1. The Use of NATA Position Statements in Clinical Athletic Training
James Onate, PhD, ATC, FNATA
The Ohio State University
Member, NATA Foundation Pronouncements Committee

2. The Game Plan: What is a position statement?
What are recommendation grades and how should they be used?
How are Position Statements developed?
What are the legal implications?
Use of position statements to drive policy, change, and education.

5. Number of Published NATA Position Statements?19

6. Current Position Statements
Fluid Replacement (2000)
Emergency Procedures (2002)
Exertional Heat Illness (2002)
Spearing (2004)
Asthma (2005)
Diabetes (2007)
Disordered Eating (2008)
Cold Injuries (2008)
Prehospital Care of the Spine Injured Athlete (2009)
Skin Disorders (2010)

7. Current Position Statements
Overuse Pediatric Injuries (2011)
Weight Control Issues (2011)
Prevention of Sudden Death (2012)
Illegal Performance Enhancing Substances (2012)
Sports Nutritional Supplements (2013)
Lightning v2 (2013)
Management of Ankle Injury (2013)
Preparticipation Exams & Disqualifying Conditions (2014)
Concussion v2 (2014)

9. Position Statements in Production
Management of Joint Dislocations
Dental Injuries
Fluid Replacement v2
Exertional Heat Injury v2
Prevention and Management of ACL Injury
Patellofemoral Pain
Overhead Shoulder Injuries / SLAP
Medial Tibial Stress Syndrome
Burnout in Athletic Training Professionals
Spearing/Head Down Contact v2

10. What is a Position Statement
Scientifically based
Peer reviewed research with a team of authors who are experts on the subject - AT Lead
NATA Pronouncements Committee has oversight over position statements (NATA Website)
Timely
Author expertise
Relevant to clinical practice

11. What is a Position Statement
Condensed information on a clinical or professional topic
Series of recommendations for consideration by administrators
Reference for clinicians and educators
Content area
Strength of the literature that supports the topic

12. Statements Related to NATA
Position Statements
Official Statements
Consensus Statements
Support Statements
Best Practice Guidelines
Other Published Reviews

13. Recommendations Criteria

18. Level of Evidence (LOE): SORT Level 1-3

20. What are the Recommendations?
A tool or reference for clinicians, educators, and administrators
Statements supported by levels of evidence:
Strength of recommendation (A, B, or C)
Quality per study/article (1, 2, or 3)
They are NOT a set of rules
They are a part of establishing educational standards and a clinical standard of care
They are fluid: they may change as better evidence becomes available

21. How should Recommendations be used?
As a reference for clinical practice
As a reference to evaluate current practice and policy
As a resource to help change current practice or policy (if needed)
As a resource to help find literature on a certain topic
As a tool to help secure resources to enhance practice or policy
They are NOT a replacement for common sense, law, and reasonable practice in various circumstances

22. Disclaimer
“The NATA and NATA Foundation publish position statements as a service to promote the awareness of certain issues to their members. The information contained in the position statement is neither exhaustive nor exclusive to all circumstances or individuals. Variables such as institutional human resource guidelines, state or federal statutes, rules, or regulations, as well as regional environmental conditions, may impact the relevance and implementation of these recommendations. The NATA and NATA Foundation advise members and others to carefully and independently consider each of the recommendations (including the applicability of same to any particular circumstance or individual). The position statement should not be relied upon as an independent basis for care but rather as a resource available to NATA members or others. Moreover, no opinion is expressed herein regarding the quality of care that adheres to or differs from the NATA and NATA Foundation position statements. The NATA and NATA Foundation reserve the right to rescind or modify its position statements at any time.”

23. How are Position Statements Developed?
Idea
Membership, current issues
Voted on by PC
Select Lead Author (ATC)
Put together writing team
One year to submit reviewable draft
Review by Pronouncements Sub-Committee
Revision
External Review by International Experts

24. How are Position Statements Developed?
Revisions
Review by Pronouncements Committee
Review by NATA & Foundation Boards
Revision
Publication (typical time = 3 years)
Review of Position Statement for Revision (7-10 years)

25. What are the Legal Implications?
Position Statements are a part of establishing a standard of care. In addition to:
State law
Educational standards
Job description
Institutional policy
“Reasonable” practice
Expert opinion
Other

26. Establishing a Standard
Educate yourselves with regard to the criteria that help to establish a standard
Make sure your practice is either consistent with Position Statement Recommendations OR you can support your practice with other criteria used to support a standard of care
Where possible obtain documentation

27. Use of PS to Drive Evaluation and Change
Provide copies of position statements to administrators, physicians, coaches, and parents.
Be able to explain the strength of the recommendations to all involved.
At least annually, discuss policy and practice as it relates to recent statements. Determine if change is necessary.
Provide additional data, rationale, and budget implications for major changes with sufficient time that the information can be assessed.

28. Administrators Example

29. Action Plan & Response Team
911 Medical Emergency
Action Plan & Response Team
National Athletic Directors Conference December 15, 2014 James Onate, PhD ATC FNATA Researcher NFHS Sports Medicine Advisory Committee

30. What is an Emergency Action Plan
A written document that defines the standard of care for the management of emergencies.
Provides an outline of the policies and procedures well in advance of an emergency to establish protocols and avoid debate/confusion about critical decisions during the emergency.
Helps facilitate a prompt, efficient, coordinated response in a medical emergency.

31. SCIENTIFIC SUPPORT

32. NATA POSITION STATEMENT 12 KEYS TO EAP’S
Each organization must have a written emergency plan. EAP must be comprehensive and practical, yet flexible and adaptable.
Emergency plans must be written documents and should be distributed to all personnel and developed in consultation with local emergency medical services personnel.

33. NATA POSITION STATEMENT 12 KEYS TO EAP’S
Identifies the personnel involved in carrying out the EAP and all involved personnel should be trained in AED, CPR, first aid, and prevention of disease transmission.
The emergency plan should specify the equipment needed to carry out the tasks and location of equipment. The equipment available should be appropriate to the level of training of the personnel involved.

34. NATA POSITION STATEMENT 12 KEYS TO EAP’S
Establishment of a clear mechanism for communication to appropriate emergency care providers and identification of the mode of transportation for injured participant.
EAP should be specific to the activity venue. Each activity site should have a defined emergency plan that is derived from the overall organizational policies on emergency planning.

35. NATA POSITION STATEMENT 12 KEYS TO EAP’S
Emergency plans should develop, incorporate, and notify the emergency care facilities to which the injured individual will be taken.
The emergency plan specifies the necessary documentation supporting the implementation and evaluation of the emergency plan.

36. NATA POSITION STATEMENT 12 KEYS TO EAP’S
The emergency plan should be reviewed and rehearsed annually or as frequent as necessary. The results of these reviews and rehearsals should be documented.
All personnel involved with the organization and sponsorship of athletic activities share a professional responsibility to provide for the emergency care of an injured person.

37. NATA POSITION STATEMENT 12 KEYS TO EAP’S
All personnel involved with the organization and sponsorship of athletic activities share a legal duty to develop, implement, and evaluate an emergency plan for all sponsored athletic activities.
The emergency plan should be reviewed by the administration and legal counsel of the sponsoring organization.

39. The Take Home
Position statements are graded recommendations that should be used as a resource to drive practice and policy
Position statements are NOT a set of rules
Position statements follow a stringent process to publication with expert authors and reviewers
Position statements should be considered as one criterion for establishing a standard of care

40. Questions & Comments? Onate.2@osu.edu tyhopkins@byu.edu
Thank You
Questions & Comments?