Chapter 1: The Athletic Trainer and the Sports Medicine Team

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Chapter 1 The Athletic Trainer and the Sports
Medicine Team

• John Hardin MA, ATC, CSCS
• Sports Medicine
• Spain Park High School

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Sports Medicine

• Broad field of medical practices related to
  physical activity and sport
• Involves a number of specialties involving active
  populations
• Typically classified as relating to performance
  enhancement or injury care and management

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Sports Medicine
Human Performance
Injury Management
Practice of Medicine
Exercise Physiology
Biomechanics
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage
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The Players on the Sports Medicine Team

• Physicians
• Dentist
• Podiatrist
• Nurse
• Physicians Assistant
• Physical Therapist
• Athletic Trainer
• Massage Therapist
• Ophthalmologist
• Dermatologist
• Gynecologist

• Exercise Physiologist
• Biomechanist
• Nutritionist
• Sport Psychologist
• Coaches
• Strength Conditioning Specialist
• Social Worker
• Neurologist
• Osteopath
• Psychiatrist

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Growth of Professional Sports Medicine
Organizations

• International Federation of Sports Medicine
  (1928)
• American Academy of Family Physicians (1947)
• National Athletic Trainers Association (1950)
• American College of Sports Medicine (1954)
• American Orthopaedic Society for Sports Medicine
  (1972)
• National Strength and Conditioning Association
  (1978)
• American Academy of Pediatrics, Sports Committee
  (1979)
• Sports Physical Therapy Section of APTA (1981)
• NCAA Committee on Competitive Safeguards and
  Medical Aspects of Sports (1985)

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National Athletic Trainers Association (NATA)

• Purpose
• To enhance the quality of health care for
  athletes and those engaged in physical activity,
  and to advance the profession of athletic
  training through education and research in the
  prevention, evaluation, management and
  rehabilitation of injuries
• 30,000 members

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Purpose of Professional Sports Medicine
Organizations

• Promote involvement of various health related
  professions
• Dentistry, podiatry, chiropractic medicine
• Focus on athletic health and safety
• All bodies have worked towards the reduction of
  injury and illness in sport

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Sports Medicine Journals

• A variety of publications exist, providing
  excellent resources to the sports medicine
  community
• Journal of Athletic Training
• Journal of Sports Rehabilitation
• International Journal of Sports Medicine
• Physician and Sports Medicine
• Clinics in Sports Medicine
• American Journal of Sports Medicine

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The Athletic Trainer

• Charged with injury prevention and health care
  provision for the athlete and physically active
  population
• Consists of athletic, recreational or competitive
  activities
• Requires physical skills and utilizes strength,
  power, endurance, speed, flexibility, range of
  motion and agility
• Athletic trainer deals with the athlete and
  injury from its inception until the athlete
  returns to full competition

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Roles and Responsibilities Performance Domains

• Prevention of athletic injuries
• Clinical evaluation and diagnosis
• Immediate care of injuries
• Treatment, rehabilitation and reconditioning of
  athletic injuries
• Health care administration
• Professional responsibilities

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Personal Qualities of ATCs

• Stamina and Adaptability
• Prevents burnout
• Empathy
• Ability to detect stress with a desire to
  minimize that stress
• Sense of Humor
• Helps relieve tension and promote relaxation

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Personal Qualities of ATCs

• Ability to Communicate
• Oral and written communication is necessary
• Intellectual Curiosity
• Lifelong commitment to learning
• Ethics
• High standard of conduct and integrity

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The ATC and the Athlete

• Major concern for the ATC athlete
• All decisions impact the athlete
• The injured athlete must always be informed
• Be made aware of the how, when and why that
  dictates the course of injury rehabilitation

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The ATC and the Athlete

• The athlete must be educated about injury
  prevention and management
• Instructions should be provided regarding
  training and conditioning
• Inform the athlete to listen to his/her body in
  order to prevent injuries

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The ATC and Parents

• ATC must keep parents informed,
• Particularly in the secondary school setting
• The parents decision regarding healthcare must be
  a primary consideration
• Insurance plans may dictate care
• Selection of physician

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The ATC and Parents

• ATC, physician and coaches must be aware and
  inform parents of Health Insurance Portability
  and Accountability Act (HIPAA)
• Regulates dissemination of health information
• Protects patients privacy and limits the people
  who could gain access to medical records

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The ATC and the Team Physician

• ATC works under the direct supervision of a
  physician
• Physician and ATC must be able to work together
• Have similar philosophical opinions regarding
  injury management
• Helps to minimize discrepancies and
  inconsistencies

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Roles and Responsibilities of the Team Physician

• Compiling medical histories and conducting
  physical exams
• Pre-participation screening
• Diagnosing injury
• Deciding on disqualifications
• Based on medical knowledge and psychophysiological
  demands of the sport

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Roles and Responsibilities of the Team Physician

• Attending practice and games
• Commitment to sports and athletes
• Potentially serve as the ATEP Medical Director
• Provides input into educational content
• Provides programmatic instruction

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The ATC and the Coach

• Must understand the role of the ATC
• Coach must clearly understand the limits of their
  ability to function as a healthcare provider
• Directly responsible for injury prevention
• Appropriate conditioning programs

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Roles and Responsibilities of the Team Physician

• Coach must be aware of risks associated with the
  sport
• Provide appropriate training and equipment
• Must have knowledge of CPR and first aid
• Must have thorough knowledge of skills,
  techniques, and environmental factors associated
  with sport
• Develop good working relationships with staff,
  including athletic trainers

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Athletic Training

• Where have we been?
• Where are we now?
• Where are we going?

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Athletic Training Where have we been clinically?

• Traditional employment settings deal exclusively
  with an athletic population
• Colleges
• Secondary schools

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Athletic Training Where are we now clinically?

• Today, ATCs work in a variety of settings
• Professional sports
• Hospitals
• Clinics
• Industrial settings
• The military
• Equipment sales
• Physician extenders

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Athletic Training Where are going clinically?

• Employment opportunities are becoming
  increasingly diverse
• Dramatic transformation since 1950
• Due largely in part to the efforts of the NATA
• More employment settings will include
• Research
• Administration

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Athletic Training Where are we going
clinically?

• Evolution of the profession has led to
• Recognition of ATCs as healthcare providers
• Increased diversity of practice settings
• Passage of practice acts
• Third party reimbursement for athletic trainers
• Constant revision and reform of athletic training
  education

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Athletic Training Where have we been
educationally?

• Formerly there were two types of athletic
  training education programs
• Accredited education programs
• Competency-based education
• Internship education programs
• Quantity-based education

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Athletic Training Where are we now
educationally?

• In 1998, the NATA - Education Council was
  established to dictate the educational
  preparation for the athletic training student
• Focus has shifted to competency based education
  at the entry level
• Education Council has significantly expanded and
  reorganized the clinical competencies and
  proficiencies

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Athletic Training Education Competencies Twelve
Content Areas

• Risk management
• Pathology of injuries and illnesses
• Assessment and evaluation
• Acute care
• Pharmacological aspects of injury and illness
• Therapeutic modalities
• Therapeutic exercise

• General medical conditions and disabilities
• Nutritional aspects of injury and illnesses
• Psychosocial intervention and referral
• Organization and administration
• Professional responsibilities

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Athletic Training Where are we now
educationally?

• June 1990 the AMA officially recognized
  athletic training as an allied health profession
• Committee on Allied Health Education and
  Accreditation (CAHEA) was charged with developing
  the guidelines for academic programs to use in
  preparation of individuals for entry into
  profession through the Joint Review Committee on
  Athletic Training (JRC-AT)

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Athletic Training Where are we now
educationally?

• June 1994 - CAHEA dissolved
• Replaced immediately by the Commission on
  Accreditation of Allied Health Education Programs
  (CAAHEP)
• Recognized as an accreditation agency for allied
  health education programs by the U.S. Department
  of Education
• Entry level college and university athletic
  training education programs at both undergraduate
  and graduate levels are currently accredited by
  CAAHEP

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Athletic Training Where are we going
educationally?

• In 2003, JRC-AT became an independent accrediting
  agency
• New name Commission on the Accreditation of
  Athletic Training Education (CAATE)
• CAATE will accredit athletic training education
  programs without
• No involvement from CAAHEP

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Athletic Training Where are we going
educationally?

• CAATE will seek affiliation with CHEA once it is
  fully independent
• CHEA is a private nonprofit national organization
  that coordinates accreditation activity in the
  United States
• Recognition by CHEA will put CAATE on the same
  level as other national accreditors, such as
  CAAHEP
• CAAHEP accreditation will be discontinued in
  2006 CAATE will begin in 2007

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Athletic Training Where are we going
educationally?

• Specialty Certifications
• Build on entry level knowledge
• NATA is in the process of developing specialty
  certifications
• Further enhance professional development
• Aid in expanding scope of practice

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Athletic Training Where are we going
educationally?

• Seven proposed specialty certifications
• Business practice, medical care management,
  occupational health, wellness, pediatric/adolescen
  t health, adult/geriatric health, special health
  populations
• Candidates will have to complete experiential
  requirements and pass a standardized examination

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Requirements for Certification as an Athletic
Trainer

• Must have extensive background in formal academic
  preparation and supervised clinical experience
• Upon meeting the educational guidelines
  applicants are eligible to sit for the Board of
  Certification (BOC) examination

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BOC Examination

• Examination consist of the following
• Written portion
• Practical portion
• Written simulation
• Exam assesses the 6 domains
• Prevention of injuries
• Evaluation and diagnosis
• Immediate care of injuries
• Treatment, rehabilitation reconditioning
• Organization and administration
• Professional responsibility

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BOC Examination

• Upon passing BOC examination, you are a BOC
  certified athletic trainer
• Credential of ATC
• BOC certification is a prerequisite for licensure
  in most states

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Continuing Education Requirements

• Continuing education is a requirement to maintain
  the ATC credential
• Ensure ongoing professional growth and
  involvement
• Requirements that must be met to remain certified
• 80 CEUs over the course of three years

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• Purpose
• To encourage ATC to obtain current professional
  development information
• To explore new knowledge in specific areas
• To master new athletic training related skill and
  techniques
• To expand approaches to effective athletic
  training
• To further develop professional judgement
• To conduct professional practice in an ethical
  and appropriate manner

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• CEUs are awarded for
• Attending symposiums, workshops, seminars
• Serving as a speaker or panelist
• Certification exam model
• Participating in the USOC program
• Authoring a research article authoring/editing a
  textbook
• Completing post-graduate work
• Obtaining CPR and first aid certification

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State Regulation of the Athletic Trainer

• During the early-1970s NATA realized the
  necessity of obtaining some type of official
  recognition by other medical allied health
  organizations of the athletic trainer as a health
  care professional
• Laws and statutes specifically governing the
  practice of athletic training were nonexistent in
  virtually every state

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• Athletic trainers in many individual states
  organized efforts to secure recognition by
  seeking some type of regulation of the athletic
  trainer by state licensing agencies
• To date 40 of the 50 states have enacted some
  type of regulatory statute governing the practice
  of athletic training
• Rules and regulations governing the practice of
  athletic training vary tremendously from state to
  state

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Licensure

• Regulation may be in the form of Licensure
• Limits practice of athletic training to those who
  have met minimal requirements established by a
  state licensing board
• Limits the number of individuals who can perform
  functions related to athletic training as
  dictated by the practice act
• Most restrictive of all forms of regulation

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Certification

• Regulation may be in the form of Certification
• Does not restrict using the title of athletic
  trainer to those certified by the state
• Can restrict performance of athletic training
  functions to only those individuals who are
  certified

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Registration

• Regulation may be in the form of Registration
• Before an individual can practice athletic
  training he/she must register in that state
• Individual has paid a fee for being placed on an
  existing list of practitioners but says nothing
  about competency

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Exemption

• Regulation may be in the form of Exemption
• State recognizes that an athletic trainer
  performs similar functions to other licensed
  professions (e.g. physical therapy), yet still
  allows them to practice athletic training despite
  the fact that they do not comply with the
  practice acts of other regulated professions

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Future Directions for the ATC

• Determined by the efforts of the NATA and its
  membership
• Ongoing re-evaluation, revision and reform of
  athletic training education
• CAATE will become an accrediting agency
• Third party billing will gradually become the
  rule, not the exception for ATCs
• Standardization of state practice acts
• ATCs will seek specialty certifications
• Expanding breadth and scope of practice

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Future Directions for ATC

• Increase in secondary school employment
• Increase in recognition of ATC as a physician
  extender
• Potential for expansion in the military,
  industry, and fitness/wellness settings
• With general population aging, there may be
  increased opportunity to work with aging
  physically active individuals
• Continue to enhance visibility through research
  and scholarly publication

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Future Directions for ATC

• Continue to be available for local and community
  meetings to discuss healthcare of the athlete
• Increase recognition and presence internationally
• Most importantly, continue to focus efforts on
  injury prevention and to provided high quality
  healthcare to physically active individuals who
  are injured while participating in sport