Sideline Life‑Savers: Essential Sports Emergency Equipment

Here is the transcript for the episode featuring Ryan Hart and Ray Castle discussing emergency care equipment and supplies in sports settings: Ryan Hart: Welcome back to the AT Pit Crew Podcast. I'm your host Ryan Hart. And today we're diving into a crucial topic, contemporary emergency care equipment and supplies in sports setting. Joining me today is Ray Castle, CEO of Action Medco and co-author of the July, 2024 journal of EMS paper best practices for emergency action planning and implementation in athletic settings. Ray, let me start by asking you, why were equipment and supplies such a key section in the best practices paper? Ray Castle: Hey Ryan, so you know when we looked at this paper and I've got to give credit out to Ron Corson who's a co-lead author on this paper. We had a fantastic group of authors. We took several years in working through this whole document and really making sure we got it right the first time. This is first big update that came in since the NATA positions paper. I think that was in 2002. And then also right about the same time this came out in the Journal of EMS, NATA had their position paper come out and had some similar components to it. From equipment standpoint, you need to have it's not more important, but it definitely has just a unique perspective in it. It really gears to where it's interlinked and some people may not think of that. So if you have a protocol, say for example, sudden cardiac arrest, you need to have the right equipment that's aligned with that protocol. But also you have to have the personnel and the training that go along with that. And then you have the emergency, venue specific emergency action plan and other things that stack along with it. So if you don't have equipment, it's hard to do whatever that is, knowing where to access it, where the training is, make sure people appropriately can utilize it, make sure it's up to date. This really sits as really one of the, you know, just kind of a really key element. And it's based on setting, based on the uniqueness of what the instance of injuries occur. You know, you're like, for example, if you were working an endurance event, you're probably not gonna need a, you know, equipment removal or spine board, but keep in mind, you have to the same, similar rescue equipment in terms of life support, so along those lines. Ryan Hart: Yeah, that's an awesome foundation for our listeners. So let's round lap one talking about minimum equipment every venue needs. So Ray, let's talk about the absolute essentials. At the most basic level, what's the equipment every athletic venue should have on hand? Ray Castle: Well, you have to think of it as an athletic venue, what type of venue it is. Is it a practice venue that to some degree versus a public venue, like for a stadium, for example, regardless, you're still going to have the same equipment, maybe the needs and where that's located. So one, we know we have to have an AED. You need to have a bleeding control kits. That's core component. Have to, know, communications. We'll talk about that separately, but that is a piece of equipment that or what that mode is going to be from a communication side. One thing we think of equipment needs is appropriate signage. You know, knowing where that equipment is, so it's very visible. And that gets more in the venue specific EAP. But we think about, you know, like I said, the AED, bleeding control, wound care, you need based on the level of training. You know, if you have a have providers there, you need airway access or airway management. So that'd be a B at a minimum would be a BVM, OPA, or a fair and dual airways, nasal fair and dual airways. And again, that fits like for athlete trainers, that's within their skill set and training. And it fits within what there as well. Have to have obviously, gauze wound care equipment. Think also of a patient litter. You can transport a mega mover, for example, you can move people. And that's really the, of the key components that you need, other than wound care and also fracture equipment that would be, or at least be able to do the initial stabilization component. And then you have other, then you get into medications as a whole. Another kind of, we'll talk about that. I'm sure, on the, later on, but we'd have to think about what the initial equipment is just to provide life-saving or critical care to stabilize the patient. The other side of that equipment is also, I didn't mention, is just the diagnostic equipment. And, you know, in all of our kits that we, our response kits we have for all of our events, they all look the same. They all have the same pockets. They have the same, and we check those. So we have to have, you know, blood pressure, stethoscope, with a stethoscope. You have a glucometer. You have a pen light. And then also the pulse oximeter. And once you have those things, you're gonna do a vital sign set. So if it's a possible head injury and altered mental status, you're still gonna take vitals. If you do, if it's somebody who has respiratory problems, you're gonna still do those vitals as well to get trending vital sets. Ryan Hart: Yeah. That's great information, Ray. You know, you touched on AEDs and I want to circle back to that for just a quick moment. You know, we know AED access can make the difference between life and death. Why is placement and proximity so crucial in this step? Ray Castle: Well, you look at a lot of statistics and look at the statistics and it's overwhelming. You know, the one is if you have, if an AED is accessible within the first two minutes, that means you're putting the AED on, or you have a seven-fold increase in survivability versus if you go down a couple of minutes, it goes down to four-fold. So, and the problem is if someone's already in cardiac arrest, you're having to before they move into a system, you've got to get you starting CPR or and also starting that that life saving process, that chain of survival. In addition to calling 911 and getting additional resources there. So it's really the closer you can have it available. It needs to be in a secure area. Say it's not secure area in a I'm going say a prominent area where you see like in gyms, like we go here. To, I do some periodic coverage at East Baton Rouge Parish Schools. And we go to basketball or volleyball, it is very evident it's on the checkpoint, on the wall. So it's more of a public access. Think of that standpoint as well. If you're carrying it, know what you have. You don't want to have it locked up unless there's no activity. Somebody has to have keys. That's the worst thing that can happen. Is it's not being locked up or not being used, period. And that gets the not being used is a whole nother issue from a, that gets into training and response. But there are many cases out there where an AED was available and was not used or wasn't used timely. Ryan Hart: Yeah, that was an excellent first lap Ray. You know, let's continue this going at full throttle here, rounding lap number two, tailoring equipment to personnel and settings. So Ray, talk to our listeners, about matching equipment to the people using it. You know, how should. Athletic trainers align their supplies with their level of training and the type of venue they're working. Ray Castle: Well, I would say even Ryan, it's not, not athletic trainers. It's, it's anyone who is there providing medical support. Have to have the appropriate equipment with their training and, and give somebody the ability to be successful. And for example, you know, while I'm doing credential as EMT and an athletic trainer, I have learned on both sides, having emergency response, we do the training, but if I don't have an AED, there's only so much I can do. Or anyone can do. Or you have a BVM, for example. I can only do so much if I only have that. Now that's the last ditch. If I didn't have that type of equipment, would still have a mask or just do mouth to mouth if needed to. It's not ideal, but we have to have that, give people the tools to make them successful. And when you're dealing in seconds and minutes, you don't have a lot of time to do that. Know, tourniquets doing those things as well. You've got to be, and you've got to be trained to use those appropriately. So that's really the key component is making sure, regardless of who it is, does that. Now, kind of philosophically, we have, like I know for our events we have, we have the same response kits. And, you know, depending on who you talk with, that just, it goes down to an institutional or an organizational decision is that, you know, we have set number of equipment and we have that equipment. Now, not everybody is trained in that equipment, but we need to be able to move. If I had to walk into an area, I didn't have a kit with me, but one of our other staff did, they may not, somebody else or a volunteer, not there. They don't use, they don't have that equipment typically or not trained in it. We do that on the front side and say, look, you're not equipped. You need to follow your protocol based on your level of training. And your qualifications, this is where it is and this is what you use. Don't go beyond that. But if I walk in, then I have the full set or like Ronnie comes in or, you know, if you have that yourself as well, you have all the tools there that you're capable of doing. And again, it goes back to, there's another layer of this in the personal training is what's your, what is your scope of practice and for providers. So we could have a physician there, could have a PT, we could have a nurse and EMT, you know, we could have just general volunteer. We just give them the base tools to be successful. Ryan Hart: Yeah, that's some excellent information for our listeners. You know, let's, let's round out lap two here with, another question pertaining to this topic. And it's one of the biggest risk on the field when it comes to outdoor athletic venues and that's heat illness. Talk to our listeners a little bit about what equipment should be in place to prepare for and treat exertional heat stroke. Ray Castle: Obviously you have to have the right cooling. You have to have your vital signs. And we know that, well, the gold standard is to have a core rectal thermometer. If we trained in that, you may not have access. Like during the last year, there was a shortage of that equipment because there was an issue with the manufacturer that specifically sold us one device. You had to pivot to a different device that is not stationary, there's a flexible thermistor, like in the day, like one particular type. Others have more of the harder tip, but it does, which then requires you to pivot on your protocol, is you're still getting a measurable vital. It's a point, a trending vital. So we measure it, but we'd have to take them, we'd have to remove it, put them in cold water or an ice immersion. If that's indicated and then put them back in. So you're doing it at set intervals. It's not being, you're not getting a constant reading as you would with one with a flexible thermistor. So that's the only downside. You have to pivot on your protocol or your treatment algorithm that's being done. In terms of equipment, obviously having your vital signs, having your vital set diagnostic tools, you have to have either depending on the setting, some type of cold water immersion. We're to bring them to a cool area where it's a tent. It's off the main venue, it's secure or private. Think of having either you could have a tarp, we think of a taco method. We're using a lot, we're moving, making a big pivot in disaster bags because they use them in emergency rooms and it's easy to contain the ice. It's self-contained. When you get into a big tub, that's great to have with ice, but the problem gets into maintaining that cool water over a period of time and access. So it's hard to bring that out like to a cross country match or country meet, sorry. So you think about where the setting is and what the number, and it goes back to statistics of how many you think you will have during that given time. And that's just not something I'm gonna think of. I'm gonna have one or not. You've got to have a wet bulb, low thermometer. That's the other side of making sure what this measurement is, or getting the potential for increased risk and you have to scale up your operations accordingly. You may have other cooling methods, I said like the body bag, you have a tarp, you have a tub. There are other ones like a polar pod type device. You've seen that's a more commercial device. There's also the vest, like I've seen one, I think it's called... maybe cold vest or something like that. But anyway, those are different types of ice, have ample ice and other mechanisms, cooling mechanisms, misters, et cetera, as deemed appropriate. But again, you got to go back and be able to cool them. And also think of having a mylar sheet as well, because once you get them past, if they are in heat stroke, they move down below 102 on their core body temp, not, not. Thermal, know, a infrared, not temporal, not, you know, not ocular or oral temperature, but core rectal thermometer below 102. Then you have to be thinking of now they have an unstable thermal regulatory system, more likely they're going to go into hypothermia. So now you've got to have mylar sheets to help keep them warm and to keep them, because they're not going to get hotter. If you keep them a cool environment, they're just going continue to regress around that. And that's another critical risks, especially if EMS is not already on site. Ryan Hart: Yeah, that's some really good information Ray. Let's continue on into lap three, talking about equipment checks and maintenance. You know, of course, all the gear that you've been mentioning only matters if it's ready to go when it's needed. You know, what's the best practice that you recommend for regular equipment checks and maintenance? Ray Castle: Well, the best practice is you have your policy procedure, your emergency action policy procedures manual and you dictate it there and then you enforce it there. So that's going to be, know, for organizations you have this as well. So, you know, like for us, we had an event recently and we went through each of the kits, you know, and we were going back through them again, what was it, 5.30 in the morning, I think we were doing a checkoff, you know, before an eight o'clock race. We're going back through them one last time because we had transported, make sure batteries checks. We have that written down what the equipment is. If anything's expired, as far as the AEDs or you get into medications, or even topicals, alcohol, other things that have an expiration date, you need to document that. So making sure what that looks like in terms of for those as well, and then replacing those items. Ryan Hart: Yeah, that's great. You know, you mentioned documentation, talk to our listeners about, how they should be thinking about organizational documentation and tracking of these, equipment checks to stay compliant and make sure nothing is really slipping through the cracks. Ray Castle: Well, I think it just matters what resources you have. Know, where I know one organization I used to work with, we used a Google Sheet and they had an automated send out monthly and they had to fill the form out and it would get a record that somebody's checked it off. And it's during the set time, like once a month, they had somebody, whoever's checking, they go through all the items there, making sure they're there as well. That versus some things required more frequently. For example, BVMs, they don't have to be checked every time, but you need to make sure you're checking them because they may have, the bag may be damaged. So it's the worst thing that could happen is you have that hose connection where the mass meets the BVM. If that's fractured, it's kind of hard for the BVM to work if it's fractured or have an open gap. So I've seen that before. You know, just an infrequent check and got to go back in. You don't check it for a while. So those are the things to make sure you have your policy, have it regular. Whatever that is, just make sure you're doing that on the regular basis for that. Ryan Hart: Great stuff. Let's shift gears now and move into lap four, talking about rescue medications and special conditions. Ray, talk to our listeners kind of beyond the basics, which rescue medications should venues strongly consider keeping available? Ray Castle: Well, I think the first thing is, you know, it's based on what you're permitted to do by who the people are there, what you can use. You know, if you have, you know, oxygen can be, you know, it may, depending on state practice, how that's regulated, you know, that's, you have to have the one with the regulator. It's not the ones you have, know, whatever the bottle, you can squeeze it and whatever come in, you know. Over the counter stuff, that's not medical grade oxygen that we're talking about. Have to have, oxygen is a, I think one of the most critical ones is most under utilized one that anybody should fight for to have that if you have the training for that. Outside of other medications, obviously glucose, glucose 15 or some type of a tablet for in case for that. You need to have some type of any medication that will help with anaphylaxis. But again, that's a prescribed medicine, EpiPen. And a couple of years ago, there was a cost issue where the EpiPen was maybe $500 per. The person may have it, but you have to have a protocol on how to assist an administration of that if the person already has one. Think of albuterol. That's another one as well. Aspirin is an easy one just for the standpoint for, know, potential for cardio respiratory arrest or potential for someone maybe moving into that position or there as well. And again, having a protocol for that. And then also think about more from a, the other one would be like nitroglycerin. Those are some of the base ones you have. And then the other one that's very common now is naloxone or Narcan. Having inhaler. I think that's, that is something that you have, that's easily available. Uh, you have to, it's different. Think for everybody listening, if you're a healthcare provider, if it's not explicitly said, you can administer that, then you need to check with your state board, respective boards licensing to have that, because it's not like going to a, over the, going to a pharmacy that's meant for the lay person to go have it as a rescue. It's not intended, now you're getting into prescriptive side. That's just something to be aware of just to make you note, just to check that. But those are the common ones you want to think about. And then obviously there are other, based on your level of training and prescriptive abilities or the administrative, I should say the administrative abilities as well. Other medications you can have there, again, just got to go back to what your organization encompasses, what your scope does. For a lot of our events we cover, we do endurance events, we don't have medications at all. Because we have such a wide variety of people, we see one event versus another event. We keep a very limited scope on that. And then you have just the topicals, like for example, for a bee sting, et cetera. That may help with pain or something like that. That's just, that's not a, I don't consider that a rescue medication or from a pain standpoint, but again, think about what those are things to look for. Ryan Hart: Yeah, that's great. Know, Ray, you briefly mentioned, practice sacks, talk to our listeners a little bit about maybe some considerations related to practice sacks for various providers. Ray Castle: Well, I think, you look at EMS and they have a very strict protocol. They have protocols that they go by and what they have available. But again, they, they, have limitations on when they can use it and what and who they're working on, you know, work for as well. Again, you're giving your providers the ability to be successful. And, you know, we see this in highly organized areas such as college athletics, where you have a very type-defined medical team. You have a lead physician. You have maybe the athletic trainer or athletic trainers. The thing about those, make sure you have the right ability to have that, like oxygen administration, et cetera. You may be allowed for that because in probably some states, working in an academic setting, may be, you may have an exemption for certain medications as well. You still have to go through the steps. You have to have it documented. You have to have the regular checks. You have to have it aligned with a protocol. You have to make based on the provider and the training and qualifications. Those are other things we think about as well. But again, just go back to what respective practice acts are and make sure it's under, you know, and that's the idea is having a athletic healthcare team and having a review like even at a high school. It may be somewhat nebulous, but you start with having a physician like over a district and you have an overall team that pushes a consistent policy procedure manual throughout the school district where everybody's on the same page and you're not doing something different, especially if you work in a unified school district. Ryan Hart: Yeah. It's a great perspective and great takeaways. So our final lap is, here. The white flag is waving Ray. If you had to give athletic trainers, just one key takeaway about equipment readiness, what would it be? Ray Castle: Wow, that's a tough question because there's so many, you know, things to think about. Think the one thing is, just make sure you're having like from equipment, you're having your equipment, you have it in place and think of the person who may be there to give them to be successful. But it has to be within scope of practice, scope of training. That's where you look at having equipment. When you have it, you're just going to align it back to. If it's a coach, they only have access to certain equipment or the provider making sure, but they have to be successful, fully available to be successful. So think of that as the, the take home is make sure that equipment's aligned with their protocol and the, the, the persons that are available there. And then training is a whole nother, you know, in documentation and stuff, that's a whole nother aspect of it and readiness, but at least you have to have the equipment ready there. And it's functional. Ryan Hart: Yeah. And that is the checker flags folks. The victory lane is here, Ray. Thank you so much for sharing your expertise and for your leadership and developing best practices for emergency action planning. Thanks to all of our listeners, for tuning in to this podcast, the AT pit crew podcast. Be sure to follow us on your favorite podcast app. So you never miss a lap and for more resources and training opportunities. Visit actionmed.co. I've been your host Ryan Hart and we are out of here.