Episode 9 -
Sports Medicine
Sports Medicine
Released
August, 2023
Hosts
Scott Wildenheim
Ray Pace
Caleb Ferroni
Guest
Dr. Robert Flannery - UH Drusinsky Sports Medicine Institute
Links
UH Drusinsky Sports Medicine Institute
Episode Videos
Sports Medicine Part 1
Sports Medicine Part 2
Sports Medicine Part 3
Sports Medicine Live!
Episode Audio
Show Notes
What is Sports Medicine?
Primary Care Sport Medicine
Physicals
Concussion
Adult and Pediatrics
Medical issues related to sports
Heat Illness
Sports related psychological
Non-musculoskeletal issues
Surgical Sports Medicine
Musculoskeletal issues
Operative repair
Support
Rehabilitation
Athletic Trainers
Who does Sports Medicine service?
Professional Teams and organizations through local community youth athletes - everyone
Professional Event Planning
Professional planning scales down to local events
Professional planning - small hospital worth of assets
Emergency action plans developed and trained / re-evaluated yearly
If stakeholders can't get together to make sure the EAP is solid, then you are dealing with wrong people
Away team staff leans on home / local team planning and plans
Events of recent highlight the need / necessity / and outcome of EAP's and traning
Smart Heart Sports Coalition - Tenants - Access to AED, EAP, and CPR training
Professional event may have multiple Physicians (Medial / Ortho / Neuro / EM / Anethesia), EMS, Trainers and observers
Visiting doctors have treatment "rights" in locker room or sidelines - need local docs to get local assets
Local Event Planning
Must have communications with the athletic trainers before the event
Plan for hyperthermia - are tanks available
Availability of ice, water, and shade
Availably of rectal thermometer - continuous monitoring
Handoff procedure
Use of backboards - what is expectation
Hyperthermia
If core temp can be gotten down in first 30 mins, good outcomes near 100%
Approximately 0.5 degree per min in ice water
Put tub in shade
Stir ice and water
It is worth the time to cool on scene
Ad-hoc methods are worth the time for non-sports hyperthermia
Hospitals have poor ability to cool anyone
Stay in tub regardless of siezure, vomiting, etc.
Use sheet / blanket / towel under arms to keep patient over water line
Transport when temp <102 or return of mental status
Time in tube important - can estimate what was, or what should be
Benzodiazepines may be helpful if combative
FRST Program
Goals of the Program
Developed by Robert Flannery, MD and the University Hospitals Drusinsky Sports Medicine Institute, the FRST course has two primary goals:
To provide first responders with instruction and hands-on training in treatment protocols for unique emergencies during athletic events.
To enable a dialogue between EMS, medical staff and other first responders to formulate a unique emergency action plan for a venue before the start of each season.
Specific training modules include:
Optimal responses to traumatic injury in an athlete as opposed to the injuries, conditions and patients more typically seen by EMS
Various EMS sports response case studies and scenarios
Methods for communicating and collaborating with athletic trainers, team physicians and emergency department clinicians
Hands-on instruction and best practices for helmet and pad removal
Four hours of continuing education units and a two-year FRST certification, accredited through University Hospitals EMS Institute
AED in 3
If an athlete experiences sudden cardiac collapse, the goal from time of collapse to shock is 3 minutes or less. The goal of the AED in 3 challenge is to raise awareness about this importance of practicing and implementing at Emergency Action Plan.
PRE-GAME™ Approach
The FRST course teaches an innovative PRE-GAME approach to ensure that first responders are ready for any situation or emergency that might arise during an athletic event.
Prepare: Review the emergency action plan (EAP) for each venue prior to the rehearsal
Rehearse: Have every team member rehearse each aspect of the EAP
Evaluate: After the rehearsal, evaluate the EAP and make changes based on the most up-to-date recommendations or changes to the venue
Get the Picture
Access & Activate
Mobilize Plan
Evacuate
Sudden Cardiac Death
Get the Picture
May look like a seizure
Access & Activate
ABCs, Send for the AED
Mobilize Plan
Start CPR & defibrillate
Evacuate
Transport as soon as possible
Cammotio Cordis
Get the Picture
May look like a seizure, will take a couple of steps before falling
Access & Activate
ABCs, Send for the AED
Mobilize Plan
Start CPR & defibrillate
Evacuate
Transport as soon as possible
Heat Illness
Get the Picture
Noticeable confusion, lack of sweat
Access & Activate
ABCs, level of consciousness, Prep cold tub with ice water
Mobilize Plan
Wrap towel under arms to control body weight
Evacuate
Do not transport until core temp reaches 102°F or starts to shiver
Sickle Cell Trait
Get the Picture
ATC or family should know the history; No confusion, lack of sweating, soft muscles
Access & Activate
Send for or bring to closest oxygen, IV
Mobilize Plan
Administer oxygen, IVF, pain medication
Evacuate
Transport as soon as possible
Concussion
Get the Picture
Must give time to allow adrenaline to wear off, then look for worsening symptoms
Access & Activate
ABCs, Neuro checks
Mobilize Plan
Re-evaluate at 10 – 20 minutes to allow symptoms to emerge
Evacuate
Transport only if worsening mental status, vomiting, agitation, slurred speech or facial asymetry
Cervical Spine Injury
Get the Picture
Note any deformity or if head is turned any mechanical block to moving back to midline. Do not move
Access & Activate
ABCs, Send for immobilization resources and removal tools if needed
Mobilize Plan
C-spine stabilization if mechanical block, do not force to neutral position
Evacuate
Transport as soon as possible
FRST for coaches coming soon, will include other required coach for training so its a one stop course
The Protocols
Episode Shorts
From The Episode
Dr. Flannery discusses his entry into sports medicine
Dr. Flannery describes the ammenities at the new UH Druzinsky Sports Medicne Building at Ahuja Hospital
Scott learns to count with critique from Caleb
Ray and Scott discuss the intrastate Physician practice