Transcript
And, new new content.
And then the CU unleashed is where you get the on demand replay.
So there are no, replays except through the, online portal, cuenlease.
So check that out at actionmed.co if you want more information about that.
I know, Ray is, in emergency medicine.
He's one of the foremost experts in, education of athlete trainers.
And so, he started this company with that, with that purpose in mind.
We have a lot of, a lot of, background in, athletic training as he has been a a professor at LSU.
I used the word loosely retired, because he's working as hard now as he's ever worked.
But, Ray's gonna share with us, you know, the the the protocols and guidelines, on how your equipment and training, all lined up.
So I'm turning it over to Ray to present and educate us on this.
Ray?
Great.
Thank you, Ronnie.
Yes.
I I wouldn't say I guess, work hard is not the right thing.
I'm just having a lot of fun in this in this space, and, it's something I will I've enjoyed, really, as my focal point, for a long time and and get to do this all the time.
And this is just a fun topic, I think.
And and, again, if you have questions, as we move along, feel free to, Ronnie, you just kinda monitor those.
And, any questions come up, let me know, and we'll we'll move through this.
This is this is probably one of the most important topics, I think there is because when it gets into this it's a delivery of care and what what goes on you know, we have a prac a protocol or guideline and, where that fits in with the equipment and your and all those things kinda meld into the delivery of care.
So let's go ahead and jump start it.
I have no I have, no conflicts or disclosures.
I don't think I don't have any, particular devices or products we're talking in this presentation.
It's not an endorsement.
Just giving this example only.
So what we're gonna look at is, like, you know, think about how we how or how you would think about your emergency care protocol.
Now I'm gonna just like this quick disclaimer.
When I'm referring to a protocol, I'm refer I'm I'm gonna say, yes.
It is a protocol.
It's very specific versus a practice guideline.
So you can use these interchangeable not interchangeably because they are have a little different context of what you can and cannot do.
But just keep in mind, if you have if you're working on practice guidelines, and that may be under your physician direction, This applies to the you know, how this what this this talk is interchangeable for practice guidelines or protocols.
What think about what equipment you're utilizing in maintenance and, what it means for regular checkups.
And, we have to we go through regular checkups and, your equipment and everything else does as well and how it aligns with protocols and also where training qualifications are in alignment.
And this is not just for the you as a provider and the ones you work with.
Think about athletic setting coaches.
You think about the lay personnel.
It's incredibly important to take those into consideration.
So I'm just gonna snapshot this for a second.
And, you know, you see this example of the injury over here to the side, and think about where your protocols, training equipment fit within the overall, emergency action plan.
And this is just kind of these big areas these are big hit areas, you know, personal training qualifications.
You've gone through the reviews.
Are you making sure what those the the process works well?
Do you have the appropriate equipment, supplies, location?
Are they marked?
All those things, you know, how you communicate during your response plan in, in general.
What are you know, you do you are you doing the medical time out with every with the relevant stakeholders?
Do you have where your documentation is where you're verifying that you've done this?
Just like a medical record or patient record, if you if it's not documented, it did not happen, especially here, in as far as equipment checks and things like that.
And then, also post critical incident response.
That's after the something's happened, obviously, and we're not gonna get into that.
But here's just an example of, a protocol.
And, again, it's just one example I I pull off.
You know, it has a written description.
It has this, on the side of the algorithm.
Either way works fine.
It's just work works best for you.
Some people are you know, if if you explain it or have a combination of both, it works real well because now it's clearly understandable.
You can work through steps as well.
But when we again, we think about this is a process.
It has a deliberate steps in it.
You have to you're having the evaluation.
You have the oxygen.
You have a metered dose inhaler in this or, a nebulizer in that case.
You have to think about your head tilt.
I mean, using, airway, access, an oral or nasal pharyngeal airway.
Do you have an eye gel, supragliotic airway, potentially?
You your oxygen.
That's equipment.
Think about your vital signs.
Just move on.
And then you your assessment side.
So think about all those things that go into place, and are those in place, and do you know how to use them?
So the first thing we have to tackle is scope of practice.
And we have training.
We have equipment.
We have protocols.
But all that cog, this could all get, think of that wheel running continuously in a perfect world, but that scope of practice can come in and lodge in, and it can stop and shut down the whole process.
So we you have to have a clear understanding of what your scope of practice is and and direction depending on who you are, what your provider level status is, what you can and cannot do.
Obviously, based on the practice, think about practice acts.
You think about, for what, not just for BOC, for athletic trainers, but are there other providers?
What's their practice act what their scope of practice is within their standards?
It varies from practice from profession to profession.
Position and consensus statements provide tremendous leverage in terms of what to do, and how to do that in best practice.
Doesn't mean you have to do that exactly, but you you have that as and looking what other professions or what other medical providers have have created, you can that applies cross discipline.
Again, it's a medicine is medicine.
It doesn't have to it's not stuck in a one discipline.
Obviously, for an athlete trainer, it's physician direction and supervision, what that looks like by state practice direct, for that as well.
So it's really critical you have a medical direction and having standing orders and or having, some have written documentation and said, hey.
I can do this or I cannot do that.
Again, think of that you wanna leverage that team approach and what your education as well.
Look at what late providers do, especially in like, you look at example, high school settings.
You know, people come out of the stands or things like that or who can assist in different, who may have minimal training.
It look at the systematic processes where you gain evidence from.
Obviously, clinical research, those practice statements, etcetera, look at, what are industry best practice standard.
This gets into this is, like, kind of expert opinion, and it's not there it may there's a lot of the stuff that may not be documented.
But it is a best practice and it's well documented that it's best practice.
So having that justifiable, what that's done.
Think about what education, standards are for various disciplines.
And then, for high school, you have secondary school student athletes' bill of rights.
And above all, making sure you're you're doing this on a review on an annual basis to make sure you're staying current.
Just kind of buyer be you know, kind of buyer beware and, is thinking about, what and this comes up, I know, for, in athletic training.
There are some things with if a school, you know, for example, on heat related illnesses and when you look at, like, or exertional heat stroke is whether to whether or not use a, colorectal thermometer.
It's emergency medicine.
They have problems over and employers, per se, cannot supersede practice acts, impeding delivery of care.
That's actually it becomes it's a very nebulous area, but you it's there's nothing that, prevents that.
You, you know, don't have you have to you're providing care provided within your scope of practice and within state practice.
It doesn't supersede that.
But, again, go back and check with your, legal state practice acts, your your your state regulatory board.
They will provide an opinion.
You can ask that question, and that's the definitive opinion because it'll go through legal review.
Personnel training qualifications and what are the roles?
So everyone has a role, and everyone has to know what their skill but you have to identify that in emergency action plan.
If it is a coach, this is what these specific things they can do.
And it may be within just a certain a limited role, but, nonetheless, there is a role.
If it's an administrator, if it's if it's a student, I know that, if it's an athlete, certain settings may have athletes perform training in case, they need additional hands on deck.
And that's that's, an excellent resource.
It's often underutilized.
Know what the responsibilities are and, wait make sure equipment is ready and assessable.
And then performance assessment, you have to if you have equipment, you have to know that different people have you have to have confidence or readiness.
Now something that becomes up is kinda can you have to be can get lulled into is that if you have equipment, the same equip same type of equipment, but 2 different brands.
So for example, you have 2 different, you know, spine boards.
Well, if persons are coming in and out, you have to they need to be trained on how to use that in different, you know or if it's an AED, they do run they do operate a little so there are some differences in AEDs, or some other equipment.
So they need to have training in both, not assuming they know how to use 1 or the other.
So as we move into you know, as far as developing protocols and I just give this one example.
This is was one for a late provider to easily show out stop the bleed is where it runs through.
It's very simple to do this.
But you you map you have to have that initiation through medical oversight.
In in the focus is having the physician, you know, it's this team approach, this umbrella approach of, directed practice, for that.
And it is not a one person show.
It is interdisciplinary.
You need to think of that in terms of how even if you have if you have limited resources at your own location, you you need to work towards finding that and making sure that you codify those external stakeholders like EMS and have a physician direction and other ones as well.
And, again, my practice act dictates that.
So to not have a any physician direction is not following within state practice act and having it in writing.
That's something that, like, no schools may have, it takes more time with that from a from a that process, but there has to have some direction.
Think about who the, the athletic trainer or, you know, public safety personnel, administrators are involved in all this process.
As as far as, making sure that, it's not to reinvent the wheel.
You know, we think about having the gold standard.
The gold standard can be very difficult, for anyone to meet, depending on what the carrier is.
And, again, looking at what that looks like as whereas you have to have access to equipment, you have to have an ample personnel, you have to have the policy in place.
I will say this.
I've, I've heard this before.
It's I I'm I just can't do that or I'm not going to do that, is not justifiable in any in the legal sense and medical sense, otherwise.
If you're not going to do it, you need to provide justification why you cannot do that.
And just saying not doing it is is withholding medical care.
So you have to, you know, look at best evidence.
You have a protocol or practice guideline.
This is what you're going to do, and this is the evidence to show this is why I'm doing this.
And that's and that's relatively easy to do.
It's having some justifiable documentation is that you don't have this you may not have this type of resource available.
But, again, it's allowing you to practice within your full scope of care with the available equipment you have.
And that's making sure that that, is in place.
And, again, you're by doing that, you're addressing the capabilities within your setting, and it's understandable.
It's justifiable, and it's going through a review process.
Here's an example, a comprehensive list of equipment that you athletic trainers, physicians, EMS would would have available.
Doesn't mean you have to have all of these, but this is just a in a a full sample list of things you want to have.
Again, it's based on what your protocols are.
A lot of places may not have this available, period.
This is in a perfect world with everything available.
But, again, some things may or may not, may not be needed.
And it's based on setting the practice act with this what the particular environment is, whether you need some of that or not.
And then, also, if you're working with our groups and they already have another like, a if you already have EMS on-site all the time for different events, they they may have that equipment already.
So you have a shared resources capabilities.
So now let's move on equipment per protocol.
This has becomes the really important cog in the wheel.
So it has to match the protocol your equipment capabilities are and, you know, it's to be matched across the organ those kits or medical kits have them tagged, have them located.
They're very easily definable.
You know, you have emergency care kit or trauma response kits, and then you have everything else.
And then it's a scope of practice for all personnel.
So, you know, here, this is, a kits that, my company had we put in place.
And on the right hand side, this is what's in that kit.
It's available for various different personnel to use.
Again, they go through their own we have we we establish what they do and would not use, but it's also this is built on a functionality because we do a lot of event coverage in lot of, you know, different providers are coming in and out.
So I may have some so I need to be able to know if I have someone with a kit with a kit.
They may not be able to use all of this based on their training.
But if I walk up and I don't have it and I have it right there with them so it's a functionality.
Or if Ronnie walks up, he knows we know what this equipment is.
You see that it's been checked.
It's clearly labeled.
It has those things that are we need it has it's expiration dates, and we do those rechecks on those after every use, and we refill, every use as well.
So this is some things to think about.
Very simple form we have, with my company that we use something like this.
Finally, one of the bigger things is having equipment per protocol moving in.
You have the equipment.
You have the training.
You've gotta work through this practice side and know those scenarios that that will fit the protocol or what the intended, in this case, a spine motion restriction, making sure you have, applicable equipment as far as the removal for spine motion restriction.
Does not mean you still have to think about oxygen administration and other things that may be going on, with that person.
So, again, it's it's it's multifaceted in making sure that you practice that.
And once you when you practice it, you really start to see where the problems exist or may exist in the in whether the equipment is right for the setting and so on and so forth where the cog works well.
So as we wrap up, just real simple is identify the I know this is a quick fly by, but, hopefully, it gives you this, 3 a a really good step back and 360 view, or or 10,000 foot view of what needs to happen.
One is identifying your you have to identify you need a protocol or or guideline and and finding what that's that one would be.
And with that, you're establishing what the equipment is needed for protocol.
If it has a protocol and you don't have that equipment, it may you have to modify that down based on what the available training is as well.
That goes back to personnel training.
Who can who the scope?
Who can and cannot utilize the equipment?
In some cases, you may have a kit just for coaches, then you may have a kit just for the the medical staff, which and, again, it's delineated what's what is what and what can be used.
Then you have to match that protocol guideline to the equipment and the standard of care of those individuals who are who will be using that equipment.
You have to train them for competency and docu and also document it.
And then as you review it and you go through it, like, you know, this doesn't quite work well, or you have an incident report that comes through that okay.
A post incident report, well, we had this problem, and this is what was encountered in this situation, why this may not work well.
So it gets into the revision side.
And then lastly, just leaning on EMS, for protocols and, their guidance.
And and, again, it's about, making that easy transition of care.
And if we are using the same or similar to what either EMS agency has, then they're they're more likely gonna give it to you and say, hey.
We want you they it's gonna make their job easy, make your job easy as well.
So, with that, I'm gonna live, for anytime we have left for some, q and a time.
So thank you.
Alright, Ray.
Good stuff.
Good overview and a reminder of the connection, between your protocols, your equipment, and the the the syncing of all that.
I'm waiting for a question.
Please raise your hand.
I would love for you to come in and, have an open mic and ask your question.
We encourage that as well as just insert it into the chat.
Ray, so let's here's my question.
Let's say, I go to a conference and there's a presentation.
Somebody is presenting on something in emergency medicine.
So they're talking about, MP airways, OP airways, The importance of establishing an airway, and you go, okay.
They didn't teach that in basic CPR class.
However, it doesn't look that complicated, and, I can see the value.
So I get excited.
I come back home, and I'm ready to push the envelope of getting that into our kits, getting that into our scope of practice.
Right?
So walk me through how you would see this happening, as to how to take something new and then insert it into your daily scope of practice within the as an athlete trainer in emergency medicine?
Well, I think the probably the first thing is is looking is before implementing that is one is what you have to make sure that what you have is in place.
So we have you know, the base thing we have, like, for example, for airways, where we have BLS, we have those are standards of practice and care.
So those things are you know, can be relatively inexpensive, like using an eye gel or, as a supraglottic or using a king tube.
Those can those can get can be costly based on your, you know, based on what your resources are.
I got the money.
I got the money, Ray.
I'm ready to spend money, and I'm ready to go walk through what I need
to do.
To justify it in my life.
Right.
Right.
So we're having to justify that.
And based and I was just trying to just get that for every you know, based on what the setting is, you still have to justify that with your with your medical direction and have that approval process.
The problem gets into while you may have had that you wanna do the training and have that included, you may get resistance on including that as part of, in initial the care you can provide.
So the first thing to do though is, before you're adding it into it is making sure you can find or get the get the equipment, get you know, you have approval for it or at least have access to it.
You can get it.
It's reasonable.
And then get that training.
You have to get yourself trained because you have to understand what you're doing with that, and that's why you may go to a local EMS unit or go to one of the education a local education programs, or the simple thing is advocating for it at one of your, continuing education course that they have that type of training, and then being able to put that in and working with your medical direction to put it in as a protocol and then practicing it and move through it.
So I hope that answered the question.
I knew we have it or not have it.
It it could be it's that becomes fairly it can be difficult at times, but, at the base level, you need to make sure you're having the necessary equipment to do the things you need to do.
So I go meet with my medical director, and I get my act together.
I get some information.
I get examples.
So, I go to my medical director.
It takes me a little bit of convincing, and he says, okay.
Yeah.
Let's add it to our scope of practice.
That makes sense.
So I got that done, checked.
I've I've got the training done, checked like I went.
It's not that complicated to get and do, to feel confident with it.
Now what?
Now what's the next step?
The next thing would be if you've gotten the training, you have to have make sure the protocol is current with that.
It goes through you have a review process.
And then once you have the equipment and you have a protocol, you need to practice that in a scenario situation.
You have if you if you've already have base competence in that of how to not just doing CPR, but putting it into the actual full blown scenario.
Like, you have a 16 year old.
You're on the field.
You have everybody works through that scenario to make sure it's a functional, you have a functional protocol guideline.
It's gonna it's going you're going it's going to the the protocol is going to be successful if you perform it with the training and making sure there aren't any hiccups along the way that, come into normal delivery of care.
That's the first thing with that, and you then you documented it, and then you put it into practice.
And if it has to be revised, it and then it becomes a revision process, down the line with continual doc doc documenting.
Well, I see that pattern playing out a lot because if you hang out in emergency medicine, if you even just pay any attention, there are so many things out there in emergency medicine that athletic trainers should be doing, because the standard of care has changed dramatically in the last 10 years, and a lot of athletic trainers don't even know it.
There was a day
and time where AEDs were like, okay.
I believe in it, but I don't have one, and now it's commonplace.
Right?
It's like it's like I can't even imagine going to an event without having it in my scope of practice.
Well, there's at least 20 of those mere kind of important elements of emergency medicine, like an AED, that athletic trainers as they learn, have to start this process in getting that medical approval, getting a protocol, getting the training, getting the functional practice in, and doing it, a So there's a lot of things like that that they have to go through.
So what's my my final question, and and, please, anybody else jump in.
Is it possible that I perceive that a protocol, equipment training, I have it in place now, Is it reasonable that something in emergency medicine will be applicable for one event but not applicable for another event?
Would there ever be a case where I don't have to take out my my my rectal thermometer and my tub if I'm going to a certain event?
Like, is there a place where protocols aren't really relevant for event?
Well, I I think the I'll I'll I'll make the I think I know what you're saying.
I think the one is they're always they're always relevant, the protocol, and that's relevant.
It's just what what it is.
So more than likely, you know, is you have to assume what the reasonable likelihood of that and, again, it goes back to the research side of it of something actually occurring.
You can justify you need to have justifiable reason why not to do this.
So, it is do you need a cold tub for volleyball?
Volleyball.
Yeah.
Do you need it?
No.
But and I say but, is there a likelihood that you need to have that you need to have the plan b, which would be you still you may wanna think about it.
But if it's in August, if it's still hot in the gym, etcetera, it could there is a likelihood it still could occur.
Very slim, but they're still moving through a number of days or compete ultra competition or practice.
You know, you may have okay.
I have a tarp, and you have a cooler.
That's that's the next best thing.
You know, that's that's one thing to think about.
There are and even, like, for I I use that, for example, for race.
Like, we do it, you know, in, you know, I I do a lot of, we we cover a lot of endurance events.
And we know that, historically, there is not a lot of, once you get into colder temperatures, the likelihood of an exertional heat stroke is very slim, especially if you're in the but it could still happen.
So you still have to be prepared for it, but, you know, is it gonna happen?
Probably, likelihood is very slim to none.
So you have to weigh that.
But, again, it goes back to what injury epidemiology has that if you justify that, you can that's where you really wanna look at and have some good evidence to show why I did not have it there to begin with or somebody else has it.
So I'm an EMT you are too.
If we went to work for, an ambulance agency every single day when you show up, you have the same equipment with the same truck, doing the same scope of practice.
It is set.
You do not go outside of that.
In athletic training, I call it a sliding scope of practice, and that's what I was getting to is like, yes.
It's there, but you don't take everything with you all the time.
Just like on JV freshman football on a weekend when it's just me and myself, you know, I take, just the face mask off to manage the airway.
Whereas on Friday night, the just 2 days later, my scope changed because now I have additional staff and I have local EMS there, and we take all the equipment on.
So, like, EMS doesn't have to have a sliding scale scope of practice depending on the event or the setting.
They show up every day, same equipment, same protocol, whereas in athletic training, you're constantly sliding your scope of practice based on the event that you have.
I would tell you just to be consistent.
I think it's better just to find that you have to find that window of consistency.
I think that's where trying not to slide as much, but know you have that for everything and moving.
And maybe 1 or 2 pieces you may not move, you know, but most part, try to be as consistent as possible.
Yeah.
Will I got Will who raised his hand.
Will, good morning.
Good morning.
How are y'all?
Hey, Will.
Doing great.
So we talk about training and kinda that sliding rule that, doctor Harper's talking about whether f you're on the athletic training scope or you're on the EMT scope.
So besides the, you know, rectal thermometers, the AEDs, Where where does that line stand to where a traditional athletic trainer needs documented training on a specific piece of equipment?
Obviously, the more evasive you gotta have it, but, like like, glucose monitoring, some something simple like that.
Is that something that needs to be documented that you had training on, or is it because it's sold over this counter, we're good to go?
You know, that's a that's a great that's really a great question because, you know, I had a I had this question not too long ago about, well, how off how often do we need the blood pressure training?
Well, if you've used it, you know the equipment.
The the question gets into, are you using the same equipment, or is it something different?
We if you know how to use it, you can go through that.
I think some things are very rote skills.
The the harder the harder thing work gets into us in getting into this, scenario, you know, scenario based training is that are you able to do that during a situation and you're doing it timely, or giving it to someone to do it or making that decision to use it?
That's, that's probably the where you really want to lean in because what you what you do is you end up finding that you may not do it correctly in the field.
And that's really where you wanna correct based on, you know, like, for example, you know, that's glucose might doesn't work.
The battery's dead.
Whatever it does, how are you going to respond to that or do that as a situation?
I think those are that's something it gets into.
It has to be decided as a as a organization is how often you're going to reassess that.
I think if you've had that training in certain things, it's fine.
It's you know, I think it goes back.
Whatever it is, just have it in your operations manual and say, hey.
This is what we've done this training.
You've shown this.
We shouldn't have to do that again, but go for you know, you you just you have to determine the frequency.
There's no set standard for that.
But if anything, the AP and these scenarios should be reviewed at least once a year as a as a global, process.
So my answer is to summarize that is your medical direction sets the tone.
You can influence that medical direction, but whatever it is, be consistent.
So if you train on an AD twice a year, train on glucometer twice a year.
If you do spinal motion restriction once a year, right, just just do it once a year if that's what you need, or every other year, whatever the training formula that you do, and then just document that.
And some, like spinal, requires more training than a glucometer.
So you might do that, and document and update on that.
But medical direction, influence that medical direction, and then set your own tone.
Just be
Are Your Emergency Care Protocols/Guidelines Aligned With Your Equipment and Training/Qualifications?
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