Organizing & Administering An Athletic Health care Program Chapter 2 Organizing & Administering An Athletic Health care Program

Athletic Training Room Must be designed, adapted, or setup to meet the needs of the school - Location of Athletic Training Room: proximity to locker rooms & athletic fields - Size of School: size of the ATR should be proportionate to total # of student athletes in the school - Access: best location for access after school hours, coaches have access if needed, outside entrance? - Number of Athletes: size of room needs to be able to accommodate biggest team - Sports Offered: size of room needs to accommodate number of teams per season - Daily Schedules: is the ATR accessible during practice & game times, is it available to all athletes during high traffic times - OSHA: the ATR should be designed to meet regulations & guidelines established by OSHA - Power Supplies: are there enough outlets for needed equipment? - Water Supplies: is there a water supply & drainage system for Ice, Whirlpool?

Athletic Training Room The athletic training room should be treated as a medical facility The athletic training room should be cleaned DAILY Equipment & tables in the athletic training room should be cleaned between patients Athletic training rooms ideally need to be a minimum of 1000 square feet. Athletic training rooms with an area of less than a 1000 square feet are impractical. The athletic training room should be organized & have distinct areas designated for: - Taping - Treatment - Rehabilitation - Wet (ice, whirlpool, refrigerator, freezer, coolers) - Storage (supplies, crutches, drinks, water bottles, bulky equipment) - Physician or Private Evaluation (x-ray box, medicine storage, sink, prescriptions) - Office (medical record storage)

Athletic Training Room

Athletic Training Room

Athletic Training Room Rules Develop policies & procedures that will act as a guideline for athletic training room operations - Who will be taken care of in the athletic training room? (Teachers, general student population, coaches) - To what extent will athletes be served? - Who is allowed to provide treatment in the athletic training room? - Will athletes have to make appointments? - Will the teams have scheduled access? - Who is responsible for cleaning the athletic training room? - Is there a sign in policy? - Can athletes complete rehabilitation/therapy in the athletic training room? - Do athletes have to shower before treatments? - Is food or drink allowed? - Is equipment allowed?

How is Athletic Training Coverage decided? Athletic Trainers should follow NATA recommendations & NCAA Guidelines Lower risk – must have someone physically present who is certified in first aid, CPR, AED & prevention of spreading Bloodborne Pathogens Baseball Fencing( M & W) Softball Water Polo (M & W) Crew (m&W) Golf (M & W) Swimming ( M & W) Cross Country ( M & W) Outdoor Track (M & W) Tennis ( M & W) Moderate Risk – should have a ATC physically present or able to respond in 3-5 minutes @ practices, & ATC present for competition. Must have someone physically present the if certified in first aid, CPR, AED & Prevention of spreading Bloodborne Pathogens Basketball (W) Diving (M &W) Field Hockey Indoor Track (M & W) Lacrosse (M & W) Soccer (m & W) Volleyball (M &W) High Risk or Increased Risk – Must have an ATC physically present for all practices & competition Basketball (M) Football (M) Gymnastics (M & W) Ice Hockey (M & W) Skiing Wrestling

Protocols Hydration – 20 oz. 30 minutes prior to competition, drink during activity, 20 oz. for every pound lost during activity. Drink a mix of water & sports drink. Do not drink caffeine, carbonated drinks, drink high in sugar Heat Illness Concussion – SC passed a Law in June 2013 Lightning – Clear Fields if lightning is within 6 miles, No activity until 30 minutes after last strike Emergency Action Plans – Field/Sports Specific & Different for practices vs. competitions Bloodborne Pathogens – Act as if everyone has a transmittable disease, all wounds must be covered

Pre-participation Physical Exam 4 components - Medical History: must be filled out by an adult, signed by adult & athlete, reviewed by ATC before physical exam - Physical Exam: - Height: male 6’1” female 5’10” - Weight: Height & Weight can be used to determine BMI - Vision: 20/20 even & minimum of 20/40 to participate in sports - Blood Pressure: average resting BP in adult is 120/80 - Pulse: average resting HR in an adult is 72 BPM - BMI: Body Mass Index, most accurate method is underwater weighing - Maturity Assessment: Open growth plates, hormone production, disordered eating - Orthopedic Screening: Range of Motion, Pain, Strength, Previous injury or surgery

Body Mass Index

Sudden Cardiac Death Congenital Defects

Marfan Syndrome Genetic Disorder of connective tissue Indicators - Height: 6’1” male, 5’10” female - Wingspan: measure fingertip to fingertip, greater than height - Skinny - Double Jointed: hypermobile - Barrel Chest - Poor Vision: 20/40 or worse - Murmur

Hypertrophic Cardiomyopathy Heart muscle becomes abnormally thick This thickened heart muscle can make it harder for the heart to pump blood. Hypertrophic cardiomyopathy may also affect the heart's electrical system Hypertrophic cardiomyopathy often goes undiagnosed, because many of those with hypertrophic cardiomyopathy have few, if any, symptoms. In a small number of people with this condition, the thickened heart muscle can cause signs and symptoms: Shortness of breath Chest pain Fainting Dizziness Fatigue Problems in the heart's electrical system resulting in life-threatening abnormal heart rhythms (arrhythmias) Hypertrophic cardiomyopathy is usually caused by gene mutation. The condition is usually inherited. People with hypertrophic cardiomyopathy also have an abnormal arrangement of heart muscle fibers. The heart muscle cells become jumbled, known as myofiber disarray Hypertrophic cardiomyopathy is the leading cause of heart-related sudden death in people under 30 Arrhythmia Obstructed blood flow Mitral valve problems Heart failure Dilated cardiomyopathy

Injury Reports Documents an athlete’s injury & allows for communication with parents if necessary. Carbon Copies Injury Reports are a better option. Injury Reports are Hipaa Regulated. Serves as a record for future reference & offers protection in the event that treatment & procedures are questioned. Injury Reports are part of the official medical record. 4 Essential Components - History: Ask - Observation/Inspection: Look - Palpation: Touch - Special Tests: Orthopedic testing of a joint & joint structures

Treatment Logs Sign log for athletes to document athletic training room visits & care; done daily. Treatment Logs are Hipaa regulated. Holds athletes & athletic trainers accountable for injury care. Also documents treatments for future reference Essential Components - Date - Athlete Name - Sport: the sport they were playing when injury occurred - Body Part - Modality: Heat, Cold, E-stim, Ultrasound, Iontophoresis, Phonophoresis - Tape: tape, brace, cast, wrap - First Aid: wound care, blister care, medications, glucose check, splinting - Evaluation: name the injury - Rehabilitation: name exercises

HIPAA – Health Insurance Portability & Accountability Act Health Insurance Portability & Accountability Act HIPAA forms need to be completed on a yearly basis & must be signed by an adult HIPAA protects a patient’s Personal Medical Information (PMI) Federal Law enacted in 1996 Established a national framework of security standards In addition to protecting patient’s, HIPAA also gives patient’s legal access to their own medical records Examples - MRI reports, Office notes, treatments logs, injury reports, Xray reports, Operative notes, lab results, ER notes, Patient Identifiers (ssn, dob, full name, chart #)

Personal Information Cards Used in the event of an emergency Has information needed to check someone into a medical facility for care/treatment Essential Components (Demographic Information) - Athlete’s Name - Athlete’s Date of Birth - Athlete’s SSN - Athlete’s permanent address & phone - Insurance Name, Type, ID#, Group #, Address, & phone - Copy the Insurance Card, Front & Back - Parent who carries insurance: Name, Dob, SSN, Address, Phone & Employer Info. (guarantor) - Emergency Contact: Name, Cell #, Home #

Practice Site Note – Progress Notes These notes are done by physicians to document care & diagnosis. These notes are in the permanent medical record. Practice site notes & progress notes are very detailed & include information regarding the entire visit. Practice Site Note: Initial Evaluation, discuss findings & include a plan of care Progress Note: Follow up visits for initial injury, discuss progress with the plan of care & how the injury is healing

Supply & Equipment Inventory Monthly Inventory of Supplies Yearly Inventory of Supplies: what is left & how much is needed Inventory is a necessary evil: tedious & time consuming Inventory allows you to order as needed, especially if you are short on space. Inventory also assists you in managing your budget wisely.

Annual Reports Track Injuries: numbers, types, return to play time Track Referrals: How many athletes were referred to physicians Track # of surgeries: look at injuries patterns in sport or sex (male vs. female) Track $ made, spent, & saved Track # of athlete contacts: justify your job