 Hey all, I wanted to share a presentation that I've put together helping another chiropractor who's working on providing musculoskeletal care during this coronavirus pandemic and So I dug into the research put it all together or at least what I found into a slide deck And I wanted to share it because I know this is a Conversation that's ongoing across the country especially in the next gen ACA of chiropractors wanting to offer services to do what they can to Flatten the curves, so I don't have the answers I don't know exactly how to go about this But I wanted to put this together and provide it as a resource so that people can use it and improve upon it and Share and continue the conversation. So what are we talking about with flattening the curve? Well, it's this idea that during a pandemic That spreads rapidly as does COVID-19 This is what it would look like if there were no protective measures, right? So if you're not social distancing if you're not using protective personal protective equipment in hospital and in clinic settings If people are just going about their data day-to-day lives the number of cases will exponentially increase and hit a peak Very quickly But if we take measures protective measures to slow that down We we're not going to necessarily Change the area under the curve, right? The same amount of people may get ill may contract this virus and the disease COVID but if Implementing these protective measures can slow it down that flattens the curve Which is important because we only have so much health care capacity and so if we can Slow it down to the point where our hospitals urgent cares can manage the inflow have enough hospital beds Then that is a good thing even if the same number of people get the disease So there are a couple factors to consider At least in this conversation we're having about the role of chiropractors The number one is the burden on the health care system. Okay, so patients coming into the ED Put a burden on it put a pressure on it and the more we can reduce that the better and then there's just the Exposure of people going into a hospital or urgent care where other people are sick And so even if they don't have the virus they may be at a greater risk to contract it In a recent paper in JAMA just over a week ago This article is about supporting the health care workforce It was clearly stated that one problem is the emergency department where crowding is Identified as a major concern Too many people going in then can be handled This is where we come in potentially because musculoskeletal disorders are The most common class of complaints among patients presenting for care in the emergency departments. In fact internationally in this paper By a matter fat at all The numbers are that musculoskeletal disorders represent more than 25 percent of all emergency department visits Now papers here in the States aren't quite that dramatic The data from the CDC in their National Hospital ambulatory medical care survey and there's these numbers are from 2017 the most recent There were a hundred thirty nine million visits to the emergency department that year of Those eleven point two one million fell into that category of musculoskeletal system the m zero zero to m ninety nine ICD-10 codes Of those eleven point two one million about forty percent are low severity musculoskeletal complaints Which to me means that there are roughly four and a half million Emergency department visits that don't need to be emergency department visits. I these are low severity Probably non-acute musculoskeletal conditions chronic low back pain that just flares up this type of thing that can Feasibly be managed by chiropractor in another paper This is by Irwin Discussing the role of primary spine care So because of this overwhelming burden of musculoskeletal conditions on the health care system This idea of a primary spine care provider could be helpful so the PSP is a concept first conceived by Scott Haldeman and then later promoted by Don Murphy and others in fact Don Murphy's books the crisp books Pretty much revolve around this model. So the idea is that a primary spine care practitioner plays the role of a PCP or a GP for Musculoskeletal complaints right so your GP can see 80% of Conditions and manage it without referral a PSP would do the same specifically for musculoskeletal complaints Chiropractors happen to be Ideally suited to fill this role, okay PSP or the primary spine practitioner could be a physical therapist could be a physiatrist but chiropractors have great training to allow them to fill this role and This was done in Wisconsin there's a paper discussing this role in Massachusetts Plymouth, Massachusetts at Jordan Hospital This paper by Piskowski outlines the spine care pathway that was implemented and It looks like this. It's quite simple. It makes sense if you think about it so a patient would present to urgent care the emergency department or primary care and The idea is if it is a musculoskeletal primary complaint that they would be triaged or evaluated by a chiropractor of PT or an MD and If there were any red flags We know to look for this things like history of trauma history of cancer or fracture that type of thing if they exist That patient's gonna go to the ED right go the regular medical route If there are no red flags then kind of a second evaluation will take place to determine whether they could potentially go through conservative care if yes, then they are classified in this case they mainly used kind of the McKenzie method looking for a Directional preference and that type of thing with end-range loading and then they go on to management by this musculoskeletal practitioner or whatever it may be so it's an interesting model and Similar things have been done in many other situations in England in Europe It's very common for a physical therapist to be in the emergency department to fill this role and so There's data out there that shows some of the benefits Primarily it can de-burden the hospitals right you're pulling away these musculoskeletal patients from the ED from the emergency physicians who are working with other more serious care cases Potentially pulling them out of urgent care as well. So de-burdening the hospitals. You're also decreasing exposure of Patients to other ill patients. So in situations like the coronavirus pandemic, you're lowering that vector There are many other benefits that aren't specific to the current situation But are nevertheless positive right chiropractors and other physical medicine practitioners tend to do less imaging It results in less spinal injections less surgeries That means in general that care by a chiropractor is Much less expensive 20 to 40 percent some number show than if patients are seen by an MD partly because of the decreased cost of interventions And initiating care with a chiropractor can't actually decrease opioid exposure. This has been another hot topic in In our field. So we know that these are some Other benefits other than decreasing the burden and exposure of patients to viruses There are some concerns though right questions that may come up. So I wanted to address those Number one. What are patients going to think? Well the data out there From that same paper of the jordan hospital is that 95 percent of patients Rated their care as excellent when they were seen by the chiropractor instead of the medical doctor Another concern as well with these advanced practice providers or primary spine providers be as effective And the truth is yeah, they are as effective or even more effective than usual medical care For pain as well as disability mainly in the short term, but they're As effective in the long term as well Another concern maybe well, what about the risk of missing a serious condition right or chiropractors are going to catch these things In general, yeah, we're trained to find these red flags and The reality is that the prevalence of serious spinal pathologies in primary care is less than 1 percent But in the emergency department It is up to about seven and a half percent Probably a little bit lower than in most cases two to five percent but There's a portion right but as long as you're following those red flags These can be caught those red flags are effective at Detecting potential serious pathologies Okay, so with that data in mind, what are the next steps can chiropractors fill a role during this coronavirus pandemic to um Deburden the healthcare system and to prevent the spread of coronavirus Well, it's really unclear at this point. This is where I don't have the answers Um other people have had more experience in this area and are figuring this out So some things to consider Well, first of all the models that I showed the data that we have Is with a chiropractor or physical therapist integrated into the hospital system So they are right there where the patient is going to come anyway um The ambulance may deliver them But what we're talking about In most cases right now is something that's not going to Take a while to develop. We want to implement this as soon as possible. We want to have a rapid response We're probably talking about sending patients to chiropractic clinics rather than going to ed And that may not be practical. I know here in south dakota The state law and i'm Being trained as an e-empty but not having much experience riding on a rig or anything um Most states have laws where ambulance have to Transport to the emergency department and so to divert them to reroute to a Community clinic may not be feasible. So these are the some things that we've got to um grapple with Other things to consider are well the benefits of treating Patients like this or you do decrease that burden on the health care system. You do decrease exposure, but You have to weigh that against the risks of um Number one being a vector yourself And your clinic as well to transmit coronavirus, right? You you're not completely Isolating um and shutting down and stopping the spread The other thing is that some anecdotal evidence is that during pandemics like this The musculoskeletal burden actually goes down. People Are aware That there's more serious things going on. They're aware that they put themselves at risk for contracting This disease and so even though they're in pain they stay home and so The effect that we have may not be all that great What is this clear, however, is that we can play a role And mainly that is informing patients of the correct Ways to go about preventing Passing on or contracting the coronavirus So following those CDC recommendations following the information provided by the world health organization as well as the world federation of chiropractic message on proper advertising on Being consistent with messaging with your patients So being an informed healthcare provider is probably our first role and being a good source of information So that's what I have again. I don't have the answers. I'm not totally sure of the proper way to approach this But I think it's a good conversation to have We need to grab with those decisions between staying open to provide care Versus shutting down to prevent Being part of the spread ourselves So I'm curious to hear what you think please leave your comments below And check out my website where I'll post In a blog this video as well as the power point to share So you can download it you can make changes you can Use it as you see fit and I hope that it's helpful Hopefully we can approve upon it and you can share things with me as well Thanks for watching. I hope that's informative