1. Essentials of Athletic Injury Management 10th Edition

2. Chapter 2: Organizing and Administering an Athletic Health Care Program

3. Rules of Operation for and Athletic Healthcare Program
Determine who will take care of athletic health care facility
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

4. Providing Coverage Facility Personnel Coverage Sports 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

5. 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 athletic trainers in the high school setting

6. Athletic Health Care Facility 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 2-4
Policies regarding environmental conditions and emergency protocols should also be set

7. Keeping Facilities Clean
Rules concerning room cleanliness and sanitation must be set and made known to population using facility
Examples
No equipment/cleats in athletic training room
Shower prior to treatment
No roughhousing or profanity
No food or smokeless tobacco
Preventing spread of infectious disease is everyone’s responsibility
Must adhere to OSHA standards and guidelines
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

8. Establishing Health Habits for the Athlete
Promotion of good health and hygiene is critical
Are the athletes cleared to participate?
Is each athlete insured?
Does the athlete promptly report injury and illnesses?
Does the athlete follow good living habits?
Do they avoid sharing clothes and towels?
Does the athlete exhibit good hygiene practices?
Does the athlete avoid common drinking sources?

9. 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

10. Emergency Action 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

11. Record Keeping Critical responsibility of healthcare program
Necessary for accurate, timely assessment and evaluation of practices
Documents all practices to assure that responsibilities and expectations are being met.
Paper vs. electronic records
Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

12. 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
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)

13. Medical History Physical Examination Maturity Assessment
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
Maturity Assessment
Means to protect young physically active athletes
Methods
Circumpubertal (sexual maturity)
Skeletal
Dental
Tanner’s five stage assessment is most expedient

14. Sport Disqualification
Orthopedic Screening
Part of physical exam or separate
Various degrees of detail concerning exam
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

15. Release of Medical Records
The release of medical records cannot 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

16. HIPAA Regulations
Regulates how any 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

17. FERPA Regulations Family Educational Rights and Privacy Act
Protects privacy of student educational records
Provides parents certain rights with respect to inspection of child’s educational records
Can request corrections if inaccurate or misleading
Rights transfer to child
Age 18 or upon entering school beyond high school (become “eligible student”)
School must have written permission to release information

18. 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 health care facility
Filled out in triplicate
Copy to school health office, physician and one copy should be retained

19. Personal Information Card
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 and FERPA regulations
Personal Information Card
Contains contact information for family, personal physician, and insurance information

20. 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.

21. Supply 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

22. Annual Report Summary of athletic health care function
Can be used to evaluate/recommend potential changes for program
Includes number and types of injuries seen/treated

23. Developing a Budget
Different settings = different size budgets and space allocations
Many high schools have difficulty providing sufficient funding
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

24. Ordering Supplies and Equipment
Expendable items
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

25. Additional Budget Considerations
Other operating costs
Telephone and postage expenses
Contracts for outside services
Purchases relative to liability insurance and professional development
Clothing to be worn in the facility
Purchasing Systems
Direct buy vs. competitive bidding

26. Athletic Health Care 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

27. 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