Transcript
Ronnie Harper, who I get the opportunity to work with every day here at Action Medicine Consultants.
And this is a series that we started, last year, critical decision points, and this is not your typical, presentation.
We had it's interactive.
You get to make you get to make a decision and be a part of that decision in how, you're gonna handle this case, and doctor Harper's gonna guide you through that.
So with that moving forward, doctor Harper, I know this is gonna be a great case today on managing a baseball player with spine motion restriction and a arterial bleed brachial artery.
So I know you're gonna I think for the audience, you're gonna get your imagination going on this.
So, doctor Harper, I'm gonna give it over to you.
Alright.
Thank you, Ray, so much.
This is number 7.
Can't believe this is our 7th one that we have done a, scenario like this, and they're fun to do.
So, this is not a sit back and just watch.
This is get your phone out and participate.
And so, I am a cofounder of, my sports dietician, but also a co owner and cofounder here of of Action Medical Consultants.
And so we're gonna focus today mostly on patient assessment when regards to, seeing signs up and primary assessment.
And we'll focus on you have seen an athlete that has not only arterial bleeding, but he also has a potential spinal injury.
So hang on, and here we go.
So, this is our framework.
And so we do the the the pre check.
Right?
We call it medical time out.
We call it prevention.
It's getting ready for that event, and this event happens to be a baseball game.
So put yourself in context of you preparing yourself for a baseball game, which in most cases should not be, as risky as, say, high school Friday night football game or other sporting activities that are higher risk.
But then we go to the actual scene itself.
And so we have heard in the presentations today, and we constantly we hear in in emergency medicine, this idea of a scene size up that includes, BSI precautions, evaluating the mechanism of injury, dealing with life threats, such as severe bleeding, calling for additional resources.
So what you're gonna hear from me today is an emphasis not to blow by that so fast, which we have a tendency to do, when we actually are practicing, our athletic training services.
Then we'll get into the idea of, the primary assessment, which is ours, CABs, as well as our life threats.
This is a find and fix, mindset.
Find the most life threatening and start fixing them before you get excited about all the other stuff.
So this is our framework that we're working from.
And then in the middle of, number 2 and 3, since our primary assessment, This is the fixing interventions or the fixing component.
What have we found, and what are we doing to try to fix it?
So from prevention down through assessment of the scene and assessment of the patient, and then what do we do to try to solve or mitigate that at that point in time?
So here we go.
I said, this is number 7.
You know, when you go to athletic events early in my career, I remember being like, alright.
I got a baseball game tonight, basketball, whatever, football.
And I I just love the output at the arena.
I love preparing athletes.
It was just exciting.
And I really didn't go in thinking, what's the worst thing that can happen today?
And then as I got to the middle and end of my, career, I'm retired now from Dutchtown High School after 23 years in a high school setting and then, 10 years in the collegiate and, academic arena.
But I remember going to a point in time in my career where it got to be a lot different because I started actually encountering weird, crazy, intense things.
They didn't happen often, but when they did happen, the burden was on me.
Then I began to ask, what's the worst thing that could happen at this event today?
As simple as it seems this event is going to be, such as a freshman baseball game or a JV baseball game.
You know, some of those are just just so laid back, and they you know, you have to always have that mindset.
You have to always be prepared.
That's our job.
So in this case, we had a 17 year old male baseball player chasing on a foul pole, and, you know, he's looking back up.
And, some fences do have adequate padding, and even those who don't have who do have adequate padding, they still have exposure elements within the outfield area.
And I know if you have been in this a while, you have been out on the field with a baseball player who has hit something.
And so here we go.
What is our scene size up?
Like like, let's just focus on that first.
And so, when you go to the scene, when you see the scene and you watch the scene, this is what you're seeing as you approach that scene.
You saw the collision, and as you're heading out to the outfield, it is not good.
You see some significant bleeding, and you know that it was a hard impact.
A metal piece, from somewhere on the fencing slashed right into his brachial artery.
What is the worst thing that can happen today?
This is probably going down that path of the worst thing that can happen today.
So get your phones out, and, you can go to slido.com and enter that number, 157 6334.
I'm a give you a little bit of time to get this up and going.
But I I really I think we all would like to know this information.
How do I know I can answer this myself, but I'm gonna answer it right now.
But you can take your phone and do the QR code as well.
And let's see, you know, from the audience, like, how do we compare against others when it comes to baseball games and having a medical time out?
Is there any preparation done in the prevention component?
So we have 6 people participating.
Hopefully, everybody can because we're gonna do a lot of these.
So, and, hopefully, you see the response, and we'll talk about this response as we go through it.
So we got 9 people participating.
I know we got about 50 online, so you're missing out if you don't get a chance to, work through this.
So you'll leave your app open.
You'll leave your your website open, and, we'll continue to process through additional questions and be transparent and honest about this because I'm gonna fit into the category of most of my baseball games.
I know early in my career, the answer was no just like 70% of you are reporting.
And then as time went by, especially in in recent years, the answer was yes.
We did have the medical timeouts before baseball games because they were mandated.
Now what version of that and how did it occur, was was was different depending on, what time I got out there and who I was able to talk with from the opposing coaches to the umpires, to the head coach, to the administrator, to the resource officer.
And in a lot of cases, it wasn't as organized as a Friday night football game, but I did find myself checking off the boxes.
So very good.
Twelve people participating, and you can see that, we still have room to grow when it comes to that area.
Alright.
Let's move on.
So, let's do this one.
Let's rank the order you would propose that athletic trainer do first.
So here we go.
We're in their scene.
You saw the athlete that is supine kinda rocked over.
You see some severe bleeding.
You know you're gonna have to take spinal motion precautions because yeah.
Well, you know it's gonna have to happen, but let's start ranking here a little bit.
Like, what do you think you would do first?
We're in the same size up.
We're not in primary assessment.
We haven't necessarily touched the patient yet at all, but we're trying to process the same.
What do you think?
Call for additional resources?
Do we put on our personal protective gear as we're going out to the same?
Do we ensure there are no other objects that could hurt that person?
Right.
Very good.
We got 4 people, 6 people participating.
Alright.
Very good.
Yeah.
I've got a good group.
I think I think this brings about great discussion because this scene size up.
And the point I'm trying to get to is don't blow by.
Don't don't rush it.
On a scene like this, what do you do first?
And so, you know, what I have to respect here is that you can do a lot of these things simultaneously or within just split seconds.
So, do they all have is there a hard ranking order like in CABs and the same size up?
And so the answer is the same size up doesn't have necessarily a hard ranking order like we will find in the primary assessment.
And so all of these are actually correct in the form that you're gonna be doing them simultaneously.
Ask the question, which would you naturally maybe do first?
And I would tend to agree, yes.
When I saw something significant like that and I saw bleeding, it's like stop and get resources.
Now resources can be defined by a lot of things.
It could be, like, call 911.
It could be, that I need, my medical kits out here.
I need more adults out here with me, or all the above.
You're going to need more help and and you need to be prepared.
And, of course, you should have your PPEs close by, and, you will be taking spinal motion across as you as you expect the scene.
So once again, appreciate you participating.
So we've sort of moved out of the scene size size up, and now we're diving into the primary assessment.
We're actually going to now touch the patient.
Right?
During your primary assessment, what do you focus on first?
Like like, let's let's just type this in here.
This is not a rank.
This is not a poll.
It's not a QA.
Just start typing in.
What would you focus on first in this scene?
Let's see what we got.
All this is anonymous.
So tell us tell us what you think.
Let's let's get something on the board here.
Worst case scenario is happening in front of your eyes, and it was supposed to be a good day.
And now you find yourself with arterial bleeding and a potential, cervical spine fracture, at a game you might not have had a medical time now for.
Right.
You know, I'm hoping you're trying to put yourself in in your facility with your athlete and when you're out there.
And, you know, in the same size that we holler for resources.
And so, hopefully, those resources are on their way, very quickly, and, hopefully, you, you are going out on the field with some kind of personal protective equipment.
If not, you need to, like like, at least stop that.
And if you do nothing but a gloved hand until your resources get there, then definitely that's the first step until your resources get there.
Now I like, I like everything I'm seeing here.
I like, Yeah.
And, again, a lot of this happened simultaneously.
You can see, the, the the CAB is really circulation.
Circulation has 3 elements, to it.
The skin color and temperature, stop severe bleeding, and, check for a pulse.
But in this case, it is severe bleeding, and we will do everything we can to stop.
That's how they're going to dial on us the quickest.
Is get that bleeding under control and, would be anxious to see, that.
Now let's kinda rank these.
We kinda threw those around a little bit and, said there's a lot of things to do, but let's just say our resources have arrived.
Our kit has arrived.
Assistance has arrived, and you're now touching the patient, and now you're you're, taking a look at a multifaceted things that you're trying to do.
This is more than just pick the first one.
Let's figure out, is there an order?
And in this primary assessment, there really is there really is order or priorities, and those priorities have a reasoning.
So let's take a look here.
What do we work on and in what order?
Is there an order?
Those of you, and I forgot to mention, for those of you who are watching the recording, I apologize, but these QR codes won't work.
This is all live.
Be patient here.
Gotta take a little time to think this through.
Alright.
8 people responding here.
So when you think about the primary assessment, it does have an order, and, it starts with, it starts with, like, your CPR class.
Hey.
Hey.
Are you okay?
Establishing a mental status.
Where are they at?
I know you got severe bleeding, that you have to account for, but you're trying to establish some level of mental status.
Now once again, you now have help, so you can assign responsibilities, to these other tasks, which includes severe bleeding.
You can assign an administrator or coach to call 911.
I mean, this is happening at light speed.
You can have a student, not a student, but you can have another adult possibly hold c spine.
You'd prefer not to get wrapped up in the direct care of this as long as you can have competent other adults.
When I say wrapped up, I'm talking about, like, putting your hands on things.
Now holding your your, you know, the severe bleeding might require your skills, your equipment, your technique.
But as much as you can outsource and train other people to assist in some of these statuses, then you would definitely get to it.
And so first of all, we we understand CAB means circulation, and we do have to stop the bleeding.
And then we start working our way through, assessing their, breathing as we continuously focus on their cervical spine.
So very good.
Very good.
Thanks for participating.
So I'm I'm curious about this.
Just just curious.
How many of you have a turn to get in the and your kids were calling the baseball game?
Is it in there?
Well, of course, this is probably me just being curious because I'll be honest with you.
It wasn't early in my career.
No.
The answer was no.
Didn't even think about it.
And then as I started coming across some of these crazy you stay in this long enough, you'll have stories to tell for sure of of of events that happen.
They don't happen often, but, then pretty soon you're you enter those arenas and you go, what's the worst thing that could happen to me today?
The job doesn't get quite as much fun when you enter an arena thinking, I'm not prepared for this worst case scenario thing.
And, there's a lot to think about in emergency medicine, when it comes to your responsibility because if you wait and call 911 and So you have to be prepared.
So, yeah.
Okay.
Very good.
Thank you all for participating.
Interesting.
If if you don't have one, then let's think about getting one.
And, hopefully, this will this will motivate you to continuously to be prepared for the worst case scenario at any event that you're responsible for.
Alright.
What who else would you need trained or educated on how to handle this at your baseball venues?
Let's list them out.
Who else do we need to have prepared to help us in this worst case scenario?
Who else?
This is not a one man show by any means to manage that scene.
Yes.
Yes.
We're all on the same page with this.
Right?
I mean, there are people.
That's why we do the medical time out.
That's why we do the preseason training.
That's why we have these conversations.
You have to stay the course and constantly bring it forward, and be prepared for all of your venues, all of your sporting events that you're responsible for.
You know, our administrators, our coaches, our student ATs, our admin, our our umpires.
You know, nobody on this list interestingly put, the I see helpers, but nobody put parents on here.
And, yes, we could have a a an interesting conversation about who's going to come to your scene that might or might not contribute to the positive outcome, and you have to account for those.
And that's why you need your resource officer out there because there might be that person that comes flying out there that pushes you out of the way.
If you haven't had that happen to you, just hang on.
It will.
And, I am I am a nurse, here to save the day, and they start taking over or even, interestingly enough, in a position, will do it, and they they're not equipped and prepared.
And then you find yourself in a disagreement argument.
But you can see you have a lot of resources, but you gotta use them.
They gotta be prepared, for the worst case scenario, which includes severe bleeding, which includes no pulse, no breathing, spinal motion restrictions, and all the things that come.
Thank you for participating in that.
So we're almost finished.
Let's quick review.
Are you prepared before, events happen?
Medical timeouts, ramp it up.
Don't get lazy.
Continue to work.
Get your equipment ready.
Make sure you're well equipped.
Right?
Don't blow past the same size up.
It's a multi faceted aspect that happens in in light speed.
Don't just run to get to the patient, and start touching the patient without processing the same size up.
When you do get to the primary assessment, there is an order.
Severe bleeding, is the c part of that.
That's where you that's why they changed it from a, b, c to c, a, b, because you're gonna focus on circulation, and then you work your way out from there as we have all indicated that we would do.
This is a find it and fix it mentality.
What is life threats that I can find quickly, and how do I fix them?
Nothing else matters.
We're not gonna get into secondary assessment, doing vitals, and and head to toe assessments, and and, hand off reports as for another session.
But that's going to wrap us up in managing the worst case scenario at a baseball one of the worst case scenarios that you could possibly have and how to be prepared and how to manage that.
Thank you, doctor Harper.
To everyone, definitely, if you have a question, feel free to raise your hand.
We've got time for 1 or 2 questions before we move on to, our final presentation for the day.
And, you know, the first thing when, you and I talked about this before, but this scenario, it just you know, you vividly think about this is not a good situation.
You know, just think multiple things going on, and, you know, your fault your your if it's an outfielder, you're having to run to that person.
That's that's taking the time away from that situation.
You're recognizing there is severe bleeding.
And I think you hit the the main point is having the essential equipment with you when you're going out there.
You have to assume that's going to happen, like a fracture, things like that.
You know, that's not not a lot to carry a tourniquet, you know, in you know, if you have cargo pants or in a kit, little things that make a world of difference.
And then just how to prioritize that, very rapidly and how you're going to you know, especially if they're hung up other than could be that person could be hung up on the the fencing.
And that creates a whole another challenge in itself.
So Yes.
Absolutely.
Yeah.
It is, when you approach those arenas, what's the worst thing that could happen?
And am I ready?
And, don't don't get lazy, and, don't take anything for granted and be prepared.
Well, I think the one thing, you know, you you've been emphasized in this is you really have to be tuned into you know, you're not in this case, you're not trying to figure out, you know, what the diagnose you just know there's problem.
You're gonna treat the problem.
You have to, really escalate and under understand and escalate the the importance of the interventions you are applying is the first things first.
You and I talk about that, and we talk about this in, you know, in presentations and lab sessions all the time, is do the first things first.
And you see what the problem is.
You can get someone to, you know, use your resources available, have them call 911 or activate the EMS on-site, and then moving through treating and stabilizing and then moving down the line.
And I think that's probably the most and then trying to make you know, but you have to practice that as well.
This is not this is a very unique situation in itself, but being able to think about how you are going to handle something similar to that, what resources you have.
I think that was a great question of who else are you going to involve with this?
You know?
Could you involve athletes?
Yes.
I mean, some people may do it based on the situation.
May doing basic training, with them or coaches or administrators, etcetera.
So
Right.
We got a question from Abby.
And Yep.
Great question, Abby.
This is, I think about this a lot, and it starts with your medical director, Abby.
The conversation starts with your medical director and getting a plan, ready to educate everybody, and that starts with administrators.
Administrators have to understand that that that they're part of the solution of thinking of worst case scenario, and you have to go hand in hand with administrators, in order to make everybody pay attention to the education that you're trying to get in front of them.
So once you get your medical director aligned with your administrators, and then it trickles down to your coaches, now now you got a shot.
If you work your way up starting with starting by your little self, trying to get a coach to pay attention, administrator, resource officer, you're gonna run yourself crazy.
Like, you'll just be frustrated all the time.
So work your work your way top down, and it's a long process in some cases as to how you create that culture and mindset of being prepared.
That's what I think.
Yeah.
I I think that's a you know, Abby, you have a great question there.
I think we you know, and you've handled it.
You know, that's that was spot on, Ronnie.
I think the one to add to that is I know that here in Louisiana, I did some work with our State High School Association doing a larger study, you know, several years ago with them, look at probably, all the referees and coaches.
And one of the things that we found was there was this disconnect, between the the code the referees, the majority, thought that the administrators were in charge of the sit of this of the of the event, and the administrators thought that the referee was and thought the referee was in charge of the event, which is the importance of you have to have a clear communication channels.
The the host institution controls the overall venue, which means activating EMS and and along with that as well.
So you have to have those, you know, you have to have those just what you said, doctor Harper, you have to have that conversation, and you have to make sure that it's been you've had follow-up with that.
We got one more question, and then we'll have to wrap it up.
Thomas, and, welcome, Thomas, to the to our broadcast.
He's in the secondary settings in New York.
We are starting to bring teams into our training.
Have your teams having your train your I'm sorry.
Having your teams trained is essential, and I think that's an excellent point.
It doesn't take a lot to show stop the bleed and just doing CPR, like hands only CPR.
Those are 2 of the most critical things.
And that's an excellent point to, bring, that you've mentioned, Thomas.
I'd love to see that in practicality.
Yeah.
I'd like to see how that works.
Because But it would take
a lot, though.
I think just having a quick session with teams, you know, having 15 set 15 minutes.
You can do a lot of training in 15 minutes with just a coach, and they recognize bleeding.
And don't be afraid.
You know, tourniquets, people have this misconception that, oh, you're gonna cause damage.
Well, what's more damage than putting a tourniquet on or them person not surviving?
So and and their survivability works it's it's incredible results with that.
You know, you know, don't worry about the results with that, the long term ramifications if they are able to thank you the next day or 2 after that.
So Yeah.
Yeah.
Fine.
With that.
Alright.
So, doctor Harper, thank you again for joining us today.
And we'll wrap things up.
And then we gotta move into our last session.
And so have a great day.
And, again, this we'll we'll have this recorded and push this online, for later use.
So thanks again.
Alright.
Thank you.
Critical Decision Points 2.0: Interactive Case in Managing Uncontrolled Bleeding In A Baseball Player
General Course Information
Learning Material
Presentation (Video)
Updated Apr 23, 2024
1955 Cherokee Street
Baton Rouge, LA 70806
United States
Baton Rouge, LA 70806
United States
Copyright © 2024 Action Medicine Consultants, LLC
___MESSAGE___
___MESSAGE___