Local print and television media here in Winston-Salem produced nice stories about the "Sports Medicine Crisis Management Workshop" we've developed here at the the WFU School of Medicine. The program brings together teams of folks - including team physicians, athletic trainer/first responders, and coaches/administrators - from local high schools who are responsible for managing medical emergencies for their athletic departments.
There are two main principles we focus on during this seminar:
1. Teamwork
The aviation industry has been a leader in recognizing that while individual knowledge and abilities are important, it is usually the ability of the aircraft crew to work together effectively that determines the safety of a flight. The Tenerife Airport Disaster in 1977, still the deadliest aviation accident in history, was the ultimate example of teamwork failure that lead to industry wide changes.
The medical field has been catching up in this regard over the last 10 years or so. One of many examples of the importance team concepts in medicine was a study by Risser and colleagues which showed that a majority of malpractice awards from emergency room cases could have been avoided with proper teamwork behaviors.
The sports medicine setting - like an airplane or an emergency room if not more so - demands teamwork due to the time stress, the uncontrolled environment, the scattered information, and high stakes that are a part of responding to an emergency out on the football field or in the middle of a crowded gym. Then consider that the sports medicine "team", especially for high schools, is often a loose association of people with varying training, experience, and even familiarity with each other who are expected to instantly work together as a well oiled machine during a crisis situation.
I think if nothing else, just bringing together the team doc, athletic trainer, coach, administrator, and local EMS providers into the same room so the end up getting to know each other and talking about these issues is the biggest benefit of the course. To facilitate matters I provide a couple of presentations and exercises on teamwork concepts like role assignment, communication, situation assessment, and back-up behavior.
2. Practice in a realistic environment
It is one thing for a team to study their playbook, it is another to actually run those plays against a live defense in a scrimmage. The same holds true for emergency preparedness - it's great to have a plan and understand teamwork principles but you have to practice. Fortunately, emergencies don't occur that often in the athletic setting. The downside is that when a crisis occurs - and they do, as the deaths of 5 high school athletes in NC last year will attest - it is usually the first for those responding. You can't rely on learning on the job.
For our workshop, we use a high fidelity simulation mannequin - he talks, opens and closes his eyes, breathes, has a pulse, even sweats - in full athletic equipment as the "victim". Around this patient we use a referee, PA announcements, crowd noise, camera crews, real sideline medical equipment, ambulance crews, and other surprises to make the setting seem as real as possible. The teams then have to deal with changing information and distractions in order to stabilize the patient, all in front of a group of onlookers. While the setting is still artificial, the idea is to get the participants used to doing their job at "game speed" with the adrenaline pumping. Then we break down their performance just as coaches would look at game film so the group can learn from the experience.
So far feedback has been very good. We hope to publish the results of particpant confidence surveys and teamwork performance during the emergency simulations as part of a paper on the topic of how to improve emergency preparedness in the athletic setting.
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