© 2009 McGraw-Hill Higher Education. All rights reserved Chapter 2: Health Care Organization and Administration in Athletic Training

© 2009 McGraw-Hill Higher Education. All rights reserved What should one do to organize and operate an athletic training room? Facility Design Policies & Procedures Budget Personal Management Record Keeping Doing all the Roles & Responsibilities of an Athletic Trainer

© 2009 McGraw-Hill Higher Education. All rights reserved Development of Policy & Procedures Manual –Creation of policies and procedures for all involved in health care –Policies = clear and accurate written out statements of basic rules That What and Why –Procedures = describe the process The How

© 2009 McGraw-Hill Higher Education. All rights reserved Issues Specific to Athletic Training Program Operations 1. Scope of Program: Who will be served by program? –Athlete: to what extent and what services will be rendered (systemic illness, musculoskeletal injuries, in season, out-of-season, club sports) –Institution: who else can be served medically and educationally and what are the legalities (Students, Faculty, Staff, Spectators) –Community: outside group and community organizations with legalities again being an issue

© 2009 McGraw-Hill Higher Education. All rights reserved 2. Providing Coverage Facility Personnel Coverage –Dependant upon when the Athletic Trainer/Adult First Responder is there (All day, weekends, just during games, practices etc) Sports Coverage –Certified athletic trainer should attend all practices and games Most High School AT’s are assigned to football home/away, therefore Adult First Responders cover other events that are being played at home fields (soccer, field hockey, volleyball)

© 2009 McGraw-Hill Higher Education. All rights reserved 3. Hygiene and Sanitation Athletic Training Facility –Operation should abide by policies set forth by OSHA (Occupational Safety & Health Administration) due to blood and bacteria; Cleaning both by custodial staff and athletic training staff. –Examples of Policies No equipment/cleats in training room Shoes off treatment tables Shower prior to treatment No roughhousing or profanity No food or smokeless tobacco

© 2009 McGraw-Hill Higher Education. All rights reserved Gymnasium (general issues concerning facility and equipment cleanliness) –Facility Cleaning of gymnasium floors Drinking fountain and shower/locker facility disinfecting Mats cleaned daily (wrestling) –Equipment and clothing Proper fitting equipment Frequent clothing and equipment laundering Appropriate equipment for weather conditions Use of clean dry towels and equipment daily

© 2009 McGraw-Hill Higher Education. All rights reserved Athlete –Promotion of good health and hygiene is critical Prompt injury and illness reporting Follow good living habits Showering after practice Avoid sharing clothes and towels Exhibit good hygiene practices Avoid common drinking sources Avoid contact with athletes with contagious disease or infection

© 2009 McGraw-Hill Higher Education. All rights reserved 4. Emergency Telephones Accessibility to phones in all major areas of activity is a must Landline in case wireless isinterupted Radios, cell and digital phones provide a great deal of flexibility

© 2009 McGraw-Hill Higher Education. All rights reserved Budgetary Concerns Size of budget?? Different settings = different size budgets and space allocations Equipment needs and supplies vary depending on the setting (college vs. secondary school)

© 2009 McGraw-Hill Higher Education. All rights reserved Supplies –Expendable Involves supplies that cannot be reused- first aid and injury prevention supplies –Non-expendable Re-useable supplies - ace wraps, scissors…etc) –Yearly inventory and records must be maintained in both areas

© 2009 McGraw-Hill Higher Education. All rights reserved Equipment: Items that can be used for a number of years –Capital: remain in the athletic training clinic (including ice machine, tables) –Non-consumable capital: –reusable but leaves the –athletic training room (crutches, coolers, training kits)

© 2009 McGraw-Hill Higher Education. All rights reserved Purchasing Systems –Direct buy: going straight to a vendor and making an order –vs. Competitive bidding: usually for more expensive purchases, getting multiple bids and buying the least expensive –Lease alternative (borrowing for set time) Additional Budget Considerations –Telephone, Utilities, Contracts for outside services, Insurance (if not covered by employer) and professional development for CEU’s

© 2009 McGraw-Hill Higher Education. All rights reserved Developing a Risk Management Plan 1. Security Issues –Accessibility to training clinic (staff, physicians, athletic training students) –Athletic training students must be supervised when in the clinical setting –Coaches may have access in secondary school settings 2. Fire Safety –Post evacuation plan in case of fire –Smoke detectors/alarm system and fire extinguisher should be tested and in place

© 2009 McGraw-Hill Higher Education. All rights reserved 3. Electrical and Equipment Safety –Major concern (GFIs) –Be aware of power distribution system to avoid accidents 4. Emergency Action Plan –Accessing emergency personnel outside setting in the event of emergency –Include transportation of athletes to emergency facilities –Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care

© 2009 McGraw-Hill Higher Education. All rights reserved Athletic Training Clinic Design Multipurpose area for first aid, therapy/ rehabilitation, injury prevention, medical procedures and administration 1. Size –Varies between settings –Must take advantage and manage space effectively

© 2009 McGraw-Hill Higher Education. All rights reserved 2. Location –Outside entrance (limits doors that must be accessed when transporting injured athletes) –Double door entrances and ramps are ideal- getting athletes in and out –Proximity to locker rooms and restroom facilities –Light, heat and water source should be independent from rest of facility

© 2009 McGraw-Hill Higher Education. All rights reserved 3. Special Service Areas A. Treatment Area: area that accommodates 4-6 adjustable treatment tables, 3-4 stools, and hydrocollator (heat packs in water) and ice machine accessibility B. Electrotherapy Area: area that houses ultrasound, electrical stim (e-stim) units, storage units, grounded outlets, treatment tables and chairs, under constant supervision

© 2009 McGraw-Hill Higher Education. All rights reserved C. Hydrotherapy Area: area with centrally located sloping floor to drain, equipped with 2- 3 whirlpools, shelving and storage space and outlets 5 feet above the floor D. Exercise Rehabilitation Area: area that provides adequate space and equipment to perform reconditioning of injuries E. Taping, Bandaging & Orthotics Area: 3-4 taping tables and storage cabinets to treat athletes with proximity to a sink

© 2009 McGraw-Hill Higher Education. All rights reserved F. Physician’s Exam Room: space for physician to work which may hold exam table, lockable storage, sink, telephone G. Records Area: space devoted to record keeping which may include filing system or computer based database, that allows access only to medical personnel (ideally will be a separate office off of the AT Room)

© 2009 McGraw-Hill Higher Education. All rights reserved 4. Storage Facilities –Athletic training clinics often lack ample storage space –Storage that holds general supplies and special equipment –Large walk-in storage cabinet for bulk supplies –Refrigerator for supplies, freezer for ice cups, medicine and additional supplies

© 2009 McGraw-Hill Higher Education. All rights reserved 5. Athletic Trainer’s Office –Space at least 10x12 feet is ample –All areas of training room should be able to be supervised without leaving office space (glass partitions) –Equipment should include, desk, chair, tack board, telephone, computer and independent locking system (filing cabinet)

© 2009 McGraw-Hill Higher Education. All rights reserved 6. Additional Areas –Pharmacy Area: separate room that can be secured for storing and administrating medications (records must be maintained concerning administration) –Rehabilitation Pool: if space permits, must be accessible to individuals with various injuries, with graduated depth and non-slip surface

© 2009 McGraw-Hill Higher Education. All rights reserved When designing an athletic training room what are the 6 main parts one must have in their design? Size Location Special Service Areas Storage Facilities Athletic Trainer’s Office Others

© 2009 McGraw-Hill Higher Education. All rights reserved

Assignment: Design your own athletic training room See handout and grade sheet

© 2009 McGraw-Hill Higher Education. All rights reserved Issues Specific to Athletic Training Program Operations in Clinic, Hospital Corporate of Industrial Settings Staff must be prepared to provide care to a wide range of patients –Pediatrics –Adolescents –Young adults and adults –Geriatric patients May also involve additional duties in management, marketing, outreach, along with fiscal and financial responsibilities

© 2009 McGraw-Hill Higher Education. All rights reserved Scope of Practice –Diverse patient population –In hospital settings time may be spent with in- patient, out-patient, or emergency care. –Owner of out-patient facility will dictate patient population seen at clinic –The ATC may be involved with patient care, onsite employee fitness, ergonomics, outreach programs, athletic event coverage –Limitations and restrictions will be dictated by state regulatory statutes

© 2009 McGraw-Hill Higher Education. All rights reserved Potential Athletic Training Duties Outside the Scope of Athletics A. Ergonomic Assessment –Ergonomics is the science of designing products, machines and systems to maximize comfort, efficiency and safety –Primary goal often involves injury and accident prevention in workplace by minimizing risk factors

© 2009 McGraw-Hill Higher Education. All rights reserved B. Work Hardening/Conditioning Programs –Intensive outpatient therapy for individuals injured on the job Work conditioning = treatment 3 hours/day, 3 days/week Work hardening = 8 hours of treatment daily, 5 days/week

© 2009 McGraw-Hill Higher Education. All rights reserved C. Wellness Center –ATC may be involved in organizing wellness screenings and workshops for: Asthma & diabetes Hypertension & stroke Cholesterol Osteoporosis Prostate/skin cancer

© 2009 McGraw-Hill Higher Education. All rights reserved D. Community Outreach and Marketing –Some athletic trainers may be clinic or hospital based in the morning and may provide athletic training coverage in afternoons and evenings Outreach may occur in the collegiate setting, secondary schools or for single athletic events

© 2009 McGraw-Hill Higher Education. All rights reserved E. Corporate Fitness Programs –Involves in-house fitness programming for employees

© 2009 McGraw-Hill Higher Education. All rights reserved F. Drug Testing Programs –Athletic trainers may be asked to oversee drug testing programs –Program may act as a deterrent to employees coming in unfit for duty

© 2009 McGraw-Hill Higher Education. All rights reserved What are the 6 potential duties an athletic trainer maybe asked to do? Ergonomic Assessment Work Hardening/Conditioning Programs Wellness Center Community Outreach and Marketing Corporate Fitness Programs Drug Testing Programs

© 2009 McGraw-Hill Higher Education. All rights reserved Record Keeping Major responsibility The rule not the exception - accurate and up-to-date Records Include: Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

© 2009 McGraw-Hill Higher Education. All rights reserved Maintaining Confidentiality in Record Keeping 1. Release of Medical Records –Written consent is required –Waiver must be signed for any release (include specifics of information to be released and to whom including coaches, staff, colleges, professional organizations)

© 2009 McGraw-Hill Higher Education. All rights reserved 2. Health Insurance Portability and Accountability Act (HIPAA) –Regulates release of Personal History Information (PHI) by coaches, ATC’s, physicians or other members of sports medicine team –Guarantees athlete access to information and control over disclosure –Athlete may provide written authorization for release of information

© 2009 McGraw-Hill Higher Education. All rights reserved 3. Family Educational Rights and Privacy Act –FERPA = law protecting privacy of student education records, may contain medical –When child turns 18 rights are transferred to student –School must have written permission prior to releasing information

© 2009 McGraw-Hill Higher Education. All rights reserved Administering Pre-participation Examinations Initial pre-participation exam prior to start of practice is critical, gives baseline Purpose it to identify athlete that may be at risk Should include –Medical history, physical exam, orthopedic screening, wellness screening, cardiovascular screening & maturity assessment

© 2009 McGraw-Hill Higher Education. All rights reserved 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 VS. Station Examination –Provides athlete with detailed exam in little time

© 2009 McGraw-Hill Higher Education. All rights reserved 1. Medical History –Complete prior to exam to identify past and existing medical conditions –Update yearly and closely review by medical personnel 2. 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

© 2009 McGraw-Hill Higher Education. All rights reserved

3.Cardiovascular Screening American Heart Association recommended in order to recognize abnormal heart sounds and other signs 4. Orthopedic Screening –Part of physical exam or separate –Various degrees of detail concerning exam

© 2009 McGraw-Hill Higher Education. All rights reserved 5. Wellness Screening –Purpose is to determine if athlete is engaged in a healthy lifestyle

© 2009 McGraw-Hill Higher Education. All rights reserved

6. Baseline Concussion Testing IMPACT (Immediate Post-Concussion Assessment and Cognitive Testing) the first, most-widely used, and most scientifically validated computerized concussion evaluation system. Measures player symptoms Measures verbal and visual memory, processing speed and reaction time Reaction time measured to 1/100th of second Assists clinicians and athletic trainers in making difficult return-to- play decisions Provides reliable baseline test information Produces comprehensive report of test results Results can be ed or faxed for fast consultation by a neuropsychologist Automatically stores data from repeat testing Testing is administered online for individuals or groups

© 2009 McGraw-Hill Higher Education. All rights reserved What are the 6 parts of a pre- participation exam? Medical History Physical Examination Cardiovascular Screening Orthopaedic Screening Wellness Screening Baseline Concussion Testing (IMPACT)

© 2009 McGraw-Hill Higher Education. All rights reserved 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

© 2009 McGraw-Hill Higher Education. All rights reserved Personal Information Card Contains contact information for family, personal physician, and insurance information Injury Reports and Injury Disposition Injury reports serve as future references, Necessary in case of litigation SOAP note format –S: Subjective (history of injury/illness) –O: Objective (information gathered during evaluation) –A: Assessment (opinion of injury based on information gained during evaluation) –P: Plan (short and long term goals of rehab)

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Supplies and Equipment Inventory Managing budget and equipment/supplies is critically important Inventory must be taken yearly in order to effectively replenish supplies

© 2009 McGraw-Hill Higher Education. All rights reserved Collecting Injury Data Accident - unplanned event resulting in loss of time, property damage, injury or death Injury- damage to the body restricting activity Case study- looks at specific incident of injury

© 2009 McGraw-Hill Higher Education. All rights reserved Using Injury Data Valid and reliable data can be utilized to decrease injuries May allow for: –Rule modification –Assist coaches and players in understanding risks –Help manufacturers –Educate parents, athletes and the public on inherent risks associated with sport