Essentials of Athletic Injury Management 10th Edition

Chapter 2: Organizing and Administering an Athletic Health Care Program

Rules of Operation for and Athletic Healthcare Program Determine who will take care of athletic health care facility Must develop policies and procedures Delineate daily routine of program Define scope of program Who will be served by program? Athlete: to what extent and what services will be rendered Institution: who else can be served medically and educationally and what are the legalities

Providing Coverage Facility Personnel Coverage Sports Coverage Budgetary concerns may be a limiting factor What personnel are available? Sports Coverage Different institutions (including high schools) have different levels of coverage based on personnel and risks involved with sports

Hiring a Certified Athletic Trainer in Secondary Schools Problems occurring later from improperly managed injuries could be avoided with proper management from an athletic trainer According to the NATA “…all secondary schools should provide the services of a full- time, on-site, certified athletic trainer (ATC) to student athletes.” American Academy of Pediatrics (1998) adopted a policy recommending employment of athletic trainers in the high school setting

Athletic Health Care Facility Policies Facility should be used only for prevention and care of sports injuries Rules must be established in the interest of sanitation See Focus Box 2-4 Policies regarding environmental conditions and emergency protocols should also be set

Keeping Facilities Clean Rules concerning room cleanliness and sanitation must be set and made known to population using facility Examples No equipment/cleats in athletic training room Shower prior to treatment No roughhousing or profanity No food or smokeless tobacco Preventing spread of infectious disease is everyone’s responsibility Must adhere to OSHA standards and guidelines Cleaning responsibilities are divided between athletic training staff and maintenance personnel Division of responsibilities Maintenance crew Sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste baskets Athletic Training staff Clean treatment tables, disinfect hydrotherapy modalities daily, clean equipment regularly

Establishing Health Habits for the Athlete Promotion of good health and hygiene is critical Are the athletes cleared to participate? Is each athlete insured? Does the athlete promptly report injury and illnesses? Does the athlete follow good living habits? Do they avoid sharing clothes and towels? Does the athlete exhibit good hygiene practices? Does the athlete avoid common drinking sources?

Emergency Telephones Accessibility to phones in all major areas of activity is a must Should be able to contact outside emergency help and be able to call for additional athletic training assistance Radios, cell and digital phones provide a great deal of flexibility

Emergency Action Plan A plan must exist for accessing emergency personnel Must include transportation of athletes to emergency facilities Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care Must have knowledge of local and community health services and agencies in the event of referrals

Record Keeping Critical responsibility of healthcare program Necessary for accurate, timely assessment and evaluation of practices Documents all practices to assure that responsibilities and expectations are being met. Paper vs. electronic records Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

Administering Pre-participation Examinations Pre-participation exam prior to start of practice is critical Purpose: Identify athlete that may be at risk Establish a baseline Reveal condition that may warrant disqualification Satisfy insurance and liability issues Examination by Personal Physician Yields an in-depth history and ideal physician-patient relationship May not result in detection of factors that predispose the athlete to injury Station Examination Provides athlete with detailed exam in little time Team of nine is ideal (2 physicians, 2 non-physicians and 5 managers/student athletic trainers)

Medical History Physical Examination Maturity Assessment Complete prior to exam to identify past and existing medical conditions Update yearly and closely review by medical personnel Collect medical release and insurance info at the same time Physical Examination Should include assessment of height, weight, body composition, blood pressure, pulse, vision, skin, dental, ear, nose, throat, heart, lungs, abdomen, lymphatic, genitalia, maturation index, urinalysis and blood work Maturity Assessment Means to protect young physically active athletes Methods Circumpubertal (sexual maturity) Skeletal Dental Tanner’s five stage assessment is most expedient

Sport Disqualification Orthopedic Screening Part of physical exam or separate Various degrees of detail concerning exam Sport Disqualification Certain injuries and illnesses warrant special concern when dealing with sports Recommendations can be made American with Disabilities Act (1990) Dictates that athlete makes the final decision Potential disqualifying factors should be determined during the pre- participation exam

Release of Medical Records The release of medical records cannot occur without written consent If the athlete wants records released to colleges/universities, professional organizations, insurance companies or news media, he/she and the parents/guardians must provide written consent Waiver must specify information to be released

HIPAA Regulations Regulates how any members of the sports medicine team can share health information concerning an athlete Provides athletes with access to their medical records and control over how their health information is used and disclosed Athlete can provide blanket authorization for release of specified medical information on a yearly basis

FERPA Regulations Family Educational Rights and Privacy Act Protects privacy of student educational records Provides parents certain rights with respect to inspection of child’s educational records Can request corrections if inaccurate or misleading Rights transfer to child Age 18 or upon entering school beyond high school (become “eligible student”) School must have written permission to release information

Injury Reports Injury reports serve as future reference Reports can shed light on events that may be hazy following an incident Necessary in case of litigation All reports should be filed in the athletic health care facility Filled out in triplicate Copy to school health office, physician and one copy should be retained

Personal Information Card Treatment Log Sign-in to keep track of services Daily treatments can be recorded Can be used as legal documentation in instances of litigation Subject to HIPAA and FERPA regulations Personal Information Card Contains contact information for family, personal physician, and insurance information

Injury Evaluation and Progress Notes Injured athlete should be evaluated by an athletic trainer or physician Record of the evaluation should be kept If not available, a coach should encourage athlete and parents to set appointment with a local physician for injury assessment, diagnosis and documentation.

Supply and Equipment Inventory Managing budget and equipment/supplies is critically important Inventory must be taken yearly in order to effectively keep track of: New equipment that is needed Equipment that needs to be replaced Equipment needing to be replenished

Annual Report Summary of athletic health care function Can be used to evaluate/recommend potential changes for program Includes number and types of injuries seen/treated

Developing a Budget Different settings = different size budgets and space allocations Many high schools have difficulty providing sufficient funding Equipment needs and supplies vary depending on the setting College vs. high school Continuous planning, inventory and prioritizing is necessary to effectively manage monetary allocations to meet programmatic goals

Ordering Supplies and Equipment Expendable items Supplies that cannot be reused- first aid and injury prevention supplies Equipment Items that can be used for a number of years Fixed (remain in the training room- ice machine, tables) Non-fixed (crutches, coolers, training kits) Yearly inventory and records must be maintained in both areas

Additional Budget Considerations Other operating costs Telephone and postage expenses Contracts for outside services Purchases relative to liability insurance and professional development Clothing to be worn in the facility Purchasing Systems Direct buy vs. competitive bidding

Athletic Health Care Facility Design Design will vary drastically based on number of athletes, teams, and various needs of the program Size Varies between settings Must take advantage and manage space effectively Interact with architect relative to needs of program and athletes Existing space or newly designed

Location Outside entrance (limits doors that must be accessed when transporting injured athletes) Double door entrances and ramps are ideal Proximity to locker rooms and toilet facilities Distinct areas Taping and bandaging Injury treatment with rehabilitation equipment and/or therapeutic modalities Wet area (whirlpools, refrigerator, ice machine) Physicians examination room Office space