to clear a whole bunch of other life threatening things for before I could just dismiss it as a bad day.

29:54

Yeah. I think it was it's just one I remember I I wasn't involved in this, but I was like, when I was working at the university that there was a case where I heard about where a student non athlete, but a student, but it involved an athlete trainer, and a teaching a class student is having an epic having a mental crisis episode And when they said, okay. We just need to call EMS. Of course, the what what I was told was student saying no. No.

30:26

No. Don't don't call EMS. Don't call EMS. Well, you need to it goes back to the protocol wherever you you gotta move that in place, and I think you You give that as a handoff. It's not.

30:36

Just get you're just getting resources because, evidently, this is a against a norm of your regular know, know how you're gonna handle that protocol and and stay steadfast to it, and it goes back to what you just said earlier what he you don't know until you don't know. And, you know, it's and and you and you're gonna continue to not know until, you know, you keep moving down that line. So it's really important just regardless of what they say, look, we're we're just gonna call EMS, and I encourage that all the time. And what I've done like, look. Just call EMS when in doubt.

31:06

And when they get there, It doesn't mean they have to transport, but at least someone else has had another eye on it, and it may actually it may necessitate it the the additional care or it may be something where they're like, for example, pediatric patient, they may they're they if they're having some type of medical or a trauma emergency, they're fine until they start decompensating really rapidly. And that may be showing other things as well. So That was a excellent example you gave, Woody, and also who also role listeners.

31:38

So so if you build them onto the you know, your best practices, right, at at athletic trainers. Right? If if you can challenge your your your pre pre preconceptions. Right? You know, to understand, you know, and and and and Tim showed the great slide on his introduction.

31:57

Right? Most of these folks have been a victim of violence. Very few of them are perpetrators of violence. That doesn't mean not all of them. Right?

32:08

You know, you have to you know, please, you know, if as athlete trainers, we have access to at least a written history 3 and they're physical. Right? You know, do it and and, you know, what's their rate. Right? It's a uniform thing.

32:26

Right? A a a police officer showing up and a and a dad in the stands that is having a a, you know, PS PTSD crisis, you know, hey. Let's not introduce that right now. Let get him calm down. Right?

32:46

You rule out the medical thing the best that he can. I think that I don't are always important. Right? You don't raise your voice. Don't tell the patient to calm down.

32:58

Don't get defensive. Don't argue. Don't be judgmental. Being an athletic trainer. Right?

33:04

If you're being an athletic trainer that genuine you care about the kid, you care about the adult, and you gain that sense of trust and with trust come commerce. Right? As much as you can explain, please explain what's happening. Right? These folks feel out of control.

33:26

The out of control, it what rings on and everything starts to escalate. Right? You never wanna make them feel trapped. You never wanna make them feel out of control. I love, and I do mean I love getting these books to the athletic training room as quickly as I can.

33:44

And the reason why it's familiar, I can I can get it out of the view of cell phones, And I have resources, and the the EMS known for that, like, training room is right? And and we can calm things down. The, you know, the priority always has to be the safety of you, the bystanders, and the victim. Right?

34:14

Yeah. I mean, that's just you know, it goes back to that simple question simple statement is instead of saying, you know, what's what's wrong You don't you don't wanna say what's wrong. Hey. So what's going on? Hey.

34:25

I'm so and so. Tell me what's going on today. And this is you invite them at none and opening a question. So With that, I'm on a Alyssa who gave that question about that multiple. She would like to share this a little bit.

34:37

So I'm a put her on the on the talk side. So let me go right here. So good morning, Alyssa.

34:45

Well, hello. I did not expect that.

34:48

No. This is good. This is this is even better. So go go ahead. This is

34:54

yeah. No. Actually, we ended up Last fall, it started, like, mid September, and we ended up with 4 adolescent females, only females. And they were all athletes. 2 were volleyball.

35:10

1 was wrestling, and 1 was basketball. For about 4 months, we went through just different episodes. Yes. And it was fortunately well, fortunately and, unfortunately, Their classmates actually got very good at recognizing when these were just starting.

35:29

Yep.

35:30

And we're able to get them you know, down on the ground or somewhere where they're not gonna get hurt and then would let myself or one of the other first responders in the building know. But, yeah, we went through. We there there was CTs, EKGs, like, just the whole blood panel And I actually have a case study submitted to journal math like training to to kinda spread some awareness on this. One of our girls was actually further diagnosed with conversion disorder. But, yeah, just looking at those those previous traumas and just that whole background and and impacts that those can have on those athletes.

36:18

That's a thank you for sharing that. I I guess the question I have for you and we were gonna we're gonna talk I was gonna ask Woody this, but I'm gonna ask you this or ask both of you all this is that in any of those situations, I know I've encountered this for EMS is, like, there's somebody there who's videotaping. Video recording, they pull their phone out. If you did y'all have that encounter, Alyssa, where kids were starting to videotape you while you're having to deal with the patient, or you've seen, like, in these particular situations you had. Or and if not, then I'm gonna ask, what are that?

36:51

Same question.

36:53

Okay. As far as just for, like, to share on social media, what's going on through a Snapchat or whatever, there was no videoing? We actually did video a couple of the episodes just for physician diagnosis because they were not seeing the actual episodes. Just so then they could have a little clearer picture of what was going on. And those, again, were all with patient and parent, consent, in physician direction.

37:24

Okay. The gosh. I I the the world that I live in, and and let me apologize. I'm gonna go just a little dark. The when was it December 14th?

37:38

I'd have to I think that was right a couple of years ago. We had a guy that tried killing us. So we killed it home first. The and and and and our world of EMS we we we we we we are getting video tape, and that is the presumption and I will take a step further. Not so much in EMS, but in law enforcement, most of us have body cams.

38:10

So we can learn body cams to a seasoned officer. You know, the the resistance with their But time and time and time again, it had proven itself both financially, career, and public perception to be a a a great value. So so the concept of someone Pulling out a cell phone. I don't even know that I would recognize it anymore just because on the EMS side, that's happening. Now if someone did her bearing, that were I either give my taser out or one of my friends in blue, because now we have a a immediate public safety issue because of that of that.

38:59

But but the public had to write the videotape it. The if you bring it back into a level of athletic training, hey. Gosh. If they're with you, would you want someone videotaping you? And both kids will lower their eye, to lower their head, then they'll swank a little bit?

39:18

No. Right? I you know, if you you hold the kid that the student athletes accountable and sometimes you'll get compliance, but Lord knows. Right? They are bored Their social status is how many clicks or likes that they get on on TikTok.

39:36

And so it's just a normal it's it's a normal world in EMS.

39:42

Yeah. I think you said to be recognized. I know the time several times I had to I would have somebody come up on the on the unit, and we don't have law enforcement there. But you know, it's about maintaining privacy and dignity, and you can still do that. I think we do that already by having the medical tent, you know, and the sidelined or moved them somewhere.

40:02

Just simply ask them, you don't wanna confront somebody because then that can agitate this person who wanna watch. Just simply look, I'm trying to take take the person to person or just ask the patient, do you are you okay with that person filming you? And if no, then that definitely changes the context for that person as well. But, again, just, you know, be you don't wanna create a escalate a problem and stay focused on a patient. Just say step away, back away, and let me do my job.

40:32

Because as as you just said, Woody, if they can't do that and you can't do your job, then you do have to bring in and I think that's something you'd have trades, bring in security, bring in law enforcement. You have to have those measures in place for games and, you know, somebody running on the field while it's been worked while, you know, it's it happens. You wanna work through that already to eliminate that as best you can and have that just have that process where you can communicate with them. So I just wouldn't don't share that briefly.

41:03

Yeah. And and let's take it just one step farther for the athletic trainer safety. Right? You know, just like an athletic trainer with an AED, it's never going to save a 100% of a clapped athlete on a field. Right?

41:19

An athletic trainer, is there going to be a time where the hair is on the back of your neck all the bills internally are going off that said, this is not safe. And the best thing that how athletic trainer can do give yourself permission to back away. Right? And and it's, you know, a schizophrenic, excited delirium, a complete severance, of normality, whether this was due to just the a a a neural electrical issue or a drug induced issue, an athletic trainer, we never want someone getting her because they tried to be the they tried to intervene. Right?

42:10

When when those bionic sensors are going off, there is nothing wrong with backing off and seeing we need the Calgary and we need them now, and this is no longer, you know, envision a 6+6 £310 offensive linemen having a violent crisis in the locker room that, hey. Well, you know, I'm small. I'm pet pee. I'm his friend. You have got to have an exit because this is way beyond what what we're talking about today, and I just don't want to give this.

42:60

Oh, we're gonna save everybody. That's how psychiatric episode now, and I know Tim's going to really build upon that sometime you've got to just back away.

43:12

Yep. I mean, I've had that in closing, I've had that situation where I actually had the instead of having the it was a £68380 Wyman actually came in and enter and grabbed the other athlete who was angry and just started the lashing out for no reason at all. Mhmm. I thought they escalated the situation situation. So, you know, I think the the in closing, you have to think about your safety you had in safety is, you know, one thing you you we need training in is also is if someone lashes at you or goes towards you, the last thing you want to do is if you hesitate and then go back and retaliate.

43:50

Right. That's a whole another I think we may have to go this might be another conversation, another talk with you, you know, and and how you how you handle those situations, but you have to be trained and have that self awareness, but it goes back to protocols. And, anyways, I know we're running a little bit over time What do you this was fantastic. Oh, we didn't get the probability. I think we got most of the questions we wanted to get to, but I think we hit the most ones of communication and the protocol importance for protocols, importance for understanding protocols with EMS, you know, how to ensure patient privacy and dignity, how to some tools to deescalate the the an emergency and and and also from a collaboration.

44:29

So thank you for attending this session. Woody, thank you again for your time and expertise. Look forward to having you again in the near future on another webinar. With that. So thank you.

44:42

Well, I I appreciate the invitation. I appreciate everything that Tim doing up there as well, and we'll Stay safe out there, and we'll see you later.

44:51

Yeah. Definitely. Okay. Audience. So