Chapter 2: Health Chapter 2: Health Care Organization Care Organization and Administration and Administration in Athletic Trainingin Athletic Training

System of Healthcare System of Healthcare ManagementManagement

►Strategic Plan DevelopmentStrategic Plan Development Determine why there is need for such a Determine why there is need for such a

programprogram Determine function of program and what Determine function of program and what

the goals should bethe goals should be Decision of administrators will determine Decision of administrators will determine

extent of health care program in athletic extent of health care program in athletic trainingtraining

Develop written mission statement to Develop written mission statement to focus direction of programfocus direction of program

►Strategic Plan Development (cont.)Strategic Plan Development (cont.) Strategic plan development must Strategic plan development must

include administrators, other allied include administrators, other allied healthcare providers, student-healthcare providers, student-athletes, coaches, physicians, athletic athletes, coaches, physicians, athletic trainers, parents and community trainers, parents and community health leadershealth leaders

Ongoing process that reviews Ongoing process that reviews strengths and weaknesses of programstrengths and weaknesses of program

►Development of Policy & Development of Policy & Procedures ManualProcedures Manual Creation of policies and procedures Creation of policies and procedures

for all involved in health care for all involved in health care Policies = clear written out Policies = clear written out

statements of basic rulesstatements of basic rules►Critical element for operation of athletic Critical element for operation of athletic

training clinictraining clinic

Procedures = describe the processProcedures = describe the process

Issues Specific to Athletic Issues Specific to Athletic Training Program Training Program

Operations Operations ► Scope of ProgramScope of Program

Who will be served by program?Who will be served by program? Athlete: to what extent and what services Athlete: to what extent and what services

will be rendered (systemic illness, will be rendered (systemic illness, musculoskeletal injuries)musculoskeletal injuries)

Institution: who else can be served medically Institution: who else can be served medically and educationally and what are the legalitiesand educationally and what are the legalities

Community: outside group and community Community: outside group and community organizations with legalities again being an organizations with legalities again being an issueissue

Providing CoverageProviding Coverage►Facility Personnel CoverageFacility Personnel Coverage

Appropriate coverage of facility and sportsAppropriate coverage of facility and sports Setup of treatments, rehabilitation, game Setup of treatments, rehabilitation, game

and practice coverage varyand practice coverage vary

►Sports CoverageSports Coverage Certified athletic trainer should attend all Certified athletic trainer should attend all

practices and games practices and games Different institutions have different levels of Different institutions have different levels of

coverage based on personnel and risks coverage based on personnel and risks involved with sportsinvolved with sports

Hygiene and SanitationHygiene and Sanitation►Athletic Training ClinicAthletic Training Clinic

Rules concerning room cleanliness and sanitation Rules concerning room cleanliness and sanitation must be set and made known to population using must be set and made known to population using facilityfacility

Operation should abide by policies set forth by OSHAOperation should abide by policies set forth by OSHA ExamplesExamples

►No equipment/cleats in the athletic training roomNo equipment/cleats in the athletic training room►Shoes off treatment tablesShoes off treatment tables►Shower prior to treatmentShower prior to treatment►No roughhousing or profanityNo roughhousing or profanity►No food or smokeless tobaccoNo food or smokeless tobacco

Cleaning responsibilities should be Cleaning responsibilities should be addressed appropriately by athletic training addressed appropriately by athletic training staff and custodial staffstaff and custodial staff

Division of responsibilitiesDivision of responsibilities Maintenance crewMaintenance crew

►Sweep floors daily, clean and disinfect sinks and Sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste tubs, mop hydrotherapy room, empty waste basketsbaskets

Athletic Training staffAthletic Training staff►Clean treatment tables, disinfect hydrotherapy Clean treatment tables, disinfect hydrotherapy

modalities daily, clean equipment regularlymodalities daily, clean equipment regularly

►Gymnasium (general issues concerning facility Gymnasium (general issues concerning facility and equipment cleanliness)and equipment cleanliness) FacilityFacility

►Cleaning of gymnasium floorsCleaning of gymnasium floors►Drinking fountain and shower/locker facility disinfectingDrinking fountain and shower/locker facility disinfecting►Mats cleaned daily (wrestling)Mats cleaned daily (wrestling)

Equipment and clothingEquipment and clothing►Proper fitting equipmentProper fitting equipment►Frequent clothing and equipment launderingFrequent clothing and equipment laundering►Appropriate equipment for weather conditionsAppropriate equipment for weather conditions►Use of clean dry towels and equipment dailyUse of clean dry towels and equipment daily

►AthleteAthlete Promotion of good health and hygiene is Promotion of good health and hygiene is

criticalcritical►Prompt injury and illness reportingPrompt injury and illness reporting►Follow good living habitsFollow good living habits►Showering after practiceShowering after practice►Avoid sharing clothes and towelsAvoid sharing clothes and towels►Exhibit good hygiene practicesExhibit good hygiene practices►Avoid common drinking sourcesAvoid common drinking sources►Avoid contact with athletes with contagious Avoid contact with athletes with contagious

disease or infectiondisease or infection

Emergency TelephonesEmergency Telephones

►Accessibility to phones in all major Accessibility to phones in all major areas of activity is a mustareas of activity is a must

►Should be able to contact outside Should be able to contact outside emergency help and be able to call for emergency help and be able to call for additional athletic training assistanceadditional athletic training assistance

►Radios, cell and digital phones provide Radios, cell and digital phones provide a great deal of flexibility a great deal of flexibility

Budgetary ConcernsBudgetary Concerns► Size of budgetSize of budget►Different settings = different size Different settings = different size

budgets and space allocationsbudgets and space allocations► Equipment needs and supplies vary Equipment needs and supplies vary

depending on the setting (college vs. depending on the setting (college vs. secondary school)secondary school)

► Continuous planning and prioritizing is Continuous planning and prioritizing is necessary to effectively manage necessary to effectively manage monetary allocations to meet monetary allocations to meet programmatic goalsprogrammatic goals

►SuppliesSupplies Expendable Expendable

►Involves supplies that cannot be reused- Involves supplies that cannot be reused- first aid and injury prevention suppliesfirst aid and injury prevention supplies

Non-expendableNon-expendable►Re-useable supplies - ace wraps, scissors…Re-useable supplies - ace wraps, scissors…

etc)etc)

Yearly inventory and records must be Yearly inventory and records must be maintained in both areasmaintained in both areas

►EquipmentEquipment Items that can be used for a number Items that can be used for a number

of yearsof years Capital (remain in the athletic training Capital (remain in the athletic training

facility including ice machine, tables)facility including ice machine, tables) Non-consumable capital (crutches, Non-consumable capital (crutches,

coolers, athletic training kits)coolers, athletic training kits)

►Purchasing SystemsPurchasing Systems Direct buy vs. competitive biddingDirect buy vs. competitive bidding Lease alternative Lease alternative

►Additional Budget ConsiderationsAdditional Budget Considerations Telephone and postage expensesTelephone and postage expenses Utilities – heating/cooling, electricityUtilities – heating/cooling, electricity Contracts for outside servicesContracts for outside services Purchases relative to liability insurance and Purchases relative to liability insurance and

professional developmentprofessional development

Developing a Risk Developing a Risk Management PlanManagement Plan

►Security IssuesSecurity Issues Accessibility to athletic training clinic Accessibility to athletic training clinic

(staff, physicians, athletic training (staff, physicians, athletic training students)students)

Athletic training students must be Athletic training students must be supervised when in the clinical settingsupervised when in the clinical setting

Coaches may have access in secondary Coaches may have access in secondary school settingsschool settings

►Fire SafetyFire Safety Post evacuation plan in case of firePost evacuation plan in case of fire Smoke detectors/alarm system and fire Smoke detectors/alarm system and fire

extinguisher should be tested and in extinguisher should be tested and in placeplace

►Electrical and Equipment SafetyElectrical and Equipment Safety Major concernMajor concern Be aware of power distribution system to avoid Be aware of power distribution system to avoid

accidentsaccidents

►Emergency Action PlanEmergency Action Plan Accessing emergency personnel outside setting in the Accessing emergency personnel outside setting in the

event of emergencyevent of emergency Include transportation of athletes to emergency facilitiesInclude transportation of athletes to emergency facilities Meeting with outside personnel is necessary to Meeting with outside personnel is necessary to

determine roles and rules regarding athlete and determine roles and rules regarding athlete and equipment careequipment care

Accessing Community Based Accessing Community Based Health ServicesHealth Services

►Must have knowledge of local and Must have knowledge of local and community health services and community health services and agencies in the event of referralsagencies in the event of referrals

►Referrals should be made with Referrals should be made with assistance from a physicianassistance from a physician

►Parental involvement is necessary Parental involvement is necessary when dealing with psychological and when dealing with psychological and sociological eventssociological events

Human Resources and Human Resources and Personnel IssuesPersonnel Issues

►Assembling appropriate personnel to Assembling appropriate personnel to achieve program goals and objectives is achieve program goals and objectives is critical to success. critical to success.

►Recruitment, hiring and retaining qualified Recruitment, hiring and retaining qualified personnel is necessary to be effectivepersonnel is necessary to be effective

►Specific policies are established relative to Specific policies are established relative to hiring, firing, performance evaluations and hiring, firing, performance evaluations and promotionspromotions Must adhere to these principlesMust adhere to these principles

►Roles and responsibilities must be Roles and responsibilities must be established established Job descriptions - job specifications, Job descriptions - job specifications,

accountability, code of conduct, and scopeaccountability, code of conduct, and scope

►Head athletic trainer must serve as a Head athletic trainer must serve as a supervisor and work to enhance supervisor and work to enhance professional development of staffprofessional development of staff

►Performance evaluations should take Performance evaluations should take place routinelyplace routinely

Athletic Training Facility Athletic Training Facility DesignDesign

►Design will vary drastically based on Design will vary drastically based on number of athletes, teams, and number of athletes, teams, and various needs of the programvarious needs of the program

►SizeSize Varies between settings Varies between settings Must take advantage and manage space Must take advantage and manage space

effectivelyeffectively Interact with architect relative to needs Interact with architect relative to needs

of program and athletesof program and athletes

►LocationLocation Outside entrance (limits doors that must Outside entrance (limits doors that must

be accessed when transporting injured be accessed when transporting injured athletes)athletes)

Double door entrances and ramps are idealDouble door entrances and ramps are ideal Proximity to locker rooms and toilet Proximity to locker rooms and toilet

facilitiesfacilities Light, heat and water source should be Light, heat and water source should be

independent from rest of facilityindependent from rest of facility

► IlluminationIllumination Well lighted throughoutWell lighted throughout Reflective ceilings and walls will aid in Reflective ceilings and walls will aid in

processprocess Natural lighting is a plusNatural lighting is a plus

►Special Service AreasSpecial Service Areas Treatment AreaTreatment Area: area that accommodates 4-: area that accommodates 4-

6 adjustable treatment tables, 3-4 stools, and 6 adjustable treatment tables, 3-4 stools, and hydrocollator and ice machine accessibilityhydrocollator and ice machine accessibility

Electrotherapy AreaElectrotherapy Area:: area that houses area that houses ultrasound, diathermy, electrical stim units, ultrasound, diathermy, electrical stim units, storage units, grounded outlets, treatment storage units, grounded outlets, treatment tables and wooden chairs, under constant tables and wooden chairs, under constant supervisionsupervision

Hydrotherapy Area:Hydrotherapy Area: area with centrally area with centrally located located sloping floor to drain, equipped with 2-3 whirlpools, sloping floor to drain, equipped with 2-3 whirlpools, shelving and storage space and outlets 5 feet above shelving and storage space and outlets 5 feet above the floorthe floor

Exercise Rehabilitation Area: Exercise Rehabilitation Area: area that area that provides adequate space and equipment to perform provides adequate space and equipment to perform reconditioning of injuriesreconditioning of injuries

Taping, Bandaging & Orthotics Area: Taping, Bandaging & Orthotics Area: 3-4 3-4 taping tables and storage cabinets to treat athletes taping tables and storage cabinets to treat athletes with proximity to a sinkwith proximity to a sink

PhysicianPhysician’’s Exam Room:s Exam Room: space for space for physician to work which may hold exam physician to work which may hold exam table, lockable storage, sink, telephonetable, lockable storage, sink, telephone

Records Area:Records Area: space devoted to space devoted to record keeping which may include filing record keeping which may include filing system or computer based database, system or computer based database, that allows access only to medical that allows access only to medical personnelpersonnel

►Storage FacilitiesStorage Facilities Athletic training facilities often lack ample Athletic training facilities often lack ample

storage spacestorage space Storage in athletic training room that holds Storage in athletic training room that holds

general supplies and special equipmentgeneral supplies and special equipment Large walk-in storage cabinet for bulk suppliesLarge walk-in storage cabinet for bulk supplies Refrigerator for equipment, ice cups, medicine Refrigerator for equipment, ice cups, medicine

and additional suppliesand additional supplies Space should be designated for storage of Space should be designated for storage of

patient belongingspatient belongings

Figure 2-2

►Athletic TrainerAthletic Trainer’’s Offices Office Space at least 10x12 feet is ampleSpace at least 10x12 feet is ample All areas of athletic training facility All areas of athletic training facility

should be able to be supervised without should be able to be supervised without leaving office space (glass partitions)leaving office space (glass partitions)

Equipment should include, desk, chair, Equipment should include, desk, chair, tack board, telephone, computer and tack board, telephone, computer and independent locking systemindependent locking system

►Additional AreasAdditional Areas Pharmacy Area: Pharmacy Area: separate room that can be secured separate room that can be secured

for storing and administrating medications (records for storing and administrating medications (records must be maintained concerning administration)must be maintained concerning administration)

Rehabilitation Pool:Rehabilitation Pool: if space permits, must be if space permits, must be accessible to individuals with various injuries, with accessible to individuals with various injuries, with graduated depth and non-slip surfacegraduated depth and non-slip surface

Restrooms:Restrooms: Should be at least one available within Should be at least one available within the facilitythe facility

Figure 2-1

Issues Specific to Athletic Training Issues Specific to Athletic Training Program Operations in Clinic, Program Operations in Clinic,

Hospital Corporate of Industrial Hospital Corporate of Industrial SettingsSettings

► Staff must be prepared to provide care to Staff must be prepared to provide care to a wide range of patientsa wide range of patients PediatricsPediatrics AdolescentsAdolescents Young adults and adultsYoung adults and adults Geriatric patientsGeriatric patients

►May also involve additional duties in May also involve additional duties in management, marketing, outreach, along management, marketing, outreach, along with fiscal and financial responsibilitieswith fiscal and financial responsibilities

►Scope of PracticeScope of Practice Diverse patient populationDiverse patient population In hospital settings time may be spent with in-In hospital settings time may be spent with in-

patient, out-patient and/or ambulatory carepatient, out-patient and/or ambulatory care Owner of out-patient facility will dictate patient Owner of out-patient facility will dictate patient

population seen at clinicpopulation seen at clinic The AT may be involved with patient care, onsite The AT may be involved with patient care, onsite

employee fitness, ergonomics, work hardening employee fitness, ergonomics, work hardening programs, outreach programs, athletic event programs, outreach programs, athletic event coveragecoverage

Limitations and restrictions will be dictated by state Limitations and restrictions will be dictated by state regulatory statutesregulatory statutes

►Location of ClinicLocation of Clinic Patient base is critical and therefore location is key Patient base is critical and therefore location is key

to attracting patientsto attracting patients Other factorsOther factors

►ZoningZoning►Traffic concernsTraffic concerns►Physician referralsPhysician referrals►Will physicians use athletic trainers to provide servicesWill physicians use athletic trainers to provide services►Can the clinic provide additional services relative to Can the clinic provide additional services relative to

industrial rehabilitation and workplace assessmentindustrial rehabilitation and workplace assessment►Sports medicine coverage for schoolsSports medicine coverage for schools►Direct and indirect competitionDirect and indirect competition

►Hours of OperationHours of Operation Clinic will need to be opened at times that do not conflict Clinic will need to be opened at times that do not conflict

with normal working hourswith normal working hours►Early morning and evening hoursEarly morning and evening hours►Weekend hours may also be usefulWeekend hours may also be useful

►Clinic Personnel and Human Resource IssuesClinic Personnel and Human Resource Issues Athletic trainers will work with multiple healthcare provider Athletic trainers will work with multiple healthcare provider

in clinical/corporate and hospital treatment centers in clinical/corporate and hospital treatment centers Formal job descriptions are critical for all individuals Formal job descriptions are critical for all individuals

working in environmentworking in environment Communication and team approach is criticalCommunication and team approach is critical

Potential Athletic Training Potential Athletic Training DutiesDuties

►Ergonomic AssessmentErgonomic Assessment Ergonomics is the science of designing products, Ergonomics is the science of designing products,

machines and systems to maximize comfort, machines and systems to maximize comfort, efficiency and safetyefficiency and safety►Based on anthropometry and biomechanicsBased on anthropometry and biomechanics►Applied to industrial engineeringApplied to industrial engineering►Used to design, adapt and alter workplace environments to Used to design, adapt and alter workplace environments to

accommodate to a personaccommodate to a person’’s strengths, limitations, sizes s strengths, limitations, sizes and shapesand shapes

Primary goal often involves injury and accident Primary goal often involves injury and accident prevention in workplace by minimizing risk factors prevention in workplace by minimizing risk factors ►Postures, vibration, repetition & forcePostures, vibration, repetition & force

An athletic trainer may work with An athletic trainer may work with an occupational therapist or an occupational therapist or ergonomist to assess environmentergonomist to assess environment

Will provide assessment, make Will provide assessment, make recommendations, provide recommendations, provide instruction on injury prevention instruction on injury prevention techniquestechniques

Report is generated and provided Report is generated and provided to site administrators with follow-to site administrators with follow-up reviews often conducted to up reviews often conducted to ensure implementation of ensure implementation of recommendationsrecommendations

Figure 2-3

►Work Hardening/Conditioning ProgramsWork Hardening/Conditioning Programs Intensive outpatient therapy for individuals Intensive outpatient therapy for individuals

injured on the jobinjured on the job►Work conditioning = treatment 3 hours/day, 3 Work conditioning = treatment 3 hours/day, 3

days/weekdays/week►Work hardening = 8 hours of treatment daily, 5 Work hardening = 8 hours of treatment daily, 5

days/weekdays/week

Goal is to restore functionality and return to Goal is to restore functionality and return to full duty capacityfull duty capacity

Both an evaluation and report are assembled Both an evaluation and report are assembled and are used to develop a rehabilitation planand are used to develop a rehabilitation plan

► The evaluation involves:The evaluation involves: Musculoskeletal examination (strength, Musculoskeletal examination (strength,

posture, flexibility, gait, neurologic posture, flexibility, gait, neurologic screening) screening)

Functional capacity evaluation Functional capacity evaluation ►Prolonged sitting, standingProlonged sitting, standing►Hand grip strength and lifting abilitiesHand grip strength and lifting abilities►Ability to perform repetitive tasksAbility to perform repetitive tasks►Carrying capabilitiesCarrying capabilities►BalanceBalance

These elements are continually monitored These elements are continually monitored and allow for program adjustment in order and allow for program adjustment in order to facilitate the patientto facilitate the patient’’s return to s return to appropriate levels of performanceappropriate levels of performance

Figure 2-4

►Wellness CenterWellness Center Athletic trainers may be involved in Athletic trainers may be involved in

organizing wellness screenings and organizing wellness screenings and workshops for:workshops for:►Asthma & diabetesAsthma & diabetes►Hypertension & strokeHypertension & stroke►CholesterolCholesterol►OsteoporosisOsteoporosis►Prostate/skin cancerProstate/skin cancer

Designed for early detection, awareness and Designed for early detection, awareness and preventionprevention

Programs designed to educate individuals on Programs designed to educate individuals on nutrition, health and safety may be offerednutrition, health and safety may be offered

Health fairs are often an effective means of Health fairs are often an effective means of providing screenings and educationproviding screenings and education

►Community Outreach and MarketingCommunity Outreach and Marketing Some athletic trainers may be clinic or hospital Some athletic trainers may be clinic or hospital

based in the morning and may provide athletic based in the morning and may provide athletic training coverage in afternoons and eveningstraining coverage in afternoons and evenings

Outreach may occur in the collegiate setting, Outreach may occur in the collegiate setting, secondary schools or for single athletic eventssecondary schools or for single athletic events

Serves as an effective marketing tool to promote Serves as an effective marketing tool to promote and advertise clinicand advertise clinic

Also provides visibility for the clinic to other Also provides visibility for the clinic to other healthcare providers and potential future healthcare providers and potential future consumers/patientsconsumers/patients

►Corporate Fitness ProgramsCorporate Fitness Programs Involves in-house fitness programming Involves in-house fitness programming

for employeesfor employees Provides numerous health-related Provides numerous health-related

benefits to employeesbenefits to employees Also serves to reduce health costs, Also serves to reduce health costs,

increase productivity, reduce increase productivity, reduce absenteeism, improve morale, lower absenteeism, improve morale, lower healthcare expenditures and reduce healthcare expenditures and reduce sick leavesick leave

Often involves fitness screening and Often involves fitness screening and individual program designindividual program design

Figure 2-5

►Drug Testing ProgramsDrug Testing Programs Athletic trainers may be asked to oversee drug Athletic trainers may be asked to oversee drug

testing programstesting programs Program may act as a deterrent to employees Program may act as a deterrent to employees

coming in unfit for dutycoming in unfit for duty May be necessitated by federal guidelines or pre-May be necessitated by federal guidelines or pre-

employment screeningsemployment screenings Legal defensibility is the most important aspect of Legal defensibility is the most important aspect of

any drug-testing programany drug-testing program The corporation should use federally certified testing The corporation should use federally certified testing

laboratories with all positive tests results confirmed laboratories with all positive tests results confirmed via a medical review departmentvia a medical review department

►Fiscal ManagementFiscal Management Having a basic understanding of business practices Having a basic understanding of business practices

may be necessary in for-profit clinical settingsmay be necessary in for-profit clinical settings Knowledge of billing practices is critically importantKnowledge of billing practices is critically important Maintaining positive accounts payable vs. accounts Maintaining positive accounts payable vs. accounts

receivable ratio is the goal of all successful receivable ratio is the goal of all successful businessesbusinesses

Other responsibilities may includeOther responsibilities may include►Financial planningFinancial planning►Establishing contractual obligationsEstablishing contractual obligations►Efficient billing and collection systemsEfficient billing and collection systems►Budget formulationBudget formulation

Record KeepingRecord Keeping

►Major responsibilityMajor responsibility►The rule not the exception - accurate The rule not the exception - accurate

and up-to-dateand up-to-date►Medical records, injury reports, Medical records, injury reports,

insurance information, injury insurance information, injury evaluations, progress notes, evaluations, progress notes, equipment inventories, annual reportsequipment inventories, annual reports

Maintaining Confidentiality in Maintaining Confidentiality in Record KeepingRecord Keeping

►Release of Medical RecordsRelease of Medical Records Written consent is requiredWritten consent is required Waiver must be signed for any Waiver must be signed for any

release (include specifics of release (include specifics of information to be released and to information to be released and to whom)whom)

►Health Insurance Portability and Health Insurance Portability and Accountability Act (HIPAA)Accountability Act (HIPAA) Regulates dissemination of personal history Regulates dissemination of personal history

information (PHI) by coaches, ATinformation (PHI) by coaches, AT’’s, s, physicians or other members of sports physicians or other members of sports medicine teammedicine team

Guarantees athlete access to information Guarantees athlete access to information and control over disclosureand control over disclosure

Athlete may provide written authorization Athlete may provide written authorization for release of informationfor release of information

►HIPAA AuthorizationHIPAA Authorization Description of information to be disclosedDescription of information to be disclosed Identification of parties authorized to provide Identification of parties authorized to provide

and make use of PHIand make use of PHI Description of each purpose of the use or Description of each purpose of the use or

disclosuredisclosure Expiration date or eventExpiration date or event IndividualIndividual’’s signatures signature Description of his/her authority to act for the Description of his/her authority to act for the

individual if signed by personal representativeindividual if signed by personal representative

►Family Educational Rights and Privacy Family Educational Rights and Privacy ActAct FERPA = law protecting privacy of student FERPA = law protecting privacy of student

education recordseducation records Provides parents with certain rights with Provides parents with certain rights with

respect to childrespect to child’’s educational records s educational records When child turns 18 rights are transferred When child turns 18 rights are transferred

to studentto student School must have written permission prior School must have written permission prior

to releasing informationto releasing information

Administering Pre-Administering Pre-participation Examinationsparticipation Examinations

► Initial pre-participation exam prior to Initial pre-participation exam prior to start of practice is criticalstart of practice is critical

►Purpose is to identify athlete that may be Purpose is to identify athlete that may be at riskat risk

►Should includeShould include Medical history, physical exam, orthopedic screening, Medical history, physical exam, orthopedic screening,

wellness screeningwellness screening

►Establishes a baselineEstablishes a baseline►Satisfies insurance and liability issueSatisfies insurance and liability issue

►Examination by Personal PhysicianExamination by Personal Physician Yields an in-depth history and ideal physician-Yields an in-depth history and ideal physician-

patient relationshippatient relationship May not result in detection of factors that May not result in detection of factors that

predispose the athlete to injurypredispose the athlete to injury

►Station ExaminationStation Examination Provides athlete with detailed exam in little timeProvides athlete with detailed exam in little time Team of nine is ideal (2 physicians, 2 non-Team of nine is ideal (2 physicians, 2 non-

physicians and 5 managers/student athletic physicians and 5 managers/student athletic trainers)trainers)

►Medical HistoryMedical History Complete prior to exam to identify past and existing Complete prior to exam to identify past and existing

medical conditionsmedical conditions Update yearly and closely review by medical personnelUpdate yearly and closely review by medical personnel Collect medical release and insurance info at the same Collect medical release and insurance info at the same

timetime

►Physical ExaminationPhysical Examination Should include assessment of height, weight, body Should include assessment of height, weight, body

composition, blood pressure, pulse, vision, skin, dental, composition, blood pressure, pulse, vision, skin, dental, ear, nose, throat, heart, lungs, abdomen, lymphatic, ear, nose, throat, heart, lungs, abdomen, lymphatic, genitalia, maturation index, urinalysis and blood workgenitalia, maturation index, urinalysis and blood work

►Maturity AssessmentMaturity Assessment Means to protect young, physically active athletesMeans to protect young, physically active athletes MethodsMethods

►Circumpubertal (sexual maturity)Circumpubertal (sexual maturity)►SkeletalSkeletal►DentalDental

TannerTanner’’s five stage assessment is most expedients five stage assessment is most expedient

►Orthopedic ScreeningOrthopedic Screening Part of physical exam or separatePart of physical exam or separate Various degrees of detail concerning examVarious degrees of detail concerning exam

►Wellness ScreeningWellness Screening Purpose is to determine if athlete is engaged in a Purpose is to determine if athlete is engaged in a

healthy lifestylehealthy lifestyle

►Sport DisqualificationSport Disqualification Certain injuries and illnesses warrant special concern when Certain injuries and illnesses warrant special concern when

dealing with sportsdealing with sports Recommendations can be madeRecommendations can be made American with Disabilities Act (1990) American with Disabilities Act (1990)

►Dictates that athlete makes the final decisionDictates that athlete makes the final decision Potential disqualifying factors should be determined during Potential disqualifying factors should be determined during

the pre-participation examthe pre-participation exam

Personal Information CardPersonal Information Card► Contains contact information for family, Contains contact information for family,

personal physician, and insurance personal physician, and insurance informationinformation

Injury Reports and Injury Injury Reports and Injury DispositionDisposition

► Injury reports serve as future referencesInjury reports serve as future references► Reports can shed light on events that Reports can shed light on events that

may be hazy following an incidentmay be hazy following an incident►Necessary in case of litigationNecessary in case of litigation► All reports should be filed in the athletic All reports should be filed in the athletic

training roomtraining room

Treatment LogTreatment Log►Sign-in to keep track of servicesSign-in to keep track of services►Daily treatments can be recordedDaily treatments can be recorded►Treatment of daily therapies can be Treatment of daily therapies can be

monitored along with compliancemonitored along with compliance►Can be used as legal Can be used as legal

documentation in instances of documentation in instances of litigationlitigation

Injury Evaluation and Injury Evaluation and Progress NotesProgress Notes

► Injuries and progress should be monitored Injuries and progress should be monitored by athletic trainer and recordedby athletic trainer and recorded

►SOAP note formatSOAP note format S: Subjective (history of injury/illness)S: Subjective (history of injury/illness) O: Objective (information gathered during O: Objective (information gathered during

evaluation)evaluation) A: Assessment (opinion of injury based on A: Assessment (opinion of injury based on

information gained during evaluation)information gained during evaluation) P: Plan (short and long term goals of rehab)P: Plan (short and long term goals of rehab)

Supplies and Equipment Supplies and Equipment InventoryInventory

►Managing budget and Managing budget and equipment/supplies is critically equipment/supplies is critically importantimportant

► Inventory must be taken yearly in Inventory must be taken yearly in order to effectively replenish order to effectively replenish suppliessupplies

Annual/Seasonal ReportAnnual/Seasonal Report

►Summary of athletic training program Summary of athletic training program functionsfunctions

►Can be used to evaluate recommend Can be used to evaluate recommend potential changes for program potential changes for program

► Includes number of patients and Includes number of patients and types of injuries seen/treatedtypes of injuries seen/treated

Computer as Tool for Athletic Computer as Tool for Athletic TrainerTrainer

► Indispensable toolIndispensable tool►Can make the job Can make the job

more efficient with more efficient with appropriate softwareappropriate software

►Must maintain Must maintain securitysecurity

►Must determine for Must determine for what computer will what computer will be usedbe used

►Should consult experts in order to determine Should consult experts in order to determine what systems are appropriate for specific usewhat systems are appropriate for specific use

►Factors to considerFactors to consider Access to mainframe and internetAccess to mainframe and internet Hardware (desktop, laptop, personal digital Hardware (desktop, laptop, personal digital

assistants)assistants) Software – various programs for multiple usesSoftware – various programs for multiple uses

►Record keeping needsRecord keeping needs►Word processing, budget maintenanceWord processing, budget maintenance►Educational softwareEducational software

World Wide Web and access to emailWorld Wide Web and access to email

Collecting Injury DataCollecting Injury Data

►Accident - unplanned event resulting in loss Accident - unplanned event resulting in loss of time, property damage, injury or deathof time, property damage, injury or death

► Injury- damage to the body restricting Injury- damage to the body restricting activityactivity

►Case study- looks at specific incident of Case study- looks at specific incident of injuryinjury

►Epidemiologic studies may assess Epidemiologic studies may assess various areasvarious areas Age or genderAge or gender Body part Body part Occurrence in different sportsOccurrence in different sports Contact, non-contact, limited contact, Contact, non-contact, limited contact,

collision sportscollision sports

►Catastrophic InjuriesCatastrophic Injuries 98% of injuries requiring hospital emergencies 98% of injuries requiring hospital emergencies

are treat and release relative to sportare treat and release relative to sport Sports deaths (struck with object, heat stroke)Sports deaths (struck with object, heat stroke) Catastrophic injuries also include spinal cord Catastrophic injuries also include spinal cord

trauma, cardiorespiratory injuries/problemstrauma, cardiorespiratory injuries/problems Most injuries are related to appendagesMost injuries are related to appendages

►Strains, sprains, contusions, fractures, abrasionsStrains, sprains, contusions, fractures, abrasions

►Current National Injury Data-Gathering SystemsCurrent National Injury Data-Gathering Systems State of the art injury surveillance is still developing State of the art injury surveillance is still developing Ideal situation involves epidemiologic approachIdeal situation involves epidemiologic approach

►Epidemiology Epidemiology Takes an evidence-based approach for identifying risk factors for Takes an evidence-based approach for identifying risk factors for

injury and determining optimal treatment methods in clinical practiceinjury and determining optimal treatment methods in clinical practice Serves as foundation for intervention in interest of public health and Serves as foundation for intervention in interest of public health and

preventive medicinepreventive medicine

►Extrinsic factors (activity, exposure, equipment)Extrinsic factors (activity, exposure, equipment)►Intrinsic factors (age, gender, neuromuscular aspects, Intrinsic factors (age, gender, neuromuscular aspects,

structural aspects….etc)structural aspects….etc) Number of different surveillance systems in placeNumber of different surveillance systems in place

►Surveillance SystemsSurveillance Systems National Safety Council National Safety Council

►General sports injury dataGeneral sports injury data

Annual Survey of Football Injury ResearchAnnual Survey of Football Injury Research►Public school, college, professional, sandlot football Public school, college, professional, sandlot football

injury datainjury data

National Center of Catastrophic Sport Injury National Center of Catastrophic Sport Injury Research Research ►Tracks catastrophic injuries in all levels of sportsTracks catastrophic injuries in all levels of sports

NCAA Injury Surveillance System NCAA Injury Surveillance System ►Data collected on most major sports- ATC data Data collected on most major sports- ATC data

collectioncollection►Converted to web-based data collection systemConverted to web-based data collection system

National Electronic Injury Surveillance National Electronic Injury Surveillance System System ►Monitor injuries relative to different products --Monitor injuries relative to different products --

consumer safety, determine if products are consumer safety, determine if products are hazardous or defectivehazardous or defective

Using Injury DataUsing Injury Data

►Valid and reliable data can be utilized Valid and reliable data can be utilized to decrease injuriesto decrease injuries

►May allow for:May allow for: Rule modificationRule modification Assist coaches and players in Assist coaches and players in

understanding risksunderstanding risks Help manufacturersHelp manufacturers Educate parents, athletes and the public Educate parents, athletes and the public

on inherent risks associated with sporton inherent risks associated with sport