Efficient Athletic Health Program Management Guide

1. Essentials of Athletic Injury Management 10thEdition

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 • 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 • 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. 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. 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