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

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.

Number of Published NATA Position Statements? 19

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)

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)

http://www.nata.org/position-statements

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

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

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

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

Recommendations Criteria

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

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

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

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.”

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

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)

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

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

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.

Administrators Example

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

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.

SCIENTIFIC SUPPORT

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.

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.

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.

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.

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.

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.

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

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