Dec 21, 2016
Emergency Response: Part 2
Timothy Neal

Last week, we described Timothy Neal’s immediate response to a football player with heat stroke. In this second installment, discover the treatments the sports medicine team applied while waiting for paramedics to arrive.


As Troy pulled the cart to the curb in front of Manley, Ryan was unconscious, with a pulse and respiration but not sweating. Dr. Tucker was already running up to the scene, and the graduate assistants were spreading the equipment on the sidewalk. I then climbed on the cart to monitor Ryan’s vitals. He was in tachycardia, and when I took his blood pressure, I found he was in hypotension.

While I was performing vitals, I directed the graduate assistants to perform the following tasks: start ice towels and ice bags to Ryan’s extremities; open up the AED on the grass a few feet away on a plastic sheet in anticipation of using it (not wanting the electrical circuit field wet when we deployed the AED in the event of cardiac arrest, as Ryan, me, and the others were already wet with ice towels); and start portable oxygen to oxygenate Ryan’s breaths. This is where thinking under pressure and anticipating potential consequences played a major role in preventing a bad situation from getting worse. I instructed the graduate assistant athletic trainer to change the facemask off the oxygen hose and replace it with nasal cannulas. He looked at me strangely, but did as I ordered. In my experience of caring for heat exhaustion, I have seen athletes vomit, and while this was my first (and only) experience with heat stroke, I know that some of the sequela may be vomiting and anticipated the occurrence of vomiting during this emergency.

I placed the nasal cannula on Ryan, started the oxygen, and with the help of the graduate assistant athletic trainer, turned Ryan slightly onto his side while monitoring his vitals. During this time, Brad and Troy worked quietly, quickly, and very efficiently in assisting Dr. Tucker with the IVs and directing the cooling of Ryan. Within seconds of placing the nasal cannulas on Ryan and turning him onto his side, he started to projectile vomit. The graduate assistant athletic trainer aiding me gave me a look I have seldom seen — one of total clarity mixed with relief. Had we placed the facemask on Ryan, he would have vomited into the mask and likely aspirated it into his lungs, setting up a catastrophic event on top of a medical emergency.

Within seconds of placing the nasal cannulas on Ryan and turning him onto his side, he started to projectile vomit… Had we placed the facemask on Ryan [instead of the nasal cannulas], he would have vomited into the mask and likely aspirated it into his lungs, setting up a catastrophic event on top of a medical emergency.

In the midst of all that was happening, I instructed another graduate assistant athletic trainer to find Will Hicks, CSCS, then the Football Head Strength and Conditioning Coach (now the Assistant Athletics Director for Athletic Performance), who was someone I trusted and who worked very well with the athletic training staff. He is a levelheaded professional who had helped me during previous emergencies with injured athletes in keeping the scene under control. I told the graduate assistant athletic trainer to find Will, inform him of the situation, have Will immediately find Paul Pasqualoni — who was the Head Football Coach at the time — and have them both come to the scene. I anticipated a crowd to form at the curb as other teams returned from practice, and they did. Will and Coach Pasqualoni arrived in minutes to help control the scene and reassure those watching that everything was being done to help Ryan.

I continued to sit on the cart next to Ryan and monitor his vitals. Though he was still unconscious, I spoke softly into his ear and told him that he was over-heated and that we were taking care of him.

Shortly thereafter, Ryan regained consciousness, asked me how he got to Manley, and told me that he had heard me talking to him just moments prior. I told him that were going to take him to the hospital for further evaluation and care and that I was going to stay with him the entire way.

At that point, approximately 10 to 12 minutes had passed since arriving on the curb, and Dr. Tucker had already put six IV bags of lactated ringer’s solution into Ryan. Everyone was soaked to the bone from the use of ice towels and ice bags. Coach Pasqualoni and Will briefly spoke with Ryan just as the ambulance arrived to the scene. By then, nearly 50 athletes from various teams were standing and watching.

As the ambulance pulled up, I left Ryan’s side and greeted the lead paramedic, who I knew from our pre-year emergency planning meetings. I informed him of the situation, and we immediately loaded Ryan into the ambulance and started to St. Joseph Hospital in downtown Syracuse, with sirens wailing and lights flashing. Dr. Tucker called the emergency room from the scene before leaving for the hospital and informed them of the situation and our imminent arrival.

Check back next week for the conclusion of “Emergency Response.”

Timothy Neal, MS, ATC, is Program Director of Athletic Training Education at Concordia University Ann Arbor. Previously, he spent more than 30 years at Syracuse University, serving in a variety of sports medicine roles. He can be reached at: [email protected].

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