Initial Development of the Early Intensive Behavioral Intervention Parental Self-Efficacy Scale: A Pilot Study.

Early Intensive Behavioral Intervention (EIBI) is an effective treatment for children with autism. However, it is known that some parents struggle to fully implement the program, and providers are not always able to identify the specifics of each family's individualized challenges. The purpose of this pilot study was to begin the process of developing a new instrument, the EIBI Parental Self-Efficacy (EPSE) Scale, to help providers better assess and assist parents in regard to EIBI implementation. The methodology included four phases: scale construction, expert review, pretest administration, and a large sample pilot study (N = 192). The final 29-item EPSE Scale contained strong reliability properties (Cronbach's alpha = .900). Factor analysis established five subscales: Family Well-Being, Preparing for Successful Sessions, Team Participation, Not Giving Up, and Working with your Child. Following this pilot study, future research is recommended to refine and validate the EPSE Scale as a useful clinical tool for EIBI providers.

Medical Learning from the Special Olympics World Games 2015.

The Special Olympics World Games (SOWG) were held in Los Angeles, CA, during the summer of 2015. Medical care for 26 sporting events spread over six major venues across the city was provided to more than 6,000 athletes and 3,000 delegates from 170 countries. Education on care for individuals with intellectual and developmental disabilities and athletes with additional medical issues was provided in addition to the usual sports medicine care. This required coordination between major medical providers as well as law enforcement, fire rescue, transportation, public health, and the organizers of the games. This article reviews the planning, training, and outcomes of the medical care and the Healthy Athletes program for the SOWG 2015.

A Magnetic Resonance Imaging Study to Define Optimal Needle Length for Humeral Head IO Devices.

INTRODUCTION: Intraosseous (IO) devices have gained popularity because of TCCC. The ability to gain access to the vascular system when intra venous access is not possible, and techniques such as central lines or cut-downs are beyond the scope of battlefield providers and tactically not feasible, has lead to the increased use of IO access. Since tibias are often not available sites in blast injury patients, the sternum was often used. Recently the humeral head has gained popularity because of ease of access and placement. The optimal needle length has not been defined or studied. METHODS AND MATERIALS: Fifty consecutive shoulder MRIs among 18?40 year old patients were reviewed. Distances from the skin surface to the cortex from anterior and lateral trajectories were simulated and measured. Two different lateral trajectories were studied described as lateral minimum and lateral maximum trajectories, correlating with seemingly less and greater soft tissue. The cortical thickness was also recorded. Mean values and ranges for the measurements were determined. RESULTS: The anterior trajectory represented the shortest distance. Mean anterior, mean lateral minimum and mean lateral maximum distances were 2.3, 3.0 and 4.7cm with corresponding ranges of 1.1?4.1, 1.6?5.7 and 2.8?7.4cm respectively. The cortical thickness was 4mm in all cases. CONCLUSIONS: Although this information was gathered amongst civilians, and many military members may have more soft tissue, these results indicate that needle length generally in the 40?50mm range should be used via the anterior approach. Use of a standard 25mm needle often used in the tibia would be inadequate in over half the cases, and may result in undue tissue compression or distortion.

Traveling with the team.

The team physician may be asked to travel with the team to away venues. This takes special planning to provide for travel advice, proper immunizations, treatment of travel related diseases, appropriate planning for supplies, and care not to disturb any local laws and regulations. Increased security screening and limitations of what is allowed on the airplane in the cabin and in checked luggage have particularly affected air travel. Local laws, be they state or national, take precedence over the laws and regulations we are all used to practicing under. Close relationships with the hosting team's medical staff can help mitigate many of the problems that may arise.

Equipment and supplies for sports and event medicine.

There is an art and a science to determining the contents of an appropriate medical bag for sports and event medicine. Sports and event medicine encompass a broad range of activities and venues, and the medical bag's contents must be adapted accordingly. We discuss relevant considerations as well as general principles and recommendations accompanied by a checklist, using coverage of football games as a model.

Safety, security, and preparing for disaster at sporting events.

There is a heightened awareness of terrorism in this country. There always remains the possibility of nonterrorist disasters at sporting venues. The team physician will be among the first medical responders to a disaster at a sporting venue. By being involved in the creation of an emergency action plan, learning the incident command system, understanding triage, and obtaining basic trauma life support skills, the team physician can be prepared to respond to mass casualty incidents at sporting events.

Sideline splinting, bracing, and casting of extremity injuries.

Emergent and nonemergent splinting, bracing, and casting are effective ways to safely remove an injured athlete from the playing field, allow immediate return to play, and permit an athlete to return to play before an injury has completely healed. Sideline providers should be familiar with the materials and resources currently available, and be aware of the sport-specific guidelines regarding their use. Properly applied splints, casts, braces, and padding should function to prevent further injury, promote comfort, and not pose a risk of injury to other participants.

When Anxiety Attacks.

In brief The athlete who panics or hyperventilates requires immediate stabilization and assessment to rule out more serious diagnoses. Repeated attacks may indicate panic disorder, which can be treated effectively with a combination of psychological and pharmacologic therapy. Drug options include selective serotonin reuptake inhibitors, benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors.

Advanced Cardiac Life Support.

In brief Changes in the advanced car-brief diac life support guidelines in-elude a new classification system for interventions, training in the use of automated defibrillators, and required early defibrillation for ventricular fibrillation. The algorithms for treating ventricular fibrillation and pulseless ventricular tachycardia, pulseless electrical activity, and asystole are reviewed. Cardiac arrest caused by special circumstances-hypothermia, near drowning, trauma, and electrical injuries-presents additional treatment considerations.

Instituting the Updated CPR Protocol.

In brief Because the team physician may be called on to provide basic life support for athletes or spectators, knowing the latest CPR protocol is essential in developing an emergency response plan and training personnel. Practice with removing protective equipment and performing cardiopulmonary resuscitation on a mannequin can be helpful.