Heat stroke treated on-scene?

[Christopher]

That's a huge problem outside the sports med community. EMS doesn't know what an ATC is able to do, and doesn't recognize them as anything higher than a lay person.

The trick to working with any provider (or providers) you've never met on a call you're dispatched to, is to begin incorporating your team into their team to ensure continuity of patient care. Usually it becomes immediately obvious where everyone should fit in the newly formed team.

If we're called to haul, I expect some sort of handoff (ISBAR is a good start).

If we're called to assist then haul, I expect some understanding of where our protocols start and end w.r.t. patient care. This is usually where we get hung up with "outside" providers.

 

[Christopher]

Does anyone have experience with being called for a likely heatstroke patient at an athletic event, but having the trainers refuse to have the patient transported until they have cooled the patient?

There are some position statements from the athletic trainers that seem to support this approach, but I haven't heard first-hand of any conflicts between EMS and trainers.

(See page 9 of this position statement from the NATA to read their reasoning)

We do lots of sports standbys and they pretty much only ask for us when they're ready for us to take the patient away. Rarely we've been brought in to assist in treatment.

The way I look at it is I'm in their house, so I'll play by their rules until a proper handoff has been made.

 

[mycrofft]

Ice bath, or even a cool water (< 59 deg. F) in a whirlpool is extremely effective. Wide open garden hose works well too. The problem with using damp sheets for cooling is that the body will warm up the water immediately next to it, thus limiting heat transfer. Same will happen with cool water baths if the water isn't agitated. Chem packs don't work that well... but are better than nothing.

Yep. Wet sheets and active adequate air conditioning, or even a strong fan, create an effect sort of like stirring the water. And deep baths will tend to stratify warmer water (up where the pt head hopefully is)…but also where the ice is.
I first saw the ice bath thing done using inflated sports rafts on a concrete floor and ice from the hospital kitchen machine.

PS: I had twenty or so folks overheating in chemical warfare sits once. WE were given rest time under shade, and I discovered the slab there was still cool from the night, so I had them lie down. Good heatsink, and when there got up there were these weird sweat pictures from their bodies' contact points, sort of like Pompeii. No one had to de-suit.

 

[mycrofft]

The trick to working with any provider (or providers) you've never met on a call you're dispatched to, is to begin incorporating your team into their team to ensure continuity of patient care. Usually it becomes immediately obvious where everyone should fit in the newly formed team.

If we're called to haul, I expect some sort of handoff (ISBAR is a good start).

If we're called to assist then haul, I expect some understanding of where our protocols start and end w.r.t. patient care. This is usually where we get hung up with "outside" providers.

YES! This has to be top-down, though, or each section's boss will assume that he or she is responsible and try to run it.

 

[mycrofft]

Done correctly, that stuff will be addressed and will be well known and disseminated to all participants on the medical end of things. I've done sports standbys that were very well run and everyone knew where they fit in the overall plan... from physicians (team and stadium in that case), to the RN's working with the stadium physicians, to the ATC's on the field, to the Paramedics and EMTs in the venue. I know your last gig wasn't as well set up... by far. And that's all I'm going to say about that.

Haha re my last gig.:lol: Issue there (this time) was working out of class for me, which is another whole can of worms if you hire out to do "first aid standby" at events.

You were involved in well-regulated events then. My experience was in Jr Peewee Football and their cheerleading auxiliary, as well as Spartan Race and Tough Mudder (observer/bystander) .

 

[Akulahawk]

The trick to working with any provider (or providers) you've never met on a call you're dispatched to, is to begin incorporating your team into their team to ensure continuity of patient care. Usually it becomes immediately obvious where everyone should fit in the newly formed team.

If we're called to haul, I expect some sort of handoff (ISBAR is a good start).

If we're called to assist then haul, I expect some understanding of where our protocols start and end w.r.t. patient care. This is usually where we get hung up with "outside" providers.

This is another area that's not well provided for in EMS provider protocols. Those protocols usually assume that anyone providing assistance at any "scene" is a layman, or has to fit into some sort of "physician at scene" or something similar, with no provision for the Paramedic to setup or work within a collaborative care environment that would be present at an athletic event where ATC's are present. In other words, unless there's a physician there, EMS is directed to assume the role of highest medical authority and take over care.

Because of the somewhat unique situation of sporting venues, and the usual lack of problems requiring EMS to go there, I would expect that not much thought would have been put into how EMS interacts with sporting venue medical personnel. ATC's know this, so that's why when EMS does sports standby's, the ambulance folks are directed NOT to respond to something unless called to it. In effect, the problem is avoided instead of dealing with finding a way to provide the best care possible.

Is this problem solvable? Yes. Likely to happen? Not any time soon because of the solution that is currently in use.

 

[Christopher]

This is another area that's not well provided for in EMS provider protocols. Those protocols usually assume that anyone providing assistance at any "scene" is a layman, or has to fit into some sort of "physician at scene" or something similar, with no provision for the Paramedic to setup or work within a collaborative care environment that would be present at an athletic event where ATC's are present. In other words, unless there's a physician there, EMS is directed to assume the role of highest medical authority and take over care.

Yeah, that is definitely codified in many a protocol book. Ultimately, as mycrofft pointed out, somebody has to be in charge. But, that can be fluid as the case progresses.

Because of the somewhat unique situation of sporting venues, and the usual lack of problems requiring EMS to go there, I would expect that not much thought would have been put into how EMS interacts with sporting venue medical personnel. ATC's know this, so that's why when EMS does sports standby's, the ambulance folks are directed NOT to respond to something unless called to it. In effect, the problem is avoided instead of dealing with finding a way to provide the best care possible.

Is this problem solvable? Yes. Likely to happen? Not any time soon because of the solution that is currently in use.

We work really closely with a number of non-prehospital professions on the disaster team I'm a part of, and we enjoy the company of everybody from HVAC technicians to physical therapists when we work events. Once you break down some of those barriers between different professional groups, you can work really well together.

 

[mycrofft]

Yeah, that is definitely codified in many a protocol book. Ultimately, as mycrofft pointed out, somebody has to be in charge. But, that can be fluid as the case progresses.1.



We work really closely with a number of non-prehospital professions on the disaster team I'm a part of, and we enjoy the company of everybody from HVAC technicians to physical therapists when we work events. Once you break down some of those barriers between different professional groups, you can work really well together.2.

DMAT?

1. Not too fluid. "Who's in charge" can ratchet up but not down. If the big chief comes and takes over, he either stays, or when he arrives he makes sure he or she sort of takes the boss aside and drops some orders, then shuts up and lets the on scene commander command the scene. Otherwise, the Big Chief either stays and works there, or splits and leaves swirling uncertainly behind.

2. "You can work really well together" to a point. Up to that point you could be using well-trained Walmart clerks and Midas muffler guys, then if professional skills start coming into play it begins splintering again…unless yo keep yourselves muzzled.

 

[Mariemt]

As a bls provider, I have a question about active cooling.

I have suffered heat stroke and before anyone got home I tried a cold bath. Apparently that was a bad idea as it can cause seizure activity.
This was long before I was in ems.

As for who is in charge. Our protocols state once we are dispatched, if a physician is on scene and wants to take charge, they must be prepared to accompany us to the hospital. Trainers here in this area are not medically trained beyond wrapping ankles which is why I stated they can not stand in my way or try to treat the pt once I am there, not allowing me to take over.

 

[Akulahawk]

As a bls provider, I have a question about active cooling.

I have suffered heat stroke and before anyone got home I tried a cold bath. Apparently that was a bad idea as it can cause seizure activity.
This was long before I was in ems.

As for who is in charge. Our protocols state once we are dispatched, if a physician is on scene and wants to take charge, they must be prepared to accompany us to the hospital. Trainers here in this area are not medically trained beyond wrapping ankles which is why I stated they can not stand in my way or try to treat the pt once I am there, not allowing me to take over.

If trainers aren't medically trained beyond wrapping ankles, then it's quite likely you live in Alaska, California, or Hawaii. You should ask them if they're ATC certified...

 

[mycrofft]

As a bls provider, I have a question about active cooling.

I have suffered heat stroke and before anyone got home I tried a cold bath. Apparently that was a bad idea as it can cause seizure activity.
This was long before I was in ems.

As for who is in charge. Our protocols state once we are dispatched, if a physician is on scene and wants to take charge, they must be prepared to accompany us to the hospital. Trainers here in this area are not medically trained beyond wrapping ankles which is why I stated they can not stand in my way or try to treat the pt once I am there, not allowing me to take over.

Now they are proposing cold baths, but I'd not recommend any treatment for true heat stroke without attendants. They used to say a cold water plunge would cause a heart attack (really rare) or a cold water bath for heat exhaustion or heatstroke would cause so much shivering the pt would have a core temp increase (not if you keep cooling them). How about sitting down in a cool shower if you are alone?

If you have a current citation about seizures and cold baths please share!!

 

[hops19]

First of all, if I call you onto the field of play, DO NOT try to act like he/she is YOUR patient. Guess what? When I am hosting an event, my team physician and I ultimately have the responsibility for every player, coach, official, etc on that field of play.

With regards to exertional heat stroke (EHS) it is crucial that cooling is started IMMEDIATELY! If your protocols specify transport first in an EHS case, you need to be talking to your supervisors. This is one of probably very few cases where EMS transport must wait. For football in the heat, I keep cold towels, lots of ice, and a rectal thermometer on the sideline. I keep my whirlpool inside filled up. If we have a kid go down and suspect EHS, the cold towels will go on while we transport into the ATR to get him into the tub. Once we have the core temperature down, then we will transport via EMS.

I would recommend you trying to set up training sessions with your local athletic trainers. We may not deal with the same emergencies EMS does on a daily basis, but we can and should be your biggest allies when it comes to sports emergencies. We are trained to handle the equipment commonly found in sports.

Technically and legally, I operate under the direction of a physician just like EMS does. But realistically I call the shots on the field. That is my job. And when emergencies strike and we initiate EMS, we must work as a team for the betterment of the patient.

I had an incident earlier this year which necessitated EMS activation. From the time I initially arrived at the patient on the field, I never took my hands off the kids head/neck until he was strapped to the backboard. At that point, he is "your patient."

 

[mycrofft]

disregard

 

[clydemoses781]

Very useful. Thamks