Transcript
Officer since 2012.
Ray, thank you so much.
It's great to have you here.
I'm gonna turn it over to you.
Great.
Tab is fantastic to be here.
I love the stuff that you all are doing.
And as we're doing this, I'm a go ahead and get this up and running so I can do all this.
Anyways, just see the work you all do and seeing the impact you make is really phenomenal, and I'm just blessed to be here today.
And thanks again for the invitation to be here.
So Purple 1, hello.
Great to see the numbers on here, and we'll definitely get a chance to answer some questions at the end.
And you know, as Tavis said, I love emergency medicine.
I think all of us have a as a healthcare provider in in that sector, You love it, but you definitely don't wanna practice it unless you have to and or at least implement it when you need to.
That's the last thing we wanna do and but also, we wanna do things well and try to make an impact.
So the thing we talked about today is really looking over the high school symposium.
It's really thinking about one of the most highlighted cases we've seen in the country is on the Demar Hamlin case in Monday night football.
And I think that the as most people would agree that it is simply that no a lot of people have never seen the full implementation on the on field venue act activation of EMS for cardiac arrest.
And I think that was we see it, you know, in many times, people have injuries, etcetera.
But what does this mean to the high school setting in tons of doing the same thing.
And we'll go through that today as well.
So, obviously, a brief I'm not gonna read through this, but you can read that disclosures and financial interest.
And big one thing here is, you know, I have some So, obviously, disclosures, no product will I'm gonna talk about today.
It's it's only used for demonstration purposes or only in it's not in a specific endorsement.
So let's move ahead.
So really what we wanted to talk about today, as I mentioned earlier, is thinking about, you know, one is What are components of emergency action plans and procedures?
How we analyze and how what's a process for process improvement?
And we're using this as a backdrop for a very high profile case of in the sudden cardiac arrest, which is very prevalent.
In the emergency care, and we see that very often.
And then also talk about the care standard of care and then how we can a fire implement, we wanna make sure the interdisciplinary healthcare delivery.
So those are some things we can do from a training standpoint, and the barriers that we see is across.
And and Understand.
I work in a number of different settings over the years.
And these same barriers that will I'm gonna talk about some that to or talk about these today.
These occur at all different levels.
It's not just at a high school level.
It is at a college level.
Professional level.
International sports.
Those things but there are also many opportunities there and how to identify those.
So as I was preparing this, this was just something I came up with, and I just I was sitting I was kind of thinking about where what AEDs are are really the clutch player.
And, you know, you think about that.
We see what that looks like.
Because they hang around the wall, or closet.
They're waiting just like any player.
You know, they they want to be that player.
We've had many dreams and aspirations of being the game winning play.
They're genetically engineered to score a basket with no time left, and they are 100% fantastic.
They are the Michael Jordan's, the you know, the Serena Williams.
You name it.
They are the the you name who they are.
They are that person that you want to give the ball to, and they're going to make that game win that shot to tide and go in the and win the game.
And then but most times, unlike them, the AEDs are left on the sidelines watching another loss.
And this happens way too often, and or or wait till the wrong time to bring them into play.
So you'll see here, this case here, was a high school athlete several years, so full cardiac arrest on the court involved.
I'm just gonna play this for a second.
And you'll see some of this what what occurs here.
Everyone runs to her side.
The teen is an full cardiac arrest.
One coach performs CPR, but it's not working.
It's looking grim for seventeen year old Claire Crawford.
Then somebody rushes in with a defibrillator.
There it is.
It's in the black box.
Sure enough.
You can see Claire's body choked from the electric charge.
Julie Sermons is the quick thinking school administrator who used it a fibrillate.
And I don't I don't wanna play this in full, but you can you can easily see this look for this for this one athlete in particular.
And if you watch some of the other videos about this athlete that occurred was that this did not happen by chance.
That was a school administrator They've gone through drills before.
They've seen this, but having to activate that so fast.
And this is a great example of you know, out of hospital cardiac arrest.
And when we look at the the data is pretty compelling in this, not just this one study, but many studies, is that if you apply an AED in def in defibrillation and within 2 minutes, under 2 minutes.
There's a 7 fold increase in survivability.
At 2 to 5 minutes, it's 4 a 4 fold increase.
So accessibility is very critical in early interventions of cardiac arrest.
And and and giving the person a chance to survive that that episode.
So I thought it would first be good.
Just to go look at a couple of imported studies have been out.
It's you know, first off is before we move into a comparison of what goes on in a professional game with that that case and then also the AP is really think about what is what do we know about southern cardiac arrest of death in the US?
So study came out by Pearson Peterson and colleagues And several years ago, they looked at the dataset from 2014 to 18.
They had 331 total sudden cardiac arrest or sudden cardiac death cases.
The majority of those were fatalities.
And you see this breakdown when we think about the adolescent setting, you're looking at a, you know, 83% in those cases of college in that and the number of athletes occur at the high school setting or a PDF.
Or middle school setting.
Average year, 16.7 years, this probably hits right in your wheelhouse for some of you here today.
And if it doesn't, it still hits your home because it's a cardiac event and it can happen anywhere.
And what they found was that the majority of these cases, they were they were male, they were basketball, or played American football, and with that as well.
And that's the distinction between looking at other types of football across the world for any international viewers.
Also, African American male, division 1, basketball players had the highest annual incidence rate.
So fairly compelling, definitely worth a good read on this.
Also, when we look at this article, that we think about where this occurs, you know, what is the survivability in death, and you think about where what they all what they where they did and how this how they trans spired it from terms of whether they survived or not and what that looked like as well.
When we see the types of incidents in this in this study, obviously, hypertrophic cardiomyopathy is the is the prevalent prevalent one Obviously, we're gonna see an enlarged heart and an athlete.
But this, again, this is an abnormally large heart heart size or are thickening of the left ventricle.
You also think about, you know, that or looking at hyper left ventricle or hypertrophy.
Or some other cardiac anomalies.
These things do occur, and some of these are all can be detected early on through appropriate screening but some of the other ones are not.
So even with that, we have to be aware of what's going on here.
Here's another breakdown.
We think about the high school versus caught versus NCAA athletes.
And you look at that breakdown.
There's still on the left is high school, and it's breaking down the majority.
We're occurred at the high school level or youth level.
And, again, think about from not just here, but but with heart, but also with head injuries, etcetera, as a as a patient or as a person who's growing developmentally, they're still developing, and they're still and they're very still a volatile age point where at the point in time when they get eighteen to twenty years of age, the body starts to normalize and and and does become more stable and more resistant to a number of different factors.
So we wanna think about what occurs here, and you can seriously break this down and you see the instance rate.
So you know, basketball and football are the 2 big ones in the in in high school.
And in college, you see some of the ones is even the smaller numbers, you're looking at those 2 main sports and as what the the most incidents occur.
Also, Doctor.
Jonathan Dresner in Washington does one of the leading authorities on cardiac rest in in athletics or cardiac anomalies in athletics.
There's a number of different articles you've seen him in position statements, etcetera.
And then, you know, the thing is, can we do better?
And this was a shorter time set.
Had a 100 or 32 cases in which Again, the sixteen point seven years of age, their overall survival was less than 50%.
And with this, even those cases, they noted that as part of the action report is that on on-site, the 83% survived when they had an athletic trainer, a licensed athletic trainer on-site for those cases.
And then 89% when the AED was used during the resuscitation.
So just keep in mind that those even with or without, you're looking at suscitation as the kicker point, and these occur both with and without.
So let's talk a little bit about Demar Hamlin's case, and and I wanna do a couple of, like, a fact versus myth type of scenario here.
And so we know that what we do know is he didn't her is publicly acknowledged through the the medical reports at the hospital, etcetera, the the NFL that he suffered a sudden cardiac arrest.
Why?
Even if they had not said anything, we were able to readily see that, a, he had CPR administered on the field.
That in itself would be an AED, that would be a indication for some type of sudden cardiac event.
What was what came out of this was there was a lot of speculation of that he had comedocortis There's never been a confirmed case.
He hit he hit the athlete.
He hit the athlete.
He hit the athlete to meet a tackle.
May got up for a couple seconds.
Took a couple steps.
And then collapsed.
Not that that would be a reason why it would not be, but just know that there is no official confirmation that he that this patient had a had terminal cortis.
And if you see that, then you seem to make that correction with anybody just to to end that propagation of that.
It's not we don't we don't know it's true, so we can't say that's the thing.
But the other thing is the more important fact is that this occurred, the survivability occurred because there was a because NFL and not just NFL, but others are cards and other settings as well.
They developed and they implement a comprehensive EAP that created the opportunity, and emphasized, create the opportunity for delivery and of an effective emergency response.
That's plain and simple.
If you don't put those things in place, it's hard to put the the delivery and response and actually have a positive outcome.
So when we look, those of you may not be familiar, there's here's just kind of a quick glimpse at the the team behind the team.
And when you look at the that's on the field providing care, that's the top you see.
I'm not gonna go full depth, but you have you have a number of the those just on either sidelines.
Now granted, it doesn't occur in every sports setting.
We know that.
But it doesn't require you to have all of these individuals on-site so that you can save a life.
And we've seen that on numerous occasions, even that previous video that showed you with the high school volleyball player.
To the right, there's a video you can search for in I just gave the in NBC the day on January 23rd, and the title is behind the scenes with the, you know, meet the NFL team.
And they interviewed doctor Jim Ellis, who is the director of emergency preparedness consultant for them, and does a phenomenal job of what and and in this video does a great job of explaining what they do, how they do the preparation, all the things that go into place.
But this is the same thing that goes in when you have a medical provider who is at a with an organization who is allowed to do the things, and they take the lead on a response.
And and it's not just something that happens by chance.
It includes the medical time out.
It includes the so many other things, the training and other things that I know that I mean, from my athletic training standpoint, we advocate vigorously vigorously for in having the the people around us and developing that team that you can do that effectively.
So as far as a, you know, a couple of key points before moving forward anymore is what we observed in in money like football It was the activation of the venue specific emergency action plan and implementation of emergency care protocols.
That venue specific plan is not the organization's EAP.
And I think that's important to realize that if if you are an athletic trainer or your coach or you're talk trying to talk to an administrator and they're you're having resistance, they need to understand that that that's a critical part of it.
There's only hey, this is how you deliver care.
That's all that it does.
It's at the one spot.
It does not take into all the intricacies and and other facets of this we'll talk more in detail with.
Emergency care protocols, keep in mind, are part of the EAP policy procedures document it's not there that when you have something about how I'm gonna handle a fracture, etcetera, that's just one come that's just delivery of care that has nothing to do with what else goes on before and after the that point.
And one thing above all is to make sure that you're dressing the kind of the big 5, and that is you know, head injury, spine injuries, or being able to manage those injuries and conditions, exertional heat illnesses cardiac arrest like this, and also things for truncle trauma.
Those are very and and that involves, you know, abdominal trauma, thoracic trauma, etcetera.
That these these 5 different things will definitely, if left untreated, depending on the severity of the injury, you will have a fatality.
So let's look real brief briefly at the cardiac care timeline.
So obviously, we saw what's on NFL, you know, money like football, 8:56:8 PM.
He collapses after attack or about 2 seconds later.
The athlete trainer, Danny Hamlin.
I mean, Danny going black in his name.
Sorry about that.
Was for the Bills responded to the field, paramedics were summoned right after that.
They do hand signals, CPR, and then AD was initiated almost, you know, within within under a minute.
Then you have about 4 minutes later, ambulance was summoned onto the field that about 10 minutes, they transferred to the stretcher.
At 9:23 at that point time he was transported.
So think about where he gets to the hospital.
I put the map up here just to understand that that's 11, 12 minutes that may take there to get that.
So it adds to that by the time he gets to the definitive advanced care.
All share on the right is a just a sample protocol that I pulled from Hamilton County, which is Cincinnati.
And, again, it is not do not assume that this is what they use.
It's a It's just one of the ones we see that talks about the protocol that goes into place.
And one, I I brought I bring this forward as an emphasis point because there's a common belief that, okay, if EMS arrives arrives and there was no other health care provider there, that they're going just to transport and pick them up and they put them in the unit and they go, it takes time to put them into a unit.
They have to start care.
The other side of this is with cardiac arrest, with a single person or a unit, one person in the back.
It is the least effective way to treat that person.
So they're gonna stay on-site for a period of time.
Typically, until they have a pulse or at least 30 minutes, it depends on what the protocol is by EMS, what that looks what their leadership the municipality or the region is, what they u jurisdiction they use for EMS.
So here, there's that same image, but I wanna emphasize this one part of this.
This is several page on the on cardiac care protocol.
For this one example, is they recognize this is the EMS now protocol.
Given the time sensitive nature of cardiac arrest.
Treatment is most effective when performed on scene, which means they're going to they're going to run the cycle in trying to obtain Rosky or or that return of spontaneous circulation.
Once they do that, then they can trans they would transfer it transfer the patient.
That occurs regardless.
So it's important to note of how that transition and we're getting you know, you may as a health care provider providing care, you may get that forced to, hey, I need to I need to get to why aren't they why aren't they leaving?
Well, they're just they're used using best medicine at that point in time.
And and they're doing the same thing.
And but also, from an ambulance standpoint, it's difficult to do CPR on a soft stretcher with almost impossible to do that really effectively as it can be plus your drop plus being driven in a vehicle.
And if you're by yourself, you need two people.
We know that that at least 2 have few people to do that effectively.
So here's just a sample.
It's just something to think about is having in your protocol at your organization.
At the at the very least, your even for the layperson, they you look at the one on the right for pediatric cardiac care, and this is just for pediatric it's American Heart Association.
It goes down.
You should be at at at through 4 being able to do CPR, and that's without an IV access.
And and and initiate the you wouldn't do that if you don't have the skills and training for that, but do a shockable rhythm, do CPR with an AED, and you still roll them through that.
Having medications is another thing altogether having an ALS unit that would come on-site as well.
So just know that these are things that do occur.
And you could easily develop a protocol.
And what's nice about I gave this one example, the pro this protocol to the left, is it shows that the the sequencing And if you go look at that source, you'll see that they have everything from what everybody can do to what is level specific and it's in sequence.
So what are seven things that really can in that can create a a significant impact on a high school setting And it really is the left side here.
You have a survivor case versus a statistic, which we'll refer to as the death.
And these are very recent cases that have come into play.
I think one, this article here, you know, this is if you practice this routine, it's a circumstance, it's a routine circumstance.
And then versus the recent case that was solved from several years ago was Matthew Magnini in the Louisville area or in, you know, in Northern Kentucky, who hadn't had healthcare providers there on-site, had they had an athletic trainer there.
They had a coach there.
They did not apply an AED.
It was 12 minutes after the onset of the event that they settled that lawsuit out.
So number of questions rise, and I'll say, for your respective setting, I'm gonna ask these couple we're gonna go through this in more detail as well.
So are your personnel trained?
And what are their call what were their qualifications?
And, specifically, what is their role in EAP?
And it's not something when you say, hey, I'm gonna go, you do this.
It is written and it is it is practice.
Everybody knows what that is.
Along those lines, everybody is in there as a stakeholder.
Do all the coaches have this?
They have this in including you know, have they done the EAP rehearsal?
Have you gone through a full process for review?
And if you reviewed the EAP as a whole, the document.
One one problem, I know that as a athletic trainer, I've had issues with before in the past, and I know others do and other providers and even coach others well is having just the correct equipment and supplies.
If you don't have the the minimal equipment needs, it's hard to save a life when you don't have access to it at all.
And though and making sure that's a is is put in place, you know, and those are different than different situations you may encounter.
Communications is communications.
It cannot overemphasize this plan much.
It's what is your communication plan, not only that, but how you will communicate and who does communication.
And this isn't this this is not this gets into, you know, think about separately, the venue specific plan, and then goes to number 5, is do you have a medical time out in place in Where does that go into place?
There's communications, and do you have redundancies in place?
There's a case in at Northwestern Universities.
A number of years ago where the phone lines died.
They could not an athlete who died.
There's a major lawsuit over that because those things failed and there was not a process or backup plan in place as well.
Then what is your documentation?
Do you are you documenting you've done it?
Just like a medical record, If it's not documented, it did not occur.
And it needs to be it's a paper trail.
It also tells process improvement as well.
And how you truly get better.
And then also, how do you at the end of the day, how would you take who's going to take care of you if you are involved in an a serious incident.
And those are things we go into and whether it be a death you know, it's just the counseling and the more so from the post critical incident response management or I'm a cross I'm sorry.
Critical incident stress management response and what that looks like.
So here's something that really we we take home and and do this as well is, you know, we're caring for someone else's child.
And that's the bottom line.
Doesn't matter what age they are.
There's someone else's child.
And we all have that shared responsibility, put note, both professionally, legally, ethically, and in writing and implementing a comprehensive plan.
This goes for schools, it goes for coaches, administrate anyone who's involved in the overall supervision, they have a responsibility.
It's not just one person to where to carry the weight of that responsibility.
When you're writing when you're thinking about the writing of an organization's EAP, just wanna take a couple things in mind.
It's one that you have be comprehensive.
It has to be practical.
It doesn't have to be overly extensive this whole plan, but you have to have the mechanisms in place that really that can talk and it it tells what's going on so that the so the anyone who comes in, oh, this is how it's done.
This is what you're doing, this is when you do it, how you do it, etcetera.
It may be very simple statements.
It doesn't have to be extensive.
It depends on the complexity of the organization that you're with as well.
Always also keep in mind is keeping an, you know, an all hazards approach.
Anything can happen any given time.
These are different threats that can occur to an athletic event that can and not just not just weather, not just active shooter or something like that.
These are it can be weather, other things as well.
Access to a field.
With gates and things like that is a hazard because you cannot get access to an injury thus delaying care.
Having tabletop exercises, but think about the barriers.
What are time commitment?
How do I do this?
You don't have examples.
There there are many of them out there, and you you can use them.
And also, people want to help others in their organizational plan.
And I think that's a really important part of that.
They're not gonna write it for you, but, again, you have to think about find others with expertise.
Others want to hey.
They have equipment.
They wanna show that equipment off.
So go out to fire and EMS you, you know, or other other local agencies that will help you as well.
Here's an example, emergency action plan.
This is right outside here in Baton Rouge at Simpson Parish School Public School System.
They have a phenomenal process that they've done over the years.
This took a lot of time and effort, but it didn't take money.
It says, takes time and effort and commitment.
And I had the opportunity to sit on this as a as a external reviewer and provide, you know, feedback and work through the and finalizing this document a couple years ago and from a revision and You know, this was this is gonna sample table of contents, things that keep in mind of you or you wanna address in your respective BAP, especially in a school setting.
So first, the number one thing.
Let's go back to this right.
We'll we'll hit these 7 things.
The 7 things that are in are really critical are in that to the high school settings specifically, but also for other settings as well.
So these are set, you know, with this.
Number 1 is, really, what's the training?
And everybody has to have some type of training.
Coaches have to be trained.
It can't be this is a major issue.
I know that schools encounter because they don't have to have they have various policies, whether it's mandates, etcetera.
If you're overseeing a child's care and you're responsible for that supervision organization, you have an inherent responsibility to be minimally trained in CPR 1st aid bleeding control.
Those are the big the big several ones.
Most most states now have athletic associations.
They're starting to mandate that some and other some of those policies, or they already have it as inherent process.
They everyone, not just coaches, but everyone needs to know what their responsibilities and where they have access, equipment access, and readiness, and making sure it's functional.
And then there needs to be some type of formal performance assessment in writing that they demonstrate confidence and readiness.
And this has passed to everyone.
This is something that Doctor Ronnie Harp and I have worked on for a couple of years now.
We do we're developing this, and and when we go out and do courses that we in teaching organizations how to do effective training to be at the highest level.
You go at the you look at this picture on the right, This is a a pit crew change, and the the world's fastest pit crew change is Formula 1.8 seconds.
And, you know, that that just didn't happen by by circumstance.
I'm gonna go out and do this today.
The same thing, you take that same mentality and approach for emergency care.
You start with the independent skill, which is, hey.
I'm gonna do CPR.
And then now you add, I'm gonna do a protocol, and now I'm practicing this specific protocol.
And then you bring it into a scenario.
Hey.
What if you have this case on and you're in a lab setting and you have a person who collapses and you bring that together with 1 or more people, and then you're moving it into bringing it via EMS, a full full full blown scenario based where you have multiple people coming in, it truly looks and feels like it would be on the field because it would be on the field and or in the stands or somewhere else where you're bringing multiple agencies in, you you test the communications and things like that.
So this is something you look for.
You it has to be in place, eventually.
Now that top wrong level, it may take several years for you to develop that, but but you're working towards that at least.
And and believe it or not, EMS and fire they welcome that.
Those types of trainings because they are tuned to being practicing in that continual role the practice makes permanent, so practice right.
And you you you always rise to your level of training.
So not not what your expectations are.
So think about that from a standpoint of understanding what knowledge and skills are and trying to identify those and and not, you know, every level But we have to understand that skill does not equal knowledge, and skill and knowledge doesn't mean they're competent.
But incompetence is doesn't mean real time confidence.
In a resistance or internal resistance to do something because you're not confident or not confident can also impact health care just as being cavalier and doing something that you're not really trained to do and you do it half half halfway or half heartedly or however you wanna say that, where it where it ends up being just by chance you got lucky.
And there is no and lucky is not a good way to be in.
So but again the day is I work a lot of large scale events, and I have different providers come in and and from volunteers that just that have no CPR training to some that, you know, other pro other providers And regardless, I tell them all the same thing.
If stay in your lane, do the things you're comfortable with and you know you can do, don't do things outside of that.
And you do that, and everything will work fine because you're still moving forward in providing care.
And if you don't know, you're gonna ask someone or call someone to help you regardless it's still being a tune up to care within within a within the the next scope of that person persons and abilities.
So when we think about stakeholder feedback and rehearsal reviews, If you're gonna write a policy, multiple people have to have it signed off.
You have to see that if no, you just can't say, hey, I'm gonna do this, and you you get no notification you're being done.
Tabletop exercises are really good, but they also you get that early challenge, but without having to go through a full sale you know, situational review because you can't do all types of scenarios.
But what you can is walk through this multiple stakeholders and see if there's a problem And then even after that, you go through you have a critical incident occurs, and you determine what that's gonna be, and then it invokes us again, okay, what work will What did not work well?
What can we improve?
And how do we basically, how are we making it better the next time?
And then the same thing know, that you have the rehearsal as well.
You do rehearsal, and then I gave you those 3 or 4 things that move down.
And, again, working on debriefing is an excellent process for that, but having that document as well.
Also, we think about stakeholders review is that, you know, think about the the reps to successful delivery of medical care.
How does weather impact me as an athletic trainer?
Well, if I'm on a grass field and I have, you know, 15 fields of soccer fields, and it rains, no lightning, and how am I going to get a potential cervical spine injury off the field when it's raining 2 inches over 3 days?
It's gonna be very hard, and you have to be thinking about that.
What's lack of human assets can be a detriment?
It overloads the system.
Where assets are located, not where they where you think they're you have to plan that out of where they may occur, but what's a centralized area to make the best, most good.
For example, on endurance races.
We have coverage throughout these events with EMS and volunteer other medical ordered as well.
But then one thing that we know it's true because of history or or data collection is that most times you're gonna have a cardiac event that occurs within the first mile or within the last mile.
And so we definitely you know, if you're gonna put an AED somewhere, You're gonna put an AED at the finish line and the half mile and a mile because though statistically that's when that's going to occur.
You don't negate the other areas, but you still you wanna make sure that you're being primed up.
So this is where this may occur because statistically it does occur more often times at those locations for that.
Other things you can read through these and where where you have access to accepting facilities to inventory access control and other factors that go out of medical care.
You know, COVID was 1.
You know, I'm not gonna talk much about that, but how would you if you know if you know now what what you didn't know back then, how would you have changed delivery of care, and what would have impacted, and have been a lot easier for everybody.
Access to emergency equipment and supplies, excuse me, is we wanna think about what are the low case accessibility.
Is is it operational or nonexpired?
We wanna think about also delineate equipment needs for each personnel.
If you have like, these are certain types of equipment that coaches will be able to use.
Then you have providers.
Then you have the you know, from physician to athletic or when you have physical therapist, whoever it may be, you need they need to be identified, and they have that they're trained for that skill set only and where we have available.
Here's an example list of equipment that a minimum that athletic trainers and team positions need to have available to them.
This is not inclusive, but we and we've haven't gotten into the all the medications, rescue medications, but those those are dictated by state practice acts.
In physician direction and protocols.
So, again, we're trying to do the things that we have to save a life and also keep from losing I I emphasize this to athlete printers, but also for other providers, you don't wanna lose your professional license.
Communication communication cannot begin to emphasize this enough.
This is the game changer that makes things run so smoothly in a number of different events.
I'm gonna give you a or an example of how what that looks at.
So not only that, we know that from a critical incident response and a critical injury.
So we're thinking about when you look at what what sirens look at and all that applies with the EMS, is if you see lights, it's probably gonna be a status 1 or status 2 call.
It's very serious.
But if you don't see lights, they're running at a at a at a different speed.
They have different regulations that the agencies have of what they can do from a speed, where they can travel, etcetera.
I've driven on ambulance previously.
And we we have a if it's if it's a status 1, status 2 call, which means we need to get there fast, then that we have up to a 10 mile an hour we can go above the right speed limit at that point.
So we wanna think about the the medical time out events.
Need to know where the, you know, the the how to activate it, and this is everyone.
This, you know, having this goes into the the having signage at the facility, letting people know where they how to access it multiple people and when to do this and not.
I heard something this other week of than it happened too long ago at a facility, and there was providers on-site.
They activated 911, but there was also EMS that was there.
And they fire trucks show up to the facility.
They did.
They had never communicated with each other.
So that creates a problem.
They're like, what's going on, etcetera?
Knowing but also knowing what their state level go back to the 1 the 3rd bullet, state regional or medical response networks, it helps for you to understand or or everyone understand where they're going to and why they're going to that, and there's a reason why they may drive by a small community hospital to go to a trauma center because the community hospital may not have the the capabilities based on what this severity of injury.
AirMed potential for landing a unit.
You need you gotta have you have a specific space in place.
For that.
You don't wanna get near those rotors within at least a 100, 150 feet.
Perfect.
And then those who most have certain guidelines, you know, policies regarding that, the Airmed facilities, and not only that, but how you approach it in the unit, etcetera.
Zello if you have it.
I'm not promoting 1, but I use that all a good bit.
I've used group me as well as Zellows like a walkie talkie.
Works good for large scale and just trying to communicate and pictures and things like that.
Whatever you use, just make sure you're using it consistently, and you can easily you can replicate that regardless of the setting and where it ultimately brings people in to communicate very time from a from a very time efficient standpoint.
Like, I use it for races and where I have to do multiple different entities or involved and but we're not really communicating.
We're texting.
So we keep radio chatter, so to speak, off the line.
Works really well somewhere to regular radio emergency response communications.
Here's an example of nonverbal communication that works real well.
This is a race that I'm coordinator for.
It's over in Saint Petersburg, Florida.
The entire race is over that bridge.
There's no they they hit the the when they last leave land and they get on land is over is on an interstate.
150 buses, 8000 runners.
The one thing that was taken it it works real well, and that that St.
Pete fire and rescue.
They do a phenomenal job.
They're they're just fantastic to work with, and we work through a extensive plan because we're we closed down the whole northbound lane.
For several hours.
We have not only have you look at the mile markers, the 2 different pictures.
They have the our well, our medical staffs have they're they're they have scientists to protect themselves.
They have medical kits.
They have Also, they had 2 different types of radios with them.
So we have different end phones to communicate in case of that.
So it's being monitored.
Also, we have, hey, it's mile 5.
It's not mile 5 on the bridge.
It's mile 5 on the course or mile 0.525.
But also there's we have zones that are color coded, which works real well.
And on the two bottom pictures, you see, this was at the bottom on the left.
Middle, sorry, was a picture taking from their incident command operator.
He said this to me that this is where all the radios are positioned.
I'm like, great because I'm using Apple Airtags, and this is where they are lined up exactly on there.
So I can see I don't have access to that that incident command center, but I do have something somewhere, so I can see where our AEDs are at any given point in time.
It's not as per site.
You know, it's not as detailed like you see on that that one, but, nonetheless, it gives some good information as well.
So when we implement the EAP, that venue or wherever it is, it is the extension of the of the emergency action plan protocols are, and keep in mind how we look at a 360 view of delivery and care.
Also, we wanna be venue specific.
And activity specific practices are different than games.
And if you move a practice, you've gotta have that that plan in place in a different place and be and you know how to activate that.
Here's an example of of you've borrowed from Dexcom High School.
It's an Ascension Parish.
You see they have they anyone can make this, but it it gets the level of detail that you need to have an EMS system or a emergency action plan in place.
And it's very easy.
It has directions.
It has area hospitals and their capabilities as well.
Another component point you hear a lot of is the venue specific EAP.
There is the medical medical time now.
Doctor James Kyle, West Virginia, created this, and They do it's just it's you can use different ways of using this.
The main thing is you have something documented.
You it's rehearsal.
NFL has a 60 minute time out, which occurs.
It's a 60 minute mark.
It's not a 60 minute meeting.
It may they they'll they'll tell you probably last anywhere from you know, it may it it's 7, 8 minutes of the most.
It's they've gone through this enough.
They know whatever thing is.
They go through review.
They work through the different scenarios, and it and it go and this the last thing they do before they step from the field.
Louisiana, for example, they went through a mandated test several years ago, and I was I they had the opportunity to work with on this is developing.
They just want to start this office for all officials.
This is what you need to check check when you're moving down and down from a from different aspects of safety at an event.
It started with football, and now it goes across all sports, 9000 second and third year now.
Above all, document document.
It's the accountability process.
We have to have if you did don't have it in place, you need to have that paper trail.
And, you know, what's qualifications?
That just that's credentialing.
Hospitals do this for providers.
The work in the hospital, you you do the same thing your organization does as well.
Having regularly scheduled equipment checks.
You can put something in Google forms or wherever it may be.
Somehow, you have a process that you can you can send stuff out.
You're getting something back in.
And you're verifying that it's occurring and what that looks at.
When you do EAP reviews, not when it was done, who was president who signs off on them, incident and post incident reports.
You do a debriefings.
Those need to be documented.
After actual reports can above all, your document one of these things is your any rehearsal or drill you do, you need to have an attendance record and have signatures.
It verifies that those individuals participate.
Or did not participate.
So the last thing is who is going to take care of you after a serious event.
And I cannot begin to under over overstate the again, overstated you keep it keeps moving on and on.
This is this is something that takes time.
And and I've I've, you know, Travis mentioned this about I was at at the finish line Boston Marathon bombing.
And the one of the things I never really thought much of it other than have I've been I've seen had a athlete who died several years, you know, about 10 years beforehand.
And but then this was a very different type of students, etcetera.
But this is one thing that the university had that had a very effective plan in place, and they brought us back in and helped us with travel back.
Helping us we got a physical exam right when we got back to campus the next day, did other things, just did the things in helping to care for the person because it gets into continuity of care and its overall health, not just short term, but long term.
For athletic trainers, we have AT's care.
It's a nominal system that you can do and or get training in.
It's a district in in the national level.
They have those numerous training opportunities available.
It's just it's just good courses like that.
And then also, those are through the International Critical Incident Stress Foundation.
That is where that training is flows through, but they have individual in group.
Soon or later, somebody's gonna be a part of that.
So just know that this is very much needs to be a written part of how you're going to deal with that and deal with that serious injury, done only just for yourself, but for coaches, athletes, etcetera.
You saw this after the after the then the I mean, the the Marhamlin case You you you've seen this how they're working with teams or working with others who have they were doing advertisements at or at least promotional type things if you did this and who you can contact in case that would it it may trigger a response.
So these are some things to think about as one thing that we don't We overlook, but it's a very important part of the overall response plan or or emergency action response plan at your organization.
So in wrapping this up, went through this pretty fast, it's just the 7 things going back again.
It's just kind of a review.
It's one is Don't think it won't happen because it will happen.
Have that all hazards approach and also think about the It just takes time.
And it just you start start small and start laying those bricks on.
It may be one policy here.
Than the next month and month and and building upon that, but also building off of what your organization already has.
Like, for example, schools have already have those things in place.
It may look differently, but it still has it has the components and you just flow that into that as well.
Collaboration with a physician direction oversight is paramount.
It is not it you have to have that.
They're gonna provide the overall They're most part, they don't have to be in the direct care all the time, but they need to be a quarterback in that medical care.
And they need to be formally part, like, in high schools, or or orthotics association.
They may not be a part of that.
So you need to have a process that it definitely links them in officially either through written documentation or or MOU, etcetera.
But also, they're given the the the direction for protocols, and they will they are a game changer.
Don't reinvent the wheel.
And I say that not just for they have an existing AEP, but also your EMS systems.
It is paramount.
If you're working in a school organization, simply adopt and work with EMS.
I had this same conversation about 5 days ago.
I was talking with EMT, at a at a area.
We're talking about just work revamping protocols, etcetera.
And I have this already, and they're like, well, look.
If you need to, we can help you get this from our order.
They they'd be more than glad to give it to you.
And I'm like, oh, no.
I'd say I just but it's also publicly available, but I also already have those things in place already.
Thank you.
But I'm gonna have I'm gonna reach back because I wanna get their feedback because it where there's difference or not dealing with different municipalities.
Also, just know that you can only do some homework is you can't copy and paste before you get caught.
So it's not something you can necessarily just copy in the whole document say we're gonna do this because every organization is different.
Think about where the the the protocol and the video specific APs, it's not this they the both themselves in itself are not it's not a it's not an answer.
You have to have this written documentation that brings and articulates all this together and makes it sing, so to speak.
And then finally is they're just a simple measure of success.
Is was the medical care provided current inefficient?
And again, there's on-site care, but this is a lot of things that go into training and other things that we've outlined.
And then how do you respond to that incident?
Is that getting into resiliency.
Do you go back and review it?
Do you get better?
Do you make changes?
Do you document that?
So those are some very simple things to look forward is 7 things to help improve things in your school.
And the last thing I'll I'll I'll I'll part with is a quote that I like to use a lot with our training is that if you can read this is under pressure, you don't rise to the occasion, you sink to that level when you're training.
And that and also for individuals as well, that may be around you.
So this is why you train hard.
This is why the things that occur.
This is why so many times you see the success for so many people or patients who survived cardiac arrest like the video I showed you in Demar Hamlin.
This did not happen overnight.
It to with practice, it have written documentation, all those seven things that crack those in those areas identified as part of the emergency action plan.
And that is it.
So thank you very much for being attentive.
Thank you, Ray.
Fantastic.
Sure.
This I mean, this is not my area of expertise, and I'm just, like, glued to the presentation because it's just so cool to see, you know, the the action plans and and how quick it really needs to be, like you said, 2 minutes.
7 fold increase and then 4 2 to 5 minutes, a 4 fold increase.
So those 2 minutes are quite critical, and those 7 minutes are incredibly critical.
If you have questions for Doctor.
Castle, please put them into q and a.
So right now, there's no questions, but that's always pretty common that we see no questions right away.
And it's either 1 or 2 reasons.
People have just been so glued and it's they don't have any questions because you answer them or they just don't know what to ask.
But if you have questions, please type them in the q and a.
If not, we'll give it just a little bit of time before we do that, but Ray has always thank you so much for sharing your level of expertise.
Yeah.
Sure.
Russell said great presentation.
Great.
Thank you, Russell.
Appreciate it.
I see some familiar names on here.
It's a good number attending, and I think a lot of folks are having have seen this, and, you know, it's just always evolving.
It's it.
And, you know, for me, I have to work on I have I have about 20 different number of events.
I have to redo this.
It's a one time, you know, it's like going to the prom.
I get to go to the dance with the I get to dance with somebody at the 11 dance partner at the at a prom, and then I'll wait till the next year, but it's another event.
And as much as they are different, they're very much the same.
So the same thing for different facilities and where we visit and, you know, I I know, you know, there everybody's doing some really great things out there and with school school systems.
But the the same thing, I wanna emphasize again, the same things that we do.
We've seen at the college level when I was LSU is no different than what we do.
At at a high school, and I've worked I I joke when you say I've worked in the middle of a cane field.
And you can I know you can appreciate that to have us being you know, South Louisiana?
I've worked as a a football game where nobody's around for 10 year ten ten miles, but they had fire.
They have EMS.
Used to do you you have to make that due diligence, and if they don't have anybody there, you're having to create that medical time out.
Hey.
This is what you do.
And this and the officials are probably used to it, but get them on board with that as well.
So Yeah.
I think there's a question up there, I believe.
Is that right?
Yep.
Yeah.
It says, is there a template for the Ascension Public Schools EAP menu?
They you mean, I guess, meaning to to get 1 or to what is that?
I guess that would be the question.
Amy, if you wanna expand upon that, if you wanna put that in q and a, just as
if you're asking me the template, I think, though, no, there's not, but there are plenty I mean, there's not something that I think you could, you know, share are far as sharing.
I know that Doctor Harper We're working we're, you know, working I know, work with him on doing that very easily to reach out.
We can definitely work on, you know, happen.
You build these are the things you need to build on and things you need to take in consideration.
The first thing I would tell you though is go back and look at your organization's your school or school district EAP, that provides the most that's the best framework you have because they're gonna have that in place.
And then you have to add some specifics about training and things like that as well.
There are also there's also some excellent supporting documentation on that are position or not position papers, but statement I mean, journal articles, etcetera, that have really good information on terms of things to look for with that.
The protocols are pretty straightforward.
Those are easy.
You can and you just gotta practice those, but the training You start building a couple of things, and but you're more welcome to reach out to me.
I'll be more than glad to help you all navigate through that process.
Yeah.
So she just expanded that.
They used the template from KSI, but they like Ascension's.
Yeah.
And and, again, without I don't own that, so I can't say how you go see it and do that as well.
But I think those are things as well that are pretty I think the the question gets into it's that was a generic template they gave, and it doesn't again, one is you can reorganize it.
It's just a template.
And number 2 because of different intricacies, etcetera.
But I know that there are some you know, I've done this with other other school systems, we do some consulting with organizations to do this.
And say, here, this is what you do.
Let's find out what what you have.
And then just trying to just mind reviewing it, being able to adapt and modify what's needed.
So that they'll be the easiest thing, I would say, in in trying to do that, but also find out what somebody else does in your district, etcetera.
Or or state or region, etcetera, as well.
And but, again, more than glad to reach out.
We're more than glad to do some to help you in that in that regards.
Okay?
Any other questions?
We just have a few minutes left before this ends, but any other questions, type them into q and a.
If not, You have raised information here.
You can reach out to his website.
You can follow him on TikTok because he likes to dance.
Just I'll do that.
One thing I'm gonna I can I can predict predict now is I know that I'm I'm wearing my I think this is early about wearing purple, so, hopefully, you know, my my the Tigers are in the final 4, so super excited, and I will that's gonna be the the highlight of the day, I guess, for, you know, we have to do that as well?
So
Excellent.
Well, thank you all so much, Ray.
Phenomenal presentation, I'd like also just to thank our co partners.
Again, tremendous nutrition, action medicine consultants.
The Moffett method, ESSAT, for excellence in secondary school athletic training, healthy roster, and finally team builder.
Tonight, we have Missy Mitchell McBepp, strength and conditioning professional topic as everything old is new again.
Why basics are best in high school strength and conditioning.
That'll be at 7 PM CST.
So be sure to tune in.
We'll go live a few minutes early as always.
And then Missy will have her presentation.
So we're almost, you know, a day and a half into this as always.
We have incredible response.
A few questions have come in on when you will get those recordings.
Usually, those get sent out pretty soon.
But if you have a VIP pass or an ultimate VIP pass, most of these things, you'll have a chance to start watching all the replays end of the symposium.
So if you have any questions for me, my email is in here.
You can always reach out to me at tpattoli@mysportsd.com.
Great.
Thank you so much.
My friend's always good to see you.
Excellent presentation.
We'll have you back in the near future.
Yeah.
Definitely.
Thank you all as well.
And, again, If I however, I can be of assistance to any of you all on the call, definitely, you can reach out through my website And so a scheduled call, etcetera.
We're more than glad to help you all out.
We're all we're all rolling the same boat.
And it's a it's a it's a good boat to be on, and we're getting better every day at rowing.
So You gotta you gotta you gotta feed that skeleton in mind.
So he looks at his kinda
humbly.
Well, that's that's the that's the little I'll jokingly say that's the that's the that's the the last player that when they lose to Alabama or some other big rivalry or old miss, etcetera, that's who they they they don't get fed for a while.
So this
has been the bet the best backdrop of all of our closing and stokes mop and had this dog.
He's in, like, an incredible laid relaxed position.
You have a skeleton, so I can't wait to see what missy has tonight.
Oh, so hey.
Just by the way, so I know from athletic training college, and we get their small helmets like this.
So I got a skeleton years ago, and I just drilled a hole in the top of it.
And the helmet, that helmet, that small helmet, you know, you put on your desk.
It aligns perfectly with the ears, you know, with the ear to come see if you're doing You're thinking about how you're doing your system, you know, with measuring helmets and stuff like this and fitting a helmet.
It's a little loose on the chin a little bit, but it does, you know, over the brow, it does real well.
So that was I've always jokingly I could use that as a demonstration tool.
So I know Russell over in Houston area.
I know you could you can you could use one of those as well and some others as well.
So
Great.
Thank you so much.
Thanks, everyone.
Management of Sudden Cardiac Arrest (SCA) During Monday Night Football: 7 Implications for the High School Setting
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Updated Jan 22, 2024
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