1. Chapter 1: The Sports Medicine Team

2. Sports Medicine Where Have We Been? Where Are We Now? Where Are We Going? Where Have We Been? Where Are We Now? Where Are We Going?

3. Where Have We Been? Trainers associated with Greek & Roman Periods. Increase in sports activities during the Renaissance. Late 19 th century AT’s involved with intercollegiate athletics in the US. Rub downs, home remedies, lack of technical knowledge. After WWI AT’s viewed as specialized in preventing and managing athletic injuries. 1950 NATA (National Athletic Trainers Association) founded in Kansas City 1980’s Athletic Training Program content for bachelor’s degree. 1980’s development of NATABOC for board certification, ATC’s. Recognized by the AMA as an allied health care provider.

4. Where Are We Now? 40% of ATC’s work outside of school athletic settings. 2004 End of internship programs ATC’s regulated and licensed healthcare providers ATC’s provide the same or better outcomes as others, including PT’s. ATC’s demonstrate high patient satisfaction ratings.

5. Where Are We Going? 2010 21,525 projected ATC jobs 2015 25,400 projected ATC jobs Continued research to develop new techniques for injury prevention, management, and rehabilitation.

6. What’s the Difference? Athletic First Responder Certified in CPR/First Aid Completes 40 hours of continuing education each year in injury prevention/management May have additional certifications/degrees in the field of sports medicine/athletic training Certified Athletic Trainer Holds a degree in Sports Medicine/Athletic Training Certified by the NATABOC (exam) (National Athletic Training Association Board of Certification) Licensed in the State for which they work

7. Practice of Medicine Human Performance Human Performance Injury Management Injury Management Exercise Physiology Biomechanics Sport Psychology Sports Nutrition Sports Physical Therapy Athletic Training Sports Massage

8. Goals of Professional Sports Medicine Organizations Develop professional standards & code of ethics Exchange of professional knowledge, stimulate research, & promote critical thinking. Ability to work as a group with a singleness of purpose to achieve objectives that could not be accomplished separately.

9. The Players on the Sports Medicine Team Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Athletic Trainer Adult First Responders Massage Therapist Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Athletic Trainer Adult First Responders Massage Therapist Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker

10. The Primary Players on the Sports Medicine Team

12. American College of Sports Medicine (ACSM) Patterned after FIMS (Umbrella Organization) Interested in the study of all aspects of sports Membership = individuals in the medical field, and those interested in sports medicine 18,000 members Patterned after FIMS (Umbrella Organization) Interested in the study of all aspects of sports Membership = individuals in the medical field, and those interested in sports medicine 18,000 members

13. Sports Physical Therapy Section of APTA Promotes the role of the sports physical therapist to other health professionals Supports research to further establish the scientific basis for sports physical therapy Offers certification as a sports physical therapist (SCS) Approximately 9,000 members Many sports physical therapists are also certified athletic trainers Promotes the role of the sports physical therapist to other health professionals Supports research to further establish the scientific basis for sports physical therapy Offers certification as a sports physical therapist (SCS) Approximately 9,000 members Many sports physical therapists are also certified athletic trainers

14. National Athletic Trainers Association (NATA) To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries The NATA now has 28,000 members To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries The NATA now has 28,000 members

15. AMA Recognition of Athletic Training June 1991- AMA officially recognized athletic training as an allied health profession Committee on Allied Health Education and Accreditation (CAHEA) was charged with responsibility of developing essentials and guidelines for academic programs to use in preparation of individuals for entry into profession through the Joint Review Committee on Athletic Training (JRC-AT) June 1991- AMA officially recognized athletic training as an allied health profession Committee on Allied Health Education and Accreditation (CAHEA) was charged with responsibility of developing essentials and guidelines for academic programs to use in preparation of individuals for entry into profession through the Joint Review Committee on Athletic Training (JRC-AT)

16. AMA Recognition of Athletic Training June 1994-CAHEA dissolved and replaced immediately by Commission on Accreditation of Allied Health Education Programs (CAAHEP) –Recognized as an accreditation agency for allied health education programs by the U.S. Department of Education Entry level college and university athletic training education programs at both undergraduate and graduate levels are now accredited by CAAHEP June 1994-CAHEA dissolved and replaced immediately by Commission on Accreditation of Allied Health Education Programs (CAAHEP) –Recognized as an accreditation agency for allied health education programs by the U.S. Department of Education Entry level college and university athletic training education programs at both undergraduate and graduate levels are now accredited by CAAHEP

17. National Athletic Trainers Association Board of Certification (NATABOC) In 1999 the NATABOC completed the latest Role Delineation Study, which redefined the profession of athletic training Study designed to examine the primary tasks performed by the entry level athletic trainer and the knowledge and skills required to perform each task In 1999 the NATABOC completed the latest Role Delineation Study, which redefined the profession of athletic training Study designed to examine the primary tasks performed by the entry level athletic trainer and the knowledge and skills required to perform each task

18. Athletic Training Educational Competencies (1999) Twelve Content Areas –Acute care of injury and illness –Assessment and evaluation –General medical conditions and disabilities –Health care administration –Nutritional aspects of injury and illnesses –Pathology of illness and injuries Twelve Content Areas –Acute care of injury and illness –Assessment and evaluation –General medical conditions and disabilities –Health care administration –Nutritional aspects of injury and illnesses –Pathology of illness and injuries

19. Athletic Training Educational Competencies (1999) –Pharmacological aspects of injury and illnesses –Professional development and responsibility –Psychosocial intervention and referral –Risk management and injury prevention –Therapeutic exercise –Therapeutic modalities –Pharmacological aspects of injury and illnesses –Professional development and responsibility –Psychosocial intervention and referral –Risk management and injury prevention –Therapeutic exercise –Therapeutic modalities

20. Certification Requirements Candidates for certification must meet NATABOC established requirements For students graduating in 2003 and beyond, NATABOC no longer requires clinical hours CAAHEP accredited programs must develop and implement a clinical instruction plan according to 2001 Standards and Guidelines to ensure that students meet all AT educational competencies and clinical proficiencies in academic courses with measurable outcomes Candidates for certification must meet NATABOC established requirements For students graduating in 2003 and beyond, NATABOC no longer requires clinical hours CAAHEP accredited programs must develop and implement a clinical instruction plan according to 2001 Standards and Guidelines to ensure that students meet all AT educational competencies and clinical proficiencies in academic courses with measurable outcomes

21. Certification Requirements Accreditation process will be concerned with the quality of experiences and student outcomes and knowledge rather the number of hours accrued As of January, 2004 the internship route to certification will no longer be accepted All candidates for certification will have to meet CAAHEP requirements Successful completion of all parts of the certification exam will earn the credential of ATC Accreditation process will be concerned with the quality of experiences and student outcomes and knowledge rather the number of hours accrued As of January, 2004 the internship route to certification will no longer be accepted All candidates for certification will have to meet CAAHEP requirements Successful completion of all parts of the certification exam will earn the credential of ATC

22. CAAHEP Accredited Programs Currently 134 institutions offer entry level athletic training education programs accredited by CAAHEP 174 are in the process of seeking CAAHEP accreditation 13 graduate programs in athletic training approved by the Education Council Post- Certification Graduate Education Committee Currently 134 institutions offer entry level athletic training education programs accredited by CAAHEP 174 are in the process of seeking CAAHEP accreditation 13 graduate programs in athletic training approved by the Education Council Post- Certification Graduate Education Committee

23. Employment Settings for Athletic Trainers Secondary Schools –1995 NATA adopted a position statement supporting hiring athletic trainers in secondary schools –1998 AMA adopted policy calling for ATC’s to be employed in all high school athletic programs –~ 30,000 public high schools in U.S. –Between 20-25% of high schools have ATC’s School Districts –ATC floats between several schools in same district Secondary Schools –1995 NATA adopted a position statement supporting hiring athletic trainers in secondary schools –1998 AMA adopted policy calling for ATC’s to be employed in all high school athletic programs –~ 30,000 public high schools in U.S. –Between 20-25% of high schools have ATC’s School Districts –ATC floats between several schools in same district

24. Employment Settings for Athletic Trainers College and Universities –Number of ATC’s varies considerably –Extent of coverage varies –2000 Task Force published Recommendations and Guidelines for Appropriate Medical Coverage for Intercollegiate Athletics Based on a mathematical model created by a number of variables Professional Teams –~ 5% of employed ATC’s College and Universities –Number of ATC’s varies considerably –Extent of coverage varies –2000 Task Force published Recommendations and Guidelines for Appropriate Medical Coverage for Intercollegiate Athletics Based on a mathematical model created by a number of variables Professional Teams –~ 5% of employed ATC’s

25. Employment Settings for Athletic Trainers Sports Medicine Clinics –The largest % of employed ATC’s found in this setting –Work in the clinic in AM and in high school in PM Industrial and Corporate Settings –ATC’s oversee fitness, injury rehabilitation, and work-hardening programs –Understanding of workplace ergonomics is essential Sports Medicine Clinics –The largest % of employed ATC’s found in this setting –Work in the clinic in AM and in high school in PM Industrial and Corporate Settings –ATC’s oversee fitness, injury rehabilitation, and work-hardening programs –Understanding of workplace ergonomics is essential

26. State Regulation of the Athletic Trainer During the early-1970s NATA realized the necessity of obtaining some type of official recognition by other medical allied health organizations of the athletic trainer as a health care professional Laws and statutes specifically governing the practice of athletic training were nonexistent in virtually every state During the early-1970s NATA realized the necessity of obtaining some type of official recognition by other medical allied health organizations of the athletic trainer as a health care professional Laws and statutes specifically governing the practice of athletic training were nonexistent in virtually every state

27. State Regulation of the Athletic Trainer Athletic trainers in many individual states organized efforts to secure recognition by seeking some type of regulation of the athletic trainer by state licensing agencies To date 40 of the 50 states have enacted some type of regulatory statute governing the practice of athletic training Rules and regulations governing the practice of athletic training vary tremendously from state to state Athletic trainers in many individual states organized efforts to secure recognition by seeking some type of regulation of the athletic trainer by state licensing agencies To date 40 of the 50 states have enacted some type of regulatory statute governing the practice of athletic training Rules and regulations governing the practice of athletic training vary tremendously from state to state

28. State Regulation of the Athletic Trainer Regulation may be in the form of: –Licensure Limits practice of athletic training to those who have met minimal requirements established by a state licensing board Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act Most restrictive of all forms of regulation Regulation may be in the form of: –Licensure Limits practice of athletic training to those who have met minimal requirements established by a state licensing board Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act Most restrictive of all forms of regulation

29. State Regulation of the Athletic Trainer –Certification Does not restrict using the title of athletic trainer to those certified by the state Can restrict performance of athletic training functions to only those individuals who are certified –Registration Before an individual can practice athletic training he or she must register in that state –Certification Does not restrict using the title of athletic trainer to those certified by the state Can restrict performance of athletic training functions to only those individuals who are certified –Registration Before an individual can practice athletic training he or she must register in that state

30. List of Regulated States L: Licensure C: Certification R: Registration Alabama (L)Kansas (R) North Carolina (L) Arkansas (L) Kentucky (C) North Dakota (L) Arizona (E)Louisiana (C) Ohio (L) Colorado (E) Massachusetts (L) Oklahoma (L) Connecticut (E)Maine (L) Oregon (R) Delaware (L)Minnesota (R) Pennsylvania (C) Florida (L)Mississippi (L) Rhode Island (L) Georgia (L)Missouri (R)South Carolina (C) Hawaii (E)Nebraska (L) South Dakota (L) Idaho (R)New Hampshire (C) Tennessee (C) Illinois (L)New Jersey (R) Texas (L) Indiana (L)New Mexico (L) Vermont (C) Iowa (L)New York (C) Virginia (C) Wisconsin (C) Alabama (L)Kansas (R) North Carolina (L) Arkansas (L) Kentucky (C) North Dakota (L) Arizona (E)Louisiana (C) Ohio (L) Colorado (E) Massachusetts (L) Oklahoma (L) Connecticut (E)Maine (L) Oregon (R) Delaware (L)Minnesota (R) Pennsylvania (C) Florida (L)Mississippi (L) Rhode Island (L) Georgia (L)Missouri (R)South Carolina (C) Hawaii (E)Nebraska (L) South Dakota (L) Idaho (R)New Hampshire (C) Tennessee (C) Illinois (L)New Jersey (R) Texas (L) Indiana (L)New Mexico (L) Vermont (C) Iowa (L)New York (C) Virginia (C) Wisconsin (C)

31. Reimbursement for Athletic Training Services During the past 40 years the insurance industry has undergone a significant evolutionary process Health care reform initiated in the 1990’s has focused on the concept of managed care in which costs of a health care providers medical care are closely monitored and scrutinized by insurance carriers Managed care involves a prearranged system for delivering health care that is designed to control cost while continuing to provide quality care During the past 40 years the insurance industry has undergone a significant evolutionary process Health care reform initiated in the 1990’s has focused on the concept of managed care in which costs of a health care providers medical care are closely monitored and scrutinized by insurance carriers Managed care involves a prearranged system for delivering health care that is designed to control cost while continuing to provide quality care

32. Reimbursement for Athletic Training Services Third-party reimbursement - primary mechanism of payment for medical services in the United States Health care professionals are reimbursed by the policy holder's insurance company for services performed To cut pay-out costs, many insurance companies limit where and how often an individual can go for care and what services will be paid for Third-party reimbursement - primary mechanism of payment for medical services in the United States Health care professionals are reimbursed by the policy holder's insurance company for services performed To cut pay-out costs, many insurance companies limit where and how often an individual can go for care and what services will be paid for

33. Athletic Trainer vs. Physical Therapist Wars It is not unusual to find a physical therapist interested in sports and athletics working toward certification as an athletic trainer A certified athletic trainer interested in working with patients outside of the athletic population may work toward licensure as a physical therapist It is not unusual to find a physical therapist interested in sports and athletics working toward certification as an athletic trainer A certified athletic trainer interested in working with patients outside of the athletic population may work toward licensure as a physical therapist

34. Athletic Trainer vs. Physical Therapist Wars Historically, the relationship between athletic trainers and physical therapists has been less than cooperative –There has been failure to clarify the roles of each group in injury rehabilitation Academic preparation is similar Individual who holds a dual credential is more marketable Historically, the relationship between athletic trainers and physical therapists has been less than cooperative –There has been failure to clarify the roles of each group in injury rehabilitation Academic preparation is similar Individual who holds a dual credential is more marketable

35. Future Directions Increase effort to enhance visibility –By making themselves available for local and community meetings to discuss athletic health care –Through research efforts and scholarly publication Continue reorganize and refine educational programs for student athletic trainers Continue to seek and strengthen state regulation of the practice of athletic training Increase effort to enhance visibility –By making themselves available for local and community meetings to discuss athletic health care –Through research efforts and scholarly publication Continue reorganize and refine educational programs for student athletic trainers Continue to seek and strengthen state regulation of the practice of athletic training

36. Future Directions Increase efforts to create job opportunities particularly in secondary schools, colleges and universities, and corporate and industrial settings Increase effort in seeking third-party reimbursement for services provided Continue efforts in injury prevention and in providing appropriate, high-quality health care Increase efforts to create job opportunities particularly in secondary schools, colleges and universities, and corporate and industrial settings Increase effort in seeking third-party reimbursement for services provided Continue efforts in injury prevention and in providing appropriate, high-quality health care