EMRs are like most things, it is not one size fits all. When looking for a solution for records management Will Ryan wanted to share his search results with all ATs.
Discussion topics:
Searching for EMR
How to obtain EMR
How to Familiarize yourself with EMR
Communications with EMR Companies
What has been your process for searching for an EMR?
Identifying limiting factors like cost. Sportsware and AT Genius are cheaper options.
Barriers to documentation – time, limited resources, uncertainty of what to document. NATA has created guidelines regarding methods of documentation. Consider the legal aspect of documentation.
How do you approach your school about obtaining an EMR?
Build value in the documentation. Explain how EMR protects patients, coaches, and healthcare providers; and keeps everything secure. Convenient place to store all UIL-required documentation.
What is the best way to familiarize yourself with EMR’s?
Pearland ISD uses Rank One – signs in upon entry and documents almost everything. We introduce our MAT program students to Rank One and have them document all patient interactions.
Did companies offer demos of their EMR systems during your search?
Combat Sports Medicine seems like an extreme environment to practice Athletic Training. Dr. Ethan Kreiswirth created Blackbelt Sports Medicine to provide Athletic Trainer care for combat sports athletes.
You are always posting gnarly pictures and videos on IG. What gives you pause or catches you off guard?
As an Athletic Trainer, I started covering tournaments around 1997.
Personal experience in the sport helps me understand the types of injuries that occur.
Tournaments now are 40 mats over 6 days
Dislocations, unconscious used to give me pause.
Now it is just running a company.
Or working youth tournaments, those are always difficult for me.
Does Blackbelt Sports Medicine have tournaments across the United States?
Yes, we work with the BJJ organizations to help provide medical care for combat sports.
A new AT is going to work in combat sports medicine. How do you prep them?
Gloves, gauze, skin lube, and nose plugs.
An Athletic Trainer working with Black Belt Sports Medicine could almost get away with just bringing their fanny pack, like the Nexus Deadbug
There is almost no taping done, maybe some finger taping.
You do a good bit of suturing…discuss that as an AT.
Many of these BJJ athletes are from out of state or another country.
Suturing on the sidelines helps them out tremendously.
I have done about 10 sutures so far.
There is a lot of practice involved with the practice kits.
Not being licensed gives me more freedom to practice the emerging skills.
We take a table behind the scenes and do the standard prep work. We also instruct them to follow up with their HCP.
The larger tournaments have an overseeing physician onsite as well.
Sign up for a tournament and see if Combat Sports Medicine is for you.
Bubba Wilson discusses Crisis Behavior or Crisis Etiquette live from the Memorial Hermann Sports Medicine Update. He has been leading D6 in ATsCare since its inception and has learned a lot over the years.
Did crisis management help you be prepared for being inducted into the SWATA Hall of Fame?
AT Cares drove me there.
CCISM credential:
Certified Critical Incident Stress Management – Level 1 deals with individuals in crisis, the majority of AT Cares population. Level 2 deals with groups in crisis.
Began Crisis Management training in 2019.
AT’s managing grief:
Grief comes in at a later time, ATs have to finish the game/event after a critical injury/event.
AT Cares reaches out once notified to ensure assistance is provided where needed
NATA Gather Program Integration:
Young professionals can use NATA’s gather program to find mentors.
Crisis on campus – what is the best method to find that definite grief to counsel them?
Don’t counsel them. Listen. Refer out.
Soapbox Warning – What is step 1 in managing the secondary loss of loved ones?
Have affairs in order. Have a will, have life insurance. Have your burial wishes written down. Have the conversation. Have a list of your account usernames and passwords. Know how many death certificates you may need. Legal Zoom is a good resource. Make sure you constantly update your affairs. The primary loss will be exacerbated if we don’t handle our affairs.
Currently working on a presentation with AT Cares members regarding their experiences with loss and what they’ve learned along the way.
Thanks, Sydney Hayes for creating the Crisis Behavior show notes
Can you share some of the things you have done to help master's students be involved and advance in the profession?
We treat the masters' students as an extension of our staff, we want them to be respected in our ATR just like us.
We have our high school students refer to them as Mr/Ms/Mrs. We interview them to make them feel that they are in a professional setting.
My assistant, Thomas, likes to ask them “What did you learn today?”. We outfit them, invite them to our pregame meals, we make sure that they feel respected. We make sure that every day they learn something new.
You interview them for the position, but they’re already assigned there?
Correct. We ask them to submit a resume, and for a lot of them this is their first job “interview” and ask them interview-like questions and ask them to submit a cover letter.
We then give them critiques so they can start working and build that resume so that when they are done with their program they can apply and be successful for their interviews for their actual job.
Do you do that just once, or every week, every 3 weeks, etc?
So our level 2’s are with us all year long, we make sure we give them monthly updates. Our level 2 this past year wanted an update every day, every week, so we always were helping her and growing her, anytime there was a hiccup or something she was unsure of, we gave her that reassurance and feedback.
For the level 1’s, it takes a while to get into that comfort zone, but we always try to give them feedback when we notice something, good or bad.
You talked about outfitting them to make them feel welcome, do we give them the ones that say athletic trainer, or the ones that the students wear, do they keep them; what does that look like for you?
So it varies, level 2 vs level 1. Level 2’s we’ll give them the game day polo for the year, and require them to look professional when they come into the ATR.
Our students will wear Nike shorts and a T-shirt. We ask that our UH students either wear something UH to differentiate them or they wear a polo with either nicer shorts or nicer slacks, with their UH ID badge. And that way it identifies them as an adult and not a student.
More Practical Preceptor Tips: Include them in almost everything! So for GHATS, we made a fun t-shirt for the t-shirt contest, and we had a team-building activity of tie-dying the shirts.
We invited our UH students to join in since they went with us to GHATS, and they were allowed to wear that shirt as a fun GHATS representation. For our level 1’s, if there’s an event going on during the time that they are with us we’ll give them one of the students' shirts, but for the most part, we’ll give them our practice shirt for the year that they can wear to Saturday treatments, etc.
One of the things I’m trying to still work out is scheduling, how do you balance that out and hold them accountable while keeping in mind that they’re college students?
You and I have the luxury of working in a high school setting, so we automatically have Sundays off, that is the one day a week they have off because they are required to have at least one day off within a 7-day span. So we keep that in mind.
We use something called “Homebase” which is a scheduling app, where our students, ourselves, and our UH kids can submit their days off requests, so we honor that.
We always remember that they are students first, so they can communicate with us if they have a big test coming up and they'd like the evening off before to study, they just have to have that communication with us, and then we treat it like how if one of us had a doctor’s appointment that morning and we’d say hey, I need this off for that; so encourage them to communicate with their staff, which is the other UH students, to ensure that things get covered.
When it comes to accountability, they've got a set amount of time with us to get the hours they need, so they know that if they’re not going to be there they have to make up the hours they need.
For games that they weren’t scheduled for but show up for, how do you handle that?
A great Practical Preceptor Tip is to have them ask them to ask us in advance. Especially for indoor games or baseball/softball because the space is limited, so we tell them if they do want to come and work extra to give us that heads up that way we can say yes or no.
Ensuring that you're providing an educational opportunity, how do you hand off responsibility to those students?
So when the first years come in, they haven't gone over any anatomy for their assessment class so once they reach the test or the ankle, knee, hip, etc; if they're going over the ankle at the time, we say that every ankle sprain that comes in here, we want you on it, evaluating it to where you're at in your studies.
Once you complete ankle, every ankle eval we say that's yours. That way they are getting that clinical experience.
Our level 2’s, get a little more autonomy when it comes to that. If they’re struggling to remember shoulder special tests, every shoulder that comes in, go get on that eval and come back and ask us questions. We’re right there with them making sure they’re completing it correctly but we want to make sure they get as much hands-on experience with different patients.
Do you have the course syllabus of when they go over certain things?
We ask to see that, we just ask them hey what did you go over today in assessment, hey what are you learning in this class and they tell us and we say okay we’ll make sure to touch on that.
We’re using a more practical time in a hands-on setting. We also meet each week to go over GHATS quiz bowl material with our kiddos and we always invite our grad students to sit in on those lectures as well.
Do you have any release of responsibility schedule or do you just have an internal feel for it?
We’re not going to give them something they’re not comfortable with, we kind of feel them out in the beginning and try to build up what they're not as confident in within their realm of comfortability, because at the end of the day, they’re students too and we want them to learn and grow, within their limits.
Our UH girl this past year wanted to learn more about admin, so we said okay, you’re going to look at our student manual and we want you to go through and make these changes. So it varies based on each individual, and we always ask “What are you not comfortable with?”, and then we try to make them comfortable.
Are any other cool things that stand out?
Something I learned when I was in undergrad, we called it twisted Tuesday. Every Tuesday the upperclassmen, whoever was in charge of that sport, became in charge for the day. The preceptors dressed down into what the students would wear, and those students in charge dressed up as the preceptors.
For every new injury that walked in, they corralled how to treat it, or tasked a student with rehabbing them, they set up practice, talked to coaches, delivered injury reports, etc. So that’s something I’ve taken over at Dawson, and every Thursday night during football season, our UH students are “in charge”, so they’re the first ones to go onto the field, they set up games for the day, and that is their time to get their autonomy and to feel confident in those high-pressure situations.
How do you prepare your students and staff for those Thursday nights?
So we go over the way games are set up in the beginning, they usually get a game or two under their belt as a UH student and then we say alright it's your turn, so they get to see what a setup looks like, they get to understand how we run things and our expectations. We tell the coaches, hey by the way you are going to be hearing from so and so tonight they are in charge.
Of course, we are always right there behind them making sure that if there is something a little bit more extreme or if they’re out of their comfort zone and need us to step in we’re right there. We let them communicate with coaches and parents, that way they get that experience in a high-pressure situation. And they know that it's coming, we give them a heads up.
When you say you're right there with them, are you still on the sideline when they go onto the field, are you kind of halfway in between, or are you standing right beside them and just not saying anything?
I am behind them, always looking over them. I’m always watching. We might stand off a little to the side especially if they don’t like someone hovering over them, but we’re always watching to make sure there's no malfeasance going on and ensuring that they’re doing everything correctly. And we do make sure that before they go do it in a game-time situation, they’ve performed the skill correctly in clinic.
What else as far as practical preceptor tips?
I just always remember my time as a student, and things that helped me, things that didn't help me. We try to give them the recipe for success.
I always want to make sure that our students feel comfortable and can come to us with any issue, we always have open communication with any question they have and we always want them to learn, so by providing that safety realm of education and comradery, we want to make sure that they know that were an asset for them, we talk to them about how we came to be who we are and we want them to feel proud in their journey too.
Anything that you've seen or heard from your students over the last few years as something you should try to avoid?
A lot of the times whenever we do kind of expose them in the first few weeks they feel kind of overwhelmed, but we explain to them that every situation you are in won't be a comfortable one, you are not always going to feel like it's easy.
A lot of times we get “At first I was nervous because you just kind of like put me in there.”, but we explained it, and we went through it, and it is scary but that's what our job is. Sometimes we have them drive our gator, and a lot of times they say they don't feel comfortable doing that so we say okay. We listen to what their comforts are and respect them.
Neuro 20 looks like a wet suit with electrodes for E-Stim built in. That is partially true, the materials a spandex or Dri-fit type material, and Wayne and Michael share a lot more on the Sports Medicine Broadcast.
Give me the big picture. Background and origin of the idea.
–Founder DJ Schmitt was injured during service and wanted to find a way to get healthy without taking so much medication.
He used his electrical engineering degree to develop the first Neuro20 suit.
The suit is made up of a compression material(spandex).
Establish firing rates for healthy individuals and be able to choose for the AT/PT to know which one to use.
Where does the name Neuro20 come from?
20 large electrodes placed strategically to engage the maximum amount of motor neurons.
Who is using it right now in sports?
NHL
Olympic Athletes
NFL
D1 Athletes
What are the most common applications of neuro20?
Prehab
Rehab
Active recovery
Motor education
Accessibility for the Athletic Trainer?
At the moment it is not accessible to the high school population because of privacy issues.
College-level or professional level
Can you set them up and “walk away?”
Patients can be set up and allowed to complete a workout session on their own.
One of our pro sports athletes uses it after games while on the plane for recovery.
Can I use Neuro20 with my high school athletes?
It is FDA-cleared for adult patients. Some youth patients have used it with waivers and clearance from their doctors but that is not the target population.
SUJI Blood Flow Restriction or BFR is changing the game with its AI-powered app. Dr. Michael MacPherson joins me and Lisette Guerrero to learn more about our new gear.
What is your 10-second sales pitch for Suji BFR?
A portable, affordable, and easy-to-use gold standard, AI-powered BFR technology
The affordability of the device is one reason we chose to add Suji BFR. Discuss current pricing.
Suji has found the middle ground. We are data-driven for incredible accuracy at an affordable price, never before seen in the BFR space.
Let's get into the app, it is one of the big differences from the Delphi unit we have.
Our AI-powered app automatically calculates LOP for the clinician and then saves that data to a patient/athlete profile, saving at least 3-5 minutes every BFR session. The AI-powered calibration process is also incredibly robust.
All patient/athlete data is stored in a HIPAA-compliant cloud that lives in your institution. A Suji institution is your team or clinic where all your Data lives. Only you have access to it as the administrator. With Suji, you only have to calibrate as often as you deem necessary.
Discuss the continuous monitoring vs the detachable hose.
With Suji Pro and its real-time pressure adjustments, you won’t need to attach the hose to adjust the pressure within the cuff.
With Suji Pro, you’ll be able to adjust the pressure on the pump in real time. Suji BFR Pro – what should we expect? Suji Pro is Lighter, Smaller, and Hoseless.
Our users are passionate about our portability and our customizable in-app recovery sessions so we’ve made advancements in both areas. Our users also expressed the desire for real-timepressure control without attaching hoses and a pump, so you can expect greater control with Suji Pro without breaking the bank.
-9-10% of injuries are spinal. About 12,000 nationally.
Looking at physicals I have a couple of athletes with previous spinal cord injuries. What are some of the things that I should be more aware of when taking care of these athletes?
-Usually due to trauma or born with cervical stenosis.
-Should have a spine surgeon associated with the athletic population
We talk about spinal cord injuries, and the first thing we think about is football. We think that it is equipment-heavyand collision-based and talk about equipment removal for that. But what is the instancein other sports?
-Happens in lacrosse, gymnastics, hockey, soccer, baseball, and basketball.
-Helmet and shoulder pads keep them in alignment then leave it on.
-If only a helmet probably needs to come off.
These spinal cord injuries, I believe you mentioned there are about 12,000 injuries per year. Are these spinal injuries with awareness in education are we increasing these or decreasing these?
-Since 1975 they have gone down.
-A lot of spinal injuries come from automobile accidents.
Is there a reason for that?
-Awareness, and if it goes away the numbers will go up again.
Moving back into narrowing down into more of an athletic training setting when working with sport athletes for example what would be our initial assessment and what would be some red flags to actually move the person onto a spine board?
-Big trauma like a head-on hit you want to be careful.
-Clinical judgment.
-numbness bilaterally
The athlete just has a lot of pain.
-Trust your gut
So once you decide to stabilize someone, I know you talked about two methods to stabilize, but what is your preferred method?
-6 man lift
-If you don’t have enough hands, nobody will fault you for doing a log roll.
When is it appropriate to move the neck into neutral?
-It is always ok as long as you do the head or trap squeeze.
-You want to make sure you have access to the airway.
Can you talk a little bit about the difference between a head or trap squeeze?
– head squeeze is more about putting you hands around the athletes head or helmet
-trap squeeze where you are putting your thumbs and finger around someone's traps and gives you more stability because you also have to add in the fatigue factor.
-Trap squeeze is more stable
Be aware that clothing could cause you to slip while holding a helmet.
I think it comes down to practice and figuring out how everything works. Because once you get it down, then when all that emotion going, if you practice over and over again it just becomes a routine.
What are some tips you have for someone who is working with an equipment-intensive sport, like hockey, that they are not familiar with the equipment?
-Practice
-Use equipment managers to become familiar with equipment.
What does it look like once they are at the hospital?
-equipment removal and go into a cervical collar.
-Then straight to a CT scan is #1.
-Transport to a level 1 hospital because you don’t want to have to move to multiple locations.
Can you talk about differences between places that have stopped using spine boarding techniques like in motorcycle accidents?
-Two different mechanisms and two different thoughts.
-Make sure everyone is on the same page
-You can always ask to talk to a supervisor because these are generally big EMS areas and you can’t control what everyone does.
Can you talk about the order you take the piece off of the helmet?
-Side pieces off first. Allows to flip and gives access to the airway
CPR with shoulder pads. With a spinal cord injury and you are having to do CPR and you are removing the equipment, you would leave the shoulder pads in place as long as you open them up?
-Open them
-If getting into CPR take them off because it has become life-threatening.
Do you have any recommendations for an AT who does not have a lot of volunteers or staff and might be working alone?
You have coaches. Train the coaches. Coaches are always there. Make sure your coaches are in line with helping you.
The highest incidents seem to be in high school/middle school. Can you talk about why?
-Proper tackling technique
-Old equipment
Is there anything else we didn’t touch upon that you wanted to add?
-Education and preparation are the biggest things.
Protect3D joins medicine and technology to help Athletes return to the sport safer and maybe faster. Kevin Gehsmann joins me to share their story and how Athletic Trainers can get their athletes braced.
Where did the idea come from?
Engineering student
Liked 3D printing
Daniel Jones, the quarterback at Duke, went down with a clavicle fracture. They decided their engineering project would help Daniel and other elite athletes needing protection.
Customized for his unique needs and ROM
What has been the most difficult hurdle for Protect3d?
In the early days, we were recognized by the NFL and won $50,000 and Superbowl tickets.
The pandemic caused a lot of challenges.
Every device we make has a positive impact on the athlete and their performance
Share a success story you enjoy.
Clavicle pads reduce the risk of re-injury and increase the confidence of the player and health care team.
It is also the original pad or brace that birthed the idea.
Outside of your own clinics where have you had doctors adapting this style of bracing?
We started with elite athletes and have worked with orthopedic surgeons and athletic trainers.
An ankle/foot orthotic is a new brace to help with foot drop.
We had a D1 athlete participate in games with a Protect3D brace for foot drop.
What do you see as a hurdle for secondary setting adoption of Protect3d braces?
The cost of the product is one hurdle.
Setting up a system for billing on demand can be an obstacle as well.
Are these braces something that could be printed on your everyday, at-home printer?
Due to the material, printer, and the need to control different variables as a medical device, they are not currently printed at home devices.
There may be options in the future as we grow and develop.
Want to test out Protect3D?
Have an athlete needing a brace?
Willing to give me your honest feedback on the podcast?
Send me an email and maybe follow it up with a social media post.
Give me the story (protect patient privacy)
If it works out then we will collaborate to get you a custom 3D-printed brace for your athlete.
