1. Rules, Records & Legalities Sports Medicine I

2. http://www.dshs.state.tx.us/at/at_scope.shtm Advisory Board of Athletic Trainers About the Profession-Scope of Practice "Athletic trainer" means a person with specific qualifications, who practices athletic training, is licensed by the board, and may use the initials "LAT," "LATC," and "AT" to designate the person as an athletic trainer. The terms "sports trainer" and "licensed athletic trainer" are equivalent to "athletic trainer." "Athletic training" means the form of health care that includes the practice of preventing, recognizing, assessing, managing, treating, disposing of, and reconditioning athletic injuries under the direction of a physician licensed in this state or another qualified, licensed health professional who is authorized to refer for health care services within the scope of the person's license. "Athletic injury" means an injury sustained by a person as a result of the person's participation in an organized sport or sport-related exercise or activity, including interscholastic, intercollegiate, intramural, semiprofessional, and professional sports activities.

3. The Athletic Training Room -The AT room should be used for the prevention and care of athletic injuries -Too often, the AT facility becomes a meeting or club room used for coaches or athletes -Unless rules are established and practiced, room cleanliness and sanitation become a problem -Unsanitary conditions must NOT be tolerated

4. Common Rules of the AT room ▫No cleated shoes are allowed. (Dirt & debris tend to cling to cleated shoes and cleats often are dangerous when walking on non-carpeted surfaces) ▫Game & practice equipment are kept outside. (Equipment can add to the sanitation problem) ▫Shoes must be kept off treatment tables. (Shoes can contaminate and tear up treatment tables) ▫Athletes should shower before receiving treatment. (This helps keep tables and therapeutic modalities sanitary) ▫Roughhousing and profanity should not be allowed. (This prevents unnecessary horseplay and resulting injuries, as well as keep up the high level of standard of care provided) ▫No food or smokeless tobacco should be allowed. (The first is to help keep the AT room clean and the latter is self explanatory)

5. Common Rules of the AT Room ▫Do not operate any equipment in the AT room. ▫Do not remove supplies from the AT room without permission. ▫Be on time for treatment. ▫No treatment, no tape policy.

6. Record Keeping Record keeping is a major responsibility of the AT program. Because lawsuits are currently the rule rather than the exception, accurate and up-to-date records are absolute necessity.

7. Record Keeping Medical records, including a current pre-participation physical Injury reports Treatment logs Personal information cards Injury evaluations & progress notes Supply & equipment inventories Annual reports Essential records that should be maintained by the athletic trainer are:

8. Injury Documentation SOAP notes HOPS Rank One ▫Computer Software Pre-Participation Physical Treatment Log Doctor Notes

9. SOAP notes S- subjective ▫What the athlete tells you, injury history O- objective ▫What you see and gather during the evaluation  Limp? Favoring? Deformity? Range of motion; Strength assessment; palpation; special test, etc A- assessment ▫The professional opinion of the AT P- plan ▫How the injury will be managed  Referral? Treatment? Crutches? Brace? Goals?

10. HOPS H- history ▫What happened? Previous injury? Acute or Chronic? Pain location, etc O- observation ▫Posture? Favoring? Limping? Deformity? Swelling? Redness? P- palpation ▫Soft-tissue and bony palpation, S- special tests ▫Neuro, ROM, ligament tests, manual muscle testing, functional performance, etc

11. Physicals The first piece of information the athletic trainer collects from the athlete The purpose of a physical is to: ▫Identify any risks before ▫ the athlete participates ▫ in a sport

12. Physicals The components of a Physical ▫Medical history  Past or existing medical conditions ▫Physical exam  Height, weight, blood pressure, body composition, vision, heart and lunge function, etc ▫Orthopedic screening  ROM and strength of muscles and joints ▫Wellness screening  To determine if the athlete is engaging in healthy lifestyles (not smoking, drinking, eating habits, etc) ▫Cardiovascular screening  1996 American Heart Association recommends assessment of abnormal heart sounds and other signs of pathology

14. Rank One Computer software used in many school districts to record injuries, treatments, progress notes, contact information, and physical forms.

17. Record Keeping Information contained in the injury log is a valuable tool in the prevention of athletic injuries. ▫This information can be used by both AT and the coaching staff to determine the nature of the injuries that have occurred. ▫If certain injuries seem to be occurring with any sort of regularity, additional protective equipment can be purchased.

18. Record Keeping ▫Other records, like the pre-participation physical and emergency insurance information & consent form, provide you with important information regarding an athlete’s treatment in the event he/she is injured. ▫Doctor notes must be kept in the athletes file  Athletic trainers work under physicians and we must go by what the doctor says  No contact, no running, rehab and treatment, follow up in 3 weeks, etc

19. Record Keeping Proper record keeping is necessary to protect you and the team or the school from legal action in the event of a serious injury.

20. Liability Liability means being legally responsible for the harm one causes another person. A great deal of care must be taken in following athletic training procedures to reduce the risk of being sued by an athlete and being found liable for negligence.

21. The standard of reasonable care Negligence is the failure to use ordinary or reasonable care—care that persons would normally exercise to avoid injury to themselves or to others under similar circumstances.

22. The standard of reasonable care The standard of reasonable care assumes that an individual is neither exceptionally skillful nor extraordinary cautious, but is a person of reasonable and ordinary prudence. It is expected than an individual will bring a commonsense approach to the situation at hand and will exercise due care in its handling.

23. The standard of reasonable care In most cases in which someone has been sued for negligence, the actions of a hypothetical, reasonably prudent person are compared with the actions of the defendant to ascertain whether the course of action followed by the defendant was in conformity with the judgment exercised by such a reasonably prudent person.

24. The standard of reasonable care The standard of reasonable care requires that an AT will act accordingly to the standard of care of an individual with similar educational background or training.

25. Torts Torts are legal wrongs committed against the person or property of another. Such wrongs may emanate from an act of omission, wherein the individual fails to perform a legal duty, or from an act of commission, wherein he/she commits an act that is not legally his/hers to perform.

26. Torts No matter which act was committed, if injury results, the person can be held liable. In the case of omission an AT may fail to refer a seriously injured athlete for the proper medical attention.

27. Torts In the case of commission, the AT may perform a medical treatment not within his/her experience, training, or education from which serious medical complications develop.

28. Negligence When an AT is sued by an athlete, the complaint typically is the tort of negligence. 4 elements of Negligence ▫Duty- law requires a standard of conduct for the protection of others ▫Breach of Duty- failure to conform to standard of conduct ▫Proximate or legal cause- connection between the conduct and resulting injury ▫Damage- actual loss resulting from injury

29. Negligence Negligence is alleged when an individual… 1.Does something that a reasonably prudent person would not do or 2.Fails to do something that a reasonably prudent person would do under circumstances similar to those shown by the evidence.

30. Negligence To be successful in a suit for negligence, an athlete must prove that the AT had a duty to exercise reasonable care, that the AT breached that duty by failing to use reasonable care, and that there is a reasonable connection between the failure to use reasonable care and the injury suffered by the athlete or that the AT’s action made the injury worse.

31. Negligence If the AT breaches a duty to exercise reasonable care, but there is no reasonable connection between the failure to use reasonable care and the injury suffered by the athlete, the athlete’s suit for negligence will not succeed.

32. Negligence Examples of negligence is when an AT, through improper or careless handling of a therapeutic agent (like electrical stimulation or ultrasound), seriously burns an athlete.

33. Negligence ATs employed by an institution have a duty to provide athletic training care to athletes there. An AT who is employed by the public schools or by a state-funded college/university may be protected by the legal doctrine of sovereign immunity.

34. Negligence Sovereign immunity essentially states that neither the government nor the individual who is employed by the government can be held liable for negligence. However, the level of protection afforded by sovereign immunity may vary significantly from state to state.

35. Negligence The Good Samaritan law has been enacted in most states to provide limited protection against legal liability to any individual who voluntarily chooses to provide first aid, should something go wrong.

36. Negligence As long as the first aid provider does not overstep the limits of his/her professional training, and exercises what would be considered reasonable care in the situation, the provider will not be held liable.

37. Statutes of limitation A statute of limitation sets a specific length of time that individuals may sue for damages from negligence. The length of time to bring suit varies from state to state, but in general plaintiffs have between 1 and 3 years to file suit for negligence.

38. Assumption of risk An athlete assumes the risk of participating in an activity when he/she knows of and understands the dangers of that activity and voluntarily chooses to be exposed to those dangers.

39. Assumption of risk This assumption of risk can be expressed in the form of a waiver signed by the athlete or his/her parents/guardian or can be implied from the conduct of an athlete under the circumstances of his/her participation in an activity.

40. Assumption of risk Assumption of risk may be asserted as a defense to a negligence suit brought by an injured athlete. The AT bears the burden of proving that an athlete assumed the risk by producing the document signed by the athlete or his/her parents/guardian, or by proving that the athlete knew the risk of the activity and understood and voluntarily accepted that risk.

41. Reducing the risk of litigation The coach or AT can significantly decrease the risk of litigation by paying attention to several key points.

42. Reducing the risk of litigation The coach should follow these guidelines: ▫Warn athletes of the potential dangers inherent in their sport. ▫Supervise regularly and attentively. ▫Properly prepare and condition athletes. ▫Properly instruct athletes in the skills of their sport. ▫Ensure that proper & safe equipment & facilities are used by athletes at all times.

43. Reducing the risk of litigation Examples of what the AT should do includes: ▫Work to establish good personal relationships with athletes, parents, & coworkers. ▫Establish specific policies and guidelines for the operation of an AT facility, and maintain qualified & adequate supervision of the training room, its environments, facilities & equipment at all times.

44. Reducing the risk of litigation ▫Develop and carefully follow an emergency plan. ▫Become familiar with the health status and medical history of the athletes under his/her care so as to be aware of problems that could present a need for additional care or caution.

45. Reducing the risk of litigation ▫Keep factually accurate and timely records that document all injuries and rehab steps, and set up a record retention policy that allows records to be kept and used in defense of litigation that may brought by athletes. ▫Obtain, from athletes and from parents/guardians when minors are involved, written consent for providing health care.

46. Product liability Manufacturers of athletic equipment have a duty to design and produce equipment that will not cause injury as long as it is used as intended. They are strictly liable for defects in the design and production of equipment that produces injury.

47. What is Medical Insurance A contract between an insurance company and a policyholder in which the insurance company agrees to reimburse a portion of the total medical bill after some deductible has been paid by the policyholder

48. What 3 things does a general health insurance policy cover? ▫Illness ▫Hospitalization ▫Emergency care

49. Accident Insurance ▫To protect against financial loss from medical and hospital bills ▫Encourage an injured student to receive prompt medical care ▫Encourage prompt reporting of injuries ▫Relieve a school of financial responsibility

50. Accident insurance The school’s general insurance may be limited; thus accident insurance for a specific activity such as sports may be needed to provide additional protection. ▫This type of coverage is limited and does not require knowledge of fault, and the amount it pays is limited.

51. Accident insurance For serious sports injuries requiring surgery and lengthy rehab, accident insurance is usually not adequate.

52. If a school district has general liability insurance, what are they protected against? -Against damages that may arise from injuries occurring on school property In what kind of case does liability insurance typically cover negligence? Civil or criminal? -Civil

53. Professional liability insurance Most individual schools and school districts have general liability insurance to protect against damages that may arise from injuries occurring on school property. Liability insurance covers claims of negligence on the part of individuals. Its major concern is whether supervision was reasonable and if unreasonable risk of harm was perceived by the sports participant.

54. Professional liability insurance All ATs should carry professional liability insurance and must clearly understand the limits of coverage. Liability insurance typically covers negligence in a civil case. If a criminal complaint is filed, liability insurance will not cover the AT.