Football EMS Standby

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hops19

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All, I tried to do a search, but I didn't find much on the message board. And what I did find was more than a few years old...

First off, I'm not an EMT. I'm an Athletic Trainer. We have been given permission to contract with our local fire department to provide EMS Standby for Varsity Football games. What I'd like to hear from you is any kind of expectations y'all have as EMS showing up to our games? And anything in particular we should expect from the EMS? I do know that we will have a dedicated ALS unit onsite with two paramedics on board. They won't be leaving to respond to 911 calls.

Most games we will have two Licensed Athletic Trainers on our home sideline. Plus we normally have our orthopedic surgeon and a PCP. Almost always will we have one of the two. I plan to provide the paramedics with a stadium radio and the department will be provided with our Varsity Football Emergency Action Plan, once it gets revised this spring/summer.

Anything else that I should consider? Anything that I should be letting them know of ahead of time? Other thoughts?...
 
You have two physicians, including a surgeon, at high school football games?...

For all the high school games I've done, all we ever did was stage outside of the track and get waved in if needed. A radio would be great, but where we typically staged it wasn't needed.

If you have players with medical conditions, it would help to have easy access to that information. You don't need to give a list to the medics, as they wont likely be that involved. But have one handy for yourself in case someone goes down, then just pass on the info to the medics.
 
Yes, we are well covered in many cases. But it's Texas football... We are nuts! Lol Smetimes for home games we have closer to 8 doctors on the field.. Depends on how many residents/fellows show up with our team docs that week. We do carry copies of medical information and emergency contact info for our kids so that's always handy. Fortunately we don't plan for the medics to do much, but they are there in case of an emergency we can't handle onsite. Our facility is equipped with numerous AEDs and we carry additional cardiac supplies for the doctors. We also carry a variety of splints and equipment removal gear. You'd think this was more of a small college, rather than high school based on some of the things we have...
 
I have lived in both worlds. From the ambulance side of things, there are a few things I need to know. Since you usually have a physician on the field, I want to know who that person is and meet him/her so that I can recognize that person later if need be. I need to know when I'm needed on the field. I radio would be good to have. I also know that I'm not going to be called out on to the field for very many things and all of them are going to be bad. What I also need to know is whether or not I'm going to need my airway kit and/or my spine board (and associated gear). I also need to know who has access to whatever method you've got on hand to remove the facemask and what that method is. Lastly I need to know if we're going to be working a code. If you have a card that has the injured player's info on it, that's fantastic as it lets me know name, age/DOB, allergies, medical history, and any medications being taken.

From the AT side, I don't want the medics to rush out onto the field until they're summoned even if they see a player go down. There are safety issues behind this. Furthermore, we can handle many things "in-house" without their assistance. Medics need to know that AT's know a LOT more about orthopedic trauma (among other stuff) than they do and often know exactly what broke and may actually only be requiring transport and pain management services from the medics when summoned. If I've already splinted the injury, please don't remove the splint. There's nothing to be gained from it if you take the time to listen to what I have to tell you about how it happened and what my evaluation is.

From both sides, this is a closed medical system that exists outside the usual prehospital system. Each side has knowledge, skills, and abilities that the other does not possess and this is to be respected.
 
Yup, South Texas here. Lived, played for, and even did standby for a good sized 6A team. Never once saw a physician, though. Just thought it was interesting.
 
I’ve found it useful to have the Ems crew actually meet both team’s head athletic trainers before the game. Take that opportunity to confirm that EMS will only come onto the field if clearly signaled (decide/confirm that signal then). Something new (since August 2015) is to make sure that all parties agree on the removal (or non-removal) of helmet and other football pads if a player is being transported.
 
STXmedic said:
Yup, South Texas here. Lived, played for, and even did standby for a good sized 6A team. Never once saw a physician, though. Just thought it was interesting.
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Sorry, saw your location after I posted. I'm up in Dallas. My understanding is many games have a physician on the sideline. Or maybe we're just fortunate. Our orthopedic surgeon splits his time between us and another high school. Last year he made it to 7 of our games I believe.. I think there were only two games where we didn't have at least one physician on the sideline with me.
 
I was an ATS in the Austin area (25-4A at the time, now 25-6A I think.. yeesh...). We had our team ortho surgeon and/or family practice doc (who headed up our concussion team) at every home game, in-district away game, and playoff game. They get free sideline passes to some awesome football and patient referrals in return for a few hours of service a week, so it seems like a pretty fun gig if you ask me.

I completely agree with everyone's recommendation of a pre-game meeting. There should be a pre-season meeting with the department to discuss and pre-plan the EAP, transport locations, decision makers, etc. Then there should be a pre-game meeting between someone on the AT staff and the crew to shake hands, see faces, and clarify roles/expectations.
 
I did the student-trainer thing in college for a D1 hockey program. We were fortunate to have a dedicated group of paramedics (and now me) for that standby, and we could only be used for players, coaches, and officials. Twice a year we would go through some scenarios on the ice with a fully padded equipment guy to make sure everyone was on the same page. Our student trainers were also EMTs so they would participate as well. The doctors were left out as frankly the goal was to move the patient from the ice as quickly barring any sort of airway compromise or need for immediate pain management.

The ambulance crew, students, and ATC all had radios to communicate, and in the event the ATC took a player back one of the EMS group and a student would meet him back there to assist. Our crews could and would help the docs out with suturing or with IV starts. The students and an ATCs all keep cards with the players and coaches basic demographics, history, meds, and allergies, these are super helpful.
 
I volunteer for a not for profit football program that doesn't have the money for formal sports medical care. It isn't a big thing, just myself, another EMT, and a medic on the sidelines with basic equipment. I also have a girlfriend who is an ATS.
From my experience what I find would be most helpful is to have clear lines of expectation. EMS is not ideal for sports injuries since we do not have that kind of specialized training, hence AT's, but when there is something serious, we are very well prepared. If everything is spelled out in the beginning, there should be no issues, but if it were my ambulance at the field, I don't want to be clashing heads with the AT or MD. I want to get my patient and do my thing. The help of ATs and doctors would be very helpful, but it has to be clear who's patient it is once EMS is summoned.
That's my two cents, and I did not see anything like that discussed in the thread.
 
jjs said:
The help of ATs and doctors would be very helpful, but it has to be clear who's patient it is once EMS is summoned.
That's my two cents, and I did not see anything like that discussed in the thread.
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This is a hot debate in the AT community, and there are many professionals on both sides that will argue against you. The subject athlete becomes your patient when the AT transfers care to you, just how your patient is not the ED's until you transfer care to them. ATs do injury and incident documentation as well, but to much greater detail than that of EMS because they will probably be seeing that athlete the next day, and the next day, and the next day. ATs work under a physician's license, just like EMS providers.

My easiest example is of an athlete with a suspected spinal injury. At programs with the right gear, you can usually expect a fully packaged patient before EMS is even on-scene if they weren't staged. In the event that EMS (or Fire) arrives to AT staff preparing to board a patient, many professionals would consider it inappropriate for EMS to step in with anything more than "I'm here, I've got stuff, knowledge, and hands if you need me. Where are the demos?" The simple matter of the fact is that any level of EMT cannot offer anything more to the patient than an AT other than anxiety of a growing situation, especially with adolescent athletes. When it is time to get off the field, the handoff can be finalized and EMS can load onto the stretcher and into the ambulance.

That said, not all athletic-related injuries are first-aid or even BLS level calls. It is the responsibility of both professionals to know when they are batting. If post-log roll a patient stops breathing and becomes unresponsive, hands may change. If the patient was in cardiac arrest upon EMS arrival, hands probably changed before the crew was in arm's reach.

It is worth noting though that the AT profession is greatly growing in its capabilities. At more-funded and/or progressive programs ATs will have oxygen, airway adjuncts, BVMs, and even IVs and certain fluids, and the training and protocols to go with them. I can say from experience as an ATS at a D1 school, the ambulance may be just a formality and/or a ride.
 
Thanks everybody for your thoughts. And I'd love to hear more. I agree with the idea that Friday night is not the time to be picking battles with each other and we don't want that. Let's be honest, if I was looking for that battle, I wouldn't have sought out and gained the approval to have EMS there! It's about providing appropriate and excellent Athletic Healthcare to our student-athletes. EMS is a part of that team.

Fortunately I don't think we are going to have a problem with that, we've built a working relationship with the department already and I think this will help to grow that relationship even more. The first time that my assistant and I called an ambulance for an injury, we had a paramedic walk up and basically pretended that he was talking to a bunch of coaches. It took everything we had for the 3 ATs on the field to not lose our mind on him. Every other time we've called (and we've called numerous times in the last two years) we've had great experiences. The paramedics show up and one of us is holding c-spine. We give details, We basically go through normal instructions and we do it. No bickering of who is in charge or anything like that. We all understand that the individual at the head is in charge and they're giving directions. Just that simple.

Our goal is for the paramedics to pull up in the ambulance and just roll. We expect to have an EAP that is logical to everybody involved, have clear communication, and run smoothly. We've never rehearsed an emergency action plan in the two years we've been here... but we've run it smoothly 8 times. Our medical staff knew what we needed to do, our security staff and game administrators knew their role, and EMS stepped right in to provide what was necessary.

And I agree about meeting with EMS prior to every game. In fact, the NATA came out with the recommendation of a "Medical Time-Out" in pre-game much like what is done in the operating room, to communicate and make sure everybody is on the same page. When we go to an opposing school who has an ambulance, I make it a point to visit them before the game and introduce myself. And then I tell them "I hope I don't have to talk to you again tonight." :)
 
hops19 said:
The first time that my assistant and I called an ambulance for an injury, we had a paramedic walk up and basically pretended that he was talking to a bunch of coaches.
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That Paramedic probably did think he was talking to a bunch of coaches who have far less training than he does. On top of that, Paramedics are used to being the ones giving directions, not taking them from those they consider "lay people." In all of the EMS policies that I've read there is nothing in place that recognizes any person other than a physician (MD or DO), an RN, or another EMS person as being capable/allowed to provide patient care. As capable as ATs are, they're just not formally recognized. The closest any policy I've seen that could potentially allow for this is something similar to Sacramento's Policy #2036: "Authority for patient health care management in a non-disaster medical emergency shall be vested in that licensed or certified health care professional, which may include a Paramedic, or other prehospital emergency personnel at the scene of the emergency, who is most medically qualified specific to the provision of rendering emergency medical care." That particular policy also requires the presence of 2 or more ALS providers from different agencies to be on scene. This allows for Flight Nurses to take control of medical care on scene. Otherwise there would be problems when a ground ALS provider transfers care to a Flight Nurse as without this policy, there's no mechanism truly in place to allow this as otherwise Sacramento County recognizes the RN as being only a BLS provider unless they're locally accredited as an MICN. Some policies do have a specific policy regarding transfer of care from ground personnel to a Flight Nurse even though they otherwise generally recognize RN personnel the same way in the field... BLS unless MICN.
 
Beyond what everyone has said, i would add the you should specifically review spinal motion restriction with all parties involved. With football season ending and wrestling in full swing, we have had a few issues in the department. These trainers are expecting full c-spine while we have moved away from that. We just met with our HS training department following an incident of disagreement on a wrestling mat.

That being said, we have now decided to hold a meeting at the beginning of each season with the department to review any changes in either sides policies and address special consideration for that seasons sports.
 
@hops19 , it's awesome to see someone like you seeking out our feedback :)

From my days doing high school football standbys, things were always vague, and there was a lot of hope that EMS wasn't needed. College was much better, partially because the school has a large AT education program, and lots of AT students invovled, as well as others. They handled their own stuff, and very rarely did EMS get involved. Heck, some of the time, EMS got called to the locker rooms after the AT staff drove someone back in and worked on them in their training area.

I'll also say that I had more EMS issues with non-players than with players - band member heat illness, football booster burning themsevles in the concession stand, chest pain and syncope in the stands, etc.

So... as a medic showing up at your games, I'd like to know:
  • When and how you will involve me in an on-field emergency

  • What your take on spinal motion restriction is
    • Backboards?
    • What gear comes off/stays on (do you just pull the mask, or take of the helmet?
  • What am I responsible for
    • Fans, or JUST players
    • Can I transport a fan? Or do I call another ambulance to hand-off the patient
    • Do I need to get another truck to the stadium ASAP, because play stops without an ambulance?
      • This is how PA is at high school and college level.
  • Who the medical "players" are, on both teams, so I know who to work with.
 
Lots of helpful replies here.

This is what I have to offer. We provide BLS standby at EVERY highschool game. Frosh, JV, and Varsity. Sometimes we will send ALS of there is no BLS available, but they only get billed for BLS standby.

The doctors on the field is VERY excessive. There is little a doctor can (or will) do without a team in a hospital to help. I understand having one to assess and reset dislocations, etc, but a surgeon, or 8?! Excessive and likely to only cause problems. As some people pointed out, most EMS policies do not recognize a physician in the field as a car provider and they are considered lay persons.

One thing we are required to do before every came is meet with the home coach and athletic trainer. We talk, and we have to physically see a facemask removal tool. Depending on the school, they may give us a radio. It would also be good to have the students' emergency cards ready. Often EMS will need these to contact parents. This is especially important to communicate to your away team if you are hosting.

Also, hospitality is nice. Tell the snack bar to give the guys a free coffee or something to make them feel welcomed. We never expect anything like that, but it's nice to know we're welcomed at the school.
 
NPO said:
Lots of helpful replies here.

This is what I have to offer. We provide BLS standby at EVERY highschool game. Frosh, JV, and Varsity. Sometimes we will send ALS of there is no BLS available, but they only get billed for BLS standby.

The doctors on the field is VERY excessive. There is little a doctor can (or will) do without a team in a hospital to help. I understand having one to assess and reset dislocations, etc, but a surgeon, or 8?! Excessive and likely to only cause problems. As some people pointed out, most EMS policies do not recognize a physician in the field as a car provider and they are considered lay persons.

One thing we are required to do before every came is meet with the home coach and athletic trainer. We talk, and we have to physically see a facemask removal tool. Depending on the school, they may give us a radio. It would also be good to have the students' emergency cards ready. Often EMS will need these to contact parents. This is especially important to communicate to your away team if you are hosting.

Also, hospitality is nice. Tell the snack bar to give the guys a free coffee or something to make them feel welcomed. We never expect anything like that, but it's nice to know we're welcomed at the school.
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Having doctors available is a godsend in the athletic training field. Care can be provided there, as can exams and scripts. If they want to send eight to watch the game in exchange for free visits, by all means. While normally I am not going to immediately default to a physician, they are part of the care team and should be treated as such. Generally we have three docs at both our lacrosse and hockey games, we are yet to have an issue. It makes even less sense to discredit them if you're BLS too...
 
Thanks Jon. Like I said, it's about providing appropriate and excellent Athletic Healthcare. The AT is the main provider and on the front lines in order to do this, but there are other providers who are important to our Sports Medicine Team. Our team doctors are also very important to us and I think the thing I like the most about them is the fact that they let myself and my assistant do our jobs on Friday nights! (And every other day too haha). Our docs know their role and they aren't afraid to back up and let us do our thing. They largely play a supervisory role and they don't put their hands on a patient until I request that they do so. Is the fact that there are sometimes 8 of them out there overkill? ABSOLUTELY! I've said it too. But they don't get in my way and they don't interfere with what I do. On the field, our doctors do not evaluate injuries. I do. I even have a picture of the entire group on the field once this past season and I realized later that I don't think my assistant even got down next to the athlete.. only I did. But I had plenty of help if I needed it! I have been fortunate to always have team doctors who were of the mindset that "we're here to watch a football game, the AT is in charge!"

I don't want this to be vague. I want this rock-solid. That's my plan. The ideal situation would be if the department sent the same two paramedics each week, but i understand that's probably not feasible or likely to happen. It's a big department! We will also work to make sure that our EAPs are set up with them both on-site and from 911 perspective. It should all be smooth.

Our EMS still uses the spine-board and has always used it when we've requested it. And they don't remove the athlete from the board until they get to the ER, in my experience. I am considering asking if they could give us one to keep on-site all the time and then swap out with the responding ambulance. I don't know if they'd do that or not, but it's worth asking. As of right now, we are prohibited from removing equipment other than the face-mask. Our docs are telling me no. We do carry an assortment of face-mask removal equipment. I carry shears in my belt back, a quick-release tool in my belt pack, an additional pair of shears in our cardiac backpack and an additional quick-release tool in that pack, plus we keep screw drivers and a cordless drill on the sideline.

I know that every ambulance we will have on-site or have respond 911 to our stadium is an ALS rig with two paramedics on board. We are not required to have EMS onsite for football (I wish we were!) so calling another ambulance in that situation is not necessary. What I will have to find out is who is responsible for transport.. will the onsite truck leave or will they call a duty rig? Preferably, in most cases, we'd like for them to call a duty rig and only have the onsite ambulance leave in case of an emergency that requires immediate care (i.e. SCA).

I expect the paramedics will be called upon to provide basic first aid for spectators and other off-field individuals. I'd prefer they handle those minor things, because otherwise it's likely that the ATs will be called by stadium management to do so! Wouldn't be the first time! Problem is the stadium ops manager on Friday nights does not see eye-to-eye with the medical staff as he and I have had a couple of disagreements over the last two years. I actually went around him to get EMS approved this year after he told me "we can't afford that!"
 
I think you have the right idea. We used to give local sports medicine people backboards all the time and now do the same with vacuum mattresses. The "research" I have seen says to leave football player's helmets on unless you can't remove the facemask. Their pads are large enough to provide for neutral alignment. Hockey and lacrosse helmets should be removed.

If you are paying for a standby ambulance I think it is reasonable to require it remain onsite and use another crew for transport.
 
Tigger said:
I think you have the right idea. We used to give local sports medicine people backboards all the time and now do the same with vacuum mattresses. The "research" I have seen says to leave football player's helmets on unless you can't remove the facemask. Their pads are large enough to provide for neutral alignment. Hockey and lacrosse helmets should be removed.

If you are paying for a standby ambulance I think it is reasonable to require it remain onsite and use another crew for transport.
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The NATA and a few other organizations came out with a consensus statement last summer that said we should start removing equipment on the field, when possible. The logic for that is that chances are the ATs and other sports medicine staff members are more likely to be familiar with the specific equipment rather than the ER staff. I would certainly agree with this idea, however the statement has seen much criticism and currently is one of those ideas that thrown up in the air. My doctors currently tell me that I am not to remove the equipment, other than face-mask, under any circumstances. I obviously have to follow orders, even if I disagree with them.

One alternative I'm seeing in protocols is suggesting that a member of the sports medicine team travel with the injured athlete in the ambulance so they are able to assist with equipment removal in the ER. Obviously the problem with that is having the personnel available to be involved in transport and be pulled away from the game. All of it remains a work in progress and much to be considered!
 
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