Sports pre-hospital immediate care training – not a Road Traffic Collision to be seen – Guest Blog by Dr Jonathan Hanson

March 7, 2012 by

Fortunately for athletes, the days of a medic in the bar in a suit are mostly behind us. The general advancement in pre-hospital care and in particular through primary care avenues has led to the recognition that there is “no place for a token Doctor” in the sporting environment.

Ethically and medico-legally, pitchside medical staff need to be trained and equipped for the service for which they provide. The exact level to which this training has taken place will vary from sport to sport, with motorsport and equestrian events requiring a level of training comparable to that of general pre-hospital care specialists dealing with immediate medical response to complex polytrauma.

However, therein lies the current problem of pre-hospital care teaching and the sporting environment – the injury profiles, or at least those that we know, of most sports are generally not comparable to the case load for which a pre-hospital care specialist would regularly manage. Although sports such as American football, Rugby, Australian rules football and ice hockey have particularly ferocious collisions, they do not cause the patterns of multiple injuries or tissue damage that one would see in a road traffic collision, a fall from a height or a blast injury. Hence, many training courses aimed at tackling standard pre-hospital care scenarios are not entirely appropriate for the pitchside sports physician or physiotherapist.

Within pre-hospital emergency care training there exists a niche for a separate entity of sports pre-hospital immediate care courses – courses that reflect not only the injury profiles of the sports for which they are designed, but also the speed of response of the pitchside responder, so that when they meet tachycardia, tachypneoa and distress on the pitch – they have “shock” at the back of their minds, but “recovering from sprinting” at the front. Indeed, the speed of response of pitchside medical staff means that many pre-hospital principals need viewing in a different light.

On-field trauma patients don’t really have time to bleed 2 litres of blood into the abdomen by the time they are initially assessed, unlike the patients being assessed by emergency services a few minutes following a car crash. Of course haemorrhagic shock does occur in sport so training needs to include the need to monitor and transfer those about which we are worried. Pelvic haematomas seldom have enough time to form during most sports, let alone be disrupted by particular manoeuvres, so some of the arguments about choice of equipment and techniques when pitchside staff extricate an athlete are more open for debate. Most athletes who compete in an environment with pitchside medical support are extremely fit and with massive physiological reserves – again another unique demographic for the expected caseload and training needs to reflect the physiological response in such individuals to trauma.  For some medics at least, every move can be live on TV – with both medical pressures and privacy issues for the athlete, and the pressures of a high media spotlight need also to be taken into consideration.

Fortunately the niche of sports pre-hospital immediate care courses has been recognised by the Faculties of Pre-hospital Care and of Sport and Exercise medicine of the Royal College of Surgeons of Edinburgh, and as a result excellent in-hospital courses such as ATLS are being replaced on the sports medicine curriculum by sports pre-hospital immediate care courses. This should lead to regulation about training standards and delivery and help regulate the recent explosion of sports trauma courses to a common standard for the good of the athlete and for the medics. Long may it continue.

Dr Jonathan Hanson FFSEM is a Sport and Exercise Medicine Physician / Rural Practitioner, at Broadford Hospital, Skye, Scotland

Image – Dr Jonathan Hanson (right) and a colleague in action

Leave a Comment

Leave a Comment

Filed under Elite sport, General Interest, Prehospital care Tagged with , ,

Next generation of anatomy apps for learning and patient education here NOW!!

March 1, 2012 by 14 Comments

Regular readers of the blog may remember the previous post on anatomy applications (apps) back in June last year, when I presented my top 5 anatomy apps on the Apple apps store for both learning anatomy and educating patients.

For those of you who need a quick reminder, apps from the Apple store are computer programs that work on several Apple-platform mobile devices including iPads, iPhones and the iPod touch, with certain apps and features within apps being available only on certain devices, limited only by hardware and next generation development issues. For example, the iPad 2 has an integrated camera whereas the first generation device had none. The value of anatomy apps lies both within clinician and patient education.

The next generation of anatomy apps are now available from 3D4Medical, running on both first and second generation iPads. There are updates for both of the Skeletal System and Muscle System Pro Nova apps (now in their 3rd editions), and new dedicated apps for the hip joint, knee joint and shoulder joint which include the complete anatomy of these regions including musculoskeletal anatomy, nervous system and vascular anatomy.

I am pleased to say that there has been a significant improvement to the existing apps which were already excellent in quality. Now, they are simply outstanding in many ways. The quality of the visuals has not gone unnoticed by Apple themselves who have showcased some of the apps on their latest TV adverts. The images really are stunning when seen on the iPad.

Both Skeletal and Muscle System Pro Nova III apps come with a new interface which allows for simpler navigation. Images can be more easily manipulated than before for different viewing angles allowing for simpler rotation, single finger-swipe cuts for coronal, saggital and transverse views, and a double-tap zoom feature. This allows you to get to the images you really want to see much quicker than before. There is a hint feature to help you to get to grips with the new graphical interface features which can be turned off once you get used to these. Pin Media labels are more extensive, and these are now spoken to allow users to hear the correct pronunciation of each anatomical feature.

The pin labels themselves now come with additional media, such as animations of anatomical movements or further images. There are also linked public notes which allows for users to read notes made by other users of the apps in the public domain. The images can be easily annotated, and shared with patients or other people who may wish to view them by email and social media via twitter and Facebook.

The new dedicated apps are perhaps the ones of most interest to clinicians, for the first time including all of the relevant anatomy of the regions to give a clear picture of the entire anatomy from surface to bone. The clarity of images within these apps is outstanding, and the animations are especially helpful for explaining how certain muscles produce certain movements to patients. Structures such as the subacromial bursa in the shoulder can easily be visualised, and when combined with the animations showing movement at the shoulder joint, it is much easier than before to explain to patients how impingement of this structure can occur under the subacromial arch.

You can check out the new features in the Knee Pro Nova video below (will only show on standard site).

Having used the earlier apps during my patient consultations as an educational tool, I have now started to use these new apps and have found them easier to use both in the consulting room and at the training ground than the previous incarnations. Patients seem to gain a better understanding of the anatomy relevant to their injuries or conditions when seeing the visuals, and the multimedia content really helps to bring functional anatomy to life.

Perhaps future additions to the series might include videos specifically related to pathologies. Examples might be video image of an inflamed bursa impinging under the subacromial arch, a ruptured anterior cruciate ligament in real time, or the dynamic anatomy of a snapping hip. For now, however, these apps give clinicians an extremely powerful set of tools for patient education, and for learning anatomy.

For further information on 3D4Medical’s new apps, see the 3D4Medical website, or check out videos of the other apps on youtube via these links :

Shoulder Pro

Hip Pro

Skeletal System Pro III (Nova Series)

Muscle System Pro III (Nova Series)

Leave a Comment

Leave a Comment

Filed under Anatomy, General Interest, Patient Education Tagged with