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 Facility Design

4. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. ► 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 Facility Design

5. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Facility Design ► Storage Facilities  Athletic Training Rooms (ATR) often lack ample storage space  Storage in ATR that holds general supplies and special equipment  Storage available in the specified areas of the ATR  Large walk-in storage cabinet for bulk supplies  Refrigerator for equipment, ice cups, medicine and additional supplies

6. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

10. 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?

11. © 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

12. © 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 ► Policies regarding environmental conditions and emergency protocols should also be set

13. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Hygiene and Sanitation ► Rules concerning ATR 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

14. © 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 Hygiene and Sanitation

15. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Establishing Health status for the Athlete ► Promotion of good health  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?

16. © 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

17. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Developing a Risk Management Plan ► Security Issues  Accessibility to ATR (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

18. © 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

19. © 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

20. © 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

21. © 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) Administering Pre-participation Examinations

22. © 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 Administering Pre-participation Examinations

23. © 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 Administering Pre-participation Examinations

24. © 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 Administering Pre-participation Examinations

25. © 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

26. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Release of Medical Records

27. © 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

28. © 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

29. © 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

30. © 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.

31. © 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

32. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. ► Summary of athletic training room functioning ► Can be used to evaluate/recommend potential changes for program ► Includes number and types of injuries seen/treated Annual Report

33. © 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

34. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. ► 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 Ordering Supplies and Equipment

35. © 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

36. © 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

37. © 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

38. © 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 Human Resources and Personnel Issues