Injury Care and the Athletic Trainer - Chapter 1

-Implied warranty -Expressed warranty -Strict liability -NOCSAE

Product liability :

Mission of the National Athletic Trainers' Association

"to represent, engage and foster the continued growth and development of the athletic training profession and athletic trainers as unique health care providers"

informed consent

-- implies that an injured party has been reasonably informed of needed treatment, possible alternative treatment, and advantages and disadvantages of each course of action -- valid consent can only be obtained from one who is competent to grant it - parent or over 18 years old -- authorization to treat in the absence of the parent, or in the event the individual is physically unable to consent to treatment, should be obtained in writing prior to the beginning of sport participation -- must be sensitive to cultural and religious beliefs and practices and honor those practices by providing appropriate care consistent with the wishes of the athlete -- exclusionary clause

Strategies for reducing the risk of litigation

-- ensure that all personnel are properly licensed for practicing within the laws of the state, particularly in providing athletic training services -- be familiar with the NATA position and consensus statements -- hire qualified members of the sports medicine team and establish strict rules for supervision and use of the facility establish a communication system at each field or gymnasium station -- maintain appropriate standard injury documentation and referral forms -- develop criteria to return an injured player to participation -- select and purchase quality safety equipment from a reputable dealer -- inspect safety equipment and supervise proper fitting, adjustment, and repair of equipment -- inspect equipment, facilities, and fields for hazards and prohibit their use if found to be dangerous -- establish policies for documentation, confidentiality, and storage of medical records -- keep accurate records of equipment purchases, reconditioning, and repairs -- post warning signs in plain sight on and around equipment to inform of the risks involved in abuse of equipment and to describe proper use of the equipment -- post visible signs in the swimming pool area giving the depth of the pool and prohibiting diving in the shallow area -- post warning signs in the whirlpool area to inform individuals not to touch the turbine device while standing or sitting in water -- require participants to wear protective equipment regularly, including protective eyewear in appropriate racquet sports -- issue only those helmets that meet standards established by the National Operating Commission on Standards for Athletic Equipment (NOCSAE); inform players that a helmet cannot prevent all injuries, and the possibility exists that serious head and neck injuries may occur in the sport -- provide continuing education for coaches and athletic trainers through in-service workshops and programs -- act as a reasonably prudent professional in caring for all sport participants

Practice Analysis (now on 7th edition)

Role Delineation Study leads to the...

• Licensure • Certification • Registration

State Practice Governance

True

T or F: state certification differs from certification as an athletic trainer

National Athletic Trainers' Association (NATA)

What is the professional association for athletic training?

Act of omission

an individual fails to perform a legal duty

battery

any unpermitted or intentional contact with another individual without their consent

sports medicine

applies medical and scientific knowledge to prevent and care for injuries or illnesses related to sport, exercise, or recreational activity, and, in doing so, enhances the health fitness and performance of the participant - branch of health care encompassing several disciplines

Exercise physiologist

can provide information pertaining to the physiologic mechanisms underlying physical activity

Tort

civil wrong done to an individual whereby the injured party seeks a remedy for damages suffered

Nutritionist

concerned with the role of proper dietary care in the prevention and treatment of illnesses -- can provide valuable input regarding the specialized needs of athletes and physically active individuals

National Operating Committee on Standards for Athletic Equipment (NOCSAE)

establishes minimum standards for football helmets -- any alteration or modification to any protective equipment may negate the manufacturer's liability

National Athletic Trainers' Association (NATA)

establishes standards for professionalism, education, research, and practice settings - professional membership organization - not required to be an athletic trainer

if you suspect a neck injury and remove the football helmet, you could be liable

example of malfeasance:

if you suspect a neck injury and improperly secure the head and neck region to the rigid spine board, you could be held liable

example of misfeasance :

if you suspect, or should have suspected, a neck injury and failed to use a rigid back board to stabilize the individual, you could be held liable

example of nonfeasance :

unpadded walls under the basketball hoops, slippery floors near a whirlpool, failure to follow universal safety precautions

examples of foreseeability of harm:

preseason meetings; post warning signs; require protective equipment

examples of methods for failure to warn :

negligence

failure to carry out a legal duty -- participants assume some inherent risk, but do not assume the risk that the professional will breach their duty of care

exclusionary clause

identifies conditions that will not be treated by the athletic trainer (e.g., injuries not associated with direct participation in sport)

implied warranty

manufacturers have a duty of care to design, manufacture, and package safe equipment that will not cause injury to an individual when the equipment is used as it was intended

malpractice

occurs when an individual commits a negligent act while providing care

Misfeasance

occurs when an individual commits an act that is their responsibility to perform but uses the wrong procedure or does the right procedure in an improper manner

Nonfeasance

occurs when an individual fails to perform their legal duty of care

Code of Ethics

principles of ethical behavior that should be followed in the practice of athletic training

Physical therapist

provides a unique and valuable resource in the overall rehabilitation of an individual

comparative negligence (comparative fault)

refers to the relative degree of negligence on the part of the plaintiff and defendant, with damages awarded on a basis proportionate to each person's carelessness

assumption of risk

require athletes to sign an assumption of risk form; this is not the same as a permission slip - does not assume the risk that the professional will breach their duty of care

Strength and conditioning specialist

specializes in the use of proper strength and conditioning to improve physicals skills, athletic performance, and fitness

Licensure (IDEAL)

strictest form of state regulation - government permission for an individual to practice a profession - required in Florida

Board of Certification (BOC)

the certifying organization for the athletic trainer (ATC credential)

Good Samaritan laws

the laws vary from state to state - laws are easy to get around and should not be relied upon by rescuers who erroneously believe the laws will protect them from litigation regardless of their actions

strict liability

the manufacturer is liable for any and all defective or hazardous equipment that unduly threatens an individual's personal safety

Mission of the Board of Certification

to certify athletic trainers and to identify for the public quality health care professionals through a system of certification, adjudication, standards of practice, and continuing competency programs

expressed warranty

written guarantee that the product is safe for use

Therapeutic intervention

• AT responsible for the implementation of treatment and rehabilitation programs appropriate to the diagnosis made during the evaluation and assessment phase

Role Delineation Study

• Defines the current entry-level knowledge, skills, and abilities required for practice in the profession of athletic training • Serves as a blueprint for the national certification examination

Examination, Assessment and Diagnosis

• addresses the responsibilities of the athletic trainer in using standard evaluation techniques and formulating a clinical impression for the determination of a course of action. • evaluation, or assessment, can involve several scenarios, including on-field (or on-site) primary assessment, off-field initial assessment, and follow-up assessment

Healthcare Administration and Professional Responsibility

• describes the responsibilities of the athletic trainer in developing and executing a series of plans, policies, and procedures to ensure individual and organizational well- being

Injury/illness Prevention and Wellness Promotion

• encompasses a broad spectrum of knowledge and skills that address the risks associated with safe performance and function • such risks range in severity from minor to potentially catastrophic injuries or illnesses..... In a similar manner, the strategies used to minimize such risks can vary from relatively simple to complex

Immediate and Emergency

• identifies the role of the athletic trainer subsequent to determining the nature and extent of an injury or illness • regardless of the setting, the athletic trainer must be prepared to care for and prevent further harm in patients with a variety of conditions

• Respect the rights, welfare, and dignity of all individuals • Comply with the laws and regulations governing the practice of athletic training • Accept responsibility for the exercise of sound judgment • Maintain and promote high standards in the provision of services • Not engage in any form of conduct that constitutes a conflict of interest or that adversely reflects on the profession

5 basic principles - Members shall:

the injured person must prove that: -- there was a duty of care -- there was a breach of that duty -- there was harm (e.g., pain and suffering, permanent disability, or loss of wages), and -- the resulting harm was a direct cause from that breach of duty

Criteria to find an individual liable:

1.Injury and illness prevention and wellness promotion 2.Examination, Assessment and Diagnosis 3.Immediate and emergency care 4. Therapeutic intervention 5. Healthcare Administration and Professional Responsibility

Domains of athletic training

•High school and collegiate settings •Professional sports teams •Sports medicine clinics •Industrial/occupational settings •Physician practices •Military •Performing arts Many other settings...

Examples of Work Settings

•Team physician -Could have orthopedic, primary care, or sports medicine specialty •Primary care physician •Athletic trainer •Participant •Strength and conditioning specialist •Additional specialists -Nutritionist, sport psychologist, physical therapist, etc.

Team Approach to Health Care

the material risks and appreciates, knowingly, and reasonably anticipating that other injuries and even death are possibilities voluntarily participation in the activity and assumes all risks of injury or even death due to their participation

What does an athlete acknowledge by signing the assumption of risk form?

act of comission

an individual commits an act that is not theirs to perform or commits an act that is their duty to perform but carries out the wrong procedure, leading to injury or harm - actions are measured against a standard of care provided by individuals who have a direct duty to provide care

Registration

an individual who wishes to practice athletic training within the state must register with a governmental agency - state may or may not have educational prerequisites for registration - an individual can be removed from the registry for abuse, fraud, or harm to the public/patient

Biomechanist

applying basic laws of physics in performing mechanical analyses of human movement, a biomechanist can offer practical insight for improving human performance as well as preventing sport- and physical activity-related injuries

distributing prescription medication; failing to follow a physicians orders

example of act of commission

failure to warn athletes of the potential risks associated with participation; failure to assess a reported injury

example of act of omission

in football, there is an implied warranty that if fitted and used properly, the helmet can protect the head and brain from certain injuries

example of implied warranty

Foreseeability of harm

exists when danger is apparent, or should have been apparent, resulting in an unreasonably unsafe condition -- can be identified during regular inspections of gymnasiums, field areas, swimming pools, safety equipment, and athletic training facilities -- unsafe conditions should be identified and reported

develop a total health care plan including staff responsibilities during emergency situations obtain adequate secondary health insurance for participants and liability insurance for the staff

have a well-established primary health care delivery team to :

- annual preparticipation health examination - insurance verification - medical data information cards - physician's clearance to participate

have an established preparticipation plan including :

- inform participants and parents of the risks involved in sport participation - obtain written informed consent from the parents of minor children before participation - document what was said at the preseason or preparticipation meeting

hold a preseason/preparticipation meeting to :

example of comparative negligence

if the athlete was found to be 30% at fault for their own injury (contributory negligent) and the defendant 70% at fault, then on a $100,000 judgment, the defendant would be responsible for $70,000 in damages and the athlete (plaintiff) would assume an equivalent of $30,000 in damages

- acts during an emergency - acts in good faith to help the victim - acts without expected compensation - is not guilty of any malicious misconduct or gross negligence toward the injured party

immunity generally applies only when the emergency first aider (Good Samaritan laws) :

primary care physician

in absence of team physician, plays a more pivotal role (highly dependent on work setting) -- administer preparticipation exams; provide initial clearance for sport participation; diagnose sport injuries; prescribe medications; clear individuals for sport participation after an injury

Certification

indicates that a person has the basic knowledge and skills required in the profession and has passed a certification examination - less common, South Carolina still requires this

failure to warn

inform potential sport participants of the risks for injury during sport participation -- participants and parents of minor children should learn that risk for injury exists and must understand the nature of that risk so informed judgments may be made about participation -- comprehending the nature of the risk is determined by the participant's age, experience, and knowledge of pertinent information about the risk

state regulations

intended to protect the public from harm by unqualified individuals; legal foundation to assure quality of care - legal standards vary from state to state; it is the responsibility of the AT to understand and satisfy the standards of scope of practice as defined in state statutes

standard of care

measured by what another minimally competent individual educated and practicing in that profession would have done in the same or similar circumstance to protect an individual from harm or further harm -- dictated by the profession's duty or scope of care -- an individual acting as an athletic trainer will be held to the standard of care expected of an individual holding the ATC credential-- an individual acting as a physician will be held to the standard of care expected of an individual holding a medical license as a physician

athletic training

medical profession involved in the prevention, assessment, treatment, and rehabilitation of injuries to athletes and other who are engaged in everyday physical activities - recognized by AMA as an allied health care profession since 1990

• Malfeasance • Misfeasance • Nonfeasance • Malpractice • Gross negligence

negligent tort may occur as a result of:

malfeasance

occurs when an individual commits an act that is not their responsibility to perform

gross negligence

occurs when an individual has total disregard for the safety of others

Scope of care

outlines the role and responsibilities of an individual in that profession -- delineates what should be learned in the professional preparation of that individual -- define the educational domains used in preparing entry-level athletic trainers; each domain is then further defined by a set of cognitive, psychomotor, and affective competencies - risk management - assessment and evaluation - acute care - general medical conditions and disabilities - pathology of injury and illness - pharmacologic aspects of injury and illness - nutritional aspects of injury and illness - therapeutic exercise - therapeutic modalities - health care administration - professional development and responsibilities - psychosocial intervention and referral -- clearance for participation -- final authority in determining participation status is the supervising physician, not the AT

refusing help

regardless of the reason given to refuse help, the conscious and medically competent individual has the right to refuse treatment -- exemption may occur when failure to move the injured party may result in an increased risk for further injury to the injured party or to others in the vicinity of the accident; example: during an organized bike race, several bikers collide and fall on a busy road; it would be appropriate to move any injured individuals off the road so as not to endanger themselves or any approaching motorists

confidentiality

release of any medical information must be acknowledged in writing by the sport participant (or if under 18 years of age, their parent); if permission is given to release information, it should identify what information can be shared with an individual other than the patient's physician -- information provided to coaches and parents should be on a need to know basis only and given with the full knowledge and consent of the athlete, supervising physician, and athletic trainer -- confidentiality should also extend to all medical records kept within the confines of the athletic training room

participant

responsible for maintaining a high level of fitness, eating nutritious foods, and playing within the rules of the sport -- responsible for maintaining and wearing safety equipment at all times during activity -- in the event of an injury, responsible for seeking immediate health care and following medical advice from the physician or athletic trainer

Coaches

should maintain current certification in cardiopulmonary resuscitation (CPR) and emergency first aid ****should not be performing or providing any care that they are not trained to do. Athletic trainers should be present or should advise coaches on how to contact them if they are needed to respond if they are not in the area (e.g. high school AT covering soccer that needs to respond to injury on tennis courts) -- in the absence of an athletic trainer, they must assume a more active role in providing health care to sport participants evaluate the daily status of sport participants, properly fit and use quality safety equipment, teach proper skill development and technique, and reinforce the importance of safety and injury prevention develop an emergency plan and practice implementing that plan -- reinforce what AT has taught to participants and parents of risks of injury associated with participation

Team physician

the final authority to determine the mental and physical fitness of athletes in organized programs -- should have a fundamental knowledge of emergency care regarding sporting events; should have a working knowledge of trauma, musculoskeletal injuries, and medical conditions affecting the athlete -- relative to athletic program administer and review preseason physical exams review preseason conditioning programs assess the quality, effectiveness, and maintenance of protective equipment diagnose injuries dispense medications direct rehabilitation programs educate the athletic staff on emergency policies, procedures, health care insurance coverage, and legal liability review all medical forms, policies, and procedures to ensure compliance with school and athletic association guidelines -- should be present at high risk competitions (commonly seen on sidelines of contact sport competitions)