I'm one of the primary care sports medicine physicians at University Hospitals, one of the assistant medical docs for the Cleveland Browns. I kind of got into on-field management of injured athletes. Whenever I was at Rutgers, I was there two years after Eric LeGrand, so if you ever get a chance to look that up or if you remember him, really inspirational guy. And my program director said, hey, whenever you get out into the real world, you need to make sure that you go and teach people how to do these things, get everybody together. So regardless of what we teach here today, what you learn over this course, if you're not practicing your emergency action plan, none of this matters. As much as we all wanna believe we're gonna rise to the occasion, the truth is is that you rise to your preparation. So we wanna make sure that we do that. I don't have any disclosures. So we're gonna talk quickly, who are the people that are going to be there? And it depends on the level. We basically have a full hospital on the sideline at the NFL games and we have the ability to do a lot. But on the sidelines at the youth level, at the college level, you may have an athletic trainer, a sideline physician, an EMT, student aides, coaches, you can use all of them as long as everybody knows their roles. And that's the most important part of this. Not all equipment is created equal. And so we wanna make sure we know what sport we're dealing with and whether or not we're gonna remove the pads, put a towel under the head or the neck before we put the cervical collar on, what we're doing to make sure that we try to keep the spine as neutral as possible. Just like Mark had said, we wanna make sure we got that taken care of because millimeters really do matter here. There's not a lot of space in that cervical collar and there may be even less depending on what congenital abnormalities somebody may have. So if you take the shoulder pads off, but leave the helmet on, you're gonna put the neck in flexion. If you take the helmet off and leave the shoulder pads on, you're gonna put the neck in extension. And if you leave it all together, the nice thing about football pads is it'll keep everything pretty neutral. The newer helmets, there are some studies that are gonna look at the newer helmets as the occiputs get a little bit bigger to make sure that that still holds. Face mask removal. What we do with the Browns is we take the face mask off. We're talking about a cervical spine injured athlete. That's all we're gonna take off. We don't wanna take a stable athlete and make them unstable. And like was said earlier, the less you move someone, the better. So if we're just taking off the face mask, that's what we're gonna do. It's fairly easy to take on and off in a setting like this, but when it gets cold in the middle of winter, when you're playing, things get frozen, things get stripped. You have to be at least a little bit familiar with how all of these things work. So whether it's a trainer's angel, I use aviation tin snips because I can get them in there a little bit easier. You wanna designate one person that's gonna be in charge of all of that equipment and make sure that everything has a backup. And everything works before you get out there. So what we don't wanna do is this. A couple of things with this. It starts, your emergency action plan actually starts with preparation beforehand. So it's talking to your athletes and making sure that nobody puts the strap through the face mask. The face masks, the helmets are getting better where they won't let them with certain ones, but if you still have the snaps, you don't wanna put it through there because when you go to take the face mask off, it'll get stuck and then you have to pop that off. It'll move it a little bit. And so whenever we get down into the hands-on portion, try to pop these off and see how much the head moves. The other thing we don't wanna do is, I know that some people will say it gets quicker. I don't think we do this much anymore, but I still see high school kids' games. This does happen. Don't do this. This creates a lever and creates a lot of, just basically a big obstruction from getting one side to the other. So it doesn't take much longer to pop these off, get it off quickly and get the whole helmet off. Couple of pearls here, so don't do that. We're gonna watch a quick video. I think it's gonna play. Not be popped off or unsnapped. Additional team members come from the side and do a tilt lift in order to lift the chest off the ground just high enough to remove the helmet and shoulder pads easily. This should be one to two inches off the ground. The second in command assumes C-spine stabilization from below and under the shoulder pads. At this point, the second in command has C-spine stabilization and makes the call to move the athlete. One, two, three, lift. So that's key. The person that has C-spine stabilization has to make the calls. And the team leader removes the helmet and shoulder pads simultaneously. The helmet is pulled toward the leader and rolled forward to facilitate removal. Do not pull out on the ear holes when removing the helmet. And down, one, two, three, down. Once the athlete is safely on the ground, C-spine stabilization is transferred back to the leader. So a couple of things when taking off the helmet. If you look inside the bonnet of the helmet, it's gonna be an oval shape. When you're taking the helmet off, don't pull on the ear holes to try to get it off. It's not designed to go on and off that way. It'll take that oval shape and turn it into a circle and that'll stick to the front and the back of the head. So you really do wanna just pull it. Sorry, I should do it this way, right? Just pull towards you and roll forward and it'll come off. So a couple of pearls, you know, and then we'll get kind of into the demonstration here. We'll get you guys on some hands-on stuff. But the helmet, if you've got a stable helmet, don't take it off. We've kind of gone over that. Remove the face mask completely. Test your tools. Remove the mouth guard, especially if the mouth guard's attached to the face mask. Make sure the mouth guard's out before you take the face mask off. Cut the chin straps. Pull the helmet towards you and roll it forward and don't pull on the ear holes. As far as the jerseys go, the big one is to remember to cut the sleeves. If you cut down the middle, you're still gonna have the sleeves on. When you go to pull the pads off, it won't come off. The shoulder pads, same thing. Cut the straps. Make sure you're cutting the midline. And then be aware of any additional equipment. You wanna make sure that if they've got a cowboy collar, if they've got flap jacket on, you're taking that off as well. C-spine stabilization has to be maintained throughout the entire process. And so once you have C-spine stabilization, that's what you've got, you're not doing anything else other than holding that C-spine stabilization. If you have to transfer it, the only time it's transferred is when the helmet's removed. So you need somebody else to make the all-call signal. Make sure that you're practicing that in your emergency action plan. If you're down on one knee, you really can't be seen all that well, whether it's hand up, whether it's hand out. So just make sure everybody knows the all-call signs. And with that, we'll kind of get into the demonstration. So if you guys wanna come up and around, we've got a volunteer who's gonna be the athlete. So Ryan, our intern from the Saints, is gonna be our model here. Just to let everybody know, Ryan's still getting paid today while he's here. So unlike Ronnie Barnes, when I was his intern, you know, he wouldn't give me anything. He'd be like, you're gonna do it and you're not getting paid for it. But once we get done with this, one of the things I do want is, so Kareem Mayer, Kareem is our ortho, our head ortho over at the Saints. And one of the things I want to bring to everybody's attention, I was with three, this is my fourth season, but me and Kareem, we're new to each other. Kareem, he's been here two years with us and we had a very similar situation and we debriefed after. One of the things I want Kareem to do, hopefully we'll run through this quickly, but before we depart from here, I kind of want Kareem to get up and talk about like some of the changes that we made because we didn't know each other, right? He's a new team physician. I'm a new head athletic trainer in a new area. And we debriefed and made some changes on how we handle some of our on the field evaluations. And it was really good and ideal for us, so.

primary care sports medicine physician

injury management

preparation

teamwork

emergency action plan