Episode Transcript
[00:00:02] Speaker A: Welcome to the AT 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 3, 2, 1.
[00:00:32] Speaker B: Welcome to the AT Pit Crew Podcast. I'm Ray Castle and today we're honored to have Dr. Jim Kyle with us. Dr. Kyle, a leader in emergency medicine, emergency and sports medicine, is here to discuss his WISE5 initiative which focuses on life-saving protocols for young athletes facing sudden cardiac arrest. This is an episode you won't want to miss, so let's get the drive started. So a little bit of background on Dr. Kyle. Dr. Kyle has over 40 years experience as an emergency and sports medicine physician and serves as executive director of the Kyle Group. Known for his pioneering work in sports medicine, Dr. Kyle has developed initiatives to improve emergency response and life saving measures in athletic settings, one of those being the medical timeout as his creation, the Friday night medical timeout. His latest project, the WISE 5 initiative, targets second stage resuscitation protocols, especially in cases of sudden cardiac arrest among athletes. Dr. Kyle has served as a medical director in West Virginia, providing medical oversight for U.S. soccer and the Olympics, and as a charter member of the American Medical Society for sports medicine. Dr. Kyle, great to have you here on the show.
[00:01:40] Speaker C: Thanks for the invitation, Ray. It's sort of cold here in West Virginia today. I wish I was in Baton Rouge with you.
[00:01:47] Speaker B: Well, it's a little cool here, but you would bring. It'll be a little bit warmer. I think you may be sweating a little bit by your by measures up there. So yes, we got, we've got a. It's cool here today and up there, but I know this is a hot topic and this is will be one that we'll see a lot more in the future of. So let's go ahead and get started. Audience Just so you know, just a reminder, we have 10 questions with Dr. Kyle, then we'll move into a final rapid, rapid fire lap and then we get into victory lane. So let's go ahead and get started. So Dr. Kyle, you know, one of the things, you know, we've talked about this a good bit is, you know, it's just talking about the WISE 5 initiative and I know you came out with a video recently as well that did a great job explaining that in the on field care and coordinated response. So when you're looking at this approach to cardiac emergency sports, can you tell us a little bit about how your inspiration behind the WAS5 and what it aims to achieve?
[00:02:47] Speaker C: Well, that's a, that's a good question.
As you recall, almost two years ago, the sports medicine community had a wake up call during an NFL game where Demar Hamlin from the Buffalo Bills suffered a cardiac arrest at a game, a night game in Cincinnati.
And the thought process later on in analyzing why, appeared to be that he received a blow to the chest, cardiac contusion, cardiac concussion, excuse me, or commotio cordis. And everybody wondered, well, that's sort of unusual.
As we watch that, as we watch that response, it was notable that he was down on the field for more than 10 minutes before they got him in the truck. Fortunately, they had a very talented group of on field rescuers, including four emergency physicians, one of whom was the airway doctor and they needed an airway on him once he got in the truck.
So that was sort of a wake up call for all of us that are involved in providing care to high school athletes saying what if this happened in a small town USA setting in rural usa, how could we take the lessons learned from the NFL resuscitation and make sure that that same quality of care could be happen in your small high school located in your own community.
[00:04:27] Speaker B: So if you get. So the idea is, is that if it's a, if you can do this in a small rural setting, there's no reason it can't occur. Then we're hitting everywhere in terms of large scope, large metropolitan areas. In theory it should happen, but that's not, we know that's not always the case. But using this initiative is a much needed upgrade in the protocols.
[00:04:50] Speaker C: And because of this, school systems immediately. Look in 2023, early 23, what are we doing about the primary response when an athlete goes down at our high school? The good news on that is if there's early recognition and two AED attempts, Ray, in the first five minutes, most of the time that's a successful outcome.
[00:05:18] Speaker B: Yeah, and that's pretty, those are pretty hard statistics there too. So it's. You have a sevenfold increase in the first two minutes versus it drops down and down significantly as you move along in that, in that continuum. So it definitely is the case, which leads into the case for doing rapid care. But also if you're having difficulty, if there is a issue in the resuscitation process. We also, I know as part of the Watchdog initiative, We discussed the second stage of resuscitation. Yes, and we know, and if we know it's a critical top phase in emergency care. So what I'd like, if you don't mind, is just explain that second stage of resuscitation, what it involves and why it's especially important for affluent trainers, pain physicians, ems, that they work with, other providers, that they, they're engaged with, the whole emergency response team. What, what they have to un, what's important to understand about that?
[00:06:17] Speaker C: Okay, well, there are several points. First of all, emphasizing what happens in the first five minutes. As we just spoke to early recognition, hands only, CPR, AED ASAP. In that process, in the first five minutes, there's plenty of time to get two AED attempts in. When EMS arrives or when the physician arrives on scene and two AED shocks have been given, that's when the Wise 5 comes into play. What to do next? What's your next step? You've got several potential interventions.
Airway, iv, mechanical CPR device, medication. What's the proper order, the proper sequence? Now remember Ray, in a high school athlete there are pretty much a finite number of causes. Hypertrophic cardiomyopathy is one.
Commotio cordis is in play.
But another entity called coronary artery anomalies also has to be considered as well as long QT syndrome and the right ventricular partner of hypertrophic cardiomyopathy called arvd, arrhythmogenic right ventricular dysplasia. So those five potentials need to be in the wheelhouse of EMS and responding.
Why didn't the shocks work? Or in the case where no shocks were delivered, if it's a non shockable rhythm, what should you expect to do? And what's the next sequence of interventions.
[00:08:06] Speaker B: Which, which gets into, you know, as an automated defibrillator. You're they if they're in asystole, you won't see that, you won't see a pulse. So it's not going to do. You won't have any response. So you're still just doing cpr. So that tie in which really gets into the advanced defibrillation techniques which we talked, which in the Wise five we're looking at vector, you mentioned vector changes. Is that significant, that next step of this process? So what role do these advanced defibrillation techniques play and improving survival rates and how. You know, as athletic trainers we. As an athletic trainer, I wear two hats. As an EMT and an athletic trainer, but as an athletic trainer, I'm there And you see a lot of athlete trainers are in practices. There's not someone immediately there. So it's a practice, it's a non event. So you may have EMS there. It's how they need to work on improving their emergency care protocols.
With that, you go into that a little bit.
[00:09:08] Speaker C: Yes. And another point, Ray, in Baton Rouge, if there's, if your next door neighbor suffers a cardiac arrest and you run over and try to help and you're packing an aed, that's great. When EMS responds, they get there in about five minutes and they're responding to a cardiac arrest in progress. But on game night at your local high school, if EMS is already there, now they're responding to a witnessed athlete in play cardiac arrest.
A whole different thought process.
So EMS providers need to think through what's different about a witnessed young cardiac arrest versus an out of cardiac arrest on a 66 year old they respond to. So that's an important, that's an important framework as you begin to learn about the next best step. And for small town USA in West Virginia, Ray, in the area that I cover with my EMS responsibilities for leadership. Out of the 18 high schools, how many athletic trainers do you think we have Certified?
[00:10:27] Speaker B: Out of 18?
[00:10:28] Speaker C: Yeah.
[00:10:29] Speaker B: Oh, I'd probably say maybe, if you're lucky, probably seven.
[00:10:35] Speaker C: We have one.
[00:10:37] Speaker B: That's it.
[00:10:39] Speaker C: We have one certified athletic trainer. So we designed this intervention in terms of the primary response team, a three person critical care triad, as we call it for equipment removal to be T shirt cut and then a cut down the middle of the shoulder pads from the left side of the athlete by the coach, exposing the chest and AED pads to go underneath the shoulder pad. In Baton Rouge in August, those, those chests are pretty wet and it's difficult to get the proper pad placement. Right side but beside the sternum, left side more in mid axillary line as opposed to underneath the nipple. That's the proper anterior lateral pad placement for the aed.
Now having said all that, we're expecting most of these athletes to be in V fib when you witness the collapse. V fib responds to the AED if the pads are in the proper place and have the proper connection.
[00:11:50] Speaker B: And so then you have further a lot if it's further down the line. And I'll also. You mentioned this earlier, like ems, how they're present, how they're getting this call, like for a nod, someone's not there.
[00:12:01] Speaker C: And you.
[00:12:02] Speaker B: We know this, that a lot of times they may call off. Okay. We have a reported seizure activity and they're thinking seizure, not knowing it's a card. That's it does that changes a lot. It doesn't change the, the initially the response but when they're there it definitely the acuity level now becomes, you know, significant. Whether they're conscious, unconscious or they, they move into, you know, the conscious state. That's a very different, you know how that information gets to EM9 11 operator and what it gets out to EMS in terms of their response. So yeah, you know, I don't want to take, you know in that I don't want to get too off target on this. But you have to be thinking about that as well is what seizure activity, how that presents or masks in actual cardiac event. Yeah.
[00:12:51] Speaker C: We've had as you know the Friday night medical timeout has always addressed the readiness for cardiac arrest on game day with location of AEDs and early awareness with sensitive seizures, seizure like activity or agonal respirations. This year we added onto it the findings from Dr. John Dresner at UW and his sports cardiology group.
Dr. Dresner has analyzed several videos from athletes sudden cardiac arrest and now he's promoting the concept of eyes open rollback and chest moving, still breathing. So early recognition seizure like activity in an athlete collapses during sports play is cardiac arrest until proven otherwise. And don't be surprised if eyes are open and chest is moving too.
[00:13:50] Speaker B: Very good. That's an excellent lead in to, you know, that's a part of the equation, A big part of the equation. But also we have to be thinking about training and the athletic trainers get formal training in airway management, you know, using supplemental, you know, airway adjuncts and thinking about Also in tidal CO2 monitoring levels are very extremely critical in cardiac emergencies, as you well know. So how does if you would talk about. Let's talk about airway management in CO2 trending to help athletic trainers and medics team physicians make those critical decisions during resuscitation. Because we see this in equal, you know that the internal CO2, you can, they have those, they have those devices on EMS units. It may. I know they have some important ones you can get less expensive and something for athletic trainers to consider as well.
[00:14:46] Speaker C: Yeah. Ray, how many of you think the of the athletic trainers at LSU have ever heard of End Tidal CO2?
[00:15:00] Speaker B: Well, I know they all have because I know they go through the training with it. But when I worked there for 20 years we, you know, we as part of our emergency medicine in our curriculum this was a, this was a key point that we would talk about and we're not, you know, it doesn't get into it because you got to have the device, but recognizing what, that what's going on with EMS when they arrive. And I know they do a lot of coordinated response with the handling servers. We did a lot of extensive training and I know several of the, their staff are EMTs as well. So I know that they're into that. I would assume that, I know they have that. But most people, most athlete trainers are familiar with CO2 with entitled CO2. So because we don't have that, we don't use the device.
[00:15:46] Speaker C: So, so that we need to certainly provide good information to the athletic training community about the utility of end tidal CO2 during cardiac arrest.
But before we get to that, our WISE five medics, medics with lots of small town experience for many years in resuscitation strongly recommend that the airway of choice and a downed athlete is a supraglottic airway.
And the most, the, the most commonly used one now is called the igem. Sort of when we were with you at LSU back in the pre pandemic period, I think we were recommending the King Airways or the Igel, sort of the next generation. One step up from the King and ease of use and fewer complications. Once that airways in place, an adapter is placed on it. And we showed this in the, in the video you, you reviewed on transition when they got in the truck.
And it gives a numerical number for the amount of carbon dioxide coming out of the airway and cardiac arrest. Circulation is impaired.
So the normal end tidal CO2 level of 35 to 40 drops below 20. So the end tidal CO2 of less than 20 as you're doing a resuscitation with effective compressions will actually trend upward and there'll be a jump of about 10 points when the heart starts beating on its own again. Suddenly it'll jump from 22 to 33 and that's a sign that return of spontaneous circulation or rusk has occurred.
So the end Tidal CO2 is a good adjunct, very helpful in making sure you're doing an effective resuscitation. Once again, part of the WISE five, if things go good in the first five, they're awake or at least breathing on their own and circulating if they don't go good in the first five minutes. End tidal CO2 is an important piece of the wise five formula.
[00:18:16] Speaker B: So that's a, that's a part of that. You know, there's some of the newer, not newer tools that's been around for a while. But for those who haven't used it, one. One of the. One of the tools, critical tools to really start to consider especially for athletic trainers to have that device available before EMS arrives. It just provides that picture of what the person is truly looking like through the continuum of the emergency response. So along those lines let's shift gears a little bit about with looking at new tools or medications and how we approach emergency response. So you know, now it's becoming more prevalent having mechanical CPR devices like for example a Lucas device where they have the compression unit as well as and. And medication or option viable options in the WISE 5 Implementing the WISE 5 initiative. And so if you would what discuss what their benefits are.
[00:19:11] Speaker C: Well, the. You're right, the Lucas device is the most popular device. The autop pulse is another device. But most of the major schools like the University of Georgia and University of Michigan athletic training staffs I think have decided to go with Lucas.
What we learned early on in the two year investigation by the WISE 5 group of physicians and medics was that in the sim lab taking the athlete from the 50 yard line to the truck, on the sidelines or in the parking lot gates, we could not do effective compressions on the stretcher moving the athlete. So in order to get effective compressions while on the stretcher, the mechanical CPR device is not only necessary, it's essential. As we thought about the sequence of interventions entitled Airway IV Lucas Lucas early on was about the last piece of the puzzle for us raise.
Now it's moved forward and it's moved forward because it allows the responding crew ems, one medic, one emt, small town usa, no athletic trainer, no team physician present, sort of trained rescuers.
It allows them to be hands free.
So once the Lucas is going, it is easier to get an IV in for example or an airway. So the Lucas has moved up in the order of intervention since we started giving these recommendations. If you've got a Lucas, you want to use it early.
[00:21:11] Speaker B: Well, it also you think about from a back, if you're in a unit that, and you know this as well is that you now have a third person who is consistently providing compressions. So it in the case of your back of the unit, you only, if you only have a BLS unit, you only have the driver and you have the other responder in the back. So they can, or it'll be a, you know even that having a paramedic, they're issuing delivered meds, they can do those things without a third person in there, ideally until they can intervene with another support group that needs to. Or if it's bls and then they're getting. And they're meeting with a.
With the BLS unit to support.
[00:21:53] Speaker C: Yeah.
[00:21:54] Speaker B: Have two people in the back.
[00:21:55] Speaker C: And it's also important to know early on if you're going to have Lucas availability. If you're not going to have a Lucas to help get the athlete to the truck, you might want to stay on the field a little bit longer.
And a good example of Crystal shell nut is a paramedic, a very wise leader in the Athens, Georgia area. She's currently the Georgia state trauma program director.
Prior to that, she was region 10 and region 10 was Athens, Clark county and the surrounding 10 counties. Those surrounding 10 counties are small town rural settings. So it makes a nice place of good example to target these interventions and see how they work compared to the regional trauma center in Athens. Those 10 counties, Ray, every one of them has those Lucas device and two or three of them have a point of care ultrasound device on the truck or pocus device.
In our southern West Virginia setting. You can't believe how many of the squads have Lucas devices and they're expensive. But. But bringing Lucas into play early, if you've got it, is probably a good idea.
[00:23:17] Speaker B: It's excellent. Yes. Excellent idea. So, Dr. Kyle, so as we move in, we're now on. We're on lap six, so we got a couple more laps to go for everybody.
Let's focus on, like we talked about this with sudden cardiac arrest in young athletes. And that presents its own unique challenges. So what are the specific challenges in addressing cardiac arrest in young athletes as opposed to an adult population? And how does the wise five tackle these?
[00:23:46] Speaker C: Okay, but once again, the first step in preparing for a potential tragic event of collapse during sports play with the cardiac arrest is to make sure that the people on scene, the head coach, athletic trainer, and another trained CPR bystander have rehearsed and are ready to go with the critical care triad. And get those shots in quick. Pads on under 30 seconds, hands only, CPR. Boom.
That works most of the time, but if it doesn't, what we think is the transition when EMS arrives can provide a crucial next step in resulting in a positive outcome.
And that crucial next step is if the AED shocks did not work, there must be a reason. And the next step is to change the direction of the energy delivered by the defib shock. Put on your monitor pads, a cardiac monitor that EMS has brought to the scene and changed the pads from anterior, lateral to anterior, posterior, front to back and deliver max energy for your next shot.
That transition I think is going to be key in resistant cases of athlete sudden cardiac arrest.
[00:25:26] Speaker B: A good point to note and how we, and I guess that that also involves one, you have to have that working through your protocol and have that work through that, but also how you integrate that with ems. And EMS has a different, you know, in their protocol as well. But that, but I would add briefly before we head on, it's just really to think about if you're, if you're an athlete trainer to school and you're working on these protocols is to reach out to your local EMS agency, the medical director. They want efficient care and you we're providing care but also I think working, I want to emphasize is having that physician directed practice with an athlete trainer and the other providers they are providing with the school as well. So just really important just to work together in collaboration standpoint to have consistent protocols with EMS and they want that everybody wants the same thing and make, makes it very easy from that standpoint. So as we move into moving, I want to focus a little bit specifically on what the role of an athlete trainer is and more so because many athlete trainers are there at a school by themselves. They have a small team, but the role they play in the advanced or I'm going to say the advanced but early intervention for emergency response. And what, what advice would you give athletic trainers and sports like the sports medicine professionals, including EMS personnel who want to incorporate the WiFi protocols into their emergency action plans?
[00:26:57] Speaker C: Can you be a little more specific? What part?
[00:26:59] Speaker B: I guess let's say for example, I'm, if I'm getting ready to adopt my protocol, change my protocols, how would I have school? How, how do I go about implementing the WISE 5 protocol? Is it, do I need to go through a different, is it a different process or go through to just to change. How would you change the protocol? Is it if you're recommending to make a change, if you're part of a review committee, what does that look like for some, for someone who hasn't had, they've had a base protocol and they're looking to make a modification.
[00:27:33] Speaker C: That's the last thing all high schools have to have emergency action plans for every venue.
Some of them are sort of rubber stamped. Some of them are pretty well defined. And Ray, you've gone around and helped many high schools put it together the right way.
So in becoming a student of the WISE 5 initiative, you as the athletic trainer at the local High school should go through the process of rehearsing the emergency action plan that involves EMS on the scene. So you invite your EMS crew, go through your initial primary response team and then the transition with EMS is the beginning of the wise five thought process.
You talk about it and say, hey, instead of leaving them on their back, let's do a log roll. When you guys get on scene, put the base of the Lucas device down during that log roll and the mega mover to lift the athlete and put the posterior cardiac monitor pad on, roll them back and do it under 10 seconds.
And it takes a little practice to be able to do that.
That sets things in motion about rethinking athlete sudden cardiac response. When EMS arrives, you gotta practice preseason and basically look at your emergency action plan for sudden cardiac arrest and see if you wanna update it.
[00:29:17] Speaker B: Yep. Seeing how I think important part of it just seeing how, you know, I think something we don't think about, like I know ecologists is having ems. Let's just see what they do, you know, first without there's, without the integration. Let's just say for example, just to have the medical, like the athletic training staff just watch and say, hey, if you're not there, let's just see what EMS does and if they're coming onto a field so you see what that looks like and how then you can start thinking about, okay, now I can easily see how the integration is because a lot of times from an EMS perspective you don't, and I've written on Amos, you don't have providers that you're not expecting providers to be there. You're expecting, it's a, it's a two or three man show, you know, you're not expecting it may have a bystander. So you have a trained provider. You're not, they're not accustomed to that either to some degree. So it requires training on both sides. So you know, as we think about the, with that in terms of, we talked about the training on both sides and having into, you know, we know that EMS does training, have athletic training. You got to bring those together. And so we know we have to have an effective protocol that makes that an efficient protocol that makes that difference and life saving difference. If we would, I want to switch gears a little bit and talk about the W Stop initiative and specifically how does it aim to improve or enhance outcomes in those, what are noticeable outcomes you're seeing or any data that supports this and say, hey, why should I go ahead and consider just moving to putting this in versus not putting it in into a protocol.
[00:30:57] Speaker C: Well, we don't have enough numbers specific to the high school athlete to make evidence based recommendations. But in the full body of out of hospital cardiac arrest OHCA data some trends have developed since the pandemic ray that are worth noting. One of those trends in vent ventricular fibrillation or pulseless V tat is that the newer defibrillator with their proficiency need to be turned up to max energy for the next shot.
So in a shockable rhythm it's very clear now that if your next door neighbor goes down or the 16 year old goes down, they need not one, not two but three max energy shocks before they need any IV medication.
Bang Bang, bang. So that's going to change your thought process at the high school field about trying to take time to put an IV in. With only two rescuers there, EMS and sid, your priority is going to be max energy, different vector. Bang bang, bang. And that's, that's that. That's proven the literature in the whole body about a hospital cardiac arrest.
[00:32:31] Speaker B: Well, I think two things that I get out of what you just said and I think it's. You know one is you go back to like Dr. Dresner's the research they've done on cardiac sudden cardiac arrest out of University Washington, their cardiology group. There are a couple articles that look at that specifically the incidence and also the what happens from a response standpoint is that one is it's relatively. Of all of the injuries that occur it's relatively. I mean less than 300. I mean not, not not estimated per year. That's about the I think the cases they had. But you gotta look at the bigger like you mentioned out of hospital care. That's, that's the trend in data. If it, if it works in the overall group why would you not do that for you know given the best chance of survival. And that's the, that's just the one thing I think you. That was really hits home for me or I think when you're. What you mismentioned is we gotta do the things that are best for cutting edge and how to do that effectively and is improving look at what the most effective outcomes are in. In those situations.
[00:33:35] Speaker C: And non shockable cardiac arrest there's a different mindset. Shockable VFib pulses VTAT.
Non shockable is pea pulseless electrical activity or asystole. Pea responds to epinephrine IV but it's gotta be within the first five minutes. So in a non shockable rhythm on the 50 yard line the first move is you're supraglottic and in tight. We'll get back to that in a second. But if it's a very good end title, it could be that this is really not true pea. But the new pseudo PEA that we're seeing more and more because of ultrasound, cardiac ultrasound capability in the resuscitation suite and ers.
But back to that point, if it's pea, supraglottic end tidal IV on the field or IO intraosseous and a milligram of epinephrine as quick as you can. So you can see now, Ray, we're given the formula for success from large studies in out of hospital cardiac arrest where epinephrine is important. Early and non shockable but not as effective as thought and shockable and could be delayed.
[00:35:05] Speaker B: Delayed at efficient care. Yeah. So which leads into, you know, where the more we learn about cardiac sudden cardiac arrest. And I think this was one that helped him, you know, seeing that at the very part of the show you talked about Demar Hamlin and we see these very visible cases. There's some other ones that have been. I know that, that I saw one talked up by a volleyball player who collapsed, you know, on the. And had a successful resuscitation is it also pushes us to do better from a resuscitation protocol standpoint and look at the future. So as, as we evolve, what are some advancements or changes you hope to see in the next few years and related to recession? Resuscitation protocols for sports settings. If it was the ideal work like you're looking, what, what do you see this happening at the, at the college, the high school professional. I mean where do you see some of those advancements or changes?
[00:36:02] Speaker C: I think it's already happening. State legislatures are really pushing the point that you've got to have a smart part focus on campus and AEDs have to be within three minutes of any location in the school or on the sports venues.
So it's not a new initiative. We, we talked about AEDs way back when in the early 2000s. And there's gradually, gradually and more and more schools. But, but I think the biggest challenge is Ray, I don't have the answer to this is how many sudden cardiac arrests have occurred in Baton Rouge Middle schools in the past 10 years.
[00:36:51] Speaker B: I know we've had some, we've had several. So I think that's.
[00:36:55] Speaker C: Yeah, it just doesn't happen that often in your school.
[00:36:58] Speaker B: Right. And, and also, but also seeing that firsthand, I think now we're seeing that law, the advancements are really getting into the law stable where you don't want to regulate something because you know we know the regulation can be too, can be a bad thing at times. But certain things for certain laws or requiring AEDs and CPR training in schools not just for coaches but for administrators for having the entire population of students, even hands only cpr, that's just, that's, that's easy to do without having the certification but having those who are supervising sports, they have to be certified. Having AEDs that are actually operational and they do, they do regular checks. I mean I can't tell you I've seen that before and it's like I, I bring my own AEDs and I'm covering, you know, not certain what's. It's great to have it in school but I like to have a, I have to have a plan B. If for some reason my, my ad would not work, then I got plan B that's right here. You got somebody stacking back up and then you also have the, you know, so to speak the calvary coming. EMS is going to. You're making the call to EMS.
[00:38:03] Speaker C: Yeah. And you know to Dr. Dresden's point, he's been pushing this the last 18 months or so.
Hands only CPR, no risky breathing.
Eyes open, chest moving. Put the pads on Ray and push the button.
Analyze. It's not going to shock unless it's refit.
So first lay rescuers many times want to try to take a carotid pulse and we've shown that in the field that the lay rescuers or medics or doctors or nurses sometimes fill there is a pulse there is none or can't fill it but it's there.
[00:38:45] Speaker B: So take the several years, several years ago several. That's one of the big changes that came into play in CPR. I want to say in 17 or either 18 I think it's when they made that change is okay, we're not doing it, we're not going. We're maybe a little bit later but it was maybe a couple years like maybe 19 camera exact year but I know that they changed. Okay we're going to do away with doing a karate false in the late in late and standard CPR because they weren't doing it right to begin with. It was more, potentially more harm than good. So.
[00:39:13] Speaker C: So this whole change in the initial five minute response I think is good and should be adopted by the sports medicine community.
After that first shock is delivered. Hands right on chest again. Don't wait and see that's an important concept.
No oxygen in the first five minutes is different. We think that the exercising adolescent probably circulates good oxygen for up to six, seven, even eight minutes. Then the so that primary response team, critical care triad response being modified from what we were taught is an important principle I think in improving outcomes.
After that primary response team does their job, EMS arrives, making the transition smooth and looking for a different vector of energy for the shock and readying for the Lucas device or the automated mechanical device to ease and transition from the field to the truck.
[00:40:25] Speaker B: We have two laps to go discussing cardiac emergency care and sports and the wise five with Dr. James Kyle. So, Dr. Kyle, you know, this is our big last question is importance of continuing education and education. So you know, we know that on not just education but ongoing education is essential for those in front lines of emergency medical response. One of the best ways for athletic trainers, physicians to the entire medical team, sports medicine team, as well as incorporating late providers such as coaches to stay informed by updates in emergency protocols and resuscitation techniques.
[00:41:03] Speaker C: Well, I think I'll say first of all, in small town USA in rural settings, which is the focus of the WISE 5 initiative, there's one common denominator in every team meeting, practice or game. And that common denominator is the coach. Coach Castle, they'll run through a wall for you if you ask them to.
So the head coach has to get buy in and the head coach should be part of the critical care triad. On practice day, the head coach has to get buy in and be the leader of the process. If you have the luxury of having a certified athletic trainer, that's a key player. Also the athletic trainers.
Certified athletic trainers need to be the catalyst for putting in some of these WI FI initiatives thought process including the transition piece by enter by chatting with the EMS squad that covers their practices and games and say, have you thought about the Wise five transition and changing the vector and that once you say that it's a common language, speak the.
[00:42:20] Speaker B: Common language and you'll get great results from it. So. All right, so let's roll in. We got five questions. This is our final lap. This is rapid fire. We're going to get five questions in about, in probably less than a minute and have some little fun here. So you ready for this final speed lap?
[00:42:37] Speaker C: Dr. Kyle, what's a speed lap?
[00:42:40] Speaker B: Well, we're going to find out real fast. So what that is. Okay, so what is. We have a little fun here. So what is your favorite number? Question one, what's your favorite place you've worked in athletic events?
[00:42:50] Speaker C: Olympics. 96.
[00:42:53] Speaker B: Wow. Yep. We. I was there as well, but we probably ran, bumped at each other. Didn't even know it at the time. So work on the.
[00:43:00] Speaker C: I was tracking field. Track and field with Ron.
[00:43:02] Speaker B: Yeah, I was at the. At the practice facility down near the airport for a couple of weeks. Working there for. Before the events began. So. So your favorite TV series or it could be a movie even.
[00:43:14] Speaker C: Dirty Dozen.
[00:43:16] Speaker B: Oh, that's a great one.
That is a great, great movie. So. And had a pretty good. Had a pretty good athlete in that movie too, right?
[00:43:24] Speaker C: Yes.
[00:43:25] Speaker B: Yep. Like that as well. So favorite cartoon character growing up?
[00:43:30] Speaker C: Winnie the Woodpecker.
[00:43:34] Speaker B: Persistent. I guess that'll be the case, huh? Yeah. All right. So your favorite food or dessert?
[00:43:41] Speaker C: I would have to go with a hot dog with bamboo chili and onions.
[00:43:48] Speaker B: That sounds interesting.
[00:43:51] Speaker C: Chili. They make a big pot of that, Ray, and it's got to be reproducible.
[00:43:58] Speaker B: Okay.
[00:43:59] Speaker C: So you go to the local high school game, get some bamboo chili on a good dog.
[00:44:05] Speaker B: You solve that question for you. I'm going to ask you a bamboozer. I haven't. I haven't quite heard that before. So. Last thing is a fun fact about you that the audience may not know.
[00:44:15] Speaker C: A fun fact. I would say that I'd have to go to the golf course and say my hole in ones.
[00:44:22] Speaker B: That's pretty good. That's a. That's a really good fun fact because an emphasize audience not holding one but whole in ones and that's even. So how many hole in ones have you had?
[00:44:33] Speaker C: 2.
[00:44:34] Speaker B: I need to come hang out with you then I make. I mean I make it good just by osmosis. So with that. So, Dr. Kyle. So we're now in the victory lane. You know our audience victory lane. Thank you Dr. Kyle, so much. And sharing your knowledge and insights on the WISE 5 initiative before we close, what's one takeaway you'd like our listeners to remember from this show throughout my.
[00:44:59] Speaker C: Career, Ray, the working with emergency medical services, EMS and athletic trainers.
Both these professions started about the same time in the late 70s, early 80s and traditionally they don't seem to like to play together easily.
You're an exception. You're an emt athletic trainer. There are others of those out there and both understand the need to coordinate and practice and prepare for the unique injuries that occur on a sporting menu environment.
We've got to talk to our EMS about sickle cell trait and delayed cardiac arrest with exercise collapse. We've got to explain to them bits and pieces about concussion and what might happen as well as heat.
And the trainers need to teach the EMS to cool prior to transport. So my take home point is that let's continue to fuel education, joint education for that sphere between EMS or er, emergency medicine and athletic training, sports medicine. That Venn diagram middle is a sweet spot, Ray. And folks like you in action medicine and other entities in the Southeast are doing an excellent job of getting the message out. Keep it up.
[00:46:34] Speaker B: Well, thank you very much. I think we're, I think the, the that that's that big sphere is getting a lot closer. It's definitely we've seen a lot closer codifying the role that both EMFs and also for athletic training the uniqueness of the advantages we bring to both the table to make for an efficient tier, make for an efficient team overall. And also I want to say ems. I think I also want to. That includes your fire department as well. Don't want to. We've talked about ems, but that includes the emergency response. So not just for the ambulance service but for fire departments as well. Shout out for them because they do some great. They do great, equally great work as well. Making our job easy. The one thing I love to do for an event, if I see anything there is like here, my job is to make your job easy. And if we don't have to call you and they understand that, they know we're on the same page and it works really well every time. So yeah, thank you very much, Dr. Kyle.
[00:47:32] Speaker C: And the medical timeout that you alluded to in the beginning that, that you've adopted there in the state of Louisiana puts everybody together, all those entities together to go through a checklist. What a great time to share information and get new knowledge. The new medical timeout for 2024 has QR codes on the back of it for Dr. Dresner's cardiac arrest video and equipment removal for C spine injured athletes, all in the back with videos that can be shared. EMS trainers fired. The whole group ready to look and learn together.
[00:48:16] Speaker B: Well, we're going to get you on the show again. If you'd like to come up, talk about the medical timeout because I know some updates we've had with that as well in the last and last year. Correct?
[00:48:24] Speaker C: Correct.
[00:48:25] Speaker B: All right, good. So, hey, thanks so much for listening and hope you enjoyed this show. Please make sure to follow click the follow button on your favorite podcast app so you never miss a lap. And don't forget, it's free. If you're interested in gaining valuable insights, courses and more from some of the best in sports emergency here. Please sign up for the Vital connection newsletter at ActionMed co. I'm Ray Castle and you've been listening to the AT podcast. We're out of here.
[00:48:58] Speaker A: Thank you for joining us on the @Picreu podcast. We encourage you to to like, subscribe and join our community.
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The medical information provided within this program reflects the opinions of the host and guests and is intended for informational and educational purposes only. It should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your healthcare provider with any questions you may have regarding a medical condition or treatment.
