Chapter 2: Organizing and Administering an Athletic Health Care Program

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Chapter 2 Organizing and Administering an
Athletic Health Care Program
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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

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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

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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 2-1
• Policies regarding environmental conditions and
  emergency protocols should also be set

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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

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• 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

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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?

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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

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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

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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

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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

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• 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)

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• 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

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• Maturity Assessment
• Means to protect young physically active athletes
• Methods
• Circumpubertal (sexual maturity)
• Skeletal
• Dental
• Tanners five stage assessment is most expedient
• Orthopedic Screening
• Part of physical exam or separate
• Various degrees of detail concerning exam

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• 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

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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

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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

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FERPA Regulations

• Family Educational Rights and Privacy Act
• Protects privacy of student educational records
• Provides parents certain rights with respect to
  inspection of childs 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

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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

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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

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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.

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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

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• 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

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Developing a Budget

• 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

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• 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

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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

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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

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• 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

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• Storage Facilities
• Athletic health care facilities often lack ample
  storage space
• Storage in the facility that holds general
  supplies and special equipment
• Storage available in the specified areas of the
  athletic health care facility room
• Large walk-in storage cabinet for bulk supplies
• Refrigerator for equipment, ice cups, medicine
  and additional supplies

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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