1. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 2: Organizing and Administering an Athletic Health Care Program

2. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Facility Design Design will vary drastically based on number of athletes, teams, and various needs of the program Size –Varies between settings –Must take advantage and manage space effectively –Interact with architect relative to needs of program and athletes Existing space or newly designed

3. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Location –Outside entrance (limits doors that must be accessed when transporting injured athletes) –Double door entrances and ramps are ideal –Proximity to locker rooms and toilet facilities Distinct areas –Taping and bandaging –Injury treatment with rehabilitation equipment and/or therapeutic modalities –Wet area (whirlpools, refrigerator, ice machine) –Physicians examination room –Office space

4. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Storage Facilities –Training rooms often lack ample storage space –Storage in training room that holds general supplies and special equipment –Storage available in the specified areas of the training room –Large walk-in storage cabinet for bulk supplies –Refrigerator for equipment, ice cups, medicine and additional supplies

5. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

7. Rules of Operation for an Athletic Healthcare Program Must develop policies and procedures –Delineate daily routine of program Define scope of program –Who will be served by program? –Athlete: to what extent and what services will be rendered? –Institution: who else can be served medically and educationally and what are the legalities?

8. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Providing Coverage Facility Personnel Coverage –Budgetary concerns may be a limiting factor –What personnel are available? Sports Coverage –Different institutions (including high schools) have different levels of coverage based on personnel and risks involved with sports

9. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Athletic Training Room Policies Facility should be used only for prevention and care of sports injuries Rules must be established in the interest of sanitation See Focus Box 2-1 Policies regarding environmental conditions and emergency protocols should also be set

10. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Hygiene and Sanitation Rules concerning room cleanliness and sanitation must be set and made known to population using facility –Examples No equipment/cleats in training room Shoes off treatment tables Shower prior to treatment No roughhousing or profanity No food or smokeless tobacco Must adhere to OSHA standards and guidelines

11. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –Cleaning responsibilities are divided between athletic training staff and maintenance personnel –Division of responsibilities –Maintenance crew Sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste baskets –Athletic Training staff Clean treatment tables, disinfect hydrotherapy modalities daily, clean equipment regularly

12. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Establishing Health Habits for the Athlete Promotion of good health and hygiene is critical Is the athlete cleared to participate? Is each athlete insured? Does the athlete promptly report injury and illnesses? Does the athlete follow good living habits? Does the athlete avoid sharing clothes and towels? Does the athlete exhibit good hygiene practices? Does the athlete avoid common drinking sources?

13. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Emergency Telephones Accessibility to phones in all major areas of activity is a must Should be able to contact outside emergency help and be able to call for additional athletic training assistance Radios, cell and digital phones provide a great deal of flexibility

14. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Developing a Risk Management Plan Security Issues –Accessibility to training room (staff, physicians, student athletic trainers) –Supervision issues Fire Safety –Post evacuation plan in case of fire –Smoke detectors/alarm system and fire extinguisher should be tested and in place

15. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Emergency Injury Management Plan A plan must exist for accessing emergency personnel –Must include transportation of athletes to emergency facilities Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care Must have knowledge of local and community health services and agencies in the event of referrals

16. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Record Keeping Major responsibility Rule not the exception - accurate and up-to- date Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

17. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Administering Pre-participation Examinations Pre-participation exam prior to start of practice is critical Purpose: –Identify athlete that may be at risk –Establish a baseline –Reveal condition that may warrant disqualification –Satisfy insurance and liability issues

18. © 2005 The McGraw-Hill Companies, Inc. 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 Station Examination –Provides athlete with detailed exam in little time –Team of nine is ideal (2 physicians, 2 non- physicians and 5 managers/student athletic trainers)

19. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Medical History –Complete prior to exam to identify past and existing medical conditions –Update yearly and closely review by medical personnel –Collect medical release and insurance info at the same time 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

20. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Maturity Assessment –Means to protect young physically active athletes –Methods Circumpubertal (sexual maturity) Skeletal Dental –Tanner’s five stage assessment is most expedient Orthopedic Screening –Part of physical exam or separate –Various degrees of detail concerning exam

21. © 2005 The McGraw-Hill Companies, Inc. 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

22. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Release of Medical Records The release of medical records can not occur without written consent If the athlete wants records released to colleges/universities, professional organizations, insurance companies or news media, he/she and the parents/guardians must provide written consent –Waiver must specify information to be released

23. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. HIPAA Regulations Regulates how coaches, athletic trainers, physicians or other members of the sports medicine team can share health information concerning an athlete Provides athletes with access to their medical records and control over how their health information is used and disclosed Athlete can provide blanket authorization for release of specified medical information on a yearly basis

24. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Injury Reports Injury reports serve as future reference Reports can shed light on events that may be hazy following an incident Necessary in case of litigation All reports should be filed in the athletic training room –Filled out in triplicate Copy to school health office, physician and one copy should be retained

25. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Treatment Log Sign-in to keep track of services Daily treatments can be recorded Can be used as legal documentation in instances of litigation Subject to HIPAA regulations Personal Information Card Contains contact information for family, personal physician, and insurance information

26. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Injury Evaluation and Progress Notes Injured athlete should be evaluated by an athletic trainer or physician –Record of the evaluation should be kept If not available, a coach should encourage athlete and parents to set appointment with a local physician for injury assessment, diagnosis and documentation.

27. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Supplies and Equipment Inventory Managing budget and equipment/supplies is critically important Inventory must be taken yearly in order to effectively keep track of: –New equipment that is needed –Equipment that needs to be replaced –Equipment needing to be replenished

28. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Annual Report Summary of athletic training room functioning Can be used to evaluate/recommend potential changes for program Includes number and types of injuries seen/treated

29. © 2005 The McGraw-Hill Companies, Inc. 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. high school) Continuous planning, inventory and prioritizing is necessary to effectively manage monetary allocations to meet programmatic goals

30. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Ordering Supplies and Equipment Expendable (supplies that cannot be reused- first aid and injury prevention supplies) Equipment (items that can be used for a number of years) –Fixed (remain in the training room- ice machine, tables) –Non-fixed (crutches, coolers, training kits) Yearly inventory and records must be maintained in both areas

31. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Additional Budget Considerations Other operating costs –Telephone and postage expenses –Contracts for outside services –Purchases relative to liability insurance and professional development Purchasing Systems Direct buy vs. competitive bidding

32. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Hiring a Certified Athletic Trainer in Secondary Schools Problems occurring later from improperly managed injuries could be avoided with proper management from an athletic trainer According to the NATA –“…all secondary schools should provide the services of a full-time, on-site, certified athletic trainer (ATC) to student athletes.” American Academy of Pediatrics (1998) adopted a policy recommending employment of ATC’s in the high school setting

33. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Human Resources and Personnel Issues The sports medicine team is only as good as the individuals in the group Recruitment, hiring and retaining qualified personnel is necessary to be effective Specific policies are established relative to hiring, firing, performance evaluations and promotions –Must adhere to these principles

34. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Roles and responsibilities must be established –(job descriptions - job specifications, accountability, code of conduct, and scope) Head athletic trainer must serve as a supervisor and work to enhance professional development of staff Performance evaluations should take place routinely