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)