August 12, 2024 • 26 mins
Welcome to JAT Chat, presented by the Journal of Athletic Training, the official journal of the National Athletic Trainers Association. In this episode, Dr. Kara Radzak from the University of Nevada, Las Vegas, hosts Dr. Samantha Scarneo-Miller, the lead author of the National Athletic Trainer Association's position statement on Emergency Action Plan Development and Implementation in Sport.
Resources:
EAP Position Statement: https://tinyurl.com/y8vm83m6
Position Statement Toolkit: https://tinyurl.com/4ah2c72s
Guest Biography:
Dr. Scarneo-Miller, an assistant professor at West Virginia University, discusses the impetus behind updating the EAP position statement after 22 years and highlights the significant changes and recommendations included in the new document. The conversation delves into the roles of various stakeholders, the importance of venue and sport-specific plans, and the introduction of the EAP coordinator role and pre-event medical meetings.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Music.
(00:14):
Welcome to JAT Chat, presented by the Journal of Athletic Training,
the official journal of the National Athletic Trainers Association.
I'm Dr. Kara Radzak, an associate professor at the University of Nevada,
Las Vegas, and your host for today's JAT Chat.
It is my distinguished pleasure to be joined by Dr.
Samantha Scarnio-Miller, the lead author on the National Athletic Trainer Association's
(00:36):
position statement, Statement Emergency Action Plan Development and Implementation
in Sport, which has been recently published in the Journal of Athletic Training.
Dr. Samantha Scarnio-Miller serves as an assistant professor and the program
director for the Masters of Science in Athletic Training in the Division of
Athletic Training at the School of Medicine at West Virginia University.
(00:57):
Dr. Scarnio-Miller received her bachelor's degree from the University of New
Hampshire and her graduate degrees from the University of Connecticut.
At this point in time, I would like to thank Sam for talking with me today.
Welcome to Chat Chat. Thank you so much. I'm so excited.
Well, we're excited to have you on because this is an amazing undertaking that you guys went under.
(01:22):
And the first thing I want you to kind of touch on is what led to the decision
of, all right, now's the time to update this EAP position statement,
how did that all come to fruition?
It is 22 years in the making for this document to come out.
So the original position statement was published in 2002.
(01:45):
And really all of the kudos goes to the pronouncements committee with the NITA
and NITA foundation kind of health under both organizations.
So pronouncements committee has made an attempt to really objectify when we're
reviewing position statements to look for updates.
And so, you know, through their new processes and through an old process of
(02:09):
somebody kind of saying, hey, we really need to be doing this,
the NATA and specifically pronouncements committee decided like,
yes, okay, let's look into it.
And there's been quite a lot of changes made in the literature,
I guess, over the last 22 years.
We've had a lot of advancements in knowing the effectiveness of an emergency
(02:31):
action plan in terms of patient outcomes and in terms of efficiency and implementation.
So you kind of put these three things together, somebody reaching out saying,
we've got to do this. It's been too long.
Pronouncements committee, you know, really changing these awesome procedures
so that it's more streamlined for when we review and when we update these position statements.
(02:55):
And then a considerable amount of research coming forward that's advancing emergency action plans.
And that's how we got to be able to start on this journey. It's a labor of love.
You guys put a lot of work into this. Tell us a little bit more about who's
on the author group, kind of what areas you guys strategically tackled to make
(03:19):
sure voices were heard at the table.
This is, again, I'm just going to keep shouting out you and pronouncements committee and Dr.
Susan Yerrigan and Jen McKeon was on the pronouncements committee when we first
started. So she was a great liaison for me.
Like all of you guys are just brilliant individuals to get us to this point
with these new methods for position statements.
And so the authorship group was developed with consideration of just researchers
(03:46):
and clinicians, but also in diversity as far as gender goes,
year and career, interdisciplinary.
Race and ethnicity was also taken into consideration.
So our authorship group was phenomenal.
There was eight of us, myself as one of our researchers. We also had Dr.
(04:06):
Yuri Hasekawa out of Japan.
She's at Waseda University, a researcher, did a lot with the IOC in the 2020 Olympics.
Dr. John Dresner out of Washington. He is a world-renowned researcher with regards
to sudden cardiac arrest and emergency action plans. Dr.
Rebecca Hirshhorn is down at LSU. She's also an EMT, so she brought this researcher
(04:29):
EMT background that was invaluable.
And then, in my opinion, our clinician group was phenomenal and really the reason
that this document is going to be successful.
And that included Mike Hopper, a high school athletic trainer from Texas.
Daryl Conway, athletic trainer up at Michigan, Ed Strap, who is a flight paramedic,
athletic trainer, state trooper, and a lot of other things.
(04:53):
And then we also had Dr.
Greg Elkins, who was a secondary school team physician down in Southern West Virginia.
And I just want to say how awesome Dr. Elkins was because unfortunately he passed
away a few weeks ago And we miss him so much.
But his contributions were amazing for this entire document because he really
(05:15):
brought that rural lack of resources perception to the document that I think
we really needed to make sure that what we were doing was scientifically sound
and also feasible as far as clinicians go.
So amazing group, loved all of them, got to teach the clinicians how to do research.
The clinicians taught us how to write some things that made more sense in their
(05:36):
brains. So we just had so much fun with it.
So basically, you're telling me this isn't a document just for your D1 schools.
This is for everyone, yeah?
This should be for everyone. We tried to do it so that anybody in the sports
setting should be able to implement this.
From our professional, you have every resource given to you,
(05:56):
down to your youth leagues that have very little resources.
Like everybody should be able to take all 25 of these recommendations and at
least make some considerations for changes of their clinical practice.
Awesome. Let's dive into those recommendations. So what are some of the key
updates or changes that might be new when people are looking at this statement? Sure.
(06:19):
So it's an interesting question because I feel like all eight of us of the co-authors,
we would all say different things.
And I think that's really interesting because we all just had different perceptions
and thoughts and considerations that we really focused on within the document.
(06:41):
So for me, my big takeaway is that I think are different from from the 2002
to 2024 documents are venue and sport specific.
So we know that your women's soccer team is going to have different resources
than your women's lacrosse team.
And they're going to have different personnel, right? Your women's soccer coach
might be a paramedic during the day, excuse me, and then we'll be out on the soccer field with them.
(07:08):
Whereas your lacrosse coach might be a finance person.
So having a healthcare person versus somebody who's not changes the roles and
responsibilities of that position.
So by making it sports specific, we can kind of acknowledge that and make those changes.
Another one that I think is really important here is the EAP coordinator role.
(07:29):
Athletic trainers are awesome. We want to do everything. We can do everything,
but we don't have to do everything.
And so using this EAP coordinator role, we can really say an athletic trainer
should be the person who is initiating this and doing kind of the logistical
planning of it, if you will.
And we should be having all of these other stakeholders included in it,
(07:51):
our athletic directors, our coaches.
We should have patients, facilities personnel, team personnel.
Maybe you have equipment staff.
You have your local responders, which is fire, EMS, and police.
All of these other stakeholders should really be included in the emergency action
plan and should be considered for the overall response and everything. thing.
(08:13):
And I think my last big kind of change from 02 to 24 is this introduction of
the pre-event medical meeting,
which has been talked about in several other papers, but has never really been
put in as a formal recommendation in a position statement like this.
So really emphasizing that things change so much in sport.
(08:36):
And we acknowledge that and appreciate that.
And by having these pre-event medical meetings. We can get everybody together
before this competition or this event takes place and run through the EAP and
see what changes we have to make on the fly. So lots of changes.
Everybody will have different thoughts on what those changes are and what's important to them.
(08:59):
And I guess those are my three big ones right now.
So you're talking about what some people call a medical timeout?
Yes. So previously called a medical timeout, the word medical timeout was changed
first by the NFL, I believe in 2014, because there is an actual medical timeout now, right?
(09:20):
So if somebody gets hurt on the field and they blow the whistle,
it's for a medical timeout, not a game or play timeout.
So therefore we suggest changing that terminology to be called a pre-event medical
meeting so that it can say exactly in the name what it is, when it happens, and what we're doing.
And I want to circle back to this EAP coordinator.
(09:42):
Tell us more about this person's role. This person has a huge role because they
are really the facilitator of the entire document.
So they're going to be the ones who write up the initial document and identify
all of the different personnel who might be involved.
(10:04):
Calling it a risk analysis, if you will. So they are going to identify within
my organization or my institution or my team or my sport, what is the most important
factors that might play into somebody getting critically injured.
And so they're going to do this risk analysis. They're going to write the emergency
action plan, identify these roles, identify the responsibilities.
(10:27):
But then they also have to take that the next step further and bring it to those
anticipated roles and responsibilities and see, you know, does this person understand what I wrote?
Because the chances of the emergency action plan being implemented when an athletic
trainer is not there is very high, especially in our secondary school setting
(10:47):
and youth setting, because we're not going to be able to be everywhere at every time.
So making sure that all of our stakeholders, including our coaches,
know what to do in the event of an emergency is important, but also making sure
that it's written in a way that they know what to do.
So, you know, my brain, just like I talked about our researchers and our clinicians
on the document, my brain works very differently than Mike Hopper's brain.
(11:11):
And it's not to say one is better than the other.
It's just we think differently. So Mike might read a sentence that I write and
he might interpret it this way, whereas I interpreted it that way.
So that way, you know, the EAP coordinator can say, okay, let me change this
because I want you to know how to use this because I know what I'm going to
(11:31):
do. So I need you to know what to do too.
And I'll rewrite that for you. So
you're naturally starting to talk about differences and you write it up.
And then, I mean, we could have just ended there, right?
Let's talk about those implementation key aspects, because I think this is an
area that you guys really delineated the steps to implementing well.
(11:54):
Yeah, so some of our previous work from 2019,
2020, and 2021 showed that athletic trainers might be really good at writing
an emergency action plan generally, but overall, it appears that we really struggle
with putting in all of the components that are necessary for implementation.
So writing out our rehearsal strategy, writing out our distribution strategy,
(12:18):
writing out our review strategy.
So we wanted to make an effort in this 2024 position statement to really highlight that.
You can write an emergency action plan. You should write an emergency action plan.
And that one pager that we all kind of think of is the emergency action plan
is really your response.
(12:39):
That's your response page.
But we need to have all the rest of this written into the emergency action plan
as far as implementation.
Distributed once a year, reviewed, rehearsed, document that rehearsal, making it available.
So really changing some of that wording from 2002 from posted to say available
(12:59):
so that we can acknowledge and appreciate the digital world that we're in right
now. Now, you know, all of us have our phones on us at all times.
So having it available on your phone would be making it available.
And we wanted to really think through all of the components of implementation
that we thought was important so that athletic trainers and other personnel,
such as athletic directors.
(13:21):
Administrators can really understand that this stuff has to be written into
your emergency action plan too.
It is maybe a separate section of your emergency action plan,
but it has to be written into there.
And we wanted to make it as easy as possible for people to go through and say,
okay, I wrote that, I wrote that, I wrote that, I wrote that.
And the goal of all of this is because that's the proactive planning part, right?
(13:46):
That way you've proactively planned for all of these things to happen and you've
written it all down and said that you've planned for this to happen so that
you can hopefully make your response a little bit more streamlined and a smaller response time.
Now, you guys did a great job, you and Dr.
Susan Yergin, at the NATA's annual meeting when you presented this out,
(14:11):
and you kind of discussed at that meeting some key aspects of when you're going
through and you're doing the rehearsal.
You gave tips and tricks of how to implement this recommendation recommendation
that it's rehearsed annually by interdisciplinary care team.
(14:31):
I know some people might have already heard it, but it was such good advice, those tips and tricks.
Can you give us some of those of how would you or how do you recommend people
consider implementing this?
So rehearsal is a really interesting strategy because everybody might do it differently.
The way that I found worked best for me in my clinical practice is I would get
(14:56):
all of our coaches together before each season with our fall one being kind
of like our most attended one.
And I would have all of our coaches come down to the gym or go out to the soccer
field or even just the parking lot.
And I would say, okay, an athlete has collapsed right here based on your role
within the emergency action plan. Let's run through this.
(15:18):
So somebody would, you know, pretend to call 9-1-1. Somebody would go to their station to direct EMS.
Somebody would go and get the emergency equipment for me. I would provide care
and we would just run through scenarios like this.
I've also had athletes fake a catastrophic injury at practice so that the coaches
would like, we'd have to see how the coaches would respond as a rehearsal strategy.
(15:42):
We've, we've done this several different ways. And I think a lot of people will find different ways.
One of the things that our authorship group did to try to make this a little
bit easier is we actually developed resources for people to be able to go and look at,
all right, here's a sample rehearsal strategy for when an athletic trainer is
present on scene and implementing your emergency action plan
(16:04):
and activating your emergency action plan.
And so we wrote it all up for people so that you can just go in and take it
and say, all right, let me go run through this rehearsal strategy today and see how it works.
So we tried everything we could to make it a little bit easy for people to,
especially with this rehearsal part, start practicing this because practice makes perfect.
(16:24):
So you're saying there's a toolkit. Where can people access that? that.
If you search Samantha Scarnia Miller WVU, you should see my faculty page pop
up and then go to the patient care section.
And we have it all kind of nested in there. And we are working on getting it
on several other websites.
For example, the Corey Stringer Institute website will house this eventually.
(16:46):
And of course, as soon as we were ready to do it, they had to launch a massive
overhaul of their website.
So everything is just a little bit slower. And right now you can find it on
my faculty page and we'll have other places soon.
Awesome. Thank you for that. And thank you guys for taking that additional,
not required of you step to make this so readily available and usable to the clinicians.
(17:09):
So what are some ways that you would recommend as we're going into the new academic
year, clinicians take this document and start kind of attacking it?
So I think the first thing that you should do is when you go to that resource
page that we just talked about, you're going to see this checklist that we developed.
So we took the recommendations and kind of made them checklist checklisty words,
(17:35):
for lack of a better term.
And that way you can go through, pull up your emergency action plan.
Now pull up the checklist, go through and say, do I have this physically written
in the document that's on my screen?
Right. So if it's physically written, go ahead and give yourself that check
mark and a pat on the back.
And if it's not written, then put a little X there and put some notes about
(17:58):
how you think this might look.
Once you're done with that, then you can go through and you can start to add
all of these different components.
If you have not done a risk analysis in the last year or two,
then I think it's really important to do that risk analysis.
Again, an example is provided on the website. site.
That risk analysis will help you identify if you are hitting everything that
(18:21):
you should be hitting and any other considerations that you might not have thought of.
Use that checklist, do a risk analysis if you haven't done it,
and then just start going. Start writing it, start rewriting it.
If you wanted to scrap your whole thing and write a whole new one,
we have a template emergency action plan up there too for you.
I also really encourage you to reach out to other people, see what they have written.
(18:44):
I think it's so much easier to reach out to our friends and use our resources
around us instead of reinventing the wheel on this.
And that can be really helpful so that we're not feeling so overwhelmed with
it all. So I think that's where I would probably suggest people start.
And another thing people might be looking at is their policies and procedures
manuals. And so how does an EAP, how do you see it integrating into the overall administrative tasks?
(19:09):
We hear so many times people asking us about their heat EAP or their lightning
EAP, and that is incorrect terminology.
An emergency action plan is written to address any type of catastrophic injury.
So whether it's the top cause of death, which is cardiac arrest,
or a cause that might not happen all the time, but it's still prevalent,
like a traumatic injury or a lightning strike, this emergency action plan is
(19:33):
written so that you can respond to anything.
So your overall response is going to be the same no matter what the catastrophic injury is.
Whereas condition-specific policies and procedures like your heat policy,
your lightning policy, your asthma policy, these documents are actually going
to be more condition-specific with the prevention, recognition, and management of it.
(19:53):
So your heat policy, for example, is going to talk more about how you're going
to assess your patient and manage your patient.
You know, what type of cooling modalities are you going to use?
So your lightning policy will talk more about how you were looking at the sky
and when you're making the decision to evacuate the field.
Those types of condition-specific policies go into your policy and procedure manual.
(20:16):
And your emergency action plan is actually a policy.
So it should be in your policy and procedure manual as well.
So policy and procedure manual has your emergency action plan and your conditions,
policies and procedures.
And they're not the same thing. Your emergency action plan is not condition specific.
And your policies on how you're practicing your emergency action plan.
(20:37):
Yeah. And reviewing too.
Yes, yes, yes. So all of that can go into your emergency action plan.
Like it can be called your emergency action plan policy for all we care,
whatever you want to call it to make it clear, more clear for yourself,
as long as you don't call it an emergency action plan for heat or lightning or condition specific,
you know, because it's not so, you know, maybe it's your emergency action plan
(20:59):
with all of these implementation strategies followed by appendices for your
venue and sport specific. That's awesome.
Lots of options on how you do it here. Just acknowledging and appreciating the
difference between the two of them.
Awesome. So what, again, were some of either your biggest takeaways or maybe
(21:20):
some things that as you were talking with the clinician authors while undergoing
this process of developing the new emergency action plan position statement?
So I think the clinical take-home points for me and for our group was making
sure that these recommendations were implementable and that when we wrote these
(21:45):
recommendations that clinicians could look at it and say, yes,
I'm doing this, no, I'm not doing that.
And the ones that I found really interesting conversations with our entire group
were the orientation at a new organization or event. So athletic trainers,
we've been working a lot more per diem lately.
How does this look? So once we get to a field or a venue, we really should be
(22:09):
developing a very quick emergency action plan that helps us identify how we're
going to respond to an injury with the limited resources we have.
And that prompted a lot of great conversations of how to write that recommendation
in a way that made it a little bit more clear for clinicians.
The other one that we all loved was obviously the pre-event medical meeting,
(22:31):
changing the name, making it more understandable in the name itself,
and really emphasizing the importance of that.
And then the one that I loved was the new venue and sports specific emergency action plan.
I think, you know, we, we have so many different teams that we are providing
services to now as athletic trainers,
(22:52):
and we have an opportunity to really acknowledge and appreciate the vast amount
of teams and the vast amount of personnel within those teams and resources.
And so really making sure that we're emphasizing that this should change between
venue and sport was really a cool recommendation that I was excited about.
(23:12):
Awesome. Thank you again so much. And thank you to the whole author group for
this giant undertaking and going that extra step of providing the resources
so that people don't have to go it alone. particularly.
I just remember being a new athletic trainer, right? Fresh out and you come
to a new high school and you're the only person, right?
(23:35):
Trying to figure out how do you manage this.
So to all of those new grads out there, I think you've done them a lot of background
work ahead of time. So thank you.
Any parting thoughts that you want to share with us of this whole process?
Because this was, this is a big undertaking.
(23:56):
It was. I know sometimes people think position statements and they think,
oh my gosh, it's these researchers on their ivory tower kind of telling us what to do.
And I hope that all of the clinicians who are listening to this can appreciate
how much effort was put into this from the pronouncements committee and from
our group to make sure that these recommendations were easy for all of us to implement.
(24:20):
And I also hope that researchers who are listening to this can appreciate the
importance and helpfulness of having clinicians on our research team,
because if we want our research to be clinically applicable,
we have to have clinicians on our research team who can tell us if it makes sense or not.
Everybody overall, I hope you take this document and really take it to heart
(24:42):
and identify where you're doing really well.
I hope you give yourself your kudos for doing things really well.
I hope you identify some areas that you can improve.
And the ultimate goal of this entire project was to save more lives.
So I hope going into the later part of the summer that people really listen
to this podcast and read the document and implement all of these strategies
(25:06):
and then save some lives.
If people do save lives, shoot me an email. I'd love to know your story and
hear how it goes because I love hearing about all of the saves.
And I really hope everybody finds this to be an easy to use document.
And if anybody has any suggestions for more resources to put up,
we are all ears because we think we just started with the bare minimum and the
(25:29):
sky's the limit of what we can put out there for athletic trainers.
So thank you again to the NATA and the pronouncements committee for letting us do this.
Thank you to my awesome authorship group for sticking with me throughout this
and putting out a great document.
And I'm excited for everybody to go save lives with this.
Thank you. And Dr. Scarnia Miller, we really appreciate you taking the time today to talk with us.
(25:51):
And this position statement is available with no cost as of all of the Journal
of Athletic Training offering or open access on the Journal of Athletic Training's website.
And we'll be also Also up on the NATA pronouncements committee website through the NATA foundation.
Thank you again for chatting with me today. Thank you.
(26:16):
Music.
Music.
(00:14):
Welcome to JAT Chat, presented by the Journal of Athletic Training,
the official journal of the National Athletic Trainers Association.
I'm Dr. Kara Radzak, an associate professor at the University of Nevada,
Las Vegas, and your host for today's JAT Chat.
It is my distinguished pleasure to be joined by Dr.
Samantha Scarnio-Miller, the lead author on the National Athletic Trainer Association's
(00:36):
position statement, Statement Emergency Action Plan Development and Implementation
in Sport, which has been recently published in the Journal of Athletic Training.
Dr. Samantha Scarnio-Miller serves as an assistant professor and the program
director for the Masters of Science in Athletic Training in the Division of
Athletic Training at the School of Medicine at West Virginia University.
(00:57):
Dr. Scarnio-Miller received her bachelor's degree from the University of New
Hampshire and her graduate degrees from the University of Connecticut.
At this point in time, I would like to thank Sam for talking with me today.
Welcome to Chat Chat. Thank you so much. I'm so excited.
Well, we're excited to have you on because this is an amazing undertaking that you guys went under.
(01:22):
And the first thing I want you to kind of touch on is what led to the decision
of, all right, now's the time to update this EAP position statement,
how did that all come to fruition?
It is 22 years in the making for this document to come out.
So the original position statement was published in 2002.
(01:45):
And really all of the kudos goes to the pronouncements committee with the NITA
and NITA foundation kind of health under both organizations.
So pronouncements committee has made an attempt to really objectify when we're
reviewing position statements to look for updates.
And so, you know, through their new processes and through an old process of
(02:09):
somebody kind of saying, hey, we really need to be doing this,
the NATA and specifically pronouncements committee decided like,
yes, okay, let's look into it.
And there's been quite a lot of changes made in the literature,
I guess, over the last 22 years.
We've had a lot of advancements in knowing the effectiveness of an emergency
(02:31):
action plan in terms of patient outcomes and in terms of efficiency and implementation.
So you kind of put these three things together, somebody reaching out saying,
we've got to do this. It's been too long.
Pronouncements committee, you know, really changing these awesome procedures
so that it's more streamlined for when we review and when we update these position statements.
(02:55):
And then a considerable amount of research coming forward that's advancing emergency action plans.
And that's how we got to be able to start on this journey. It's a labor of love.
You guys put a lot of work into this. Tell us a little bit more about who's
on the author group, kind of what areas you guys strategically tackled to make
(03:19):
sure voices were heard at the table.
This is, again, I'm just going to keep shouting out you and pronouncements committee and Dr.
Susan Yerrigan and Jen McKeon was on the pronouncements committee when we first
started. So she was a great liaison for me.
Like all of you guys are just brilliant individuals to get us to this point
with these new methods for position statements.
And so the authorship group was developed with consideration of just researchers
(03:46):
and clinicians, but also in diversity as far as gender goes,
year and career, interdisciplinary.
Race and ethnicity was also taken into consideration.
So our authorship group was phenomenal.
There was eight of us, myself as one of our researchers. We also had Dr.
(04:06):
Yuri Hasekawa out of Japan.
She's at Waseda University, a researcher, did a lot with the IOC in the 2020 Olympics.
Dr. John Dresner out of Washington. He is a world-renowned researcher with regards
to sudden cardiac arrest and emergency action plans. Dr.
Rebecca Hirshhorn is down at LSU. She's also an EMT, so she brought this researcher
(04:29):
EMT background that was invaluable.
And then, in my opinion, our clinician group was phenomenal and really the reason
that this document is going to be successful.
And that included Mike Hopper, a high school athletic trainer from Texas.
Daryl Conway, athletic trainer up at Michigan, Ed Strap, who is a flight paramedic,
athletic trainer, state trooper, and a lot of other things.
(04:53):
And then we also had Dr.
Greg Elkins, who was a secondary school team physician down in Southern West Virginia.
And I just want to say how awesome Dr. Elkins was because unfortunately he passed
away a few weeks ago And we miss him so much.
But his contributions were amazing for this entire document because he really
(05:15):
brought that rural lack of resources perception to the document that I think
we really needed to make sure that what we were doing was scientifically sound
and also feasible as far as clinicians go.
So amazing group, loved all of them, got to teach the clinicians how to do research.
The clinicians taught us how to write some things that made more sense in their
(05:36):
brains. So we just had so much fun with it.
So basically, you're telling me this isn't a document just for your D1 schools.
This is for everyone, yeah?
This should be for everyone. We tried to do it so that anybody in the sports
setting should be able to implement this.
From our professional, you have every resource given to you,
(05:56):
down to your youth leagues that have very little resources.
Like everybody should be able to take all 25 of these recommendations and at
least make some considerations for changes of their clinical practice.
Awesome. Let's dive into those recommendations. So what are some of the key
updates or changes that might be new when people are looking at this statement? Sure.
(06:19):
So it's an interesting question because I feel like all eight of us of the co-authors,
we would all say different things.
And I think that's really interesting because we all just had different perceptions
and thoughts and considerations that we really focused on within the document.
(06:41):
So for me, my big takeaway is that I think are different from from the 2002
to 2024 documents are venue and sport specific.
So we know that your women's soccer team is going to have different resources
than your women's lacrosse team.
And they're going to have different personnel, right? Your women's soccer coach
might be a paramedic during the day, excuse me, and then we'll be out on the soccer field with them.
(07:08):
Whereas your lacrosse coach might be a finance person.
So having a healthcare person versus somebody who's not changes the roles and
responsibilities of that position.
So by making it sports specific, we can kind of acknowledge that and make those changes.
Another one that I think is really important here is the EAP coordinator role.
(07:29):
Athletic trainers are awesome. We want to do everything. We can do everything,
but we don't have to do everything.
And so using this EAP coordinator role, we can really say an athletic trainer
should be the person who is initiating this and doing kind of the logistical
planning of it, if you will.
And we should be having all of these other stakeholders included in it,
(07:51):
our athletic directors, our coaches.
We should have patients, facilities personnel, team personnel.
Maybe you have equipment staff.
You have your local responders, which is fire, EMS, and police.
All of these other stakeholders should really be included in the emergency action
plan and should be considered for the overall response and everything. thing.
(08:13):
And I think my last big kind of change from 02 to 24 is this introduction of
the pre-event medical meeting,
which has been talked about in several other papers, but has never really been
put in as a formal recommendation in a position statement like this.
So really emphasizing that things change so much in sport.
(08:36):
And we acknowledge that and appreciate that.
And by having these pre-event medical meetings. We can get everybody together
before this competition or this event takes place and run through the EAP and
see what changes we have to make on the fly. So lots of changes.
Everybody will have different thoughts on what those changes are and what's important to them.
(08:59):
And I guess those are my three big ones right now.
So you're talking about what some people call a medical timeout?
Yes. So previously called a medical timeout, the word medical timeout was changed
first by the NFL, I believe in 2014, because there is an actual medical timeout now, right?
(09:20):
So if somebody gets hurt on the field and they blow the whistle,
it's for a medical timeout, not a game or play timeout.
So therefore we suggest changing that terminology to be called a pre-event medical
meeting so that it can say exactly in the name what it is, when it happens, and what we're doing.
And I want to circle back to this EAP coordinator.
(09:42):
Tell us more about this person's role. This person has a huge role because they
are really the facilitator of the entire document.
So they're going to be the ones who write up the initial document and identify
all of the different personnel who might be involved.
(10:04):
Calling it a risk analysis, if you will. So they are going to identify within
my organization or my institution or my team or my sport, what is the most important
factors that might play into somebody getting critically injured.
And so they're going to do this risk analysis. They're going to write the emergency
action plan, identify these roles, identify the responsibilities.
(10:27):
But then they also have to take that the next step further and bring it to those
anticipated roles and responsibilities and see, you know, does this person understand what I wrote?
Because the chances of the emergency action plan being implemented when an athletic
trainer is not there is very high, especially in our secondary school setting
(10:47):
and youth setting, because we're not going to be able to be everywhere at every time.
So making sure that all of our stakeholders, including our coaches,
know what to do in the event of an emergency is important, but also making sure
that it's written in a way that they know what to do.
So, you know, my brain, just like I talked about our researchers and our clinicians
on the document, my brain works very differently than Mike Hopper's brain.
(11:11):
And it's not to say one is better than the other.
It's just we think differently. So Mike might read a sentence that I write and
he might interpret it this way, whereas I interpreted it that way.
So that way, you know, the EAP coordinator can say, okay, let me change this
because I want you to know how to use this because I know what I'm going to
(11:31):
do. So I need you to know what to do too.
And I'll rewrite that for you. So
you're naturally starting to talk about differences and you write it up.
And then, I mean, we could have just ended there, right?
Let's talk about those implementation key aspects, because I think this is an
area that you guys really delineated the steps to implementing well.
(11:54):
Yeah, so some of our previous work from 2019,
2020, and 2021 showed that athletic trainers might be really good at writing
an emergency action plan generally, but overall, it appears that we really struggle
with putting in all of the components that are necessary for implementation.
So writing out our rehearsal strategy, writing out our distribution strategy,
(12:18):
writing out our review strategy.
So we wanted to make an effort in this 2024 position statement to really highlight that.
You can write an emergency action plan. You should write an emergency action plan.
And that one pager that we all kind of think of is the emergency action plan
is really your response.
(12:39):
That's your response page.
But we need to have all the rest of this written into the emergency action plan
as far as implementation.
Distributed once a year, reviewed, rehearsed, document that rehearsal, making it available.
So really changing some of that wording from 2002 from posted to say available
(12:59):
so that we can acknowledge and appreciate the digital world that we're in right
now. Now, you know, all of us have our phones on us at all times.
So having it available on your phone would be making it available.
And we wanted to really think through all of the components of implementation
that we thought was important so that athletic trainers and other personnel,
such as athletic directors.
(13:21):
Administrators can really understand that this stuff has to be written into
your emergency action plan too.
It is maybe a separate section of your emergency action plan,
but it has to be written into there.
And we wanted to make it as easy as possible for people to go through and say,
okay, I wrote that, I wrote that, I wrote that, I wrote that.
And the goal of all of this is because that's the proactive planning part, right?
(13:46):
That way you've proactively planned for all of these things to happen and you've
written it all down and said that you've planned for this to happen so that
you can hopefully make your response a little bit more streamlined and a smaller response time.
Now, you guys did a great job, you and Dr.
Susan Yergin, at the NATA's annual meeting when you presented this out,
(14:11):
and you kind of discussed at that meeting some key aspects of when you're going
through and you're doing the rehearsal.
You gave tips and tricks of how to implement this recommendation recommendation
that it's rehearsed annually by interdisciplinary care team.
(14:31):
I know some people might have already heard it, but it was such good advice, those tips and tricks.
Can you give us some of those of how would you or how do you recommend people
consider implementing this?
So rehearsal is a really interesting strategy because everybody might do it differently.
The way that I found worked best for me in my clinical practice is I would get
(14:56):
all of our coaches together before each season with our fall one being kind
of like our most attended one.
And I would have all of our coaches come down to the gym or go out to the soccer
field or even just the parking lot.
And I would say, okay, an athlete has collapsed right here based on your role
within the emergency action plan. Let's run through this.
(15:18):
So somebody would, you know, pretend to call 9-1-1. Somebody would go to their station to direct EMS.
Somebody would go and get the emergency equipment for me. I would provide care
and we would just run through scenarios like this.
I've also had athletes fake a catastrophic injury at practice so that the coaches
would like, we'd have to see how the coaches would respond as a rehearsal strategy.
(15:42):
We've, we've done this several different ways. And I think a lot of people will find different ways.
One of the things that our authorship group did to try to make this a little
bit easier is we actually developed resources for people to be able to go and look at,
all right, here's a sample rehearsal strategy for when an athletic trainer is
present on scene and implementing your emergency action plan
(16:04):
and activating your emergency action plan.
And so we wrote it all up for people so that you can just go in and take it
and say, all right, let me go run through this rehearsal strategy today and see how it works.
So we tried everything we could to make it a little bit easy for people to,
especially with this rehearsal part, start practicing this because practice makes perfect.
(16:24):
So you're saying there's a toolkit. Where can people access that? that.
If you search Samantha Scarnia Miller WVU, you should see my faculty page pop
up and then go to the patient care section.
And we have it all kind of nested in there. And we are working on getting it
on several other websites.
For example, the Corey Stringer Institute website will house this eventually.
(16:46):
And of course, as soon as we were ready to do it, they had to launch a massive
overhaul of their website.
So everything is just a little bit slower. And right now you can find it on
my faculty page and we'll have other places soon.
Awesome. Thank you for that. And thank you guys for taking that additional,
not required of you step to make this so readily available and usable to the clinicians.
(17:09):
So what are some ways that you would recommend as we're going into the new academic
year, clinicians take this document and start kind of attacking it?
So I think the first thing that you should do is when you go to that resource
page that we just talked about, you're going to see this checklist that we developed.
So we took the recommendations and kind of made them checklist checklisty words,
(17:35):
for lack of a better term.
And that way you can go through, pull up your emergency action plan.
Now pull up the checklist, go through and say, do I have this physically written
in the document that's on my screen?
Right. So if it's physically written, go ahead and give yourself that check
mark and a pat on the back.
And if it's not written, then put a little X there and put some notes about
(17:58):
how you think this might look.
Once you're done with that, then you can go through and you can start to add
all of these different components.
If you have not done a risk analysis in the last year or two,
then I think it's really important to do that risk analysis.
Again, an example is provided on the website. site.
That risk analysis will help you identify if you are hitting everything that
(18:21):
you should be hitting and any other considerations that you might not have thought of.
Use that checklist, do a risk analysis if you haven't done it,
and then just start going. Start writing it, start rewriting it.
If you wanted to scrap your whole thing and write a whole new one,
we have a template emergency action plan up there too for you.
I also really encourage you to reach out to other people, see what they have written.
(18:44):
I think it's so much easier to reach out to our friends and use our resources
around us instead of reinventing the wheel on this.
And that can be really helpful so that we're not feeling so overwhelmed with
it all. So I think that's where I would probably suggest people start.
And another thing people might be looking at is their policies and procedures
manuals. And so how does an EAP, how do you see it integrating into the overall administrative tasks?
(19:09):
We hear so many times people asking us about their heat EAP or their lightning
EAP, and that is incorrect terminology.
An emergency action plan is written to address any type of catastrophic injury.
So whether it's the top cause of death, which is cardiac arrest,
or a cause that might not happen all the time, but it's still prevalent,
like a traumatic injury or a lightning strike, this emergency action plan is
(19:33):
written so that you can respond to anything.
So your overall response is going to be the same no matter what the catastrophic injury is.
Whereas condition-specific policies and procedures like your heat policy,
your lightning policy, your asthma policy, these documents are actually going
to be more condition-specific with the prevention, recognition, and management of it.
(19:53):
So your heat policy, for example, is going to talk more about how you're going
to assess your patient and manage your patient.
You know, what type of cooling modalities are you going to use?
So your lightning policy will talk more about how you were looking at the sky
and when you're making the decision to evacuate the field.
Those types of condition-specific policies go into your policy and procedure manual.
(20:16):
And your emergency action plan is actually a policy.
So it should be in your policy and procedure manual as well.
So policy and procedure manual has your emergency action plan and your conditions,
policies and procedures.
And they're not the same thing. Your emergency action plan is not condition specific.
And your policies on how you're practicing your emergency action plan.
(20:37):
Yeah. And reviewing too.
Yes, yes, yes. So all of that can go into your emergency action plan.
Like it can be called your emergency action plan policy for all we care,
whatever you want to call it to make it clear, more clear for yourself,
as long as you don't call it an emergency action plan for heat or lightning or condition specific,
you know, because it's not so, you know, maybe it's your emergency action plan
(20:59):
with all of these implementation strategies followed by appendices for your
venue and sport specific. That's awesome.
Lots of options on how you do it here. Just acknowledging and appreciating the
difference between the two of them.
Awesome. So what, again, were some of either your biggest takeaways or maybe
(21:20):
some things that as you were talking with the clinician authors while undergoing
this process of developing the new emergency action plan position statement?
So I think the clinical take-home points for me and for our group was making
sure that these recommendations were implementable and that when we wrote these
(21:45):
recommendations that clinicians could look at it and say, yes,
I'm doing this, no, I'm not doing that.
And the ones that I found really interesting conversations with our entire group
were the orientation at a new organization or event. So athletic trainers,
we've been working a lot more per diem lately.
How does this look? So once we get to a field or a venue, we really should be
(22:09):
developing a very quick emergency action plan that helps us identify how we're
going to respond to an injury with the limited resources we have.
And that prompted a lot of great conversations of how to write that recommendation
in a way that made it a little bit more clear for clinicians.
The other one that we all loved was obviously the pre-event medical meeting,
(22:31):
changing the name, making it more understandable in the name itself,
and really emphasizing the importance of that.
And then the one that I loved was the new venue and sports specific emergency action plan.
I think, you know, we, we have so many different teams that we are providing
services to now as athletic trainers,
(22:52):
and we have an opportunity to really acknowledge and appreciate the vast amount
of teams and the vast amount of personnel within those teams and resources.
And so really making sure that we're emphasizing that this should change between
venue and sport was really a cool recommendation that I was excited about.
(23:12):
Awesome. Thank you again so much. And thank you to the whole author group for
this giant undertaking and going that extra step of providing the resources
so that people don't have to go it alone. particularly.
I just remember being a new athletic trainer, right? Fresh out and you come
to a new high school and you're the only person, right?
(23:35):
Trying to figure out how do you manage this.
So to all of those new grads out there, I think you've done them a lot of background
work ahead of time. So thank you.
Any parting thoughts that you want to share with us of this whole process?
Because this was, this is a big undertaking.
(23:56):
It was. I know sometimes people think position statements and they think,
oh my gosh, it's these researchers on their ivory tower kind of telling us what to do.
And I hope that all of the clinicians who are listening to this can appreciate
how much effort was put into this from the pronouncements committee and from
our group to make sure that these recommendations were easy for all of us to implement.
(24:20):
And I also hope that researchers who are listening to this can appreciate the
importance and helpfulness of having clinicians on our research team,
because if we want our research to be clinically applicable,
we have to have clinicians on our research team who can tell us if it makes sense or not.
Everybody overall, I hope you take this document and really take it to heart
(24:42):
and identify where you're doing really well.
I hope you give yourself your kudos for doing things really well.
I hope you identify some areas that you can improve.
And the ultimate goal of this entire project was to save more lives.
So I hope going into the later part of the summer that people really listen
to this podcast and read the document and implement all of these strategies
(25:06):
and then save some lives.
If people do save lives, shoot me an email. I'd love to know your story and
hear how it goes because I love hearing about all of the saves.
And I really hope everybody finds this to be an easy to use document.
And if anybody has any suggestions for more resources to put up,
we are all ears because we think we just started with the bare minimum and the
(25:29):
sky's the limit of what we can put out there for athletic trainers.
So thank you again to the NATA and the pronouncements committee for letting us do this.
Thank you to my awesome authorship group for sticking with me throughout this
and putting out a great document.
And I'm excited for everybody to go save lives with this.
Thank you. And Dr. Scarnia Miller, we really appreciate you taking the time today to talk with us.
(25:51):
And this position statement is available with no cost as of all of the Journal
of Athletic Training offering or open access on the Journal of Athletic Training's website.
And we'll be also Also up on the NATA pronouncements committee website through the NATA foundation.
Thank you again for chatting with me today. Thank you.
(26:16):
Music.
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