So, that concludes our talks. We have about seven or eight minutes left for questions, so please feel free to come to the microphone here and ask any questions you have for the panel or any other discussion points you'd like to bring up on these topics. Who serves as the Athletics Health Care Administrator at Ohio State, what type of person? It's a physician, primary care sports medicine trained physician. Dr. Bergfeld, what's on your mind? You've got to have some question burning in there somewhere from all these talks you've just heard today. Please, enlighten us. I would ask, Chris, your structure of the medical team is great, it's ideal. Who pays the medical director? So, there is a, yeah. As usual, Bergfeld brings good points. Who pays the athletic trainer nowadays? And it hasn't changed, I don't think. So, you saw in my presentation, I hit some things that sound grandiose. One of the things you're probably sitting there, well, it sounds good in a conference room somewhere, but in real life, those things aren't that easy to implement. And you're right. Independent medical care, that structure, there's always, we live in a real world, right? Real politics and human interactions. So, you always strive to try to achieve those guidelines and those principles as closely as possible. So, at our institution, we have a memorandum of understanding, an MOU, between the medical center through the sports medicine center and the athletic department. In that MOU, we outline what services we'll provide them and at what cost. So, they pay us to provide them services. So, their check comes from the medical center, but the athletic department comes to the medical center to pay them. So, who pays them? Ultimately, the athletic department, but their accountability and if you look at where their check comes from, it comes from the medical center. I think this is maybe an ideal situation. How many of you have a medical director that's paid? The athletic trainer is paid by the director of athletics. Yeah, yeah. And human nature is you're going to respond to who pays your paycheck. He's got to look good in the eyes of the athletic director. And I think that's a real issue. What you say is ideal, but I would, what percentage of institutions have your kind of policy, would you say, across sports, division one, two, or three? I can't answer that directly, but I think a lot of those concepts, those in the room here, you realize, ooh, we don't quite do that. Ooh, we mean to do that. We don't quite do that. You know, it's, you always have to strive to achieve that. Your question on the athletic trainers, we several times have almost moved the athletic trainers into the medical center, but it's not quite happened for a couple of reasons. And I think the athletic department is closer and closer to saying we don't want the liability of having any clinical care tracking back to us. We want it to track to the medical center. So if there's any concussion issue, whatever, all liability goes to the medical center. But at the same time, they like to have some, they call it administrative oversight of the athletic trainers. And they quickly say, but medically the thing you do is the team position, but administratively they oversee them. So there's a bit of a dance going on there. I have a question for the audience. This is a survey. Who here is a team physician? Raise your hand if you can. And how many of you are completely voluntary with what you do in your team coverage? You don't get paid for it. So the vast majority for sure. Most of the studies show that only about 35% of team physicians actually get paid for what they do or get compensated for their time, which may be changing as time goes by. And actually 15% actually have to pay to be considered the team physician as well. So that's not out of the picture either. So I'm going to show a little, any other questions for now from the audience? I'm going to show one little case presentation here. I'm going to have, I'm going to get the group's discussion. Let me set this up. This is a Thursday night game on ESPN. This happened when I was a fellow. Dr. Bradley, you were on the opposite sideline with Lee Kaplan during this game, during the first half of this game. And then I think you left at halftime maybe. But nonetheless, this happened during a pit game on national television. Boy Harris on third down. Bird has the catch. He's straining for the first down. The flag across the way. Oh, oh, gosh. It's Moses. And Young. I'm going to show a couple other angles here. Okay. So a fairly gruesome injury during a nationally televised game. And just some questions for the panelists up here. What do you do? So you're on the sideline for a game like this. Who do you send out there first? Does the trainer go straight out? Do you go out with Dr. Bradley first? Or when you see something like this, this severe, do you go right out? Or do you wait for John? I go out on the field first all the time. I'm there first all the time. I send somebody to look at the video. We've had a bunch of these. I mean, you go out to the field. I basically reduce it right on the field with John. And we just put him in a splint and get him as fast as we can to the locker room. We've had I don't know how many of these. And it's always the same thing. Or they get stuck in the mud and they do it to themselves. How often do you re-watch the video replay to see how the mechanism took place? Well, I go back in and watch it after I reduce it because I want to know the mechanism of the injury because there I can predict mostly what's going to be there. And then we're worried about, obviously, the vessel. So we immediately put him in the ambulance. He goes right to our medical center. And depending on what his pulses look like and what his nerve function is, that's what will determine which way we go. Chris, same thing at Ohio Stadium? Or what's the plan? We have our athletic trainers always go out first. The physicians, we are at 90 degrees to them on the sideline. If it's an overt injury like that, we go right out. I'd say 80 percent of the time, 90 percent of the time, we don't need to go out. If it's got the wind knocked out of them or something, they don't need to have a physician on the sideline. And then if it's a tibia fracture or dislocated ankle, they look up, give us a little sign, we go out right away. If it's overt, we go right away. But our protocol, the head AT and the number 2 AT, they go out first. Gloria, let's say this is a skiing event and you see something like this. You're on the slopes. How do you manage that situation? Is it different? It depends. So that's why I said in my talk, get to know Ski Patrol. Because most of the higher level games, you do not have field of play access. Screw that. I look at the Ski Patrol guy that's going out. He knows me already. We make friends. I go right out. There's no way I'm not going to get out. Even if they try to arrest me, I'm going to go out to that athlete and reduce him, stabilize him, and get him over to the emergency centers. She was trained at Pitt. Are you on skis when you're on the slopes, or are you walking? Are you staging yourself along the way? Yeah, if it's an alpine ski event. Slalom, giant slalom, particularly downhill because downhill is the highest risk. Yeah, I'm on skis. I've got a backpack on with all the equipment. We usually are above where the most risky jump or turn is. And then we ski right into the field of play and right over to the athlete. Pop the skis off and take care of the athlete. And usually when they fall, they end up sliding down to a more flatter surface, so it's not like you're on a grade like that. So you ski down to the athlete, take care of him. And I don't let anyone stop me. I just go. Is there a helicopter backup for you? There is. Well, it depends on the event. But most of the Olympic and Paralympic events, they do have helicopter access where they can drop a line, pull the athlete up into the helicopter and get him out of there. Because usually in some of the World Cup events and skiing, there's so many people surrounding the finish line. You can't get to them. So the only way to get to them is ski down or you drop a line and pull them up if it's really emergent. Yeah, Dr. Bruggefeld. Bradley. Yeah. Jim, how helpful is these observers that are up in the press box talking to you? So that was implemented by the league because there were a few missed concussions. But I can say they called me maybe one time. Because you and I, we watch the game, and we can tell if they get dinged or not. So we're watching the game. And in my career, I've had one of them call down during the time, and I've had one official that I know really well, he stopped the game twice and he called me over because the official saw the thing. He walked up to me and he said, you've got to watch him. And I said, we're going to get him off the field right now. Because they take it really seriously, this concussion thing. So if you and the NFL get concussed, the chance of you going back the next week and clearing a concussion is really good. I mean, I think an entire two years ago, I think 15 or 12 people, they missed more than one game, missed that game and came back the next week if you get them off the field real quick and then they go through the protocol. It's actually, the game is safer than it's ever been. Like when we first started, when I first started, oh, my God. We set them all back in. Oh, you got a little ding, yeah, go back in. Yeah, you can count to ten backwards. So, I guess though, you said you've only had one call from the spot. I've had one call from the spot to stop all the time I've had. That's surprising to me. No, only one. Is there a debrief after the games? It's called closing the circle. So, what happens is there's a person that's required to close the loop, they call it. So, in other words, let's say she's my wide out, she's concussed, all right? So, we take her to the locker room, the neuroconsultant that's there with my neurosurgeon and me, we determine, look, because I know the players pretty well, so I know when they're not right. Plus, I know them off the playbook, so I ask them some play and he can't answer the answer to that. Then we know something's wrong. So, at some point what we do is we get them into the locker room and sometimes it's really not a thing. But if there's a little bit, we make sure we send them in there. A lot of times they'll come back out and play in the game and we just overdid it, you know what I mean? Then from there, once that starts, then it starts the protocol and then our Aaron Mayers who, you know, Aaron closes our loop on our sidelines. The other team has to close their loop to say what the status is going to be and then we release it to the league. Concussions are down, by the way. The reason they're down is because they're changing the rules on kickoffs and punts are the worst. I mean, special teams are the worst. So, they're going to change the rules in those two because they want to decrease and for injuries actually. The special teams, the higher rate of injury than over any other in the NFL type of thing, running play, passing play. All right, we're just past our time slot. Any final questions for our panel here? Yeah, come up to the microphone and introduce yourself and ask your question. I'm Jeff Spang from North Carolina. I would just say in terms of the athletic trainer question and who's paying the bills and stuff like that, I'm very fortunate to work at a place where the athletic trainers are on the sports medicine side and sports medicine theoretically, of course, reports to the vice president for campus health. And it's not like UNC was visionary. It's just the way it's always been. But I would say to other people who are trying to implement that model, when terrible things happen in the athletic world at other places, it's a great time to try and take advantage of that with your administrative staff to point out liability in athletic trainers and separation and independence. So convincing the administration, every time you get a new athletic group, they're complaining a little bit about they don't have control over these things. And then when something bad happens, you remind them this separation is good for you. And so if you're at a place where you're trying to implement this model, of course, the best idea, you know, maximum independence, use a crisis at other places. As sad as that is, you know, there was a crisis, I believe, at Maryland where there were concerns about athletic trainers being captured and under the staff and the coaching. We use those times to reinforce. We have a great director of sports medicine who's a primary care guy who's doing it tons of times. But those administrators, they need reinforcement. They need to be reminded why this independence is good for them too. That's a great point. That can't happen at the NFL is the problem. I mean, the model in the NFL is that the owner, I'm paid by them, I'm a consultant, but that separation gets blurred sometimes, especially when you get new coaches. John will tell you. I mean, luckily, I've got great ownership that are behind us. I mean, I can tell you this. They have never drafted a person that I put a red X on in 31 years. So you've got a little more control then. And they realize, at least for us, that, look, this player, this is a short-term loss. We're looking for a long-term gain. And so I'm lucky. But that is the way it is everywhere, I can tell you that. There's a show that just came out recently on the Vice channel that you guys may want to check out. It's called The Dark Side of Football. And there's one particular episode that describes playing with pain. It essentially shows an NFL team player's perspective of the team position. And it's not all that positive if you watch it. So you may want to check it out just to see what we're up against. But it's certainly worth the 45-minute watch if you have the time to do it on the Vice channel. And I'll do a plug. Watch Rising Phoenix on Netflix about the Paralympic movement. It's pretty awesome. Awesome. Quick question. I'm Danny. I'm from Chilliwack, which is just outside Vancouver in Canada. I'm mostly involved in hockey. And one of the considerations we have is dealing with protocols differentiating between international cities. So what we do in our home base might be different than what you do in Pittsburgh. So a prime example would be down player. Do you rip pads off on the ice to put an AED on early? Or do you wait to get to the locker room? Face mask on versus off versus helmet on, helmet off. And we don't travel with teams typically in hockey. It's the opposing team that looks after or the home team looks after both teams. So that's becoming an increasing issue. And I'm just curious for commentary about how you guys approach dealing with other medical teams. Helmets? What we do with the helmets at the Steelers, we have a screwdriver gun. And what we do is we go out there and assess them. If his neck's sore at all, we stabilize his neck through the helmet holes. And then if there's any question, that face mask is coming off. And we have an intubation team right there in the stadium. So if he's unconscious and doesn't regain consciousness or is having trouble, they're right on the field. That's required at every stadium. We have a rapid intubation team. Chris, what's it like for a road game when you've got this situation? Your own player's injured, but you're at the away stadium. Who's in charge? We meet, the medical teams meet before the team, and we talk about things like, okay, for example, if we're the host, we ask them, if your player goes down, you're going to board him, do you want to manage the boarding or do you want us to? We're more than willing to do it, but would you rather do it or do you want to have us? And some of them say, hey, you've got your own system in place, you do it. Others say, no, no, no, we've rehearsed it, we want to do it ourselves. So we want to avoid that chaos of what's going on when a player goes down. So we have that discussion ahead of time of how, if it's a home player going down, we have our own protocol. But we discuss with them, when their players go down, how do they want to manage it? And we have that discussion, and I think it's helpful. We always board our own players. We practice it. It's required to be practiced in the NFL. And the only problem we have sometimes is the size of the board. So, you know, sometimes the boards vary in size, so we make sure we have a big enough board. That sounds stupid, but it's a problem. And that's regardless of home or away game, is that right? You board your own player? Yeah. We want to board our own player. We have an unwritten rule in the NFL is that if – I know all the guys that have been there, but if they give me this little hand wave like this, that means we're coming out there. Or if the player's been down for more than five minutes, John Norwood will walk out and say, do you guys need anything? The only person that gave us – team that gave us crap about that was New England. You know, one of the things that's come through in this is to be a team doc, physician, whether it's a high school or whatever, is a real responsibility. And one of the things that always upsets me is you're the team doc for the local high school, the team goes across the town to play, and you don't go with the team. I think you've said it. You have to make the commitment. If you're a team doctor for a high school team, that means when they play their games, you go there. You don't depend on the other team. Your athletic trainer goes there. So it's a real commitment of time. You're not going to get paid for it. And we see a lot of our fellows and our residents, yeah, they want to be a team doc, and they're out in practice for about five years, and all of a sudden, they don't want to do that because, you know, financially it doesn't pay off. It's a passion. It's something that you've got to really want to do. And, Jim, you said it, no more golf. It's not the commitment you have to make in the pros. You can still be a team doc for a high school team and play golf, but there are some things you're going to have to give up. That's your give back. So at one point in my career for 25 years, I had a Friday night game, went to high school, Saturday night game, went to high school, and a Sunday game with the Steelers when I was at home. But what it gave me was a lot of experience treating different kind of levels, and it's really helpful to treat high school athletes, and it's a lot of fun. And you just do it as a community service. I never got paid. Yeah, well, I think that's part of the fun of it too. And, of course, if you take the time to travel with the team across town, the team coach knows that, the parents know that, and it really, really helps. And I think it's a real commitment, and you shouldn't take it on if you're not willing to pay the price. You get all the families. You get the school administrators. Once they know, I mean, it's really good for your practice, only it takes a lot of time. Volunteerism is where it starts, for sure, as a team doc. All right, so I'm going to ask for one final applause for our faculty up here. This was a fantastic session. I really appreciate everyone being here today. Great talks.

Q&A session

medical teams in athletics

independence and accountability

memorandums of understanding

payment of medical director and athletic trainers