Transcript
Hi, hello, everyone.
Thank you so much for your time and patience.
For joining in tonight's session.
I'm Ray Castle.
I'll be the moderator and also the presiding this case today.
I'm gonna wait for about a couple more seconds.
And, again, I apologize for the delay in the in the technical difficulties you had.
In logging in, we'll go ahead and get started.
I'm gonna I'm gonna start some of the basics here, and then we'll have our panelists join and then we're good that we'll start rolling with this presentation.
So as you're going on, thanks so much for joining again.
We've got initial poll here, and we're looking to see a number of individuals.
If you would answer the first three questions, we just wanna see where you are in and your background is so that we can it'll help the the the panelist know at the end, and hope we'll be able to answer some of the questions you have as well.
We have, obviously, a number of variety of individuals, what their background is, range of expert.
And then also, number of individuals who've actually dealt with the heat stroke and those who have not.
So we'll continue to answer those for a minute or so.
As you come on board, please do ahead and and try to answer those questions best we can.
I'll keep that open just for a little bit longer.
So let's go ahead and get started with the tonight session.
So you'll see here We'll go ahead and start rolling this.
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So with this, I'm gonna move this forward just a little bit, and Sorry about that.
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So First off, I wanna get started with this and looking at some of the things on the introduction side.
So if you would, I'm just excuse me.
I'd like to introduce in a second, I'm gonna have them come on board.
And if they're gonna jump online, if they would, And with this is so as we move this welcome official welcome for this presentation, I need to make sure there's one quick thing here.
Bear with me as we are making sure it's recording.
So again, thank you again.
I'm Ray Castle.
We're and this is a mock trial debate on exertional heat stroke.
Management and a pediatric athlete.
For those of you who may be joining us late, my name is Ray Castle.
I'll be the moderator and presiding for this tonight's presentation.
On screen, you'll see a brief summary.
The case has been argued today.
You some of the things in here when you see this, due to time constraints, the broadcast, I will not be presenting all the information in this case.
Someone is on screen.
The the panelists have seen only the thing that that we're using.
They prepared based on the same case that was emailed to all attendees.
That will be also available on on demand as well, the full case.
And then also, please note as we're moving through the presenter disclaimer, The information is for fictional characters only, and and it gets and the things they may say, may intentionally or may intentionally state, that maybe against their normal standards of care as part of their role in this broadcast.
Again, this is a this is a broad pixel.
So the team representing the planets will present evidence to support the contemporary evidence in the management of exertional heat stroke, which includes the use of cold water immersion and the use of correctal thermometer in a pediatric act athlete.
Please welcome Jason, Kate, and Scott, arson, over the debate.
Jason, Scott?
Have audio on Jason?
There we go.
So there we go.
We're we're getting technologies worked out sooner or later.
So representing the defendants in this case, this this team will provide evidence justifying the actions taken by their defendants, the the management exertional Heatstroke and pediatric athletes did.
They did not require the use of a colorectal thermometer in this case.
Please welcome Kerry Wolf Hardlin and Christina Chapsky.
Good evening.
Hello?
Hello.
Welcome to the welcome to the broadcast, everyone.
Okay.
So we're gonna get started here, moving on through here.
So, again, couple of co disclaimers here.
Excuse me.
I wanna make sure I need to see this.
From this standpoint.
So first off, let me go back for a second.
Wanna emphasize this one this one slide.
So as we go through to the speakers moving through here and apologize for some of the this technology issue we're having here.
Again, on this debate, we're having several different things.
You're gonna see an opening statement, presentation of key witness, inhabitants, cross examination, rebuttal, closing arguments, and then you will have a chance to you as a jury to vote.
And I also asked you during this time, if you get a second, if you would, is do this is in the chat, let us know where you're from.
If you have questions during the debate, I asked you go to the q and a section, so you can please I'll make sure that's available during this debate.
So the the panelists They're gonna be moving through this process already.
We'll not answer the questions, but we'll hold those off to the end.
And then also, if if if time permits and if doesn't, we will still get these after the fact and bring this out to all the audience.
So, again, this is hypothetical information.
It's not intended for medical advice.
The opinions and arguments presented do not necessarily reflect the professional beliefs nor their participation in this educational activity and any specific medical intervention.
You can read on what this looks like as well, other things as well.
And also, it's really important to understand this information provided by the presenters but this educational session has done so only hypothetically and independently and may or may not be in line with their mission, vision, values, teaching, policies and publication or publications from their affiliations.
So as far as this specific disclaimers and credits or conflict of interest, you'll read those are.
I'll leave those on there for a second, for your viewing.
Again, you'll be able to watch these on the on the broadcast as well, and these will be available in the on demand course.
For you to view.
As I said before, this is a full debate.
And, again, this is replicating an actual argument that we may see.
And again, use the chat area below just to listen to where you're from.
We wanna hear that.
And know where you're from.
And, also, We have the q and a function as well.
We have a number of attendees here tonight.
Excited to see so many people.
You know, Andrea, Ben, Moving on down the line.
We've got Jennifer Dale.
Also, let us know where you're from.
Jessica, Mike Hopper, Matt Somack, definitely welcome and many others welcome to this to this panel as well.
Again, think about all the things we're going to do here tonight.
This is gonna be a lively debate and just know that this is going to roll move very rapidly.
So here in this non this scenario is a fifteen year old soccer player class during practice.
Athlete.
I'm sorry.
They they were coke.
They had cold water cooling.
I'm sorry.
Not emergence of typo.
Go back to the actual case.
They were transported by EMS.
The athlete spent several weeks in in in the hospital including exertional heat, stroke, and exertional rhabdomyolysis.
Diagnosis.
The key question here is this, should we use a colorectal thermometer utilize an athlete to school in this in this situation the schools excuse me.
School's athlete director aboard.
This athlete trainer was having difficulties in that case, which does become a prevalent issue today.
In several cases.
So we wanna address that question specifically.
So as we move forward and again refer to the full case that was provided.
So with that being said, I'm gonna move this forward.
I said we've got their 2 case, our opening statement, and we will begin now.
So, Jason, you now have the 4 for 2 minutes.
Thank you, judge.
Castle.
Good evening, Jerry.
My name is Jacob Pace, and I'd like to introduce my expert with this mister mister Scott Arsenal.
Would it about to be laid out before you are the facts of what transpired on July 15th.
You undoubtedly hear a lot of medical mumbo jumbo from both the defendants and the plaintiffs in this particular case.
You will hear things such as exertional heat stroke, proper dialysis, global global temperature, core body temperature, total body, cold water immersion, and many more.
However, it's very important that you the jury Stay locked in on the packs.
These are the packs that I want to lay out before you that went down on July 15th.
Lake Brewing Hospital has an unwavering duty to protect and serve the students of their district.
This includes the health, well-being of the student athletes, and especially those that participate within the LBHS athletic department.
We'll provide to you whether where there was negligent actions from the school principal, athletic director, or athletic trainer, and school board.
They resulted in a catastrophic health care event for our client, Miss Susan A.
Lack of preparedness, lack of lifesaving medical equipment, back of adherence to their own medical policies led to miss seasons for our heart.
There will be some smoking mirrors from the defendants as it pertains practice acts of licensed athletic trainers in the state of California.
I'll be first to tell the jury that this is concurrently no such thing in the state of California.
There is no practice act or licensed athletic trainers.
However, every certified athletic trainer takes a note within the National athletic trainers Association.
Every athletic trainer had a standards that they must adhere by a practice set forth by the national athletic trainer border certification.
And every athlete trainer has certain educational competencies that they must master and set forth by the eighties that he
has expired.
Jeff, Mister Kake Kake's.
Thank you very much.
Thank you.
Doctor.
Ovelin, you now have the floor for 2 minutes.
Thank you, your honor.
One of the most common settings in which exertional heat stroke is observed is in competitive sports.
In a swarth setting, high levels of motivation and exertion can in some cases blunt sensory feedback from hyperthermia that under normal circumstances alter behavior.
However, determining the exact prevalence of exertional heat stroke across different sports is problematic due to inconsistent existional heat illness terminology, diagnostic criteria, and data reporting which reinforces the multifactorial and diverse nature in which exertional heat stroke can occur.
The clinical changes associated with exertional heat stroke can be subtle and easy to miss if medical personnel do not maintain high level of awareness and monitor at risk athletes closely.
In some cases, this reptile temperature is the only discernible difference between severe heat exhaustion and exertional heat stroke on-site.
However, a core temperature of equal to or greater than 40 degrees Celsius is not a consistently meaningful risk factor of exertional heat stroke symptomology.
Sports, in particular football, have long passed the red line between competition and effective conditioning strategies, and the brutish punishment and arbitrary bullshit that the coaching staff and to a lesser extent the athletic administration and in some instances, parents deem necessary to create a championship culture.
In addition, many states, most notably California, lacks enforceable policies because its guidelines are only recommended.
Even if policies were mandated by the numerous sports governing bodies and the state health departments, they do not apply to club or travel sports teams.
Over the next hour, you will hear all the reasons why we should use core rectal temp in the pediatric and adolescent patient population.
But if you ever stop to consider that not everyone has or allows that luxury.
You're finished for your time?
Mhmm.
Great.
Thank you very much.
We'll move forward now to the next phase here.
Thank you for both your opening statements.
Alright.
So now, Mister Kate, you now have the presentation of evidence.
Now you have 5 minutes to preserve your key witness.
Thank you, Jeff.
Welcome.
Thank you, judge Castle.
I would like to introduce my key witness to start ass note.
Scott, I appreciate you being here this evening.
I appreciate you taking time to to lend your expertise in this matter.
Could you first my first question is is could you could you explain to the jury the the term cool first transport second?
Well, the the term cool first transport second really states that it's a it's just an easy way to remember just like we do when in doubt an amount of concussions is that we should always try to actively cool a patient that we've feel as as is in those parameters of exertional heat stroke to cool them first before we allow them to be transported to the hospital.
Thank you, sir.
We've we've heard this this term, this this 30 minutes, this this golden half hour.
Why is it so important to to get someone that is suffering from Is there external heat stroke their core temperature back down in this 30 minutes?
Well, we feel that that time is is before that we could have any kind of cellular cascade that would happen that before that in that critical point in time is that if we can get the body back to homeostasis, or get that that temperature down to at least 102 before we transport it, it would minimize.
It's totally preventable at that point that we could manage that that exertional hedonist if we're able to get them down, and then it would minimize the cell death as well as the the effects that it will have on the on the vital organs that we have at our bottom.
Awesome.
Thank you.
Can you tell me why why rectal temperature is, you know, medically, that that is the gold standard and being able to differentiate and diagnose EHS or exertional heat stroke from exertion or or some other medical
Well, I think it's the only time that you can truly get a true temperature of the body, what's going on, when we talk about core rectal temperature or core body temperature, it's it's been long established that by having rectal temperature is still the best temperature.
Even if you think back to pediatric patients having much younger age before, You could even do oral thermometers, on them are underneath their arm.
Theorectal temperature was still always considered the standard in which to be able to find out what true temperature was.
So in this kit in this situation, core rectal temperature is the gold standard.
And it is the best practice to be able to have that so we could accurately understand what we're going through and then how to appropriately treat that patient.
Awesome.
Last question I have for you is is emergency action plans.
We we know that LVHS had emergency action plans.
When setting up the emergency action plan for for all been used for all athletic events, Is it important to bring your your local EMS or providers in on those meetings to to practice scenarios, to go over, to talk about different things that should happen to and and to practice those?
I think practicing an emergency not just having an emergency plan for practicing.
Let's think about this, is that, you know, you go to any high school or any campus, you know, we're gonna practice fire drills.
You know, shelter in place drills.
Why do we practice those?
We practice those so they become innate.
And then that way we are able to use them without thought or processes that then we're going to action.
I think educating people on the fact of what emergency action plan is and their roles in emergency action plans is critical in any situation.
And it also allows us to be able to educate people and also create a proper management plan that if we do have to activate it, and what we'll be able to do in that scenario or in that situation, so to speak, that we'll be able to have that.
I think it's critical.
We bring all our stakeholders together together to be able to have that.
And and a big part of that is also educating people.
This, you know, hope is never is never a plan.
We hope it doesn't happen.
I think action is always gonna be the part that really exactly what it talks talks about.
Emergency action plan, not just a plan that we sit here and we talk about, but something that we produce is action.
It produces movement, it produces a direction.
So I think that's what's critical that we have to have those stakeholders, those partners, and to practice emergency action plans.
Thank you very much, Scott.
You're welcome.
Doctor Castle, you're muted.
Sorry about that.
Let me pause that for a second.
Thank you very much, Mister Kates, and Mister Arkana, you may step down.
Doctor Wolf Oddlin, you now have the floor for cross examination.
Would you like to con cross examine Mister Arsenal?
I waive your honor.
Thank you.
You may begin.
Mister Arsenal, in your current role as the sports medicine director for Santa Martin High School in Santa Martin, Louisiana.
How many years have you worked in the high school setting?
29 years.
K.
In those 29 years, how many EHS incidents have you had during that time?
I would say exertional heat stroke that created a a part, I would say 3.
Okay.
But how many heat ex heaps exertional heat on this issues have you had?
Can you specify what are you are you talking about full out collapse?
Yeah.
Anything that was diagnosed as a traditional stroke.
1.
K.
And did that result in EMS activation?
It did.
Okay.
Did it result in rectal core temperature?
It did.
K.
In your clinical practice, do you provide a cold water diversion tub at every practice competition for all the outdoor sports?
I think it's best practices that, especially in southern state like Louisiana, that our state law presents and that at any anytime it's 85 degrees or 85% WBT or greater than we do have to provide that.
But I do think that often you have to you have to use experience and to know that as you stated in your opening argument that, you know, we do have exertion can happen at any point in time.
So I think preparation is always always a key part.
Howard Bauchner:
So going back to my question that you didn't answer.
In your clinical practice, do you you provide a cold water immersion tub at every practice or competition for all outdoor sports?
Correct.
I we do.
We have a designated that we have a designated area.
For that for that cold warning immersion
Okay.
Provided that district.
Okay.
And are there variations that athletic trainers implement when treating exertional heat illness.
Could you specify that?
Meaning, does everyone follow the same recipe.
I can't I can't ever say when everyone else does.
I know that the best practices state that seawater immersion is the best practice that we have to be able to submerge someone in that temperature anywhere from that water being close to 50 degrees that we would want and try to maintain that that's what we would need to have, and I think that is what the acceptable practice is.
Okay.
And
that's been shown through research.
Right.
But there are variations.
Correct?
As far as immersion?
No.
As far as treating exertional fee illness.
Well, I think when you look at what the best practices are, there's no variation.
There is active cooling, but I don't think that when you talk about treating an exertional heat stroke.
Its cold water immersion is is tend to be the best is is is the best practice, and we'll continue to be the best practice.
Okay.
So that's what everyone uses.
That's what everyone should use.
And That's not what I that that's not what I asked.
So that's what everyone uses.
I just know what our state law says and what our best practice is.
Okay.
But not everyone lives in the state of Louisiana.
Correct.
And that's unfortunate.
Have you ever been sued for negligence?
Never.
K.
Alright.
Moving on.
Can you please describe the symptoms of exertional heat illness for the jury?
The exertional heat illness could vary in different forms and fashions depending on the dependent on the severity of it.
But most of the time that the key symptoms and signs that we have There's a lot of times it'll be despondent.
Sometimes it's even goes through exertial heat collapse where they'll actually pass out to be able to have that.
But it does have variations of it.
Some of it looks like ex just them being tired.
You know?
And I think that's where the issue lies with a lot of times in this in clinical practice is that what, you know, in athletics, I think we want people to be on the edge as you stated in your opening statements.
But I think once you do see that that to be able to know that the absence of coherent speech, the absence of being able to keep themselves upright, you know, those things that that that are normally when you look at these cases.
And also too, I believe you have to look at that risk population also.
Some of our bigger alignment, those student athletes.
And also to to to consider what is the workload of that athlete and their conditioning level.
I think that factors into that also.
Okay.
Thank you.
Moving on.
Looking at the vital signs that were present with the plaintiff when this happened, Glasgow Comascale was a 13 out of 15, which is considered slightly diminished.
I'm sorry?
You're too dependent.
Oh, sorry.
Thank
you.
Pause this for a second.
Good.
Thank you very much.
For every audience, I have this.
I don't wanna be everybody's being civil tonight, so this is very good.
So we keep it all good.
So now we will move on.
So the presentation having the having rebuttal So with that, Mister Kate, you have 5 minutes, and you're you're questioning.
You may begin.
Your audio is off, Mister Capes.
Got you.
So you said in your in your 29 years of being where you are, you have experience 11 exertional heat stroke at at your at your place of employment.
Is that correct?
That's correct.
And you said that at that time that EMS was activated.
Is that correct?
Correct.
And you said that you did use a core rectal temperature to differentiate exertional heat stroke.
Versus heat exhaustion versus a syncope or any other party act diabetic epileptic seizure.
You you use this to be able to make a medical diagnosis of exertional heat stroke.
Correct.
Can can you tell me Is is this is this rectal thermometer?
Is it is it is it several $100?
Or Is it something that you got at Costco, CVS, Walmart for for $10?
Is this a break to bank?
Did did any of your student athletes go without a pair of socks or a helmet or a jersey?
Because because you purchased this this piece of equipment in your in your district
without a No.
No.
The answer would be no.
This, you know, we use a brand of that has a flexible flexible tip.
I can't know if I can divulge a brand here.
But we do use one that's accepted.
And there's a variation.
Of course, like any anything that you have, there are models that are a little bit more expensive than others, but the brand that we use is is widely accepted as a as a reliable brand to be able to have that.
But no.
Nobody has that has had to go without because we had to afford to purchase a rectal phlebotomy.
Actually, we have several.
That way, we could have them at multiple sites as needed.
Depending on, you know, what's going on that day at our on our campus or even off campus.
So that way that we could have those.
Thank you.
That that was gonna be my next question was, did you just have 1, or do you have multiple?
So you do have multiple.
And to reiterate, you there there's not a There's not a 3rd string of alimony that doesn't get a cheeseburger on Friday night because because you have these life saving pieces of equipment.
Without a no.
And to be honest with you, Mister Bates, when our state law came out, just as I stated previously, artistic when they solved the needs that we had to have, s for s for WBT, monitors, cold water and immersion takes, you know, areas that needed to be permanent.
Our district came in and set those things up for and purchased those because they understood that was part of best practices.
Of course, our district has a risk manager, and so they understood that we needed to have the tools that we needed to be successful in this matter.
So I'm very fortunate in that aspect.
But I do feel like that even before our district were doing that as an athletic trainer, we were purchasing the proper tools that we needed to have in order to make sure that if we did have this situation, we could properly assess it and and also to move forward with it.
Awesome.
Okay.
Last question that I have here is variations of treatments for exertional heat on this.
Depending on what's asking, you know, what what other methods could you talk about other methods such as Kota, Taco Method, other other methods.
I think those are 2
of the I think those are 2 of the more widely practiced widely practiced methods to use that.
I feel that cold water immersion is the best, but that due to sometimes availability at the site of using the taco method.
I think that's, to me, would be the secondary part that we would have to be able to use that.
And so, you know, and making sure that we have the ability to cool that person down in that time frame.
And, you know, one thing too though, Mister Kates, is talks about and also in if the military supported that in the military, they do use you do have that time to transport somebody from a practice field to an area that she could have.
So it doesn't necessarily and when you talk about on-site, I think that really has to do more.
So what I would say on campus or what we would have in that situation.
Thank you very much.
Thank you, Mister Kates.
What time
is it?
Could I redirect, please?
No.
You may not.
We've had the time.
So Okay.
Thank you.
Of the time.
You will have that chance later or other session.
Fine.
That's okay.
It's okay to answer.
Never hurts to ask.
So didn't even have pulled the gal well on that one.
So thank you, Mister Kate, and Mister Arsenal, you may step down.
So now we'll have the defense team.
Doctor Ottlin, you can do now.
You have your presentation of evidence.
For that as well.
It should be that should sorry.
That's a typo.
It should be you're presenting your your information now.
Nice.
Very good.
Thank you, your honor.
Doctor Arris, in your current role as a director of athletic training and community outreach for the Center of Athletic Medicine at Henry Ford Health.
I'd like to talk to you a little bit about liability and policies and procedures.
This was a minor.
To the best of your knowledge, Was consent for treatment provided by the parents either during pre season paperwork or during the events?
From what I was able to gather from the evidence there was no authorization or parental consent given.
In fact, I had seen that these go board would not allow that to be part of the EAP.
Okay.
Is that something that you do in your position as a as a as a director where that you instruct your athletic trainers who are out of the respective high schools or colleges or universities that they explicit during explicitly talk about during their pre season meetings with parents what exactly will happen if their child suffers from exertional heat stroke?
They do not get into specifics with that in the current state law in Michigan, we have to go over concussion presentation, and they have to sign a waiver for that.
We do work with our schools that we contract with for athletic training services, and we do have a standard nomenclature about overall consent to treat.
And then obviously, with part of the high school physical, there is a blurb about emergency care, but that's the extent of it.
It does not go into specifics.
So parents are not aware that either partial or full removing of clothing below the waist to excites their child's rectum is necessary in order to ascertain a court rectal temp.
Correct.
Okay.
Alright.
If they do find this out, do you know what have you experienced a parent's typical response?
I have not we have really not broached it much.
We have not I have not received any communication from the schools regarding it.
And to the best of my knowledge, we have not had any exertional heat cases with any of our student athletes or high schools in my tenure at Henry Ford Health.
Alright.
If the parents do not sign for consent for this invasive, albeit life saving intervention, what protocols do you have in place to assess and treat exertional fee illness that do not involve a rectal core temp?
Obviously, doing oral or axel attempt is probably would be the standard of care in the absence of rectal corona.
Thank you.
According to a 2023 study, our Carcino and Miller at all.
They surveyed athletic administrators in the high school setting, and they found that 77 or almost 78% of athletic administrators reported adopting a written exertional heat stroke policy, but only 5% of them reported the adoption of all the components In your expert opinion, can you explain why certified athletic trainers do not implement or partially implement protocols concerning exertional heat situations?
I think that it needs to be discussed and streamlined.
I think that there is some controversy in what the best approach is, when you're looking at statute and you're looking at state practice act, those oftentimes can have conflict.
I know when I've consulted with General Counsel, even looking at the NHA position statement, they did make comment that the end of that physician statement almost read like a medication where it talked about all the adverse things or items.
So it basically negated and said that you have to do what is best according to your state law, your current practice act, as well as if there's any legislation in place for this type of injury.
So although it did talk about it being best practice, it really didn't give a strong argument for in that.
Thank you.
Talking about legislation, As an athletic trainer in the state of California, are you aware of state statute number 286 and number 289 regarding criminal sexual conduct concerning penetration by foreign object of a person under eighteen years old and defended over 21.
Are you aware that this Are you aware that this law includes rectal thermometers?
Correct.
Okay.
Are you also aware that in the home state of Mister Archanel, that state statute 14.43.1 regarding criminal sexual conduct clearly states sexual battery is the intentional touching of the A and S of the victim?
I am.
I'll pause for one second.
As a reminder, thank you as we've changed over.
Just for for the audience, if you would, remember that you feel free to enter your comments in on the on the chat area.
But if you have a specific question or it's a comment as we're moving through, please go to the q and a as well.
And then we will try to answer those questions or provide a response to those your your viewpoint on those things as we move forward.
So now we'll go ahead and move forward to the next phase for this.
And, Mister Capes, you have the floor.
Thank you, judge.
Christina, could you
speak to me about this murder law?
Good Samaritan Law in regards to this case or in a generality?
Generality.
Generality is the protection if you are stopping to aid somebody.
You don't have For retribution, they want to ensure that people feel comfortable to respond to emergency situations to help the general public.
Thank you very much.
In the BOC, the NATA BOC, talking about the the the the domains, injury and illness, prevention and wellness.
Examination, assessment, diagnosis, immediate emergency care, health administration and professional responsibility.
Mhmm.
As an athletic trainer, the as a certified athletic trainer, we we are appealed by these.
And a question was asked earlier about why our athletic trainers not implementing these things.
From a certification standpoint, is it not up to the athletic trainer to implement these these teachings?
Teaching is in what regard?
To their administration, to their their lawyers, their school boards, to bring forth this documentation, this educational material, to to put into these emergency action plans in the care for their student athletes.
That is accurate.
I think you you actually referenced the good Samaritan law.
So just for clarity, we are not protected under the good Samaritan law because when you're employed as an athletic trainer, and you're required to have your BOC certification or state license.
And and those oftentimes have emergency cardiac care.
You have a duty to treat.
You do not fall under the good Samaritan app just for a point of clarity on that one.
You did bring up the BOC, CRM as a professional practice.
You also talked about the domains of athletic training.
There aren't specifics in that.
In the instance, I think you also have to look at what is state mandated Also, what is protocol?
I think when I reviewed what California had, they talked about cold water immersion, but they did not give any indication on rectal temperature.
Donald Berwick:
Awesome.
Thank you for following up and clarifying that.
That difference between athletic trainers, healthcare providers, and American law.
I was hoping that you would bring that forward.
Yeah.
And and then with with the Katie standards of 7071, and 72 as it as it is specific towards exertional heat on this, how an athlete trainer is taught to handle this, care for it, and that we are athletic trainers are taught, cold water immersion, colorectal temperature, how to differentiate, how to make these diagnoses.
Would that not weigh in on that athletic trainer to perform their professional duty?
So Katie's standards are educational competencies, and you indicated being taught, it does not necessarily mean that an athletic trainer that is licensed or certified to perform duties has the right to do those.
So I can give you an example.
I went to a course on suturing, as part of our state association, and I learned how to suture it does not give me the authority or the right to go back to my health system.
And do those things unless I have shown confidence in my employer supports me doing that.
They even think of we have physicians that are trained to do certain cases and they don't have carpalaunch to do that in surgery, they might have to go through protocol or even drugs that they inject in the knee joint.
They can't just pick whatever drugs they want, they have to ensure that our health system is supportive of that drug.
Thank you very much.
That is an excellent point.
I appreciate you making that for us.
Lastly, I'll leave you with this.
Let's take this feed now, Ashley.
Let's take it from an exertional heat on this.
Each stroke.
Let's take it to a sudden cardiac arrest.
Should that athletic trainer have the availability to clear her chest to be able to put on the AED pads to be able to save her life.
Would that not be the same thing as a as a diagnosis of a rectal temperature to be able to save her life in exertional heat stroke.
The difference is the AED is delivering the shock.
There was cold water immersion in this case, and you can do it without removing clothing.
Thank you, Mister Kates.
Now, Doctor Allen, you have 5 minutes for rebuttal.
You may begin.
Okay.
So Casa in 2007 McDermott in 0 9, in RTB in 2015 all suggest in their studies that if full body, full water immersion is not available, partial body immersion with a small pool or tub or other modalities such as wet ice towels, rotate it and place over the entire body.
With or without fanny may be used, but just simply aren't as effective.
Therefore, knowing what we know about this case is it's not consistent with what the athletic trainer did.
It is.
K?
Irrespective of of a core rectal tab oh, sorry.
Moving on.
Sorry.
Is a core rectal temp necessary in order to activate EMS?
No.
K.
Is it necessary to start other life saving measures?
No.
Okay.
What is the only thing that the colorectal type provides in this situation?
Status of what the temperature is while the body is being immersed.
So I'd like to explore that for a minute if we could.
Can you explain how hands free CPR works?
Hands free CPR Mhmm.
In this case or just in general?
No.
In general.
What specific about hands free CPR?
Do you wanna know?
Meaning, do you apply breast when it's only hands only CPR?
When it's hands only hands only or hands free?
Sorry, hands only.
Hands only CPR.
You are not providing breaths.
You are just doing compressions.
Does this technique make CPR any less effective?
No.
Because when you look at it, they've activated 911.
That's the first thing that anybody would do in that instance and under delivering compressions.
So in your expert opinion, would you characterize hands only CPR to be equivalent to no rectal core temperature.
Potentially, I think for hands free or hands only CPR in that instance that would be with a layperson.
And it's a little bit different in the delivery of treatment.
But in in the case of cold water immersion that did occur, the only thing was assessing the body temperature.
But if you look at the longevity of being immersed, that most likely did cool the temperature down.
Okay.
Alright.
Thank you.
Okay.
Let's see.
Sorry.
Trying to get all my questions here.
No.
Wrong way.
Sorry.
Let's see.
Okay.
After reviewing the document, can you explain in your expert opinion why the state of California and the Department of Health and the California Interscholastic Federation is which is governed by sorry.
Both of which you the athletic trainer is covering with regards to health care and the secondary school setting does not make one single mention much less educator wire rectal core temp increases of exertional stroke?
I can't say because I was not involved with that legislation slation or that policy.
It did talk about activating the EMS and cold water immersion, which are 2 important key things for everybody to do.
I'm not I'm not certain why they didn't address it.
Alright.
After reviewing the document, Why does the National Federation of State High School Association Sports Medicine Advisory Committee not mention one time the use of rectal core temp when managing its additional heat stroke emergency,
because we're talking about managing it in in assessing a temperature is not immediate management of it.
It's activating EMS and emerging the person.
And, again, after reviewing the document, Why does the American Academy of Pediatrics not suggest the use of Repsol attempt as a means to diagnose and treat EHS?
I'm gonna go on a limb and just say because it is controversial when you look at state laws of sodomy and other things.
I just don't think that they can come to a consensus.
K?
And lastly, Again, after reviewing the document of the NETA physician statement on exertional fee illness, why do they have to include a disclaimer?
Because I don't think that they can look at everybody's state practice act or come into play and write something that would be universal across state lines.
So I think you have to look at individual state practice act.
You have to look at legislation.
You have to look at parental consent.
And so that's why they have the disclaimer.
So is it a suggestion or a standard of care?
Did not answer that question, where a comment is up.
So thank you very much.
Next, we will go into our final thank you audience again Now is the time to answer your ask your questions or statements.
We'll be able to try to address during the clinical review period.
Please feel free to do that in the q and a section.
Over these last remaining minutes before we we get to the closing side.
So, Mister Kate, you now have 3 minutes for your closing arguments.
You may begin.
Thank you, Jess Castle.
And to to our jury, thank you very much for for being with us and and sticking with us on through this.
I would like to go back to my opening statements.
Like, growing hospital as a number unwavering duty to protect and serve the students of their district.
This includes the student athletes within the athletic department.
And so with that, the the student athlete, we we've all discussed here tonight cold water temperature or cold water immersion.
In this particular instance, our client was moved to a tent, and cold cows were placed only on with a fan.
We we have talked about rotating a coattles.
There there was no rotation of coattles.
We we know that there was no rectal temperature taking when we know that is the diagnosis.
When you look at the Journal of Athletic Training from 2021, there was the roundtable increase preseason heat safety, secondary school, athletics, prehospital care of patients with their intestinal heat stroke.
This was a doctor meant that was done with the NADA Chorusringer Institute, American College of Sports Medicine, National Athletic Trainers Association.
Core rectal temperature was brought up as there there there are concerns with that.
But we know that when it comes to saving a patient's life that that this is what gives us that that diagnosis, that differential of how to care, how long to cool them, how to get their core temperature below a 102 degrees.
So that they can move.
And lastly, the the the AD made a diff a decision that only some of these sports at the school would undergo training.
The athletic trainer tried to go over the emergency action protocols with the with the school.
But the AD made an option for coaches to participate should they want to receive the online training.
And I will leave it that it is noted that the sports that did take the training coaches that follow through completed the training, football tennis, softball soccer, soccer, or our student played soccer in the cross.
She's lucky to be alive, and we hope that we have proved to you the negligence of the dependence.
For our for our case.
Thank you.
Thank you, Mister Kate.
So I had a a question from the jury from one of the jury members.
For continued finishing one question.
So, Doctor.
Chatsky, if you would, I'm gonna abide you less than a minute.
To answer your the question that doctor Odland had provided to you before this your section was over.
If you would repeat the question, Doctor.
Ottlin, please, the last question, and Doctor.
Chefska, if you please answer that question.
Yeah.
Okay.
I have to find it.
Let's see.
What do you remember
about that?
I don't remember it was.
Can you guys help me?
I honestly don't remember that.
Yes, please.
So I I got it.
Okay.
I know.
Okay.
So going back to the NATA position statement on exertional key illness.
I had asked the expert witness why they have to have a disclaimer on that that position statement, and My follow-up question was, is it more so?
Is the any type of decision statement on exertional heel as a suggestion or a standard of care?
I was I was glad that
I didn't have to answer that.
I think when you look at it, it is pulling a bunch of resources together to bring you to best practices.
But obviously, you have to look at statute.
You have to look at limitations, and you have to take what is best practice.
And make it applicable to your daily practice.
So I'm gonna give a great answer on that one because everything isn't always cut and dry and everything isn't always black and white on things.
You know, there might be areas that you're in.
I'll use sutra as an example.
I know, you know, if you are several hours away from your nearest hospital and you have to suture somebody to control the bleeding so that they can get there to get appropriate care, then that would be sufficient.
So that's kind of the angle I would take with that question.
K?
Thank you.
Okay.
So we'll go ahead and move forward then.
So now, doctor Olin, you have the floor for your closing arguments.
Thank you.
Thank you for your attention, athletic trainers of the jury on this in a very important case.
The prosecutor didn't intervene during a medical emergency that afternoon.
The judge didn't intervene during the medical emergency that afternoon, and all of you did not intervene during the medical emergency that afternoon.
Only one person did, and that's my client.
She did what she was, Katie educated and trained, and BOC certified to do.
None of us had to make the split second decision that she did.
And yet, we are still asked to second guess her tonight.
To Monday morning quarterback hurt, if you will.
It was supreme court justice Oliver Wendell Holmes.
He said that, quote, you can expect calm detachment in the presence of an uplifted knife, unquote.
Athletic trainers have to make split second decisions regarding emergency medical here on a daily basis where no 2 situations are the same.
But hindsight isn't the measure when they use judging the defendant's actions.
Rather we analyze what happened from the perspective of how things looked at the time to my clients.
According to the board of certification, there 3 types of legal wrong doings or torques that are typically seen in a negligence case.
Let me remind you the jury of what each are and whether the athletic trainer at the center of this case failed to do their duty as a credential, but unfortunately not state license healthcare provider.
Nonfees, active commission.
Sorry.
Omission.
That the athletic trainer failed to perform legal duty.
Malfeasance, which is an act of commission, Did the athletic trainer commit an act that is not his or hers to perform?
Or was it misfeesence, a mistake?
The athletic trainer improperly does something, they have the legal right to do, but ask yourself, Was there informed consent?
Did the patients and their parents understand all the factors that are involved in their decisions to allow treatment?
Was there sexual misconduct?
Did the AT discuss in advance the process of any treatment that includes touching a patient?
And was their contributory negligence?
Why aren't all parties involved including an appointive, her parents, EMS, the state of California, and the California Athletic Trainer Association being taken to task.
Does this all really fall on one person?
Although many modes of caring for the illness exist, no single treatment for patients who experience exertional heat stroke is universally accepted.
Thank you.
You waited your remaining time?
Mhmm.
Okay.
Thank you very much.
So as we move into this last couple of seconds, this will this will clock off.
Bank, both representatives, and also key witnesses for your time today as well.
We have some excellent questions that have already been posed.
Or in q and a, and we're gonna work to get to those in just a moment as we start to move through.
So as we move through the next phase excuse me.
One second.
Now it's your time to vote, and I'm gonna open the poll up.
And for that, and We're gonna end this poll right here.
I'm gonna start a new poll again.
We'll go back here again.
So now as a jury, you have two questions.
And in this, we're gonna pose 2 questions.
1, as a member of the mock trial jury, in the case of exertional heat stroke management, a high school soccer player, you're in favor of the plaintiffs or defendants arguments.
Then also the second question is of the 2 we're adding this in is which personal entity is or are most involved in the case.
This is a a multiple answer question.
You can answer 1 or 2 or 3 however you choose to do so.
So we'll do that, and we'll move forward with more of a open q and a during this process.
And the end of the 3, 4 minutes, we'll answer this down.
So the first thing I'd like to ask just to and we're gonna get to your questions in a minute.
But the first thing is we've done now that we can, I guess, the the pant the 2 panels can relax a little bit, is as you get through this, what's the one thing you think you've learned you're or you've gained the most out of this tonight?
And I'll I'll I'll start with since Jason, you went first and all of this.
I'll start with How about Doctor Olin?
Would you wanna throw us out there?
And
Oh, what was it?
I'm sorry.
What was the question?
Yeah.
I do have
I do have one clarifying, Ray.
So you're you're asking a number 2 who is most fault in this case if they side with the defendant is anybody at fault.
So is that a trick question?
Well, no.
Not quick, mate.
I know, by the way, these are Okay.
They are they are anonymous.
So you see, you know, they are they all the answers are anonymous.
So I'm into mentioning that.
I'm glad you mentioned that as well.
So yes.
It could be.
It's a partial fault.
Just looking at either side.
So Okay.
They could do that as well.
So I guess back to the question is Yes.
What's the one what's the one thing?
I know this I've I've done this before, in a case before, and just kinda curious as what what you all got from this.
And, Carrie, you don't have to answer that directly if you don't want to first off.
But when you just go ahead and give your thoughts on what Yep.
You're thoughtful.
Carry in the hot seat.
I'm happy to go first.
So when the the thing that I learned the most when somebody asks you to be a part of a mock trial, call your professional colleague that has a father that was a lawyer.
So
Yep.
So so no.
We're in the top of people that are served with Corey Stringer Institute, and then we're like, oh my god.
And we will have kids at
every house.
But that's okay.
I think, honestly, the thing that I learned the most is, you know, and I kinda have felt this way professionally.
As I know, some things have been out in the media from time to time in my career.
Cases just aren't black and white, and in hindsight is always 2020.
So, you know, it was interesting to delve into the California High School Association, just to look at some of their standards and practices, you know, there were things that were omitted.
You know, it it it's just not always cut and dry and black and white.
But it was interesting just to kinda delve into that.
I think you know, it was a little bit harder to prepare in the sense probably for both sides because there's no practice act.
So That would be your automatic default.
Would be looking at your practice act as well as your public health code aside from the state practice act.
So you know, just delving into some of the literature but just not having that standard consistency Also, there's not standard consistency across all states, so that's something to also take into account, you know, when you're looking at something like this.
Okay.
Carrie, how are you?
Oh, what did I have learned?
That it's not a it's it's well, I've always loved to argue, so it ironically, I I wanted to be on the different side of because I think even as athletic trainers support you guys, no matter what you do in the health profession, it's just we're always gonna find ourselves in hot water to fight our best intentions.
You know?
Everyone says that the road to, you know, the road to hell is paid with good intentions.
And no matter how many standards you have in place and how perfect the emergency action one is and how, you know, perfect the student athlete is, and nobody did anything wrong except for you, how vulnerable you can pee, and who's really gonna stand out there with you.
So I mean, I'm not opposed to arguing, you know, what can be argued, but then there's also common sense as well.
So it's just you know, it's been a great experience.
And so, you know, I'm really gonna apologize to the experts of this point because I was trying to mess been staring them down clearly.
But yeah.
So But
and I think that's the case here, Carrie.
I think this is a hard, you know, to We have
to ask
our ask court questions.
I hope you the audience are getting the same I mean, I'm getting I had a couple of things I was writing down, you know, just one thing you brought briefly, and I wanna I wanna hear from Scott and Jason brief as well if we wrap this up.
You brought forth the the your all's defense was in the the the the legal the the for the minor, the penetration, the the what what that concept you mentioned in Louisiana.
And so I wrote that down.
I mean, one of the questions is gonna come back at the end is one of the audience asked.
We'll get the I'll have you put that in maybe in the chat or what those two laws were.
For it was definitely for California.
1 of the attendee questions who's from California, ask what that specific wall was, and then I'll see the Louisiana as well.
So Scott or Jason, real briefly, go ahead and give us a a quick take on what you got from the night in 30 seconds or less.
I'll let Jason go first.
I'll back cleanup.
I was gonna say I was gonna say Danny Perry for pulling up those those those laws.
I thought I saw those as well, and I was talking to God.
I hope those are very cheap won't find it.
But kudos.
But, yes, doing this in real life versus getting to play this tonight.
Every weekend, every Saturday, Sunday, we see so many armchair quarterbacks, so many armchair, athletic trainers.
Remember this tonight and and and try to cut our our peers some slack.
We are the only health care profession in the world that gets to perform your duties in front of thousands that that are that are watching you.
I mean, you know, some of us have the sideline tents, most known things like that, but we're in a microcosm when we're performing our duties.
And so be there for one another and and and know what the statue is.
Know what's going on.
Know what things have happened before.
So that that you or you or armed with knowledge of when it comes to these different cases.
Thank you, Scott.
Yep.
I think one thing that that plays out in this scenario, Doctor.
Cass so that it comes back with one word or a word or statement is moral character.
I think A lot of times, we still are thrust into a situation, us as healthcare providers, but still working in a secondary school setting.
We are dependent on principles, athletic directors, school systems, athletic associations to perform with moral characters.
And a lot of times things are asserted to us to do.
But if others don't help us follow through with those, we're kinda left out on our own.
And I think that's a part of this scenario.
Where the school use things are not required.
I think it blows people's minds, how many school systems and how many athletic associations coaches are not required to be CPR certified.
And some of those issues that come out then are a basic So, you know, I think I think traders always work above and beyond, and we all have which I feel as a profession, great moral character, in ethics that we always are trying to do our job to the with Fidelity.
And but, you know, it's unfortunate that a lot of circumstances We are left kinda holding the bag in certain situations where school systems, administrators, those people aren't aren't partnering with us.
And tried to help make common sense, common, and and to be able to do that.
So, I mean, I learned a lot from this rate tonight.
I always appreciate you allowing us to participate in these things.
And there there was a you know, this is eye opening, but we live in this world every day.
And you know, as a state leader, you know, that's one of the biggest challenges we have is dealing with people and try to get people to like I said, have common make common sense common to people to have more character and and do things which are right and ethics.
I think that's still is the prevailing sentiment that I would always like to have.
Thank you.
So what I wanna do real quick is get into answering 1 or 2 questions.
We have we have a minute or so if you can spare us your time.
Panel, you can click on the q and a as well.
The first one I'm gonna throw up here is a really good question and it's from Valerie.
And with that is if rectal thermometry is denied by the school board, which central nervous system monitoring be sufficient.
Also, is the school board medically qualified to make medical decisions.
They do not have a medical professional on staff, or would this be taken consideration?
I think the first thing for that is One is you have to I think there's a common question it comes into is that as a licensed provider, you have a legal obligation to perform those duties.
And the policies and procedures and, again, you need to check with your check with legal counsel, check with your risk management, is that if you have if it's written in law that you can do that, not necessarily stating that, but if it's in in Louisiana, it says emergency care, That encompasses a whole number of things within your what was in the k tonight with your level of training and your document that, something.
Doctor Chatsky Minskin is because you can because you can doesn't mean you should.
You have to have it documented.
You have to have physician direction as an athlete trainer, other providers, again, going back to what your practice allows you to do, and then also making sure.
But they cannot tell you not to do something.
Therefore, it's your causing their cause needed to create negligence or perform a negligent act.
So that's a really important thing to keep in consideration.
And in the if you're uncertain as to ask legal counsel and risk management.
No.
It's
me.
Ray,
I wanna interrupt you really quick.
Sure.
Sure.
Sure.
Sorry.
Hold on.
I think you also have to look at making sure that you have a well written policy.
Sorry.
Because if you have flaws in your policy, That is, you know, I kinda equate it to having an AED, and your pads don't work.
Are you better off not having the AED?
In the first place because you don't want something that is inappropriately written.
I think I talked with colleagues who had talked about putting that it was the standard of care, but that they weren't mandating people to use it.
And so that was kind of debatable too.
So you wanna make sure that you have a well written policy so that you can appropriately follow-up.
Yeah.
Very good.
Very good.
Thank you, Chris.
Hey.
I was gonna I was gonna add to that real quick too about the about the school board making decisions.
When I first started at my school, the first run through or actually, the first 2 run through is a rectal temperature were denied by our school board board attorney.
But me not taking no foreign answer caused me a way to go around that.
And so we implemented our medical advisory committee to the school district.
So they're both so our school nurses, our mental health personnel, our physical therapist, We we all fall underneath that.
And as they bring things to our school board such as policies and written and things like that to be evidence based best practice, it it has gone a long way in helping us to be able to to better our practices.
Thank you for adding that.
So the the other part of that, I'm a briefly just mention that Valerie had asked was is rectal tomometry then if it's denied by the school board with simple nervous system, mine could be sufficient.
So to get into that, most part, you you look at that as a Ultimate status is one criteria.
I'm gonna tell you to go back to the go back to your core vital sign assessment.
And I've dealt with that re I've dealt with the number of heat strokes over the years and dealt one with one recently.
And I can tell you that you've got the the defining point is that while the middle status was not the initial thing that was showing up, it was it showed up pretty soon after that.
But you look at vitals.
What's the what's the paradox?
You know, is pulse oximetry off?
Is there a heart rate or whatever things they're not gonna be presenting it's cut and dry or just black and white, so to speak.
So again, have that core vital sign set.
When you're looking at a patient, is, you know, what their mental status is, what their skin temperature is.
Are they diaphoretic, or looking at I mean, looking at blood pressure, heart rate, respirations, all of those things do the core set and, you know, looking at what EMS does, those things that really determines your clinical trajectory.
And I had that as a note earlier, it's just vital signs are critical period regardless of whether to use a colorectal thermometer or not.
At the end of the day, you need to use that as the and it helps you stay out of trouble as well.
Is you're you're clinically justified to do this, but cause.
And that and, again, the the core rectal thermometer is an intervention.
I mean, it's it's a diagnostic intervention the cold water is the intervention.
And I equate the rectal thermometer to taking your temperature as a child.
If they have a if your child comes to you with a fever, what do you do?
You take a temperature.
And but the best way to do that is, well, the core rectal thermometer is is proven.
There's like a 7 degree variance.
It's one of the other questions in here.
Up to if you do an oral thermometer.
So what are you gonna do if the child has a fever?
You're gonna give him Tylenol if they have a fever.
And the cold water is the is the Tylenol for that for a person with a heat stroke.
We'll get one one more question, and we gotta wrap this up if you don't mind.
So Let's see here.
There was another quest.
One is making sure to get the state laws.
I'll we'll pull those back up as a summary statement to everyone.
I'll get those from Doctor Odlin, so we'll follow that in the email to all the attendees.
And one question, is I think you mentioned Stacy is I think the jury should know why colorectal thermometer temperature is a standard versus other methods versus oral or forehead.
Why why can other methods be effective?
Someone have one of you all tackled that briefly, if you would.
Maybe, Scott, Give me the question again.
Right?
Stacy Williams asked, I think that the jury should know why rectal core temperature is the standard versus other methods versus oral or forehead.
Why can't the other methods be as effective?
I don't think, you know, I think when we look at the accepted part of our core rectum thermometer, our temperature is because it is direct and we're and and as we take it, it is a much, much more accurate because it doesn't deal with ambient temperature.
It doesn't deal deal with a lot of the other factors that could actually give us a false reading.
And so I've been able to use that cold temperature I think it's a much more widely used temperature in the medical community.
You know?
And like I said, so I I think that's one reason not to have to get too much science with it, but that's I would think was one reason why it's gonna be a little bit more accurate, especially in that part.
And especially when we have somebody submerged in cold water, to be able to do that.
So, you know, how much of that water or evaporation or skin cooling do we have in that point?
So I think it's gonna be a much more accurate part in there where, you know, I know that a lot of times we got with the what's the typical scanners and different parts like that that we felt, like, those were really, really easy to use.
But still, you you think about when you take temperature, you know, we take this one's mouth.
Under their armpit, but still rectal still is widely used to get that accurate, accurate reading.
And and always lean back to you know, the the I was very apprehensive about doing record temperature a long time.
And, you know, when I really kinda set my mind around the fact that, you know, taking temperature.
And if you ever spent time at a pediatrics office or or a doctor's office that that, you know, taking rectal temp was still really the the the part that gave us the most accurate.
And so I think it's been widely used.
I think it's been widely studied, and I think that's one reason why it is.
I think it's much, much, more accurate.
In that situation.
And when we're making decisions, you know, think about it.
When we make decisions, we want the most information, the best information possible.
To make those decisions.
And so, especially with cool first transport, second, when are you gonna take them out, and when are you gonna bend on?
And I I could tell you the more I've learned in my practice and more comfortable I've gotten more direct attempt.
I I feel a lot lot more comfortable with it, and I think it's a lot you know, it's obviously more accurate.
And it's I feel like it gives me the best opportunity to to make those decisions at an appropriate time frame that they need to be made in.
Great.
Thank you so much, Scott.
I'm a throw in one quick answer to Jim G, who mentions by Katie standards.
I think this is a common question everybody has.
Based on your experiences whether or not you have you've been practicing for a long period of time.
And as Jim mentioned, what if the eighties have been practicing for 30 years and don't receive the training?
I think with anything, you have to stay up with the with with medical practice and what that involves is.
I'm in I'm in Scottsdale.
I didn't do I wouldn't I was were reluctant as well, and I'm admittedly reluctant with colorectal and comometer.
I went to go work Boston Marathon, And, you know, when you see that, when someone has a 108, 109 temperature, and then they can go home, and they and I've seen this on a number of occasions even you know, in the last couple of months, saw one case and more so when a parent writes you a letter and dings you for being not just having having a deliberate response to handle that emergency.
It's very humbling.
As a as a not just as a person, but as a they're thinking you've given somebody a chance.
And I think we we owe ourselves for everybody regardless of profession.
We're taking care of someone's child.
And I think that just always caught you know, someone's child, you or someone's child, and you want the best care.
And I think just staying on top of that, education has changed.
My previous life as a program director for 20 years.
I retired in August and moved in at this company.
Doing this.
The same thing applies as evolutions change, and, you know, our practices has changed, and this is and find be aggressive and try how to provide the best care.
There is a gap, but it's a we have a a moral legal ethical responsibility to stay up in time with that gap.
With that practice gap as well.
So with that being said, we're gonna try to answer the other questions offline as well.
Thank you.
Each of your questions, and I'll just get to the vote real quick.
I'm gonna ahead and get this in the poll and have a great response here.
I'm gonna share the results Hope these are sharing online.
We had a fantastic response.
So The favor the argument said the best arguments were the defendants in this case.
That sit and with that 65 to 35%.
Of that, which person entity is most fault in this case?
The 2 most were the school system and the athletic director It was where it's tied for the other 2 and the athlete was part would have been partially a fault.
So just wanted to share that with you as well.
This has been very enlightening case to say the least and and Your
honor.
Your honor?
Yes.
My honor.
I I I object.
To those
I'm a do one time.
You're out of order.
Okay?
This is the jury has made that decision, just so you know that.
Fantastic questions.
We're gonna get to those after the fact as well.
Again, I wanna appreciate your time and spending here today the audience as well.
As we close out, just a couple reminder, you're gonna receive
NEXT WITNESS PLEASE 1.0 - A Mock Trial Debate on Exertional Heat Stroke Management In A Pediatric Athlete
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