Thank you guys. I've been asked to give this talk in 10 minutes. It's kind of like in Pulp Fiction when they ask the wolf, the cleaner, how far are you away? I'm 30 minutes. I'll be there in 10. So who here has transported a spinal cord injury? Raise your hand. Okay. Yeah, it's, let's see. There we go. The reason you do it is it's the highest rate of spinal cord injury in all of American sports is in football. I've covered home and away games for 20 years and I did 11 of these. And it's a, it's a nerve wracking event. And so I only have a couple of take homes from this talk. And one of them is you got to practice because it is, it is a very stressful event that's going on. There are a lot of things that are moving. And so if you don't take anything from this, it's practice and there's a QR code to the best article there is out there. So my first NFL game, first game I ever covered in that NFL preseason game, 105 degrees outside and Irving, Texas at old Texas stadium, probably 120 on the field, fourth play of the game, guy goes down, he's paralyzed. And so we had just been asked to become the medical team just a couple of weeks before that. We hadn't had any chance to do any preparation part of this. Thankfully, we had some very talented athletic trainers, some very talented EMS and paramedics guys that honest to God paramedics that work in the field and know how to scoop people up and get them packaged, get them in the hospital. But it was, it was an eye opener and I got brain burned from that. And from that point on, I was prepared. So the take homes from this lecture is having an emergency action plan. You've heard that from everybody up here. You have to identify who you're going to transport, okay? There's some simple ways to figure out whether you're going to do this drill or not do this drill because it is a drill. And once again, you've got to download this QR code. So get your phones ready. As I said, it's a high stress environment. You have to expect it to happen. You have to practice like it's going to happen. And so when it happens, you just do it. And so instead of it being an oh shit moment, it's an I got it moment, okay? So cooler heads will prevail in this situation. Being calm brings, is very contagious and it's helpful getting through this event. So probably the best paper written on this is Best Practices in Current Care Concepts of the Spine Injured Athlete in American Tackle Football. So it was done by the Spine Injury Sport Group, which was 25 healthcare professionals. And it really is soup to nuts. And so if your phone is ready, there you go. This is the most clever thing I've ever done is converting that to a QR code. The most clever thing I've ever done. And so I'll have it again at the end of the talk. So the Emergency Action Plan, you have to have a protocol specific for the venue, local emergency medical services involvement, scenario-based training. You have maintenance of your equipment and you got to practice. So protocol specific for the venue. So what does that mean? That means your practice field. That means your home stadium. That means is there a neutral stadium that your team plays at? And you hope to God that the doc on the other team and the athletic trainer on the other team has done it for the stadium you're visiting. You have to get your local emergency medical services involved. They got to know where you are, make sure that, hey, we have a game, 7.30 Friday night. Please be informed. Because most of the time they're not going to sit in the end zone for you. And you have to understand where you're going to take them, you know, preferably to a level one or level two trauma center. And then obviously you got to keep the equipment ready and available to spineboard these people off the field. So what about practice? And so with the Cowboys, we do this every year before the season and it's a full day. And you know, it's one of those things that sometimes seems to be somewhat painful to take a day out. But I can tell you this, once you've been under the lights and you're having to do it, you're going to be very glad you did it. So I've done it 11 times, but I've practiced it 20 times. And so the ability to practice and have some facility made my job a lot easier. All these skills are perishable. They'll go away in an instant. You know, if you're just waiting from year to year to year, they're going to go away unless you kick the rust off of them. So it used to be called packaging the player. Now it's spinal motion restriction. And so it's because what we found is that you can't truly immobilize the spine once it's injured. You just can't. But you try to restrict as much motion as possible. What is scenario-based training? So they're never out there just laying flat, right? They're all crumpled up in a mess. And so you have to figure out what's the best way to get them when they're prone, when they're supine. Are they fighting you? Have they thrown up? Have they bit their tongue in half? And are they in a cardiac arrest? And so all those things need to be walked through preseason prior to your games. One of the earlier speakers talked about our medical timeout. In the NFL, it's pretty easy. I mean, there's 30 providers there. And you meet 60 minutes before the game. And you go over all the scenarios, where are the players going, who's on call, et cetera. Now in high school, it's completely different. You have an athletic trainer, probably have a doctor there. You have EMS typically on call. You have coaches who you've roped into this deal. And you have high school administrators, the principal, the vice principal, and sometimes athletic director. And so these people need to be on board to help you with this type of an emergency. So everybody has different resources. But the only skill set that you truly control is yours. And so I ask you to be prepared. So what are the steps? The first one is scene survey. What does that mean? Well, you get out there. And all the players are around. Everybody wants to help. And that's when you have to cordon off an area to make it calm so you can take care of this player. Then you do your primary survey of the player. Then you stabilize the head and the spine. Then you get them restricted. And that's when you transport. So the survey of the scene, once again, you just got to generate the zone that the players are back. And so you can get the officials to do that, get team captains to do that, you get coaches to do it. But you got to let the emergency medical personnel, including yourself, have some room to be able to do this. So what's the criteria to transport? So severe spinal pain and tenderness. Frequently they'll tell you, doc, I broke something. I felt something go squish in my neck. Here's a very important one. A neurological complaint or finding in more than one extremity. Now most of you people have seen stingers, either a brachial plexus stinger or cervical nerve root and stinger. It's a unilateral phenomenon. If you have a bilateral phenomenon, that is the spinal cord. And if you have a bilateral symptom complex, then they need to be transported. So the first step, in line of mobilization. So the first guy on the scene, typically the trainers. That's been my experience here watching the game very, very closely. And we've always let the trainers go out first. And they go out. And usually the head trainer, in our particular instance with the Dallas Cowboys, Jim Maurer, be the first on the scene, grab the head. And whether they're prone, on their side, but grabs the head. You want to try to place them in a neutral spine. There's a little bit of controversy about this. And you really want to do severe manipulation if you have some airway problems. So what about head position? Who here has been in an emergency room when they came in and their neck wasn't straight? Nobody. Right? You? Okay. So I've never been, I spent 10 years at Parkland Hospital. Everybody that came in, their head was pretty straight. So straight's a good position to put it in. Allow the athlete to do it if they can. But gentle traction and getting them straight is a very good guide. Face mask removal. Anytime you decide that you're going to transport somebody, the first thing you do after you grab their head is take the face mask off, okay? That is, it sounds easy, but it's not. We practice it with our equipment men with the cowboys. Now these guys have power drills that they use to put on face masks on and off every day. And so when we did this, you've never seen a grown man shake like that. So once again, high stress environment. Make sure everybody knows what they're doing. Sometimes you just can only retract it, but if you can remove it, remove it. You have to have the tools to remove it, okay? There's an anvil pruner. There's a trainer's anvil, screwdriver, FM extractor, power tool, but you got to practice it. In the NFL, all new face mask. Two-way high school in Texas, been sitting out in the sun, a lot of sweat, rusted. So you got to be prepared to cut it off. Here's some of the typical tools to do. So what are the devices? Long spine board, scoop stretcher, vacuum mattress, extricator, and have cervical collars. So you got to be aware of what you're using. You know, do you have this little bitty tiny spine board and you got a six, five, 325 pound kid that you got to put on it? You know, so know who you're treating, know what you have and be prepared. Here's a picture of all those different devices. So when you transfer, communication is the most important thing. So the guy that's got the head calls the ball, all right? You have to have clear and concise commands, okay? You don't want to, you know, on three, what is that? Is that on three or after three? I mean, you just call the ball, okay? The number of people and the transfer technique is typically determined by the medical professional that's there and the number of people you have and the resources you have. When you go to this paper that I've given you, the QR code, they have a sheet that shows you all the different transfer methods and the different people it takes. It's everything from three people to nine people. So depending on how you're doing it, what you're using, whether you're doing a six person lift or not, details how many people you need. So typically we're all pretty comfortable with the spine board. You want to minimize the number of moves that you do to them. Face down, you log roll them, face up, you stabilize them, then you lift them up onto the spine board. So who here has spine boarded somebody? Raise your hand again. Raise them high so I can see. There you go. Good. A lot of people have. Excellent. This is what it looks like when you're done. You want to have them strapped in. Okay? They can't move. So equipment removal, CAB, circulation airway breathing, okay? So you can take things off to get their airway. So just the face mask off doesn't do it, then you take the helmet off. And then you have to have someone managing the head, keep it in line because you've got shoulder pads on. If you need to take the shoulder pads off, okay, you split them in the middle, you bring it open so you have chest access for CPR because you can't do CPR through the chest, through the shoulder pads, and then have to have a place to put the AED on. In general, when we send someone to the hospital, we send one of the trainers with us and then we have that blessing because we have so many trainers and they're skilled at taking off equipment. But remember that the helmet and shoulder pads are typically a pair. If you have the shoulder pads on, you take the helmet off, they go into extension. If you take the helmet off and you leave the helmet on and take the shoulder pads off, they go into flexion, which may make their spinal injury worse. So in conclusions, okay, have a plan. Got to have a plan, okay? You got to practice it. You got to identify who needs to be transported because it's a total fire drill and read the article. There's the QR code again. Everybody hadn't gotten it? That's my crew. The man in the beard in the middle, I was privileged to be the officiant at his wedding. That's my son. And I got a huge family. So those are all my kids and grandkids and everything. So thank you very much. I appreciate it.

spinal cord injuries

football

emergency action plan

practice and training

scenario-based training