1. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 第 1 章 : 健康照護者 運動傷害防護員 (AT)

2. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 1: The Athletic Trainer as a Health Care Provider

3. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-3 Athletic trainers specialize in preventing, recognizing, managing and rehabilitating injuries (專門：預防、辨識、管理和復健傷害) Function as a member of a health care team which also incorporates and involves a number of medical specialties (運作：以健康照護團隊模式含醫事人員） Provide a critical link between the medical community and physically active individuals （提供：社區醫療與個人運動間連結）

4. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-4 Historical Perspective Early History –Evidence suggests that coaches, physicians & therapists existed in Greek and Roman civilizations（希臘和羅馬） Assisted athletes in reaching top performance –Athletic trainers came into existence in the late 19 th century in intercollegiate & interscholastic sports（大學間和校際間） –Early treatments involved rubs, counter- irritants, home remedies and poultices –（摩擦、對抗刺激劑、家庭偏方、糊藥）

5. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-5 Evolution of Contemporary Athletic Trainer （當代AT的發展） Traditional setting of practice included colleges and secondary schools（ 9-12年級 ） –Dealing exclusively （獨有） with an athletic population Today certified athletic trainers (ATC) work in a variety of settings and with a variety of patient populations –Professional sports, hospitals, clinics, industrial settings, the military, equipment sales, physician extenders（內科醫師的延伸）

6. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-6 Rapid evolution of the profession following WW I –Athletic trainers became specialists in preventing and managing injuries –Dr. S.E. Bilik wrote, The Trainer’s Bible (1917) –The Cramer brothers developed a line of liniments （塗藥） to treat ankle sprains (1920’s) and followed the publication The First Aider (1932) –In the 1930’s the NATA started to come into existence but then disappeared during WW II –In 1950 the NATA was reorganized and it has continued to flourish （繁榮） and expand （擴張）

7. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-7 With the evolution of the profession a number of milestones （里程碑） have been achieved –Recognition of Acts as healthcare providers –Increased diversity （多樣性） of practice settings –Passage （管道） of practice acts –Third party reimbursement （第三方賠償） for athletic trainers –Constant revision （修正） and reform （重訂） of athletic training education

8. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-8 Changing Face of Athletic Training Profession Role of the athletic trainer is more in line（ 在內部 ）, today, as a health care provider –40% of athletic trainers are employed in clinics （診所）, hospitals （醫院）, industrial （工業 的） and occupational （職業的） settings –Also involved in NASCAR, performing arts, military, NASA, medical equipment & sales, law enforcement, and the US government Has resulted in changes in athletic training education

9. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-9 Athletic trainers do not just provide medical care to athletes or those just injured during physical activity Becoming more aligned （對齊） as a clinical health care profession –Requires terminology（術語） changes Patients and clients vs. athletes Athletic clinic or facility vs. athletic training room Athletic trainers – NOT TRAINERS!!

10. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-10 Sports Medicine and Athletic Training Broad field （主要的範圍） of medical practices related to physical activity and sport（身體活動與運動） Involves a number of specialties involving active populations Typically classified（典型分類） as relating to performance enhancement （增進運動表現）or injury care and management（傷害照護與管理）

11. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-11

12. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 運動醫學 Sports Medicine 促進運動表現 傷害照護與管理 運動生理學 醫療實務操作 生物力學 運動保健 運動力學 運動治療 運動營養學 運動按摩治療 肌力訓練與調整 運動牙科 教練學 骨科醫學 個人適能訓練 矯正與修補 運動整脊 運動腳病學 1-12

13. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-13 Growth of Professional Sports Medicine Organizations International Federation of Sports Medicine (1928) American Academy of Family Physicians (1947) National Athletic Trainers Association (1950) American College of Sports Medicine (1954) American Orthopaedic Society for Sports Medicine (1972) （美 國整形外科的運動醫協會） National Strength and Conditioning Association (1978) American Academy（學會） of Pediatrics（小兒科）, Sports Committee（委員會）(1979) Sports Physical Therapy Section of APTA (1981) NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (1985) National Academy of Sports Medicine (1987)

14. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-14 International Federation of Sports Medicine Federation （聯盟） Internationale de Medecine Sportive (FIMS) （國際運動醫學聯 盟） Principal purpose to promote the study and development of sports medicine throughout the world Made up of national sports medicine associations of over 100 countries Organization includes many disciplines （章 程） that are concerned with physically active individuals

15. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-15 American Academy of Family Physicians （美國家庭醫師學會） To promote and maintain high quality standards for family doctors who are providing continuing comprehensive （ 綜合的） health care to the public It is a medical association of more than 93,000 members Many team physicians （隊醫） are members of this organization

16. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-16 National Athletic Trainers’ Association （國家運動傷害防護員協會） 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 32,000 members

17. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-17 Figure 1-1

18. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-18 American College of Sports Medicine （美國運動醫學會） Patterned （仿） after FIMS (Umbrella Organization) Interested in the study of all aspects of sports Membership composed of medical doctors, doctors of philosophy, physical educators, athletic trainers, coaches, exercise physiologists, biomechanists, and others interested in sports （成員有：醫師、博士生、體育老師、運動傷害護員、教練、運 動生理學家、生物力學家和其他對運動有興趣之人士） >20,000 members

19. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-19 American Orthopaedic Society for Sports Medicine （美國整形外科運動醫學協會） To encourage and support scientific research in orthopaedic sports medicine and to develop methods for safer, more productive and enjoyable fitness programs and sports participation Members receive specialized training in sports medicine, surgical procedures, injury prevention and rehabilitation 1,200 members are orthopaedic surgeons （ 整形外科醫師） and allied （結盟） health professionals

20. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-20 National Strength and Conditioning Association To facilitate （促進） a professional exchange of ideas in strength development as it relates to the improvement of athletic performance and fitness and to enhance, enlighten, and advance the field of strength and conditioning （肌肉適能和身體狀況調節） 30,000 strength and conditioning coaches （教練）, personal trainers （個人健身指導員）, exercise physiologists （運動生理學家）, athletic trainers （運動保健員）, researchers （研究者）, educators （教師）, sport coaches （ 運動教練）, physical therapists （物理治療師）, business owners （業者）, exercise instructors （運動講師） and fitness directors （體適能指導員） Accredited certification programs – Certified Strength and Conditioning Specialist （專家）, (CSCS) – NSCA Certified Personal Trainer (NSCA-CPT)

21. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-21 American Academy of Pediatrics, Sports Committee Dedicated to providing the general pediatrician and pediatric sub-specialist with an understanding of the basic principles of sports medicine and fitness and providing a forum（論壇） for the discussion of related issues To educate all physicians, especially pediatricians, about the special needs of children who participate in sports （目的在教育所 有醫師，尤其是小兒科醫師。以增進對孩童在參與運動活動中的 特殊需求的認識）

22. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-22 American Physical Therapy Association, Sports Physical Therapy Section To provide a forum to establish collegial relations between physical therapists, physical therapist assistants, and physical therapy students interested in sports physical therapy Promotes prevention, recognition, treatment and rehabilitation of injuries in an athletic and physically active population Provides educational opportunities through sponsorship of continuing education programs and publications

23. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-23 NCAA Committee on Competitive Safeguards and Medical Aspects of Sports Collects and develops （蒐集與發展） pertinent （相關） information regarding desirable training methods, prevention and treatment of sports injuries, and utilization （ 運用） of sound safety measures Disseminates （傳播） information and adopts （調整） recommended policies and guidelines designed to further the above objectives Supervises （監督） drug-education and drug-testing programs

24. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-24 National Academy of Sports Medicine Founded by physicians, physical therapists and fitness professionals Focuses on the development, refinement （ 細化，精緻）and implementation（履行） of educational programs for fitness, performance and sports medicine professionals Offer a variety of certifications (fitness and performance)

25. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-25 Other Health Related Organizations Various aspects of health related professions have also become involved –Dentistry, podiatry, chiropractic medicine National, state and local organizations have also emerged –Focus on athletic health and safety All bodies have worked towards the reduction of injury and illness in sport

26. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-26 Sports Medicine Journals A variety of publications exist, providing excellent resources to the sports medicine community –Journal of Athletic Training （運動保健期刊） –Journal of Sports Rehabilitation （運動復健期刊） –International Journal of Sports Medicine （國際運動醫學期刊） –Physician and Sports Medicine （內科與運動醫學） –Clinics in Sports Medicine （臨床運動醫學） –American Journal of Sports Medicine（ 美國運動醫學期刊） –Sports Health （運動健康） –Athletic Therapy & Training （運動治療與訓練） –Training & Conditioning （訓練與調節） –Athletic Training & Sports Health Care （運動保健與健康照護）

27. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-27 Employment Settings for the Athletic Trainer Employment opportunities are becoming increasingly diverse （不一樣） –Dramatic transformation since 1950 –Due largely to the efforts of the NATA Started out primarily in the collegiate setting, progressed to high schools and now 40% are found primarily in hospital and clinic settings（ 大學→高中→40%醫院和診所）

28. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-28 Settings include: –Clinics and hospitals（診所與醫院） –Physician extenders（ –Industrial/Occupational settings（工廠） –Corporate settings（公司企業） –Colleges or Universities（大學） –Secondary schools（中學） –School districts（學校） –Professional sports（專業運動項目） –Amateur/Recreational/Youth sports （業餘/娛樂/青少年運動項目） –Performing arts（表演藝術） –Military & Law enforcement（軍/警務單位） –Health & fitness clubs （健康管理中心＆體適能中心）

29. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-29 Treating Physically Active Populations 運動的意涵 Consists of athletic, recreational or competitive activities （運動的、娛樂性、競爭性） Requires physical skills and utilizes （利用） strength, power, endurance, speed, flexibility, range of motion and agility （敏捷性） （要求運動技巧、運用肌耐力、爆發力、速度、柔軟度、 關節活動度和敏捷性）

30. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-30 The Adolescent Athlete （青少年運動員） –Focuses on organized competition （有組織的競爭） –A number of sociological issues are involved（社會議題） How old or when should a child begin training? –Skeletal maturity（骨骼成長） presents some challenges with respect to healthcare –Physically （身）and emotional （心） adolescents can not be managed the same way as adults

31. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-31 The Aging Athlete（老人運動） –Physiological and performance capability （能力） changes overtime （隨者時間，生理和運動能力會改變） Function will increase and decrease depending on point in lifecycle（生命週期） May be the result of both biological and sociological effects（生物和社會影響） –High levels of physiological function can be maintained through an active lifestyle （動態生活） The impact on long-term health benefits have been documented（動態生活長期下來有助健康） –Beginning an exercise program （運動計畫）

32. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-32 –Exercise program should be gradual and progressive as long as no unusual signs or symptoms develop（分級和漸進式進行） –Individuals over age 40 should have a physical and exercise testing before engaging in an exercise program（超過40 歲者，運動前要先做運動評估）

33. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-33 Occupational Athlete 職業運動員 –Occupational, industrial or worker “athlete” are involved in strenuous, demanding or repetitive physical activity May result in accidents （意外） and injury （傷害） –Involves Instruction on ergonomic（人體力學） techniques to avoid injury associated with physical demand of job responsibilities Intervention when injuries arise –Correcting mechanics（矯正機械）, faulty postures, （錯誤姿勢） strength deficits（肌力不夠）, lack of flexibility（柔軟度差） Injury prevention is still critical （傷害預防是關鍵）

34. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-34 Roles & Responsibilities of the Athletic Trainer AT的角色和責任 Charged with injury prevention and health care provision （準備） for an injured patient –Often requires a cadre of sports medicine professionals（要求對動醫學的專業） Athletic trainer deals with the patient and injury from its inception （起初）until the athlete returns to full competition （從起初受傷，照顧到恢復能在運動競技場比賽)

35. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-35 Roles and Responsibilities: Board of Certification Domains 認證的領域 Injury/illness prevention & wellness protection 傷害預防與保健 Clinical evaluation and diagnosis 臨床評估與 診斷 Immediate & emergency care 急救 Treatment & rehabilitation 治療與復健 Organizational and professional health and well-being 全人健康組織與專業

36. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-36 Prevention(預防) –Ensure safe environment(環境安全) –Conduct pre-participation physicals(引導) –Develop training and conditioning programs (訓練計畫設計) –Select and fit protective equipment properly (護具) –Explaining important diet and lifestyle choices(營養與規律生活) –Ensure appropriate medication use while discouraging substance abuse (避免藥物濫用)

37. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-37 Clinical Evaluation & Diagnosis (臨床評估與診斷) –Recognize nature and extent of injury(辨識) –Involves both on and off-field evaluation skills and techniques(評估技巧與技術) –Understand pathology of injuries and illnesses(病理學) –Referring to medical care(轉介醫療照護) –Referring to supportive services(轉介支持) Immediate & Emergency Care(急救) –Administration of appropriate first aid and emergency medical care (CPR, AED) –Activation of emergency action plans (EAP)

38. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-38 Treatment and Rehabilitation –Design preventative training systems 系統 –Rehabilitation program design 復健 –Supervising rehabilitation programs 督導 –Incorporation of therapeutic modalities 治療方式 and exercise 整合 –Offering psychosocial intervention 社會心理 Organizational & Professional Health and Well-being 有組織的&專業性的 –Record keeping 紀錄保持 –Ordering supplies and equipment 支援與器材 –Establishing policies and procedures 制度與流程 –Supervising personnel 監督人員

39. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-39 Professional Responsibilities –Athletic trainer as educator 教師角色 –Athletic trainer and continuing education 持續進修 –Athletic trainers as counselor 諮商者角色 –Athletic trainers as researcher 研究角色 Incorporation of evidence based medicine 醫學 Participating and acquiring evidence for 證據 efficacious patient care

40. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-40 Importance of Engaging Evidence Based Practice Evidence driving patient care –Failure to engage in evidenced based care could jeopardize patient care 缺證據恐危急病患照顧 –EVB Steps –Develop clinical question –Search literature 研究 –Appraise evidence 估量 –Apply evidence 提供 –Assess outcomes 評估

41. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-41 Developing a clinical question –Utilizes the PICO format (Patient, Intervention, Comparison, Outcome) Searching the literature –Using key words to assemble 招集 a comprehensive 廣泛的assessment of available literature Evaluating the strength of the evidence –Type of study vs. quality of evidence –Must critically嚴格地 evaluate and rate 估價 the evidence Applying the evidence –Integrating evidence with patient needs and values –Bridging barriers between research evidence and clinical decisions to ensure optimal care

42. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-42 Assessing Treatment Outcomes –Determining effectiveness –Outcomes assessment measures Condition-oriented evidence 以調整狀況為主的證據 Patient-oriented evidence 以患者本身為主的證據 –Patient perceptions, experience, patient-centered goals Disablement model 表示”無能”的方式 –Evaluates functional loss due to impairment and impact on quality of life 判斷功能喪失，是以損害患者生活品質為考量 –Comprehensive assessment 廣泛性評估 –Patient reported outcomes 患者報告結果 –Global ratings of change 總體的變化分級

43. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-43 Personal Qualities of the Athletic Trainer Stamina and the ability to adapt (精力和適應能力) Empathy(心情轉換) Sense of humor(幽默) Communication(溝通) Intellectual curiosity (理性的好奇心) Ethical practice(道德感) Professional memberships(專業)

44. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-44 Athletic Trainer and the Athlete Major concern on the part of the ATC should be the injured patient 關心 All decisions impact the patient 衝擊 The injured patient must always be informed (報告，告知) –Be made aware of the how, when and why that dictates the course of injury rehabilitation 支配

45. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-45 The patient must be educated about injury prevention and management (患者需被教育：有關傷害的預防和管理) Instructions should be provided regarding training and conditioning (教學:提供對訓練和調整情況的關心) Inform the patient to listen to his/her body in order to prevent injuries(傾聽身 體訊號，預防運動傷害)

46. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-46 Athletic Trainer and Parents Athletic trainers must keep parents informed, particularly in the secondary school setting –Injury management and prevention The parents decision regarding關心 healthcare must be a primary consideration Insurance 保險plans may dictate care –Selection of physician (保險支配照護資源)

47. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-47 The athletic trainer, physician and coaches must be aware and inform parents of Health Insurance Portability and Accountability Act (HIPAA) 健康保險便携性與責任法案(HIPAA) –Regulates dissemination宣傳 of health information –Protects patient’s privacy and limits the people who could gain access 進入的權利 to medical records –(保護和限制獲得病人的醫療紀錄)

48. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-48 The Athletic Trainer and the Team Physician 隊醫 Athletic trainer works under direct supervision of physician (AT是在隊醫的督導下工作) Physician assumes a number of roles –Serves to advise and supervise ATC Physician and the athletic trainer must be able to work together –Have similar philosophical 達觀的，理性的 opinions regarding 關心injury management Helps to minimize discrepancies 不一致 and inconsistencies 不協調

49. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-49 The physician醫師 is responsible for compiling 編輯 medical histories and conducting 主導physical exams –Pre-participation screening 運動前的評估 Diagnosing injury 診斷傷害 Deciding on disqualifications 取消資格 –Decisions regarding athlete’s ability to participate based on medical knowledge and psychophysiological demands of sport Attending practice and games 出席練習或比賽 Commitment to sports and athlete 對運動本身與運動員有責任義務

50. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-50 Potentially serve as the academic program medical director (醫學學術指導) –Coordinates and guides medical aspects of program (在醫學方面計畫的協調與指導) –Provides input into educational content and provides programmatic instruction (提供教育內 容與具綱領性的研究架構)

51. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-51 The Athletic Trainer and the Coach Must understand specific role of all individuals involved with the team 教練須了解隊員們的個別差異 Coach must clearly understand the limits of their ability to function as a health care provider in their respective state 教練需了解AT並非無所不能。 Directly responsible for injury prevention –Athlete must go through appropriate conditioning program 運動員需經歷適度的調整計畫

52. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-52 Coach must be aware of risks associated with sport Provide appropriate training and equipment Should be certified in CPR and first aid Must have thorough knowledge of skills, techniques and environmental factors associated with sport Develop good working relationships with staff, including athletic trainers –Must be a cooperative relationship

53. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-53 Referring the Patient to Other Personnel The athletic trainer must be aware of available medical and non-medical personnel –Patient may require special treatment outside of the “traditional” sports medicine team Must be aware of community based services and various insurance plans –Typically the athletic trainer and team physician will consult 商量 on the particular matter and refer accordingly 相對應地 –就案例做討論，再依個別狀況做相對應的處理

54. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-54 Support Health Services & Personnel Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Occupational Therapist Massage Therapist Ophthalmologist Dermatologist Gynecologist Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Occupational Therapist Massage Therapist Ophthalmologist Dermatologist Gynecologist Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker Neurologist Emergency Medical Technician Osteopath Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker Neurologist Emergency Medical Technician Osteopath

55. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. Support Health Services & Personnel 健康服務支援與人員 1-55 Physicians 醫師 Dentist 牙醫 Podiatrist 足科醫師 Nurse 護士 Physicians Assistant 醫師助理 Physical Therapist 物理治療師 Occupational Therapist 職能治療 Massage Therapist 按摩治療師 Ophthalmologist 眼科醫師 Dermatologist 皮膚科醫師 Gynecologist 婦科醫師 Physicians 醫師 Dentist 牙醫 Podiatrist 足科醫師 Nurse 護士 Physicians Assistant 醫師助理 Physical Therapist 物理治療師 Occupational Therapist 職能治療 Massage Therapist 按摩治療師 Ophthalmologist 眼科醫師 Dermatologist 皮膚科醫師 Gynecologist 婦科醫師

56. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. Support Health Services & Personnel 健康服務支援與人員 1-56 Exercise Physiologist 運動生理學家 Biomechanist 生物力學家 Nutritionist 營養師 Sport Psychologist 運動心理學家 Coaches 教練 Strength & Conditioning Specialist 運動指導員 Social Worker 社工 Neurologist 神經科專業醫師 Emergency Medical Technician 醫療急救人員 Osteopath 整骨醫師 Exercise Physiologist 運動生理學家 Biomechanist 生物力學家 Nutritionist 營養師 Sport Psychologist 運動心理學家 Coaches 教練 Strength & Conditioning Specialist 運動指導員 Social Worker 社工 Neurologist 神經科專業醫師 Emergency Medical Technician 醫療急救人員 Osteopath 整骨醫師

57. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-57 Recognition and Accreditation of the Athletic Trainer as an Allied Healthcare Professional (AT 被認定與任命健康照護專業人員) June 1990- 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)

58. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-58 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 were accredited by CAAHEP through 2005

59. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-59 In 2003, JRC-AT became an independent accrediting agency –JRC-AT would accredit athletic training education programs without involvement of CAAHEP –JRC-AT officially became the Committee for Accreditation of Athletic Training Education (CAATE) in 2006 –CAATE was officially recognized by CHEA in 2007 CHEA is a private nonprofit national organization that coordinates accreditation activity in the United States Recognition by CHEA puts CAATE on the same level as other national accreditors, such as CAAHEP

60. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-60 Effects of CAATE accreditation are not limited to educational aspects In the future, this recognition may potentially affect regulatory legislation, the practice of athletic training in nontraditional settings, and insurance considerations Recognition will continue to be a positive step in the development of the athletic training profession

61. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-61 Accredited Athletic Training Education Programs Entry-level athletic training education programs –In 2012, 333 undergraduate programs, 19 entry-level master’s programs Advanced graduate athletic training education programs –Designed for individuals that are already certified ATs

62. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-62 Education Council 教育協調會 In 1997 the Education Council was established to dictate 支配 the course of the educational preparation for the athletic training student Focus has shifted to competency based education at the entry level Education Council has significantly expanded and reorganized the clinical competencies 核 心能力 and proficiencies 精熟

63. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-63 Athletic Training Education Competencies 核心能力 Eight Content Areas (AT 教育養成八大領 域 ) –Evidence based practice 實務證明 –Prevention & health promotion 預防與健康促進 –Clinical examination & diagnosis 臨床檢查與診斷 –Acute care of injury & illness 疾病傷害急性處理 –Therapeutic interventions 治療介入 –Psychosocial strategies & referrals 社會心理策略與參 考 –Healthcare administration 健康管理 –Professional development & responsibilities 專業發 展與責任

64. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-64 Foundational Behaviors of Professional Practice –“People” components of the profession Recognizing the primary focus of practice should be the patient (以患者為主) Understanding that competent health care requires a team approach (團隊照護模式) Being aware of legal elements of practice(合法) Practicing ethically(道德) Advancing the knowledge base in athletic training (精益求精) Appreciate cultural diversity (尊重多元文化) Being an advocate and model for the AT profession (致力專業)

65. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-65 Post-Professional Athletic Training Education Programs 15 programs are certified by the NATA Graduate Education Committee Designed to enhance academic and clinical preparation of already certified athletic trainers

66. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-66 Specialty Certifications NATA is in the process of developing specialty certifications –Further enhance professional development –Aid in expanding scope of practice Specialty certifications build on entry level knowledge

67. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-67 Purpose –To provide the athletic trainer with advanced clinical practice credential 證書 that demonstrates 證明attainment of knowledge and skills that will enhance patient care, enhance health-related patient quality of life, and optimize clinical outcomes in specialized areas of athletic training practice

68. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-68 Requirements for Certification as an Athletic Trainer Must have extensive 廣泛的background in formal academic preparation and supervised practical experience Guidelines are set by the Board of Certification (BOC)

69. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-69 Upon meeting the educational guidelines applicants are eligible有資格當上 to sit for the examination Examination is computer based Exam assesses 5 domains –Injury/illness prevention and wellness protection –Clinical evaluation and diagnosis –Immediate & emergency care –Treatment and rehabilitation –Organizational and professional health and well-being

70. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-70 Upon passing the certification examination = BOC certified as an athletic trainer –Credential of ATC BOC certification is a prerequisite 必修 的for licensure in most states

71. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-71 Continuing Education Requirements Ensure ongoing professional growth and involvement 牽連 Requirements that must be met to remain certified –75 CEUs over the course of three years

72. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-72 Purpose: –To encourage athletic trainers to obtain current professional development information –To explore new knowledge in specific areas –To master new athletic training related skills and techniques –To expand approaches to effective athletic training –To further develop professional judgment –To conduct professional practice in an ethical and appropriate manner

73. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-73 CEUs are awarded for: –Attending symposiums討論會, workshops, seminars –Serving as a speaker or panelist 專題討論小組參加者 –Certification exam writer –Authoring a research article; authoring/editing a textbook –Completing post-graduate work All certified athletic trainers must demonstrate proof of current CPR/AED certification

74. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-74 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 管理 the practice of athletic training were nonexistent in virtually 實際上 every state

75. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-75 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 48 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 極端地 from state to state

76. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-76 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 限制的 ; of all forms of regulation

77. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-77 –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 Individual has paid a fee for being placed on an existing list of practitioners but says nothing about competency 核心能力

78. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-78 –Exemption (義務等的)免除 State recognizes that an athletic trainer performs similar functions to other licensed professions (e.g. physical therapy), yet still allows them to practice athletic training despite the fact that they do not comply 遵從 with the practice acts of other regulated professions Legislation 立法 regulating the practice of athletic training has been positive and to some extent protects the athletic trainer from litigation 訴訟

79. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-79 Future Directions for the Athletic Trainer Will be determined by the efforts of the NATA and its membership –Ongoing re-evaluation, revision and reform of athletic training education –Further recognition of CAATE by CHEA will further enhance credibility –Athletic trainers must continue to actively seek third party reimbursement 償還 for athletic training services –Standardization of state practice acts

80. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-80 –Athletic trainers will seek specialty certifications Expanding breadth 寬度 and scope of practice –Increase in secondary school employment of athletic trainers –Increase in recognition of athletic trainers as physician extender –Potential for expansion in the military, industry, and fitness/wellness settings –With general population aging = increased opportunity to work with aging physically active individuals –Continue to enhance visibility 能見度 through research and scholarly 學者的 publication

81. © 2014 The McGraw-Hill Companies, Inc. All rights reserved. 1-81 –Continue to be available for local and community meetings to discuss health care of the athlete –Increase recognition and presence出席 internationally –Most importantly, continue to focus efforts on injury prevention and to provide high quality health care to physically active individuals regardless不關心的 of the setting in which the injury occurs