26/12/2012 2013 Eastern Athletic Trainers Association POTENTIAL CONFLICT OF INTEREST DISCLOSURE Meeting and Clinical Symposium EMERGING TOPICS IN SPORTS EMERGENCY CARE “ I have no conflict of interest to declare” John Boulay B.Sc.,CAT(C), EMT-PCP, D.O.(Q) “ I have no affiliation, Certified Athletic Therapist, Paramedic, Osteopath First Responder, Emergency Medical Responder Instructor-Trainer honoraria or monetary Concordia University / Osteo-MedSport Clinic, Montréal, Canada support from an industry source”. Buffalo Niagara Convention Center, Buffalo, New York, USA Saturday , January 6 th , 2013 EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) EMERGING TOPICS EMERGING TOPICS 1. Principles & Preferences 10. TBI update: 4 th CIS Nov 2011, Pediatric updates 2. Standards update: CPR/AED ILCOR-ECC 2010 UCAB vs UABC 11. Spinal Skill Sets: PHTLS / ITLS and Sport adaptation 3. Standards update: PHTLS 2010 vs ITLS 2011 12. Emerg Skill Set Training: Feedback/knowledge of performance 4. EMS/911 calls , EAP/ERP 13. Sports Equipment Removal Issues: Regional differences 5. H.A.I.N.E.S: patient position 14. Mock-ups/Simulation 6. Manual Head Stabilization: Head hold vs Trap hold 15. Community Training: ER / EMS / Coaches 7. Airway Management: Rescue airway( King LTS-D vs Combitube) 16. Standards consensus 8. Medical Issues in Sport: Asthma, Diabetes, Anaphylaxis 17. Level of training: FR→ EMR+ 9. EHS/Hyperthermia: Rectal temperature 18. EMR+Future directions EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) Principles of Sport Emergency Care 1. Principles & Preferences Emergency interventions should be sport specific. “ Efficient care at time of patient contact Mock-ups and simulations may illustrate need for modifications in approach. depends on caregiver preferences based on Guidelines are “ideals” which provide direction for optimal situation,clinical condition,providers skills intervention. and training along with equipment available.” Protocols/guidelines and quality of care may vary nationally / internationally There is always more than one way to intervene. - PHTLS- Trauma First Response - 2012 Not all venues will have an EAP/ERP or trained responders EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) 1
26/12/2012 2. Standards Update: CPR/AED Principle “What is necessary for patient improvement or survival”. ILCOR-ECC Oct 2010 UCAB vs UABC Agency/ Regional variances in application Preference “How principle is achieved in time needed and by provider available”. Heart Association (AHA / HSF Canada) . UCABd U nresponsiveness EMS/911 C irculation A irway B reathing d efib “Factors include: situation, condition, fund of knowledge of provider, equipment available at the time of incident”. Red Cross ( ARC / CRC) UABCd U nresponsiveness EMS/911 A irway B reathing C irculation d efib EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) Unresponsiveness Glasgow>AVPU Certification validity: ARC 1yr CRC 3yr While determining Unresponsiveness AHA 2 yr …observe for effective breathing. Annual refresher recommended for CPR/AED Application of GLASGOW in sport -skills good for 6 - 10.5 months Ask: What happened? On-line CPR certification not valid for professionals Tell: Open your eyes! Ask: Where does it hurt? Conscious choking: Tell: Move your fingers! ARC/CRC: 5 back blows + abdominal thrusts Give: Painful Stimuli (triceps/nailbed) AHA/HSF: abdominal thrusts EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) FOOTBALL SCA SCENARIO CAB vs vs ABC Single-rescuer time to first compression Heart Assoc. U U nresponsiveness, visualize absence / effective breathing CAB C irculation asess pulse 5-10 sec, if absent compress 30:2 CPR UCABd UABCd A irway is opened B reathing (Look Listen Feel omitted if determined pulseless) Red Cross : U U nresponsiveness, call EMS/911 Arrive 10-15 sec Arrive 10-15 sec ABC A irway opened, Unresp / visual breaths 10 sec Unresp 10 sec B reathing Look/Listen/Feel, *give 2 breaths ERP 5 sec ERP 5 sec C irculation, assess pulse 5-10 sec CPR 30;2 Pulse check 10 sec Open airway under mask 5 sec Chest access 15 sec Look Listen Feel 10 sec Lifesaving: ABC: water rescues FIRST COMPRESSION 50-55 sec Face mask removal 30 sec CAB: dryland rescues (no pulse check) Open airway/pocket mask 10 sec Paramedics: CAB: initial eval unresponsive victims 2 breaths 5 sec ABC: continous eval of non-arrested * All times approximate in optimal Pulse check 10 sec unconscious victims conditions for illustration purposes Chest access 15 sec ABC: conscious/semi-consc. victims only.. FIRST COMPRESSION 110-115 sec * varies: region / agency EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) 2
26/12/2012 3.Standards Update: UCABd PHTLS 2010 vs. ITLS 2011 More appropriate in a sports medicine setting PHTLS - Pre-Hospital Trauma Life Support Team approach in HCP: simultaneous interventions General Impression/Glasgow Airway/C-Spine Breathing Circulation/Bleeding Disability,Expose /Environment… ITLS - International Trauma Life Support General Impression/AVPU Airway/C-Spine Breathing Pulses/Bleeding Rapid trauma Survey EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) Secondary Survey… Standards Consensus Pre-hospital consensus among groups, regions difficult as resources vary. Important to follow local guidelines and be aware of variances in other regions. When a visitor, use local approach, as long as it is “safe” and is “sports specific”. Need to know variations, what works and what doesn’t. EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) SPORTS INTERVENTION MODEL PREFERENCES Primary Survey Mechanism of injury usually witnessed Response time 10-15 seconds U Unresponsiveness (Glasgow vs AVPU) Mechanism known? EMS/911 EAP/ERP CAB Secondary Survey Head to toe / PMSC x 4 / Vital Signs D: D isability (head / spine) E: E pidermis F: F racture G: G eneral EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) 3
26/12/2012 4. EMS / 911, EAP / ERP Medical Priority Dispatch System EMS/911 call protocols still need improvement - E-911/ Smart phones -Have someone else call/speak to 911 -Person calling 911 should be on-site -Focus care on your patient -Give responses to questions via call person 911 Call Center - Typical Questions : 1. Address of emergency site 2. Your call back number EMS/911 Universal questions: 1. Victim’s problem? 2. Approximate age? 3. Is victim conscious? 4. Is victim breathing? EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) 6. Manual Head Stabilization: 5. H.A.I.N.E.S. Recovery Position Head Hold vs Trap Hold (High Arm In Endangered Spine) Field interventions require spinal skill management with respect to One rescuer technique for the type of sport. unconscious patient left alone and at risk of aspiration Provides some protection for c-spine, Head stabilization and support required may vary depending on best to use head hold if possible. playing surface and protective equipment worn. Not meant as a primary technique in sports setting (spinals, helmets) Initial contact always involves manual head/neck stabilization. Prevents passive regurgitation Replaces basic recovery position Left side preferred EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) 4
26/12/2012 7. Rescue Airways Head Hold Methods Supraglottic airway devices King LTS-D placement Combitube placement Head Squeeze Trap Squeeze Best hold to stabilize Best hold during Transfers and lifts. agitated spinal suspect. Better on unstable surfaces Best with helmets And sweaty heads such, net, tramp or foam pit. Ref: Clin. Jour. Sport Med -Mar 2011 EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) King LTS-D vs Combitube Both seal larynx between esophageal and oropharyngeal balloon Both can be used whenever an OPA would have been indicated King LTS-D has 1 pilot balloon, Combitube has 2 King LTS-D success rate: 98-100%? Really dependant on insertion technique Insertion technique very important -ensure tongue jaw lift is used King LTS-D: various sizes: eg: #3 Yellow 4-5ft, #4 Red 5-6ft, #5 Purple >6ft Combitube: not for children/adults <4 feet tall KING LTS- D IS “RESCUE” AIRWAY of choice for sport physicians in the field. USA: Now part of AT airway management strategies. King LTS-D also comes in children sizes CANADA: Training with certain AT groups over past 3 years, but not yet certified. Use dependant on local EMS guidelines. Contraindicated: intact gag, known esophageal disease, caustic ingestion EATA Conf 2013 - John Boulay CAT(C) 8. Medical ASTHMATIC ATHLETE Portable spirometry allows field monitoring of FEV, (SPIROMETRY: EMR Skill) EATA Conf 2013 - John Boulay CAT(C) EATA Conf 2013 - John Boulay CAT(C) 5
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