Ch 1: The Athletic Trainer as a Health Care Provider

The athletic trainer is most directly responsible for

All phases of health care, including preventing injuries from occurring, providing initial first aid and injury management, evaluating injuries, and designing and supervising a timely and effective program of rehabilitation that can facilitate the safe and expeditious return to activity.

Osteopath (DO)

An osteopath is a trained physician who emphasizes the role of the musculoskeletal system in health and disease using a holistic approach to the patient. An osteopath incorporates a variety of manual and physical treatment interventions in the prevention and treatment of disease.

Dimension-specific instruments

Focus on one specific aspect of health status concentrating primarily on psychological well-being.

Minimal clinically important difference (MCID)

Is a published value of change in an instrument that indicates the clinical bottom line, which is the minimum amount of change required for your patient to feel a difference in the variable being measured.

There are three areas of responsibility for the team dentist:

Organizing and performing the preseason dental examination. Being available to provide emergency care when needed. Conducting the fitting of mouth protectors.

Podiatrist (DPM)

Podiatry, the specialized field dealing with the study and care of the foot, has become an integral part of sports health care. Many podiatrists are trained in surgical procedures, foot biomechanics, and the fitting and construction of orthotic devices for the shoe. Like the team dentist, a podiatrist should be available on a consulting basis.

It is becoming relatively common for industries to employ athletic trainers to oversee fitness and injury rehabilitation programs for their employees.

The athletic trainer working in an industrial or occupational setting must have a sound understanding of the principles and concepts of workplace ergonomics, including inspecting, measuring, and observing dimensions of the work space, as well as specific tasks that are performed at the workstation.23 Once a problem has been identified, the athletic trainer must be able to implement proper adjustments to workplace ergonomics to reduce or minimize possible risks for injury. In addition to these responsibilities, athletic trainers may be assigned to conduct wellness programs and provide education and individual counseling.

Athletic trainers work with both male and female professional teams, including football, basketball, baseball, hockey, soccer, lacrosse, softball, golf, and tennis

They are also employed in professional rodeo, auto racing (NASCAR), and wrestling. The athletic trainer for professional sports teams usually performs specific team athletic training duties for 6 to 8 months out of the year; the other 4 to 6 months are spent in off-season conditioning and individual rehabilitation. The athletic trainer working with a professional team is involved with only one sport and is paid according to contract, much as a player is. Playoff and championship money may be added to the yearly income.

Licensure

Through this licensing board, the state limits the number of individuals who can perform functions related to athletic training as dictated by the practice act. Requirements for licensure vary from state to state, but most require a specific educational and training background, evidence of good moral character, letters of recommendation from current practitioners, and minimal acceptable performance on a licensing examination. Licensure is the most restrictive of all the forms of regulation.

The physician determines

When a recommendation should be made that an athlete be disqualified from competition on medical grounds and must have the final say as to when an injured athlete may return to activity. Any decision to allow an athlete to resume activity should be based on recommendations from the athletic trainer.

The athletic trainer can minimize the risk of injury by

(1) conducting pre-participation exams; (2) ensuring appropriate training and conditioning of the athlete; (3) monitoring environmental conditions to ensure safe participation; (4) selecting, properly fitting, and maintaining protective equipment; (5) making certain that the athlete is eating properly; and (6) making sure the athlete is using medications appropriately, while discouraging substance abuse.

In evidence-based practice, there are five steps that athletic training clinicians should take when attempting to determine the efficacy of using a specific clinical technique

(1) develop a clinical question; (2) search the literature to find the best evidence; (3) evaluate the strength of that evidence; (4) apply the best-available evidence in the literature to clinical experience and specific patient needs; and (5) assess the outcome or effectiveness of the treatment.

Professional organizations have many goals

(1) to upgrade the field by devising and maintaining a set of professional standards, including a code of ethics; (2) to bring together professionally competent individuals to exchange ideas, stimulate research, and promote critical thinking; and (3) to give individuals an opportunity to work as a group with a singleness of purpose, thereby making it possible for them to achieve objectives that, separately, they could not accomplish.

Biomechanist

An individual who possesses some expertise in the analysis of human motion can also be a great aid to the athletic trainer. The biomechanist uses sophisticated video and computer-enhanced digital analysis equipment to study movement. By advising the athlete, coach, and athletic trainer on matters such as faulty gait patterns or improper throwing mechanics, the biomechanist can reduce the likelihood of injury to the athlete.

Athletic trainers may be employed in

An outpatient ambulatory rehabilitation clinic working in general patient care; in hospital emergency rooms: as health, wellness, or performance enhancement specialists; or as clinic administrators. Their job may also involve ergonomic assessment, work hardening, CPR training, or occasionally overseeing drug-testing programs. They may also be employed by a hospital but work in a clinic.

Disease-specific instruments

Are specific to a particular patient group that share a common disease.

Site or region specific instruments

Assess health problems in a specific part of the body.

In the various employment settings

Athletic trainers no longer treat only athletes, but instead a physically active population. Physically active individuals engage in athletic, recreational, or occupational activities that require physical skills and utilize strength, power, endurance, speed, flexibility, range of motion, and agility.

Athletic Trainer vs Trainer

Athletic training has traditionally been known as the field that is concerned with the athlete's health and safety. A trainer is someone who trains dogs or horses or functions in coaching or teaching areas. The certified athletic trainer is one who is a specialist in athletic training.

The effectiveness of athletic health care service can be evaluated only to the extent to which it meets the following criteria:

Availability at every scheduled practice or contest of a person qualified and delegated to render emergency care to an injured or ill participant. Planned access to a physician by phone or nearby presence for prompt medical evaluation of the health care problems that warrant this attention. Planned access to a medical facility, including plans for communication and transportation.

Sports Chiropractor (DC)

Chiropractors emphasize diagnosis and treatment of mechanical disorders of the musculoskeletal system, believing that these disorders affect general health by way of the nervous system. Chiropractors make use of spinal and extremity manipulations in their treatments.

At the college or university level

Clinical positions for athletic trainers vary considerably from institution to institution. In smaller institutions, the athletic trainer may be a half-time teacher in physical education and half-time athletic trainer. In some cases, if the athletic trainer is a physical therapist rather than a teacher, he or she may spend part of the time in the school health center and part of the time in athletic training. Increasingly at the college level, athletic training services are being offered to members of the general student body who participate in intramural and club sports. In most colleges and universities, the athletic trainer is full-time, does not teach, works in the department of athletics, and is paid by the institution. However, it has been suggested that athletic trainers at colleges and universities should be employed by the campus or student health services rather than by the athletic department.

burnout

Commonly used to describe feelings of exhaustion and disinterest toward work.

The Certification Examination

Computer-based exam (CBE). The CBE tests for knowledge and skill in five major domains: (1) injury/illness prevention and wellness protection; (2) clinical evaluation and diagnosis; (3) immediate and emergency care; (4) treatment and rehabilitation; and (5) organizational and professional health and well-being. Successful performance on the certification examination leads to BOC certification as an athletic trainer with the credential of ATC. BOC certification is a prerequisite for licensure in most states.

Physical activity

Consists of athletic, recreational, or occupational activities that require physical skills and utilize strength, power, endurance, speed, flexibility, range of motion, and agility.

Exemption

Exemption means that a state recognizes that athletic trainers perform functions similar to those of other licensed professions (e.g., physical therapy) yet allows them to practice athletic training despite the fact that they do not comply with the practice acts of other regulated professions. Exemption is most often used in those states in which there are not enough practitioners to warrant the formation of a state regulatory board.

Specialization that are primarily concerned with performance enhancement

Exercise physiology, biomechanics, sport psychology, sports nutrition, strength and conditioning coaches, and personal fitness training.

Patient-centered/rated outcome measures (PROMs)

Gathers information directly from the patient using structured questionnaires that have been demonstrated to provide meaningful, quantitative assessments of how the patient feels and how they are able to function with their disorders as a result of a treatment or intervention. They serve to influence patient care, provide meaningful information regarding the effectiveness of interventions, contribute to the process of clinical reasoning, enhance communication, and motivate patients.

National Athletic Trainers' Association (NATA)

In 1950, some 101 athletic trainers from the various conferences met in Kansas City, Missouri, and officially formed the National Athletic Trainers' Association. The primary purpose for its formation was to establish professional standards for the athletic trainer. Since NATA was formed in 1950, many individuals have made contributions to the development of the profession.

Physical Therapist (PT)

In many sports medicine clinics, athletic trainers and physical therapists work in teams, jointly contributing to the supervision of a rehabilitation program. A number of athletic trainers are also physical therapists. A physical therapist can be certified as a sports certified specialist (SCS). The physical therapist is prepared to treat a variety of patient populations with different types of injuries, whereas the athletic trainer is focused primarily on treating and working with the physically active population.

Some school districts have found it effective to employ a centrally-placed certified athletic trainer

In this case, the athletic trainer, who may be full- or part-time, is a non-teacher who serves a number of schools. The advantage is savings; the disadvantage is that one individual cannot provide the level of service usually required by a typical school. A less desirable means of obtaining secondary-school athletic training coverage is using a certified graduate student from a nearby college or university. However, this practice may prevent a school from employing a certified athletic trainer on a full-time basis.

Summary-item instruments

Include single items and may be specific to either a region or disease.

Nutritionist (RD)

Increasingly, individuals in the field of nutrition are becoming interested in athletics. Many college athletic training programs have sports dietitians who are engaged as consultants, either part-time or full-time. These dietitians are registered dietitians (RDs) that are also certified as specialists in sports dietetics (CSSD) programs that are geared to the needs of a particular sport. He or she also assists individual athletes who need special nutritional counseling.

Nurse practitioner (NP)

Is a registered nurse with advanced education and clinical training. NPs diagnose and treat common acute and chronic problems, and prescribe and manage medications. The nurse works under the direction of the physician. It is essential that the nurse works in liaison with the athletic trainer and the school health services.

External clinical evidence

Is clinically relevant research either from the basic sciences or medicine, or from patient-centered clinical research into the accuracy and precision of preventive, therapeutic, and rehabilitative techniques.

evidence-based practice

Is making decisions about the clinical care of individual patients based on the current best available evidence in the professional literature. For athletic trainers, the evidence-based approach raises questions about clinical techniques such as specific evaluative tests, certain rehabilitation techniques, or the effectiveness of using therapeutic modalities. External clinical evidence often invalidates previously accepted clinical techniques and treatments and replaces them with new ones that are more appropriate and efficient. Without making use of the current best available evidence, clinical practice is in danger of becoming rapidly out of date, and this will undoubtedly have a negative impact on patient outcomes.

Individual clinical expertise

Is the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.

Generic instruments

Look at a broad range of aspects of health status and the consequences of illness or conditions that may be found in a wide range of primarily healthy populations. These should be used in initial examinations and then follow-ups and reevaluations.

Practicing evidence-based medicine

Means integrating external clinical evidence from systematic research with clinical expertise while focusing on patient values and preferences.

Occupational Therapist (OT)

Occupational therapists work with patients who have conditions that are mentally, physically, developmentally, or emotionally disabling to improve their ability to perform tasks in their daily living and working environments. Some occupational therapists treat individuals whose ability to function in a work environment has been impaired. These practitioners arrange employment, evaluate the work environment, plan work activities, and assess the client's progress.

Physician Assistant (PA)

Physician assistants (PAs) are trained to assume many of the responsibilities for patient care traditionally done by a physician. A physician assistant is licensed to triage, conduct patient evaluations, diagnose and treat patients, arrange for various hospital-based diagnostic tests, and prescribe appropriate medications without conferring with or being seen by a physician. PAs have a physician supervisor but there are several levels of supervision to include the physician being available by phone. A number of athletic trainers have also become PAs in recent years.

The coach is directly responsible for

Preventing injuries by seeing that athletes have undergone a preventive injury conditioning program. The coach must ensure that sports equipment, especially protective equipment, is of the highest quality and is properly fitted. The coach must also make sure that protective equipment is properly maintained. A coach must be keenly aware of what produces injuries in his or her sport and what measures must be taken to avoid them.

Foundational Behaviors of Professional Practice

Recognizing that the primary focus of practice should be the patient. Understanding that competent health care requires a team approach. Being aware of the legal components of patient care. Practicing in an ethical manner. Advancing the knowledge base in athletic training. Appreciating the cultural diversity of individual patients. Being an advocate and model for the athletic training profession.

Referee

Referees must be highly knowledgeable regarding rules and regulations, especially those that relate to the health and welfare of the athlete. They work cooperatively with the coach and the athletic trainer. They must be capable of checking the playing facility for dangerous situations and equipment that may predispose the athlete to injury. They must routinely check athletes to ensure that they are wearing adequate protective pads.

Registration

Registration means that, before an individual can practice athletic training, he or she must register in that state. The individual has paid a fee for being placed on an existing list of practitioners. The state may or may not have a mechanism for assessing competency. However, registration does prevent individuals who are not registered with the state from calling themselves athletic trainers.

The team physician

Should be responsible for compiling medical histories and conducting physical examinations for each athlete, both of which can provide critical information that may reduce the possibility of injury. Preparticipation screening done by both the athletic trainer and the physician are important in establishing baseline information to be used for comparison, should injury occur during the season.

Certification

State certification as an athletic trainer differs from certification as an athletic trainer by the BOC. An individual who has passed the BOC exam does not automatically obtain a state certification. Although certification does not restrict the use of the title of athletic trainer to those certified by the state, it can restrict the performance of athletic training functions to only those individuals who are state certified. State certification indicates that a person possesses the basic knowledge and skills required in the profession and has passed a certification examination. Many states that offer certification use the BOC exam as a criterion for granting state certifi.

Exercise Physiologist

The exercise physiologist can significantly influence the athletic training program by giving input to the athletic trainer regarding training and conditioning techniques, body composition analysis, and nutritional considerations. Exercise physiologists monitor and assess cardiovascular and metabolic effects and mechanisms of exercise, replenishment of fluids during exercise, and exercise for cardiac and musculoskeletal rehabilitation.

Specialization that focus more on injury care and management specific to the athlete

The practice of medicine, athletic training, sports physical therapy, sports massage therapy, sports dentistry, osteopathic medicine, orthotics/prosthetics, chiropractic, podiatry, and emergency medical technology.

Dentist (DDS, DMD)

The role of team dentist is somewhat analogous to that of team physician. He or she serves as a dental consultant for the team and should be available for first aid and emergency care. Good communication between the dentist and the athletic trainer should ensure a good dental program.

Sport Psychologist

The sport psychologist can advise the athletic trainer on matters related to the psychological aspects of the rehabilitation process. The way the athlete feels about the injury and how it affects his or her social, emotional, intellectual, and physical dimensions can have a substantial effect on the course of a treatment program and how quickly the athlete may return to competition. The sport psychologist uses different intervention strategies to help the athlete cope with injury. Sport psychologists can seek certification through the Association for the Advancement of Sport Psychology.

The educational preparation for athletic trainers allows

Them to function in a variety of domains, including injury prevention, evaluation, diagnosis, management and rehabilitation, health education, nutrition, training and conditioning, preparticipation physicals, and maintenance of essential documentation. Although the contact with only the physically active population may not be as great as in other employment settings, the athletic trainer in physician practice can expect regular hours, few weekend or evening responsibilities, opportunity for growth, and, in general, better pay.

Emergency Medical Technician (EMT) and Paramedic

There are four levels of emergency medical service (EMS) providers: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic. Emergency Medical Responders are the first to arrive at the scene of an incident and are trained to provide basic emergency medical care. The EMT is trained to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. An Advanced EMT (AEMT) has more advanced training that allows the administration of intravenous fluids, the use of manual defibrillators, and the application of advanced airway techniques. Paramedics provide the most extensive prehospital care by administering drugs orally and intravenously, interpreting electrocardiograms (ECGs), performing endotracheal intubations, and using monitors and other complex equipment.