Episode Transcript
[00:00:03] Speaker A: Welcome to the @pit crew podcast. This high energy show dives deep into the world of sports emergency care. Join us as we explore cutting edge strategies, real world experiences and expert insights to help you step up your game in emergency care. We've got the tools, tips and stories you need to be ready when seconds matter. It's time for the @pit crew podcast. We have the green light in three, two, one.
[00:00:34] Speaker B: Welcome to the atpit crew podcast. I'm Ray Castle and today we're talking with Ronnie Harper, a leader in high school emergency medicine who's dedicated his career to trauma management and implementing emergency action plans. Ronnie's experience and commitment to enhancing athletic safety makes him a perfect guest for today's episode. Let's get rolling. Dr. Harper, welcome to the show.
[00:00:59] Speaker C: Thank you, Ray.
[00:01:01] Speaker B: It's a pleasure to have you here. You know, I've had firsthand and for the audience I've had been privileged and honored to work with Ronnie for 20 something, 20, 30 years and see him what he's done at the high school level during his career and improving health and safety and just kind of a quick background, if you don't, if you don't mind, Ronnie, I'm going to share with the audience, you know, just that some of the stuff that you have or things you've done not just in Louisiana, but nationwide, you know, you've been on the NH Secondary School committee, you've had the PASS standards program, helping develop the ATLAS program, have done a number of other things and not to mention even most recently for the audience, Ron, he's been in the Louisiana Athletic Trainer association hall of Fame several years ago and then this past, during, earlier this fall, he was inducted into the Dutchtown High School Athletic hall of Fame. And for those of you, that's a, I think it's a pretty big honor because he's got some pretty good company with athletes that he has worked with, you know, one being Justin Reed, who is, who was inducted earlier this, you know, along with, I'm sorry, Landon, I believe, or Justin, I'm sure it's one Ronnie, you can correct me, but Justin's a two.
[00:02:25] Speaker C: Landon. Landon, this class. Yeah.
[00:02:27] Speaker B: Okay. Justin was earlier so I knew it was one of them. So yeah. And seeing that, you know, I know the whole, the father working with him as an athlete at LSU and stuff years ago. So again, congratulations and great to have you on the show.
[00:02:40] Speaker C: Thank you. Good to be here, Ray.
[00:02:42] Speaker B: All right, so audience, this is real simple. If you getting used to this, this format, we just like a race, we're in a pit crew. It's improving emergency care. And we have 10 laps to go. So we'll ask 10 questions, we get in and we do a final rapid fire lap and then we get into the victory lane. So let's go ahead and get started. So with Dr. Harper, one of the things, you know, you know, as I've seen this and you've dedicated, I mentioned earlier, you've dedicated your career. So definitely it was the last 20 plus years improving emergency medicine, really during your time at the high school setting as well. So what initially drew you to focus on emergency medicine at the high school level and why is this setting so important to you?
[00:03:29] Speaker C: Yeah, Ray, My first year as a athletic trainer at Robert E. Lee High School in Baton Rouge, in the third game, in the, in the third quarter, at the end of the third quarter, one of my defensive backs went down on the far side and he was face down when I got out there and I saw that it was a, it was a pretty head related contact. And I went out and started my assessment, found out that he had limited sensation and movement and said, okay, we're ready to spine board. And remember, it's my first year, third game and now I have a C spine that had some significant issues.
So the team physician on the crossing side, they came over and began to confront me that I was going to spine board him with his helmet on. And he was saying, no, we got to take the helmet off. So we had this big confrontation in front of God and everybody.
And so eventually, as a young athletic trainer, I bowed down to the doctor and said, maybe I don't have this right. And then come to find out I had it right, he had it wrong. But I didn't have enough confidence. When I left that weekend, I went like, never, ever, ever, ever, ever again will I be in a situation where I'm not the smartest and most competent person in athletic emergency medicine. And then I started on a path to try to do just that. So out of fear. Right?
[00:05:02] Speaker B: That's a great, that's, you know, it brought me back to a time when I was a student. And I mentioned this in the intro podcast earlier, you know, with the show, or at least, I mean, when my initial podcast was about that one moment and interest and that was, I had something similar, you know, and this was a spine injury as well. So I didn't have that type of conflict. But they still, you're, I was a student. I'm, I'm seeing this happen. I'm having to be involved in that so that's a great lead in for where we're going to move today. So, you know, talking about the chat, you. You focused on the challenges and in high school, and I've done work in high school as well. You see, there's unique challenges. Sometimes you're out on the island. And what are some of the unique challenges compared to other levels of sports that you have worked?
[00:05:49] Speaker C: And what you said, yeah, you know, in emergency medicine is just one part of what we do. And as a high school athletic trainer, you're often involved with developing stuff like everything is new. You're always trying to advance your rehabilitation, trying to advance your policy, procedures, your equipment, your facilities. And oh, yeah, by the way, we got this thing called emergency medicine. We'll worry about that later.
And so it's just kicking that can down the road and not making it a high priority as one of the cornerstones that you're going to invest in and focus on. So I think the athletic trainer in the high school gets overwhelmed with all of the things and it just becomes a slice.
Whereas the later on when you get in your career, the further you get along and the more episodes that you cross in emergency medicine, the more you realize that no, it has to be like front and center. It has to be number one.
So it's just the maturity of letting that evolution take place that a young athletic trainer usually goes through.
[00:06:58] Speaker B: Yeah, I think it's, you know, with that you can't let your guard down, so to speak. You know, that's what I've seen as well. And, you know, and what I as that undertone that I could, I think everybody shares what you've gone through. Do that as well. So, you know, going to the emergency response side, you know, we know that it requires a quick and I don't say effective, but also, if I may say, not only replace quick but efficient and effective response can really make a difference in an emergency situation.
So how do you approach creating and implementing the emergency action plan and how you did that in high school settings?
[00:07:39] Speaker C: You know, early, early again, it was like a piece of paper. It was three or four pages long. It was sitting in a drawer. And I said, I have something. And I just basically were copying templates that other people had and said, okay, I've got an emergency action plan. It's got some phone numbers, it's got some, some entry gates, you know, some basic stuff. And then I, I just always went like, there's got to be more to this. Like. And as I began to learn and grow, began like there is a lot more to emergency action planning and it's such a multifaceted, complex entity. So it was a matter of building it. Like you build a house, you have to build the infrastructure. You got to put on the walls, you got to put in insulation, you have to began to put into flooring. There's so many layers and it doesn't happen overnight, but you have to understand you're building something. So once I had that mindset, then it was just a matter of every opportunity I could to put another brick on or lay another tile. I would try to make my emergency action plan come alive and be real. And it took. It took. It takes a long time, but it also takes commitment to doing that.
[00:08:47] Speaker B: So it's a process, I guess you would say, like that old phrase, like Rome wasn't built in the day, but you have to keep laying bricks. Right.
[00:08:53] Speaker C: So, yeah, emergency action plan is that same mindset. Yep.
[00:08:57] Speaker B: So, you know, as you're, as I was listening to you, you know, you mentioned about trauma management and I want to just for the audience, you know, there's. There's trauma management and there's medical management, and those are two different met or medical emergencies and trauma emergencies. So. And just wanted so forward this. I want to focus a little bit on the trauma side because, you know, that requires a heavy mix of training readiness and often creativity. And I think that gets into the pre planning side, you know, when you do your scenarios. So can you related to or at least unusual situations, you know, so can you share a story where your emergency training made a difference in a high school sports setting or like in your having to deal with where it really came into play. You leaned on afterwards you said, wow, I'm glad we did that deliberate training and now we're better moving forward and continue that process.
[00:09:57] Speaker C: Yeah, absolutely. It was on a Thursday afternoon before a Friday game, and we were finishing up preparations for an away game in varsity football. Freshman football was going to do walkthroughs that day and helmets and T shirts because I was ready to go when they were still out on the field. So I'm just sitting in my office and. And they know where I'm at. I'm not that far. They're in helmets and shirts. So I'm not out there and somebody come barreling into my office saying, Dr. Harp, you got to get out here. This athlete is face down. He's not moving. I said, wait, what a minute, Wait, you're in helmets. I go out there. He's with the offensive lineman. And he's face down. And I ask him, out of all the people off spine board, this is the one athlete that had nothing. Can you feel this? No. Can you move this? No. And I went like what are y'all doing out here? Well he was doing an offensive pull drill and the coach had a dummy like a, like a dummy shield in his hand and he was supposed to hit it with his, with his hands but he ducked his head and Randy's head straight into the coaches dummy shell and went face down and couldn't move. And so I once I got that picture and I knew what I was up against, I waited on EMS to arrive. And this was, this was an offensive lineman. He was rather big. He was, he was 6, probably 6, 2, 6, 3, 250 pounds. And this was before scoop stretchers were really like in the thing. And so we had two options. Log roll. We just got through practicing Ray the six person lift as an option. And this was one of those cases where we felt better to do a six to a six person. There's really eight person left by the time this got here. Anyway, when the paramedic got there I convinced him, let's, let's just, let's do a coordinated lift with the coaches and the adults that were there. And paramedic went like okay, yeah, let's do it. And he, he had never done one before but I was now at the C spine holding C spine. I was in command. I told the paramedic what was going to happen and he felt my confidence and fell right in line. And yeah, so that was an example of my preparedness from that initial scene that I would never be in that case again. And whenever somebody shows up I'm in charge and I'm large and you, I'm sort of going to direct you and you're going to follow my lead based on my knowledge and my experiences. So yeah, so part of that just involves slowing.
[00:12:37] Speaker B: It usually slowed the process down. I mean I know that like I've had you know, in my experience working, you know, riding with the ambulance and you're, you're either there, his probably his or her reaction was just we're used to having two of us or may get some assistance as needed to. Now you have a crew of having six. They just, they don't do it that often probably. But yeah, that's a great example of utilizing the lay personnel and already having that in plan for that. So which gets in kind of the prevention side, next question or next lap so to speak is thinking about preventative measures as more or less being proactive measures. I guess. So think about how sometimes they're overlooked until something serious happens. So what advice would you give schools looking to improve their emergency action plans before a crisis occurs?
[00:13:32] Speaker C: Yeah, Practice. Practice the basics. Practice the fundamentals. Just like a coach does with their sport, where they. Every day in practice, they go back to the fundamentals every single day. Whether it's a SAM splint that you need to put on or whether it's taking a face mask off or whether it is doing cpr, it's drilling practice. So whatever your core that you deem to be, it doesn't need to be once a year. It needs to be on, like, a regularly scheduled basis that you get your stuff out and you go over a review of what all the parts that are needed. So, yeah, come up with a plan and focus on the fundamentals.
[00:14:12] Speaker B: And that plan's written, I'm assuming, under the work yard that you would have written down as to when it would occur. Correct. At least having delivered, that's the goal.
[00:14:21] Speaker C: And for us, for us, quite often it was.
It was on those Thursdays that we would find opportunities to review something very basic and simple with the staff would be the opportunities that I would try to do during football season.
[00:14:37] Speaker B: So, Dr. Harper, you've been an advocate, and I've seen this firsthand. I know many who are listening on the show who have seen the impact of your advocacy for training and preparation in the high school setting across the. In Louisiana, across this, the country.
What types of training specifically? Question is, what types of training or drills do you think should be mandatory for high school athletic trainers? And not just them, but also I would expand their coaches or their athletic personnel that they're part of their medical team.
[00:15:14] Speaker C: Yeah.
So toward the end of my career at Dutch Town High School, I taught the basic EMT class or the EMT class. And the development of that profession was a lot different. Not a lot different, but it approached it with a little bit different mindset than I've done as a program director of athletic training at Southeastern.
And it was. It had just a different level of preparation toward an outcome. And so I began to really try to transfer that over to the athletic training world when I would teach athletic trainers. And that is having your core fundamentals down and then moving into an integration of those skills, like bringing four or five of those skills together in a minimock or scenario.
And then the next phase would be to put those into a full scenario. And then the next phase would be to do the full drill in practice. Quite often we would just jump all the way into the drill and practice like the major event, and we haven't progressively developed ourselves. So that is. That's sort of the mindset of the way that I think athletic trainers need to take when it comes to the preparation and then start to implement those strategies in a consistent basis.
[00:16:31] Speaker B: So it's a great lead in to. What I want to. We want to ask you about now is really think about emergency situations. And we've already discussed briefly about how, you know, it demands that quick. Not just quick response, but a collaborative response. You know, those on site and then with EMS or fire coming on site or, you know, from already inject. Coming into the situation. So how did you work with coaches, school administrators, local EMS teams to ensure that everyone understands their role in an emergency?
[00:17:07] Speaker C: I start with the local EMS team, used to I just take them for granted. Then I went like, okay, I gotta be more deliberate about this relationship. And I was having a conversation with a EMS personnel before the game, and he just got bold and said, hey, what exactly does an athletic trainer know in emergency medicine? And I went like, I thought you already knew. I made an assumption you knew what I know and what I do, and he didn't. Then I had a conversation with my doctor, my team physician, not long after that, I said, you know what I do? Do you know what my scope is? And he went like, not really. And I went like, wow. Like, until I asked them, do they understand what I know and what I can do in emergency medicine? My local EMS didn't know. My team physician really didn't know what an athletic trainer can or cannot do. And that started the process. And then when something really bad happened at my school, one of my administrators said, well, Ronnie, that's not in your responsibility. And I'm like, oh, my goodness, they don't even know what I do. And so it was education. Like, I have to be more proactive at education with all of these and make no assumptions. So lesson learned.
[00:18:17] Speaker B: So is it safe to say that not only were they asking you questions about what your role as an athlete trainer was, but in part, you started asking questions about really better understanding what. What those respective providers, what their knowledge and skill base was and what their. For a limitation scope, like, for example, a paramedic versus emt, you know, scope of practice within what their protocols, what they can and cannot do. Is that pretty. I. I'm assuming that.
[00:18:44] Speaker C: Yeah, yeah, one of my.
Yeah, one of my physicians on asylum was an ER physician. I said, oh, that's great, that's awesome. But what's his scope? Well, what can he do? It's great to have an ER physician on your sideline just for the management of stress, but he doesn't have all of his tools in his toolbox to operate. And then he's operating with a multi. Yeah. So having those conversations, absolutely. I just took more aggressive approach at talking and learning about what people know and what they don't know and what I know and what I don't know and not just make big assumptions just to attend an event.
And it was very eye opening when I really began to be aggressive in that tone.
[00:19:29] Speaker B: I think, you know, I think you, you probably, you've talked to em, EMS personnel and I've done the same as well. And you know, that's a great point that you make. You know, understanding what you've, how you've learned from them. And I know I've done the same thing as well. Just to ask even what the like for an emergency physician, what, what they do and you know, and how tricks, even tools and tricks of what they do is carried over. You know, you and I've talked about this before is what we do from a, from a practice standpoint as well. So I think it gets into, you know, we, we underestimate or maybe sometimes overestimate that is what's going to kind of, I want to change gears a little bit on that kind of, that framework of looking at the, looking at high school athletes. So in their mindset is sometimes, and you know, I think we've seen this is they, they may underestimate the severity of an injury. And so what has been your approach or your approach you developed over the years in educating young athletes about the risk and importance of reporting symptoms of injury. And I think maybe even tag into that maybe for athletes and parents about importance of reporting symptoms.
[00:20:41] Speaker C: Once I've figured out, and it doesn't take much to figure out the severity of a injury, however, they'll be in denial. So here's what I, here's my go to look, it's probably, this is my pitch. It's probably really not that bad. But I'll tell you what, let's just go rule out the bad stuff and then we can get that behind us and then we can get you back out there pretty quick. And once they heard that, then they went like, okay, he believes it's probably not that. And in the big scope of things, it's not that bad. You're not dying, you're not losing a limb, but it's still pretty significant. But let's go rule out the bad stuff and then we'll get you back out there as quick as we can. And then that would relieve everything and then they'd be more willing and cooperative to move to the next step.
[00:21:25] Speaker B: Yeah. And that's that even conversation probably changes a little bit between, let's say a younger pediatric, say 11 or 12 year old versus a 17 year old. Right?
[00:21:32] Speaker C: Yeah.
[00:21:33] Speaker B: Does that.
[00:21:33] Speaker C: Yeah, absolutely. It's all based on the reading. It's all based on the reading of the parents because the parents are the, are the controlling factor. And always ask the athlete, which parent am I going to call the mom or the dad? 99% of the time they would say call my mom. And that would give me a clue as to what, how this thing's going to be processed from the beginning. And then once I got mom on the phone or started talking to mom, that was, that was harder and to figure out where mom is coming from.
But eventually I got a, you know, I got a pretty good feel for how to handle the mom in cases like that.
[00:22:13] Speaker B: But I think part of that, you know, leading in this is a great segue into this next question about prep. You know, how you prepare yourself for an emergency and until otherwise ruled out, it is, you're having what you may think is not, we think it's not an emergency. Like you mentioned, I think in the parents or athletes, they may think it, oh, it's a murder, it's a dire emergency. So you have to understand that's a mental component for that is it's not so much mental as much as procedural. So how do you help other athlete trainers in your experiences stay calm and focused during high stress situations and what you've, what, what maybe what you've done, you developed over the years to stay, you know, I know you, I've heard you say it's time for him. Cool. You know, calm is cool and other types of processes.
[00:23:05] Speaker C: So I'm, I'm, I have a pet peeve about this and that is when we go into stressful situations, usually my student aides, coaching staff, another athletic trainer are behind me or around me. My pet peeve is your facial expressions and your tone of voice have to be stable and consistent. If I get any clue that your tone of voice or your facial expression is anything other than generic, then I will turn and dismiss you immediately. Because you can disrupt an environment just by somebody's eyes going up or somebody covering their mouth or their Hand trying to not say something. And so I would have to prep my staff to say, look, when this happens, I'm telling you like I will ask you to leave immediately if you don't bring to that table no emotion whatsoever. It's hard enough to handle the individual. It's hard enough to handle my own emotions. I cannot manage incompetent people that can't control their emotions as simple as what their eyes or face will do.
[00:24:19] Speaker B: Yeah, that's just controlling the situation is as simple as it gets. So we have two laps to go. Discussing challenges in high school trauma and emergency responses with Dr. Ronnie Harper.
So Dr. Harper, you see first, you've seen firsthand the positive impact of well executed emergency response and not just for the school, but at a school district level that you had worked with and developing over, over the years. And I might say I've seen that plan and it's, it is, it is impressive from how you all coordinated that and develop that. So moving at school for schools and athletic programs just starting to build their emergency plans, what would be your number one piece of advice to get them started on that process?
[00:25:06] Speaker C: Well, this is easy, Ray, and it's very simple. Your medical director, they have to be dialed in. They have to understand the responsibility they have. They're busy, they got lots of wheels spinning. But you have to start there and get, buy in, get input. Because when you march this thing forward, you're going to hit resistance along the path and you better have your medical director right beside you are in front of you leading the charge or you will spin your wheels to no end, wasting a lot of time and a lot of energy. Because the bulk, the buck stops with the medical director. So he needs to understand that his name, his reputation, his license is the one that's on the line here and that you are empowering that particular medical director with the resources to be in a very good position to handle emergency situations. So that's my advice is you gotta, you gotta line that up first and then keep it positive and encouraging and motivating throughout the whole process.
[00:26:11] Speaker B: So just to kind of add on there. So if you already have, you go into a, like I'm a first year athletic trainer, I'm going into a new job school, there's already been a physician there. They may have some other, you know, maybe the sports medicine clinic, physical therapy clinic, they've been working collaboratively, you know, they're part of that group. Would you encourage them getting with the physician first and then developing, bringing those folks on board and trying to finalize that as a team, as a formalized team or like I guess better review team. And then moving forward.
[00:26:46] Speaker C: Yes and yes.
Cultivate those relationships. If they don't get excited about it, then go find an advocate who, who is excited about it. Who then can help be your advocate. Back to your medical director, like an ER physician, maybe a fire chief, maybe a school nurse, maybe somebody that is an advocate with you in this space that then helps to rally those that medical staff, that medical director to say that this is an important element of our overall healthcare plan and that we need to do this first class and do it right from the beginning.
[00:27:25] Speaker B: Alrighty. So Ronnie, we are an audience. We are in the final lap. This is the speed lap. It's full throttle ahead. I've got five quest rapid fire questions. Ronnie, are you ready?
[00:27:36] Speaker C: Let's do it.
[00:27:37] Speaker B: Okay, favorite piece of emergency equipment in your kit?
[00:27:41] Speaker C: Sam Splint. Okay, Sam Splint.
[00:27:43] Speaker B: Okay, what's your go to method for staying calm under pressure?
[00:27:48] Speaker C: Keep repeating the same question. If you don't know what the next one is, just repeat the last one in a different way until your brain catches up.
[00:27:56] Speaker B: So if you weren't in emergency medicine or being an athlete, I say athlete trainer, what would you be doing?
[00:28:01] Speaker C: Business. My dad owned and managed grocery stores and that's probably where I would have been.
[00:28:06] Speaker B: I did not know that did that. And so one piece of advice for new high school athletic trainers are going either going to be experienced going in or they are a new fresh out of school and they're going into that job position.
[00:28:21] Speaker C: Same way I led off with this whole thing is the first game, first year, third game. Overwhelmed in an emergency situation. Get your ducks in a row long before you are placed in that situation. So you, you be the expert and invest in emergency medicine.
[00:28:41] Speaker B: Okay, last one. What's a fun fact about Ronnie that the audience may not know?
[00:28:47] Speaker C: I really like studying genealogy and I found out that there's a very high likelihood that Pocahontas is my great great, great, great, great, great great grandmother somewhere down.
[00:28:56] Speaker B: Okay, we may have to get you back on the show to walk as a fun. It's a fun episode of genealogy or even athlete trained genealogy for that matter. So thanks Ronnie for sharing your insights on trauma care and emergency planning and high school athletics. Before we wrap up, what would you say is the one thing every athletic trainer should remember when preparing for emergencies?
[00:29:17] Speaker C: If it, if it can happen, it will happen. When you enter an arena, you walk in and you say, what's the worst thing that could happen today, and you will. It will ramp up your focus. Do not go into an arena, an athletic arena, if you're in charge and say, hey, this is a pretty cool event. I like, I like athletics. But you have to enter in and say, what's the worst thing that can happen? And am I prepared? And that should scare you and you should be scared. And you should let that fear drive you to be better in emergency medicine.
[00:29:52] Speaker B: Thank you. So that's it for today's episode with Ronnie Harper. We hope you've gained some valuable insights into high school emergency care. Don't forget to, like, subscribe and share this episode. Until next time, we are out of here.
[00:30:12] Speaker A: Thank you for joining us on the @Pikrew podcast. We encourage you to, like, subscribe and join our community.
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