EMERGENCY CARE Lindsey E. Eberman, PhD, ATC, LAT, Report Editor The Athletic Trainer’s Role in Providing Emergency Care in Conjunction With the Emergency Medical Services

Stephanie M. Mazerolle, PhD, ATC; Kelly D. Pagnotta, MA, ATC; Kristin A. Applegate, MA, ATC; Douglas J. Casa, PhD, ATC, FACSM, FNATA; and Carl M. Maresh, PhD, FACSM • University of Connecticut

mergency planning and policy develop- life-threatening emergency that demands immediate ment are critical components of an ath- cooling before transportation. Despite the recommen- E letic trainer’s professional responsibilities. dations of the NATA,3 the Inter-Association Task Force Although most injuries sustained during on Exertional Heat Illnesses,4 and the American College athletic competition are minor, life-threatening emer- of ,5 EMS personnel are instructed to gencies can arise. A plan must be in place in order to immediately transport an EHS patient and to admin- ensure optimal patient care and a successful outcome.1 ister passive cooling en route.6 According to the National Athletic Trainers’ Association The purpose of this investigation was to gain a (NATA), each institution that sponsors athletic events better understanding of working relationships between should have a written plan to manage a life-threatening the EMS personnel and athletic trainers. Questions we emergency, which should be developed by organiza- sought to answer are (a) What are the perceptions of tional personnel who consult with local emergency EMS personnel concerning the professional role of the medical services (EMS) personnel (emergency medical athletic trainer? and (b) How can EMS personnel and technicians and paramedics).1 the athletic trainer work together to optimize patient The emergency action plan (EAP), which is a care? comprehensive plan that outlines the responsibilities of all those involved, needs to be rehearsed annually Procedures to ensure proper execution. This planned rehearsal should include emergency response personnel sum- We used qualitative methods to document the com- moned to transport the athlete, and they must support ments of emergency medical technicians (EMTs) per- the policies established by the institution to ensure taining to their understanding of the cooperation. There have been anecdotal reports of profession as well as their perspective on emergency disagreements between emergency response person- management of EHS. In focus group sessions, we nel and athletic trainers regarding care for the injured sought to identify similar or shared experiences of par- athlete. Decoster et al2 reported that 42% of athletic ticipants, thereby encouraging each participant to build trainers have encountered at least one on-the-field upon others’ comments.7-9 We chose a small group of dispute with EMS personnel regarding the care of an coworkers to ensure participant comfort that would injured football player, particularly relating to spine- promote dialogue among the group members. Limited boarding and helmet, facemask, and shoulder pad information currently exists on this topic, so we hoped removal. Exertional heat stroke (EHS) is a potentially to gather sufficient data to generate theories about

© 2012 Human Kinetics - IJATT 17(2), pp. 39-44 international journal of Athletic Therapy & training march 2012  39 the manner in which emergency care personnel view to the next. All sessions groups were recorded and procedures for the recognition and treatment of EHS. transcribed for subsequent analysis. A two-member A purposeful criterion sampling technique was research team was used, with one member serving used for participant recruitment,10 which included as the session moderator. The other member took EMTs and paramedics with a minimum of 3 years of notes to document characteristics of the interview professional experience and employment with an EMS environment,10 commonalities that arose during the agency that had an affiliation with a college of high discussions, and emergent themes.9,10 school athletic program. Basic EMTs receive 120-150 A total of four focus group sessions were con- hours of training, including classroom instruction and ducted with four different EMS agencies located in field observations, whereas paramedics receive 1200- the Northeast region of the U.S. Each session lasted 1800 hours of training through a two-year degree pro- approximately 45 minutes, and each involved 4-5 gram.11 Table 1 outlines differences in EMTs or paramedics. Although we interviewed EMTs for each type of EMS provider. and paramedics employed by the same agency, all Seventeen participants included 11 EMTs and 6 had received training and had previous professional paramedics (Table 2). All interviews took place during experience at different locations. the month of June 2010 after having obtained institu- Several strategies were used to promote the tional review board approval of the study procedures dependability of the participants’ responses and to and documentation of participants’ informed consent. avoid misinterpretation.9-12 All participants had the All focus group interview sessions were guided by a opportunity to review the interview transcripts and to semistructured format of open-ended questions about identify any changes needed for improved accuracy. experiences and opinions.10 Participants were encour- A peer reviewer with previous experience in both the aged to elaborate on responses and to ask follow-up content of the research project and focus group meth- questions that might generate further insights. odology examined the procedures used for data collec- A semistructured interview guide was developed tion and analysis process to ensure that a systematic by a group of athletic training educators, clinicians, approach was maintained throughout the process.8 and graduate students, which was reviewed by an EMT Interview transcripts were inductively analyzed in a for clarity, interpretability, and flow from one question manner consistent with a grounded theory model.2,13-15

Table 1. EMS Scope of Practice10 Level of Certification Scope of Practice Emergency Medical Initiate immediate lifesaving care to critical patients who access EMS. Provide lifesaving inter- Responder ventions while awaiting additional EMS response to assist higher level personnel. Serve as a part of the comprehensive EMS response under medical oversight. Perform basic interven- tions with minimal equipment. Emergency Medical Provide basic emergency medical care and transportation for critical and emergency patients Technician who access EMS. Provide patient care and transportation under medical oversight. Perform interventions with basic equipment found on an ambulance. Serve as a link from scene to emergency health care system. Advanced Emergency Provide basic and limited advanced medical care and transportation for critical and emergent Medical Technician patients who access EMS. Provide patient care and transportation. Serve as part of com- prehensive EMS response, under medical oversight. Perform interventions with basic and advanced equipment found on an ambulance. Serve as link from scene to emergency health care system. Paramedic Allied whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access EMS. Provide patient care and transporta- tion. Serve as part of comprehensive EMS response, under medical oversight. Perform inter- ventions with the basic and advanced equipment found on an ambulance. Serve as link from scene to health care system.

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