Youth sports EMS

[JohnWE]

I've decided to work on an idea that I had about setting up a company doing youth sports events EMS.

The idea would be to provide an on-scene EMT(s) at big tournaments to provide better first aid for the players and/or parents.

I'd love to get some ideas on what sort of equipment some of you would want to have on hand.

My initial plan would be to set up a pop-up type shelter at the event, provide some basic cots and seats for pts. I'm looking into some sort of electric scooter or maybe a golf cart for larger events, some youth soccer tournaments I've been to can cover 10 to 12 large fields, lots of walking.

Anyway, what other sort of gear would be appropriate? I'm thinking a basic jump kit for minor injuries, a small 02 setup, good supply of cold packs, maybe some OTC meds. and the phone number for the local fire dept./EMS provider.

This setup would be in place only to provide BLS on-scene and to have a centralised place for any injured player to come to.

Open and welcoming any comments, positive or negative.

John

[edge1317]

I'd add a range of splints, and maybe even CIDs & backboard. Are you planning on just a lone EMT or a team of two?

[DeputyMarshal]

Open and welcoming any comments, positive or negative.

It's certainly a field with lots of potential but I'd only have one initial set of cautions: invest in a good lawyer, legally insulate your personal liability from the business' as carefully as you reasonably can, get plenty of liability insurance through a reputable carrier, and find an MD who'll act as a consultant and review and approve your protocols if you possibly can.

[JohnWE]

Thanks for the advice guys.

As for staffing, I think I'd have to determine that by the size of the event. Obviously, at least 2 EMT's would be preferable.

Splints, c-collars to fit kids and a backboard are all good ideas.

As for the legal stuff. All good ideas. I'm already checking into the liability/malpractice insurance issues. The company would be incorporated to limit my personal liability as well.

As for protocols, I'm thinking of this as providing first aid using EMT's, not as though I'd be transporting or doing ALS treatment on location. I'll look into having an MD take a look at what I end up with so far as any treatment protocols.

My initial idea was to offer this service after having seen a few instances at baseball and soccer tournaments where well meaning but poorly informed coaches were left to try and treat minor injuries with little or no help. It struck me that having a person or persons with EMT training and a central area for people to go to if they get hurt, would greatly improve both the treatments offered as well as take some of that responsibility off of the coaches. I know that there are legal liability issues with this sort of thing. And I know that even with releases signed in advance I could still be sued. I still think it may be worth pursuing. I've been to some soccer tournaments that had over a hundred teams participating over several weekends, 10 to 15 fields in use all day. Lots of kids involved and the injuries I saw occur were almost universally treated improperly. My thinking was that the promoters could add a small fee to each entry to cover my company's costs and they could then promote their event as being potentially safer than some other event.

The planning continues...

John

[firespec35]

I guess the question is how far are you going to take this? I work for a special events company that does high school and college sporting events all the time (Mostly football and hockey but I've done most sports)and the equipment needed can vary. usually we have a BLS truck at all games but will call a second truck for tport is the pt is not critical so the event is not uncovered.
Football is all splinting and backboarding, Hockey seems to be more of the extremity injuries, knees ect..., I would imagine soccer is going to be lots of splinting and icepacks but you will need a ful compliment of BLS supplies cause your luck you'll have the 1 9 year old that thinks he can do a bicycle kick and land on his neck.
As far as logistically, you need to get hooked up wit a pvt company on the area, that way you aren't taxing the 911 system for your transports.
Depending on the event you can actually go with 1 EMT for the smaller ones. You'd be suprised what you can teach bystanders to do on the spot if you had to.

[Bones42]

Most "tournaments" in my area already have EMS on scene during the event. I know when I was still PA, it was also common there.

I'm assuming, there are areas that this does not happen?

[JohnWE]

How far? Good question.

That's what I'm trying to figure out too.

I live in SoCal and do youth sports photography on a part time basis for a local company, shoot lots of soccer tournaments, baseball, some swimming meets. All either club based or little league type tournaments. I've seen a total of 1 event that provided EMS. That was a very large soccer tournament where they had well over 100 teams playing over the course of a weekend.

That event was what sparked me into thinking about doing this, I saw how much easier and faster the EMT on-site could help kids who got hurt than could the events that relied on somebody bringing a first aid kit and a coach with little or no training.

Nothing against the coaches, they do what they can but in other events it became very obvious that most of them were simply out of their league, no pun intended, when it comes to treating injuries. For instance, kid gets kicked hard in the ankle, no real assessement done, just help him hop off the field and then if they think of it, they send someone running to the snack bar for a bag of ice.

That and a lot of "suck it up" kind of stuff going on made me think that there's got to be a better way of doing this.

I'm going to be looking into some sort of relationship with a private company but I don't think that a kid getting seriously hurt and needing to call 911 is "taxing" the system, that's what it's in place for. Or to put it another way, if I weren't there, and somebody got seriously injured, 911 would get called by someone. In LA county, EMS 911 calls are routed thru either the county or the city FD with private companies used for transport after the FD responds. Some cities have their own ambulances and transport directly but I don't know of any area around here where a private company is expected to do 911 calls on their own. Nobody would normally call a private company in any kind of an emergency situation.

I appreciate the comments.

John

[WJVaughn]

A good baseline to figure what is needed for a given event is the FEMA IS course that deals with Special Event Contigeny(sp) Planning.
I also work Event EMS covering everything from NFL,NHL all the way down to high school stuff. There is a lot to consider.

[JohnWE]

WJVaughn,

Thanks for that referral. I took a couple of online classes for my EMT class but I didn't do any of the FEMA ones, I'll check that one out.

I'm discovering that there are indeed a lot of issues to consider. I'm going to keep pursuing the idea cause it's not costing me anything but some time so far. I'm still pretty convinced that there's room for what I'm envisioning in the EMS world.

Thanks again.

John

[DrParasite]

also keep in mind that many states are changing their EMT courses, from a treat and release, to a stabilize and transport to hospital. whether you call it dumbing down or just changing the focus to concentrate getting the patient to the hospital instead of treating the problem in the field, it seems like you are looking more for an athletic trainer, or someone who is trained in treating sports injuries.

not to burst your bubble, but EMTs generally aren't the best at this.

oh, and those that do have EMTs at big events are more to handled injuries and emergencies of spectators, more than actual players.

[JohnWE]

More good points. Don't worry about bursting any bubbles, this is just brain-storming or "blue skying" as we used to call it at Disney.

So far as big events go, the tournaments that I'm going to be hopefully covering are youth soccer and baseball. Played at Little League and AYSO type soccer fields. Not stadiums. The spectators mainly consist of parents.

These tournaments are a big deal out here in SoCal, dozens of teams compete pretty much year round in various sports. These are all club or private teams, not interscholastic teams. It's not uncommon for soccer clubs to travel from out of state to compete in some of these things, they get hundreds of kids participating over the course of a weekend or two.

Because they're not interscholastic events, pretty much everything that you might expect to find at a youth sports event, such as snack bars, locker rooms, seating, photography services, etc. are all provided by the promoter. It's how a lot of soccer clubs in particular, help pay for their own seasons worth of expenses. My thought was to work with the various local clubs that are promoting the events and become a vendor of sorts.

I get the idea that some of you have miscontrued what sort of events I'm hoping to be working at. I apologise if I've confused anyone.

John

[firespec35]

Here's the main thing, if this is going to be just you and maybe a couple of your friends that you can trust then you are probably OK. If you are going to hire off the street you will run into the issues we have. #1 it's a part time gig and they just won't care. #2 It will be the rookies and the burn outs that apply and either won't know or once again don't care
Your first responsibility is of course to the patient but you can make a secondary responsibility to the people you are working for. Being customer responsive has gained us many new referrals from current customers. Most companies that come in and aren't used to doing events come in with the "ME EMS ME GOD" routine. Not to get off subject but I was at a street fair once and saw the FD and EMS go right down the middle of the street that was packed to the gills with people. I figured I was going to have to go help treat people hit by the ambulance. It illustrates my point though being customer responsive would have led them to use foot teams or parallel streets to get to the pt. When we go to a gig we never make demands unless a patients life is at stake. We either request or make suggestions. That comes back to the knowing how to do it and the caring how to do it end
The documentation end of things is another area where you are can win customers. Obviously NEVER LIE but by fully documenting things you can sometimes insulate your client from liability.

It's going to be hard and you will probably have to sell yourself a lot but it will pay off and expand where you never thought of

[Bones42]

JohnWE, as a parent who's kids and other family members have participated at events like these, it's great you are looking to help. :)

As I said, in my area, it's already a common thing and honestly, I'm surprised this is not common at all these types of events. I know myself, both here and in PA, I have performed the standby duty. And it's always been for whoever needs it, not just parents or spectators or athletes. Anyone.

Good Luck.

[hops19]

I'm not sure, but I'll have to agree with the one who said you're more looking for an athletic trainer rather than an EMT. This would fit more into the scope of a certified athletic trainer as he/she is specifically trained in the prevention, assessment, treatment, and rehabilitation of athletic injuries.

In some states you could potentially be looking at a lawsuit from an athletic training association.

www.nata.org

[JohnWE]

Hmmm...Lets assume for the sake of the argument that I go ahead and get this thing going, get my malpractice and liability insurance and so forth.

I get hired to provide EMS by the promotor of a privately run event.

What kind of standing does an athletic trainers association have over a privately run event? I'm not saying I couldn't be sued, one can be sued for anything, anytime in this country, I'm just not sure I can see how it's any associations business to sue me.

What I'm envisioning for this very tentative business is similiar to the sort of thing that AMR, to use an example I'm sure some here are familiar with, does at events. They provide an ambulance staffed with EMT's and/or Paramedics for. I'm planning on doing a similiar thing only I won't have an ambulance sitting there. I just can't imagine that if a participant in a privately run youth sports tournament were to get hurt and I were to provide care/treatment limited to my legal scope of practice that an association of athletic trainers would have any grounds to sue me.

Thanks for the ideas.

I'm still gonna pursue this.

John

[the1141man]

John:

Some CA-specific advice. You will need to incorporate, yes, good idea. You'll also need to get hefty insurance, as was already stated.
Once you have all that squared away, you will have to register with LA County (or wherever you want to provide services) EMS Agency as a Non-Transporting BLS Provider Agency. You will have to work under the LEMSA's (if not LA County, then wherever) standing orders and protocols, and your EMTs will have to be certified within the LEMSA in which you want to provide services.

Running out and providing "EMS Services" without being authorized by the State EMS Authority and LEMSA subjects you to severe civil and criminal penalties (it's against the law to "hold yourself out" to be an EMS provider without legal recognition from the State and LEMSA to do so), and may cause disciplinary action with the EMS Agency, up to and including yours and your employee-EMTs' certs being yanked.

As for the "athletic trainers"....puh-leeze. I've seen those guys at HS games where we (FD) have done stand-bys along with EMS... those guys are completely oblivious to obvious traumatic injuries or indications of underlying problems. Their solution to everything is sitting on the bench for 10 minutes with ice and elevation, then letting the coach turn the kid back loose to have the kid come back in 10 mins later....the formerly sprained ankle's ligaments have now torn completely, and the kid needs surgery and weeks in a cast to heal. Yep, some "experts". :roll:
Remember: athletic trainers work for whatever school district, team, etc, employs them, and generally are hired (and fired) by the coaching staff. So if the star QB comes in complaining of dizziness, nausea, and sleepiness from a particularly hard sack, and the coach wants him back in, well, guess what the trainer's gonna do?

As an "uninvolved" 3rd party, Fire and EMS don't feel the pressure and obligation to do "what the boss wants", and there's no conflict of interest between the player's well-being and the team's scores well-being. We're free to do what needs to be done medically without having to worry about the coach firing us for keeping his star player out...

[normbernstein]

I work part time for a company in Phoenix that does precisely what you are considering. You can take a look at our web-site: http://www.firstrespondersaz.com. Part of our work includes youth sports.

[JohnWE]

Thanks very much for the comments and links you guys.

This is still very much in the early stages and it may never go anywhere but I greatly appreciate all the various thoughts and ideas that you're sharing.


John

[mitllesmertz1]

1. Some (most) athletic trainers are very well trained, and are outstanding at recognizing traumatic injuries. Look for National certification.
2. If you hire/provide EMT's to provide care at an event, they will be operating under someone's MD license. And that MD, unless a close friend of yours, will be rather hesitant to leave anyone at the scene. They will want all pts transported to the nearest ED. They will be saying "Johnny needs to be seen for xrays" blah blah blah.
Even if they go POV, most areas require contact with base station.
So then, everyone ya see will need full documentation and signature of release etc.
Of course, minjors cant sign, so there's a whole different problem.

So perhaps having EMT's might not be the best solution.

Really, what do the events need?
They need someone trained in basic first aid.
General wound care, splinting,ice etc.
Take a good look in a "jump bag" for an EMT-B.
Throw out the O2 supplies and what's left?
Bandages and splints.
They don't need knowledge about CHF or premenstrual pain.
They don't need to give ASA and NTG to kids.

So a well trained first-aid person is really all that's needed.

Any event where an EMT is working in the field will require some type of contact with a base station regarding transport.
And that's just a whole issue that you don't want to get into.

[JohnWE]

Why can't an EMT be the person providing that first aid care? I'll have to get the details of what's required in my area but I'm not sure about that need to be working under an MD. I know of numerous companies here in Los Angeles that provide EMTs for film and television productions and I don't think that they're all working under the direction of an MD. They're there in case of an accident and they call for help if needed. Same kind of thing I'm envisioning.

Also not sure about needing a base station, willing to be wrong but I just don't know yet.

Like I said, still in the very preliminary stages.

I'm going to be contacting the LA county Dept of Health services and start finding out the actual legal stuff I'll need.

John

[mitllesmertz1]

well, part of being an EMT-B means you can give medications (ie oxygen).
Therefore, to dispense medications, you need to be operating under someone's license.
It doesn't matter if you'll be giving out oxygen, or asa,or ntg.
If you are advertising the service as "EMT", you would be expected to be operating under someone's authority. City-County-State, whatever, someone is in charge of any EMT's operating in that area.

Kind of like saying you're gonna start up an ambulance company in your mom's basement.

So really, unless there is a dramatic need for more than basic first aid, why would you want to go through all the red tape trying to provide EMT-B level service?

[the1141man]

I know of numerous companies here in Los Angeles that provide EMTs for film and television productions and I don't think that they're all working under the direction of an MD.

John....you DID go through an EMT class here in California, right? Because this should have been covered your first couple weeks of EMT class...

State EMS Authority:
Sets basic standards for training, basic and local optional scopes of practice for each level of EMT (EMT-1, EMT-2, EMT-P), accredits course providers, and provides regulatory oversight for EMT-Ps.

Local EMS Agencies (County or regional conglomerates):
Sets policies, protocols, and standing orders governing EMT operations at all levels. Certifies EMT-1s and -2s, and responsible for regulatory oversight for EMT-1s and -2s. Provides indirect medical control via protocols and standing orders, and designates base hospitals as well as base hospital physicians and MICNs for direct medical control.
If you are certified by LA County EMSA, you're expected to operate under LA County EMSA's policies, protocols, and standing orders, and may be subject to CQI audits and regulatory action if you screw up.

Now, you could technically get an MD friend to come and assume direct medical control at all your stand-bys... however, for him to write you a separate set of protocols and standing orders would be at best highly questionable, at worst would cause you all to be called under scrutiny of the EMS Authority via the LEMSA, which would forward their investigatory results on to the MD's governing board, and he could be subject to licensure action there.

Mittle: Just FYI but here in California most LEMSAs have pretty flexible protocols for RMCTs (Refusals of Medical Care/Transport)... pretty much the only time you need to talk to a BHP or MICN about an RMCT is if there's a question of the patient's ability to make an informed consent decision about refusing care, or in the case of head trauma, etc. Otherwise you just have to have them sign a standard refusal form and explain the possible issues that can arise from not taking care of their situation. *shrug* Pretty easy stuff, honestly.

[JohnWE]

1141man,

Yes I did, I even passed ...;^) NREMT too...

I should have been clearer, I understand that any thing I do would have to be within my local guidelines and under the indirect control of the county EMS, what I'm not positive about is whether I would need to have my own medical control and/or base hospital as I would not be transporting pts.

The comments I made about the film/tv industry stuff are true, they are working under the county guidelines but I don't know of any of them who have their own medical director. They typically don't transport pts. either.

Since that industry is one I've also thought about getting involved in, I'll send a note to the local union and ask them how it's currently being done in LA county.

This is all part of the things I plan on learning more about when I speak to the folks at LA County Dept. of Health Services, hopefully next week.

I know that I can't simply start treating pts. The question(s) is/are how much infrastructure do I need to do what I'm envisioning.

Thanks for your help.

John

[JohnWE]

Mittle,

You bring up an interesting point, I could theoretically call whatever I end up doing, "first aid services" and not deal with issues like O2 or NTG.

My thought was to use the training of an EMT to provide better treatment than what I've seen provided at some events I've been to. That doesn't necessarily mean I have to provide EMT legal treatments. Like I wrote, interesting.

As for the red tape, that remains to be seen. I have no doubt that it exists...

John

[the1141man]

John--local ambulance companies (around here, CenCal) do have their own "medical directors", but as I understand it they work more as an internal CQI resource and sign off on any ALS supplies (drug orders, etc), that the company makes (remember, even IV supplies technically require the signature of a physician). They don't have any authority to usurp the protocols and standing orders of the LEMSA's Medical Director, because it's his signature that appears on the back of your EMT cert.

Also, BLS units in California are generally only required to make base hospital contact (other than ETA-only call-ins) if an RMCT protocol calls for it, or if the EMT is unsure of something and wants to consult with medical control. Personally, if you as an EMT-1 are unsure about a condition, you should be calling for ALS and let the Paragods figure it out.
Generally, though, EMT-1s do BLS strictly under standing orders and protocols, no on-line medical direction is required.

[JohnWE]

Thanks, so far as I understand it, that's how things work here in SoCal as well.

It's looking more and more like what I'm trying to do would be more of a glorified first aid service than a true EMS situation, my thought was that by using trained EMT's, I could offer better trained people than what I've seen used.

As I've said probably too many times, I'll find out more when I meet with the LA County EMS folks.

John

[crash52fitty]

I don't know if I'm doing this right or not. (probably not, If anyone can advise how to post on these things please feel free to give me your advice)

I have been approached by the local youth hockey association in the past yrs to provide similar services for their tournaments. Part of the Minnesota Youth Hockey rules say that there must be an EMT present during sanctioned tournaments. As far as liability insurance, I had contacted the MNYHA and they will provide it for those that do not recieve compensation for their services. (something to look into if California youth soccer has a similar association)
However, I doubt you plan on volunteering your time for this, I know how long the tournaments can get! Just a thought on something to look into.

There are a lot of things to consider. Especially in todays society where everyone seems to be "sue happy"... Good luck

[JohnWE]

Thanks for the thoughts and good wished. And no, it's not meant to be a non-profit kind of thing, might turn into one, who knows?

As for insurance, a quick check with HPSO says I can get 1 million in liability/malpractice insurance as a self employed person working under 24 hours per week for an annual premium of $100.00.

I haven't pursued insuring a company as of yet mainly cause I don't have a company to insure just yet. I'm going to be talking to a potential financial investor later this week.

It's interesting that your hockey group mandates an EMT presence, does it explain who's supposed to pay for the service? Or under whose medical direction the EMT is supposed to be working under? Or do they just assume that the tournament organisers will hire a local ambulance company to stand by at the event?

John

[mhenrich]

I am not yet an EMT or FF so i don't know specifically what you are thinking you are trying to do, but i am part of my high schools sports medicine team (led by an atheletic trainer). we take care of all of the schools athletes during practices and during games. As far as the liability part is concerned, all athletes sign wavier forms before participating, so nothing that we do wrong can be held against us unless it is along specific lines. this is they have to prove that we had a duty to assist, and that we failed to perform that duty, we did not perform the best care we could, we were neglegent in what we did. and there was one more that i cannot remember right now but i could look up if you wanted. all of these things have to be present in order for them to have any chance of taking any legal action against us (these are for washington so i don't know about other states). also, except for patching up bleeding athletes, the only thing i see that you could do is provide emergency care for athletes who have life-threatining injuries. what were are trained to do is different from what you would be as an emt. we are trained to "rub out" an athletes muscles (basicly massage but a little different), to patch up bleeding athletes, tape injuries to prevent, or slow movement in a direction to aid in healing while they continue to play or practice. if you still want to go through with this, send me an email and i will help you get set up, let you know what we use, and to give you an idea of what to expect.

hope this helps alittle

[DeputyMarshal]

As far as the liability part is concerned, all athletes sign wavier forms before participating, so nothing that we do wrong can be held against us unless it is along specific lines.

If you actually believe that waiver is worth any more than the paper it's printed on you seriously need to consult an attorney.

[JohnWE]

Afraid I have to agree with the Deputy. There have been recent cases adjudicated in SoCal that reinforced the notion that a person cannot sign away their right to sue. Liability waivers are for the most part, a "feel good" idea that don't really do anything. Better to have insurance than a signed waiver.

Even the way that they are used to stop someone from participating in an event or an activity is legally questionable. A contract signed under duress cannot be enforced.

My favorite attempt to use something like a liability release was an organisation that will go unnamed that tried to force people to sign an agreement that they wouldn't attempt to sue the organisation if anything went wrong at an event that the organisation was putting on...Legally worthless but good for a chuckle.

Mhenrich, if I were you, I would strongly suggest that you look into liability/malpractice insurance before you treat another athlete. At a minimum, I would contact the school's administration and find out what sort of liability coverage they're carrying on the athletic trainers. You might be surprised.

John

[mhenrich]

Those are two very good points and make me think. I am not entirely sure what they have. 2 things to my advantage are, 1. I am a student, anything we do is as if our teacher did it, so anything that we would normaly get sued over actually would fall on him. But as far as the liability waiver goes, i would have to go back and look at what the waiver i signed says, but it is actually a small book. Also, the services that we are providing the athletes, we volunteer to treat them, and they chose to use our services, we don't do anything unless they ask us to. As far as providing medical services for events, you should check with the organization putting on the event because they may provide some coverage for you. i belive that because what i do is for the school district, that my teacher is covered by them, and that anything someone tries to do to them would be protected by the school district. though i am not entirely shure of this. we have never had an incident dealing with anything medical, we have only had problems with racisim, and dealing with homosexuals. we have been sued over both. in both times it was either a teacher or administrator that was named, but the school district was the one who defended them and paid the fines. although this is for washington state, i do not know anything about laws in california. I would highly suggest to check with the organization before hand, because almost for certain they will have something set up to cover any liability. they would have the resources to cover alot more than you can, so i would say try to use that as much as possible.

[FFEMT920]

John and Crash 52 please email me. I have a company that provides EMTs to do hockey standby and other like events. I have some info of interest to both of you.

[SoCalEMS]

Ok, so you are going to start a comapny here in Los Angeles. I have noticed an upswing in start-ups in the area and I must say that it is often more difficult than you think. There are so many factors you must consider before embarking on such an endeavor.

When I started my company, I wanted to bring my 20 years of experience in the fire/ems field to the table and what I ended up with is what amounts to be one of the most professional outfits. I am not trying to toot my own horn but have you seen some of the other companies and their staff? You said it yourself that you want to provide a better crop of EMT's for this type of thing and that is what I set out to do as well. There is really only one other company that is in the same league which is SetMedicsLA.

First off, do you plan on hiring or sub-contracting out EMT's? What will you require of your staff? Here, my senior staff require all candidates to be tested (written and physical agility), background checked (FBI, DOJ), Interviewed, have current certifications and licenses, at least one year working for a 911 provider, etc. etc. I will admit that we make it tough but in an effort to provide the most proficient and seasoned staff. We have to be tough since there has been a rash of incidents of EMT's falsifying info on their apps and such due to run-ins with the law.

The equipment as someone stated does vary depending on the different types of events out there. You need to have an idea of what kind of injuries to expect which is a big part of staffing events properly. Do you plan on purchasing an ambulance or two? AED's?

Uniforms is another decision that needs to be made. I place high importance on this because the uniform says a lot about an outfit. I have seen too many sloppy EMT's and that makes we wonder. If you have a well uniformed staff, it will definitely show through in their demeanor and ethics.

Insurance is a biggie!! Liability and all the necessary insurance can be as expensive as $10,000 a year. What if someone requests that you have additional coverage? Workers Comp? Things get tricky.

I am telling you that I have consulted and continue to consult with Los Angeles County EMS Authority as well as EMSA. If you plan on providing set coverage, there is yet more considerations. Events? etc. etc.

Ok, I could go on and on but for now, I think you get the jist of it.