You Probably Don't Know Who and What are Involved in Keeping You Safe at The APEX, But You Should

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Craig Elder, Athletic Training Manager at Centura Sports Medicine

Craig Elder & Centura Sports Medicine Team Member at the 2020 APEX

March is National Athletic Training Month and a perfect time for us to catch up with Craig Elder, PhD, ATC, CSCS, Athletic Training Manager for Centura Sports Medicine. He and his team do more than you probably know to keep everyone safe at The APEX

You never really think about medical coverage at an event, until you need care yourself. Exhausted, high on adrenaline, your decision-making skills might be a bit fuzzy. How do you extract yourself from the trail after a failed ejection turned into ankle injury? How do you remove a rogue stick from your thigh? Thankfully, we have healthcare professionals on course to triage and manage care for you. With spotters at high consequence locations, radio communications and drones, you are never out of sight from someone who can help for long.

Centura Health is a Supporting Sponsor of the Pikes Peak APEX, and their sports medicine department’s certified athletic trainers (ATs) were ready to respond to any emergency—cardiac, spinal, open fracture, heat and others. March is designated National Athletic Training Month to spread awareness about these essential healthcare providers - a perfect time to schedule a chat with Craig Elder, Athletic Training Manager, at Centura Sports Medicine. I wanted to get a behind the scenes look at the ATs who provided these crucial services during The APEX, and the challenges incurred at a 4-day backcountry event spread over 4 different locations.  

Samantha:  Good Morning, Craig, tell us a little bit about Centura Sports Medicine.

Craig: Centura Sports Medicine, here in Colorado Springs, is composed orthopedic surgeons, primary care sports medicine physicians, physical therapists, sports nutritionists and sports performance specialists. We operate out of a new facility -- Hybl Sports Medicine Center on North Nevada. We've been open, it’ll be a year, this April. And that group of providers is engaged in sports medicine service delivery, whether it's here on site or for community brands such as Pikes Peak APEX.

Samantha: How did Centura Sports Medicine get involved with The APEX this past year?

Craig: The Hybl Sports Medicine and Performance Center is a collaboration with UCCS. And so with those two entities, there was some history with USA Cycling, which connected us to Micah Rice, the race director. And you know, the event physician, Dr. Michael Roshon, is a physician here for Centura Health. So, we already had a little bit of a network going on, and Micah came to us and asked what it would look like for us to be involved in helping to organize and manage all the healthcare and medical coverage for the race.

Samantha: Yeah, I was really excited to see all of you at the event last year. Fun fact, for readers, I'm also an athletic trainer, and Craig was actually the head of my undergraduate athletic training education program. So that was a pretty cool surprise. I know the answer to this question but, Craig, I'll let you tell everyone. Who exactly are ATs and why are they uniquely qualified to provide medical care at an event like The APEX?

Craig: That's a great question. I think for a lot of people that have been engaged in sports throughout their life, you probably are very familiar with an Craig Elder and team at 2020 APEXathletic trainer because most likely even if it was high school sports, hopefully you had someone there to provide medical care, and that was an athletic trainer. But if you're new to sports competitions and events, you might not understand that, and a lot of times there might be some confusion in the public about that just because of the word trainer. Sometimes there's some association with athletes and training, and that means maybe sports performance or personal training. And certainly, that's not what we do. As athletic trainers, we're a healthcare provider. We are experts in musculoskeletal evaluation, and acute injuries that happen to a wide variety of sports. It could be what might be considered traditional sport competition, whether that's volleyball or soccer or football, but certainly branches out to other sports like cycling, where we are routinely working with different emergency medical services and health care providers. So, I think that's what our profession can bring to an event like this, is that we're really used to organizing events. So, if we are an athletic trainer working on a cross country event, for example, for a college or a high school, there's some of the similar things that need to be going on to effectively execute a good plan. And first off, that just starts with us assessing what the event is, and what type of personnel might be required outside of the athletic trainer.  For big events like The APEX, certainly we're going to need to leverage all the resources that we have in the community.  If you see any kind of sporting event, the first person usually to attend to an injured athlete is likely an athletic trainer.

Samantha: Over four days, there's obviously challenges in managing an event that covers four different locations in such a remote back country area. How did your team address those challenges?

Craig: I've mentioned a couple people but I just want to reiterate Dr. Roshon, Micah, Fonda Johnson and Laura Ryan, Volunteer Coordinator--it always takes a team of people to help do this. Before the race even started, we had to really determine what are COVID-19 protocols were going to be. Dr Roshon was really instrumental in helping us determine those, and we'll do the same thing this year. So, that was just an extra layer that we haven't had previously at events.

The second thing; communication is always something that as a medical provider you're going to need to know.  How am I going to talk to my people? And then if there are other agencies out there, how do you talk to the other agencies?  When you're more remote like we were on this event, that presented some challenges. Cell phone reception was not really good; you had to figure out different ways. We were fortunate enough to have volunteers that did ham radio operation for us. So that allowed us to talk to different stations throughout the course. We actually had some really fun technology on a couple of the stages.  We had some people out with drones and they could give us an aerial view. I don't know if many of the racers knew this, but we could see when the racers hit the top of Captain Jacks. We knew when they were getting into the chute, and so that gave us race updates, and as medical personnel we can kind of kind of keep up with people.

The third thing in a race like this is identifying crux points for each course.  Where's the higher probability of a crash, so we know where to position medical personnel and spotters.  You may have seen some of the tents that were there, and certainly those are start-finish, but they're also people staged throughout the course that can either notify medical personnel, or there are actually medical personnel there.

The next thing is because of the remote area there's a lot of terrain where it might dictate some expertise in extracting people from that location. Flight for LifeThat's where would talk with El Paso County Search and Rescue, and they knew where they were going to be, and what sections were most critical for us. That also determined where we were going to pick out landing spots for Flight for Life. You may have seen the helicopter, and if you didn't, don't worry about it, but it's just another layer of things you didn't know that were there just in case we had some type of traumatic incident, and we needed to get someone extracted quickly.

The last part, with any big event where there's lots of stuff going on with a lot of agencies, it's just having someone there to coordinate all of those different people, make sure they're in the right place, and that we can talk to one another. Then, when something happens we're able to execute the plan for whatever the incident is.

Samantha: Thanks for sharing all of that. As a participant and an athletic trainer, I had no idea that you had implemented all of those safety practices. I think that's great for the racers, the families of the riders and anyone who's there volunteering to know that it's a safe event, and you're not going to get lost out there for hours and hours. With courses that big, the riders do get really strung out, and you might be out there on your own for what seems like several hours, but really, the medical team’s got an eye on you the whole time. So, that's really cool.

Craig: Yeah, for sure. You know, from a race perspective, and this is not unique to cycling, but there was always a sweeper behind the last rider.  So, we knew everybody who started the race, we knew where they were, if they didn't finish, or if they did finish. Before we left that day, we knew everybody was accounted for.

Samantha: What were the most common injuries that you encountered during The APEX?

Craig: Not surprising, with a mountain bike race, abrasions and contusions are going to be your number one thing that you're dealing with. Unless there's something significant, and those are usually at the finish line, right? You know, if you come off, pop off somewhere, as long as you can keep going, you're gonna go back [to racing].  If it's really bad you might need to stop at an aid station to get bandaged up and keep going, but most of the things we would take care of like that would occur at the finish line.

Samantha: So maybe it's just my own morbid curiosity as an athletic trainer, but people ask me all the time, so I'm gonna throw it back to you.  What was the most unique injury that you encountered at The APEX?

Craig: We had incidents where people came over the top of their Medical Tent at the 2020 APEXhandlebars and had a concussion, or maybe they hit their handlebars coming across and might have had rib injuries. But none of those are really unique, and we didn't have anything I would say that was uncommon as far as injury. However, we did have one very serious incident, but the outcome was great. On one of the race sections, on the last downhill section of Captain Jacks, we had someone have a really significant incident where they actually collided with one of the motorcycles. In that instance, obviously, we know that there's never a great outcome for the bicycle when the motorcycle hits that. It just crushed the front fork, it broke the front of the frame, and stuff like that, but amazingly the rider had no significant injuries. When the rider was able to make it down the chute and get to the finish line, we were able to do a complete and thorough evaluation of on him with our physician there. So that was the excitement; that's not what you would expect, saying that we had a motor vehicle accident, on course, but that's what happened. So good outcome!  Sorry to disappoint you, but I don't have any specific unusual injury to divulge. APEX Note: This incident involved a moto volunteer and a course volunteer on a bike before the race came through. A race participant was not involved in this incident.

Samantha: That's a good thing anytime an athletic trainer has a quiet day at work!  Will your team approach The APEX any differently this year?  Are there any lessons that you learned that you'll carry into the 2021 event?

Craig: You know, there's so many things that went well for us.  I'm not taking credit for all that--all those other people had a hand in helping me source out different things. I think what we learned was that all the things that we had in place, especially the communication piece, and how helpful that was. I think if we had more opportunities, I’d like to have more drone access.  That was not something we had really planned. That was a different approach for event monitoring that I hadn't even really considered before, and I think they truly were out there more to help us know where the riders were for the race, and not really thinking from a medical standpoint.  But I obviously was like, that's really cool, how could we employ that maybe a little bit broader this year? To be able to help assess something [from afar] or perhaps there's a place where we don’t have a spotter. I feel really confident in our approach, and the outcome from last year, and after-action report confirmed that we ended up having a good plan. So, we plan to execute that again.

Samantha: The medical plan, the emergency action plan, were very impressive. Thanks for sharing that with all of us. It is National Athletic Training Month. How is Centura Sports Medicine celebrating?

Craig: I think what we're doing, through community awareness, is making sure people know what it is that we do. Sometimes, I don't know if there's a direct correlation between a health care system and providing athletic training services to the community. So, we just like to remind all the community what we do as far as engagement with local high schools and colleges, and there's a long list of them here that we're involved with in Colorado Springs.  Certainly, we like quiet days at events, but it's also good for our profession to be able to remind people all the work that does go into trying to create a safe environment.  Right now, athletic trainers are playing a huge role in keeping athletes safe because they are the ones that are managing all of the COVID-19 protocols, and there's a lot of things to think about. Not only might you think about what makes sense as far as determining whether or not someone's positive, and what you do after that, we hear a lot of that in the media as far as contact tracing and quarantining, but the extra element with athletics. We need to help make good decisions on when it's safe for that individual to return to athletic competition. There's a lot of things about inflammation around the heart called myocarditis. We know that if someone's had a very significant, severe COVID reaction that requires hospitalization, the recommendation from the NCAA is for them to have an ECG prior to returning to sports. We would make sure from a heart healthy standpoint it's good for them to return. That's a role that athletic trainers are playing right now, that maybe parents are unaware of. And it's different because we haven't had an infectious disease like this to manage before, but it's not different in the sense that we manage return to play for injury and illnesses that are more common all the time. That's just one of the roles of an athletic trainer.

Samantha: It’s always good for athletic trainers to kind of pull that curtain back, and let the community see how we are working and interacting with a program.  Not only managing the return to play aspect, but also the prevention aspect in keeping everyone safe before even going into the event.

Thank you for joining us, Craig, and we look forward to seeing your team of athletic trainers from Centura Sports Medicine back out at the Pikes Peak APEX again this year!

Craig: Thank you. It's great talking with you, Sam.