Seminar
NC Athletic Trainers Licensing Act
"Athletic trainer: a person who, under a written protocol with a licensed physician, carries out the practice of care, prevention, and rehabilitation of injuries incurred by athletes, and who, in carrying out these functions, may use physical modalities, including heat, light, sound, cold, electricity, or mechanical devices related to rehabilitation and treatment."
Risk Management
*Definition of risk management - Think of everything that could go wrong and prepare for it -Process intended to prevent loss for everyone associated with organization --Loss is not limited to financial -How can a liability suit (assume plaintiff wins) affect everyone in an organization? --Less financial resources for entire organization --Changes in policies and procedures -What is the first step in risk management for an administrator? --Identifying the inherent risks - what are the risks?
**William "Pinky" Newell**
- "Father of Modern Athletic Training" - 1954 - 1968 acted as National Secretary of NATA - Primarily responsible for organizing the modern day NATA - Emphasized education standards and gaining recognition - Head AT at Purdue for approx. 45 years
Forming the "Profession"
- 1938 - first attempt at establishing athletic training as a profession -- "Athletic trainers" met at the Drake Relays (huge track meet in Iowa) to exchange information and establish governance -- Accomplishments: *National meetings *Membership classes *Trainer's Journal *First official logo *Regional Divisions - 1944 - organization disbanded due to WWII
Reforming the "Profession"
- 1947 - colleges & universities were frequently employing "athletic trainers" - Regional meetings began to occur -- First regional meeting was in Chapel Hill, NC -- "Athletic Trainers" met at the conference track championships -- Formed the "Southern Conference Athletic Trainers Association" -- Several other regional associations were later formed
The 80's - Strengthening of NATA's Role
- Continued emphasis on education - Disparity on info being taught & what was on the certification exam -- Led to the Role Delineation Study of 1982* (delineation studies reevaluated every 5 years) --Survey on the roles & responsibilities of the ATC *Performance Domains* (split up into 6 sections) -- Most recent study in 2004
19th century
- Increased interest in sports - Injuries handled by coach or team physician - 1881 Harvard University hired first "trainer" (James Robbing)
**Birth of a Profession**
- June 24-25, 1950 - First national meeting held in Kansas City, Missouri -- Sponsored by Cramer Chemical Company -- ~125 attendees - Developed a governing body -- Board of Directors *National Secretary (president) - Charles Cramer *Representatives from 9 conferences (districts)
Why "Athletic Trainer"?
- Much controversy over the name - Emanated from horse and boxing trainers - Quote by Arthur D. Dickinson, University of Northern Iowa in a 1956 speech to the American Association of Health Physical Education and Recreation:
The 50's & 60's - Establishing the Profession
- Several major accomplishments - NATA formally established (1950) - NATA constitution and by-laws (1951) - Official logo (1952) - Journal of NATA (1956) - Code of ethics (1957) - 1st proposal for formal athletic training education (1959)
Do you have name protection?
-"....no person shall....use any card, title, or abbreviation to indicate that the person is an athletic trainer unless that person is currently licensed..." **Person who does not have a license, but claims to be an athletic trainer = Class 1 misdemeanor
Do you have service protection? (NC AT Licensing Act)
-"..no person shall practice or offer to practice as an athletic trainer, perform activities of an athletic trainer.........unless that person is currently licensed ..." -"The provisions of this article do not apply to: --Licensed, registered, or certified professionals, such as nurses, physical therapists, and chiropractors if they do not hold themselves out in the public as athletic trainers --A licensed physician --An Athletic Training student --An athletic trainer who is employed by, or under contract with, an organization........located in another state and who is representing that organization...at an event held in this state."
Statements to look for..
-"A certified athletic trainer may work under the direction of a team physician" --What is meant by direction? --Team physician vs. licensed physician? --What is meant by work? *Is that all services or just when you are getting paid (i.e. volunteering with Special Olympics)? If you are not working, do need to be under direction of physician? -"no greater ratio of two AT's to one physical therapist in the clinic setting" --Will this influence employment options in clinic settings? --Does this suggest that PT's supervise ATCs?
The very last statement:
-"Nothing in this article shall be construed to require direct third-party reimbursement to persons licensed under this article" **Why was this included? -Can't bill for service b/c PTs care b/c taking services away from them
Types of state regulation
-48 states have some form of regulation -Licensure - most stringent -Certification -Registration **Alaska = no regulation; Hawaii = exemption
Torts
-A legal / civil wrong --Different than breach of contract *Failure to perform services specified in contract --Civil law -A private wrong or injury suffered by an individual as the result of another individual's conduct -3 types of Tort --Intentional tort --Negligent tort (unintentional) (most common) --Strict liability tort
Types of negligence:
-Act of Omission Failure to act when there was a legal duty to do so -Act of Commission An action that violates a legal duty *Person responsible for these things is plaintiff or someone who bring suit *If criminal, then government responsible
Domain IV - Treatment, Rehab & Reconditioning
-Administer Ther X using standard techniques & procedures -Administer Ther X modalities ..... -Administer TX for general illnesses ..... -Reassess the status of injury, illness, or condition using standard techniques to determine appropriate care -Educate appropriate individuals about rehab -Provide guidance for appropriate individuals in TX and rehab
Ankle Supports
-Alone or with tape -- they are increasingly popular -Significant debate over efficacy -Little or no impact on performance -Compared to tape, the device will not loosen significantly with use -Research also looking at impact on proprioceptive effects
Damage
-An actual adverse outcome exists --Physical --Mental --Lost wages or tangible benefits --Pain and suffering --Many others.....
NATA Task Forces
-Appropriate Medical Care for Secondary School-Age Athletes Task Force -Appropriate Medical Coverage for Intercollegiate Athletics Task Force --Highly controversial --Ratio of ATs:athletes for certain sports -Bone & Joint Decade Task Force World Federation of Athletic Training Task Force
Assumption of Risk
-Attempts to claim that the injured plaintiff understood the risk of activity and freely chose to undertake the activity regardless of the hazards associated with it -Only valid if 2 conditions are met: --Athlete must "fully appreciate" risks --Athlete must knowingly, voluntarily, and unequivocally choose to participate in face of inherent risks *Minors cannot fully appreciate risks, but their parents have to *Someone in an altered mental state (injury, diminished mental capacity i.e. Alzheimer's and Down's syndrome, drugs, intoxication, sometime pregnant women and elderly people, prisoners) also can't fully appreciate
What can be done to avoid legal liability?
-Avoid liability altogether -Build relationships -Insist on a written contract for work -Obtain informed consent -Warn athletes of dangers -Provide physical examinations -Make sure content and frequency meet standards -Know the profession and its standards -Participate in continuing education -Make a documented attempt to avoid injury by removing or modifying potential hazards -Establish policies -Document activities -Maintain confidentiality -Provide proper instruction -Supervise your staff -Recognize your qualifications / limitations
Contact Lenses
-Become part of the eye and move with it -Corneal and sclera lenses -Peripheral vision, astigmatisms and corneal waviness is limited -Will not fog and can be tinted -Disadvantages include cost, corneal irritation, possibility of coming dislodged -Soft hydrophilic lenses and disposable lenses are very popular
Registration
-Before an individual can practice athletic training, they must register in that state --Pay a fee -State may or may not have a criteria for assessing competency (i.e. BOC certified) -Prevents those not registered from call themselves athletic trainers -No protection of services
How are athletic training services defined? (NC AT Licensing Act)
-Care, prevention, and rehabilitation of injuries -Use of physical modalities, including heat, light, sound, cold, electricity, or mechanical devices related to rehabilitation and treatment --Is this an adequate representation of what an ATC does? Yes!
3 types of liability insurance
-Claims Made (cheapest): only covers claims made during the calendar year -Tail Coverage: covers things outside of the policy year -Occurrence Policy: covers any incident during the policy year --Not just limited to work related situations
Safety Standards for Equipment and Facilities
-Concerns relative to materials, durability, establishment of standards, manufacturing, testing methods, and requirements for use -Must be in place relative to maintenance -Concern should be protective ability not appearance of equipment -A number of groups and agencies are involved in standardizing sports equipment and facilities **Every piece of equipment has safety requirements and replacement guidelines to ensure that they are effectively protective
NATA Councils
-Council on Employment -Education Council --Executive Committee --Certificates for Added Qualification Ad Hoc --Committee --Continuing Education Committee --Entry-Level Committee --Graduate Education Committee --Educational Multimedia Committee -Ethnic Diversity Advisory Council
Malpractice
-Definition = Liability generating conduct associated with the adverse outcome of patient treatment -Most common threat to ATs -Based on: --Negligent pt. care --Failure to obtain consent --Intentional conduct --Breach of contract --Use/transfer of a defective product --Abnormally dangerous Tx --Defective product - i.e. expired OTCs, not having ultrasound machine calibrated every year and caused harm
Domain VI - Professional Development & Responsibility
-Demonstrate appropriate professional conduct by complying with standards -Maintain competence through CEU's -Educate the public about the role and standards of practice for ATC's -Adhere to statutory, regulatory and case law related to practice of AT
Principle 4:
-Do not engage in any form of conduct that constitutes a conflict of interest or that adversely reflects on the profession --Private conduct is a personal matter except when such conduct compromises the fulfillment of professional responsibilities --Do not use NATA logo for self promotion --Do not place financial welfare above patient welfare --Able to seek financial compensation for services that is commensurate with their services and in compliance with applicable law
Liability Insurance
-Does not protect against intentional torts -Know what is covered by your employer -May consider purchasing personal liability insurance *Should have about $3 million coverage... still sometimes not enough
Certification
-Does not restrict the use of the title of athletic trainer to those certified by the state -Does restrict the performance of athletic training services to those certified by the state
Ice Hockey Equipment
-Easily $200-300 for a helmet -Everyone except NHL has to wear full face mask -Also have an issue that athl has to buy the equipment, so have all different kinds of equipment
NATA District Organizations
-Eastern Athletic Trainers' Association District 1 District 2 -Mid-Atlantic Athletic Trainers' Association District 3 -Great Lakes Athletic Trainers' Association District 4 -Mid-America Athletic Trainers' Association District 5 -Southwest Athletic Trainers' Association District 6 -Rocky Mountain Athletic Trainers' Association District 7 -Far West Athletic Trainers' Association District 8 -Southeast Athletic Trainers' Association District 9 -Northwest Athletic Trainers' Association District 10
Domain I - Prevention
-Educate about risks of participation -Pre-participation exams -Use of protective equipment -Prophylactic/preventative measures -Identify safety hazards in activity areas & equipment -Monitor participants & environmental conditions -Facilitate physical conditioning programs -Maintain clinical & treatment areas -Promote sound nutritional practices
Legal Defenses
-Elements of negligence not proven -Statute of limitations -Sovereign immunity -Assumption of Risk -Good Samaritan -Act of God -Comparative Negligence
Trunk and Thorax Protection
-Essential in many sports -Must protect regions that are exposed to the impact of forces --External genitalia, bony protuberances, shoulders, ribs, and spine -While equipment may provide armor it may also be used as an implement -Question must be asked concerning necessity of equipment and its role in producing trauma
Domain V - Organization & Administration
-Establish EAP -Write P & P (policies and procedures) for those involved to promote safe participation, timely care, and legal compliance -Write P & P for facilities, TX and activity areas -Comply with safety and sanitation standards for TX and activity ares -Manage resources by constructing & monitoring an annual budget -Maintain records using an appropriate system to document the services rendered
Face Mask Differences
-Face mask can be unsnapped from the bottom and flipped up -Those that have metal clips need to be unscrewed -It has been reported in FB that more head and neck movement occurred when the face mask was retracted as opposed to just cutting it off.
Grounds for disciplinary action in NC
-False information on licensure application -Convicted or pled guilty or no contest to a crime that indicates you are unfit or incompetent to practice as an athletic trainer or you have deceived or defrauded the public -Mental or physical disability or using a drug that interferes with your ability to practice as an athletic trainer -Engaging in conduct that endangers public health -Negligent acts or omissions -Willfully violating any act in the licensure act -Convicted of or pled guilty or no contest to an offence under state or federal narcotic or controlled substance laws
Face Protection
-Four categories 1.Face Guard 2.Throat Protection 3.Mouth Guards 4.Ear Guards
Face Guard
-Has reduced the number of facial injuries -Number of concussions has increased because head is most often used in initial contact -There are a variety of protective options depending on sport and position -Proper mounting of the mask must occur with no additional attachments that would invalidate the manufacturer's warranty -All mountings must be flush to the helmet **In high school hockey, face masks are required (with white plastic coating) that meet Hockey Equipment Certifications Council and American Society for Testing Materials Opening can not allow passage of sticks or pucks Additional polycarbonate face shields are also available The use of throat protectors is also mandated at some levels
Eye Protection
-Highest percentage of eye injuries are sports related -Generally blunt trauma -Glasses --May slip on sweat, become bent, fog, detract from peripheral vision or be difficult to wear with headgear --Properly fitting glasses can provide adequate protection --Lens should be case hardened to cause crumbling and not splintering on contact (disadvantage = increased weight) --May have polarizing/tinting ability --Plastic lenses while lightweight are easy to scratch
What do you do if you are responsible for administering drug screenings and 2 days before the test an athlete confides to you that they have taken drugs and are seeking help?
-If university directing drug testing, maybe have a meeting with the people in charge to discuss the situation -Really need to make sure they are actually seeking help and are not lying about it
Legal Concerns
-Increasing amount of litigation regarding equipment -Must foresee all uses and misuses and warn user against potential risks inherent in equipment misuse -If equipment results in injury due to defect or inadequacy for intended use --manufacturer is liable -If equipment is modified --modifier becomes liable **Decals, stickers change glancing glows of light on helmet --> EVERYTHING HAS TO BE APPROVED so modification is not potentially harmful and therefore that person's fault for changing it If equipment modified, person who modified it is reliable if person wearing it correctly and how it's supposed to gets hurt -To avoid litigation, athletic trainer should follow specific use instructions of equipment exactly --If the athletic trainer's modification results in injury the ATC and the institution are subject to a suit (tort)
Domain III - Immediate Care
-Initiate and/or execute techniques to mitigate life-threatening & other emergency conditions -Initiate care for medical conditions to stabilize and/or prevent exacerbation -Initiate care for musculoskeletal conditions to stability and/or prevent exacerbation -Facilitate referral or guidance for psychological crises by implementing intervention strategies -Education appropriate individuals in standard immediate care procedures
What type of individuals are you allowed to perform athletic training services on? (NC AT Licensing Act)
-Injuries incurred by athletes -"Athlete: Members of sports teams, including professional, amateur, and school teams; or participants in sports or recreational activities, including training and practice activities, that require strength, agility, flexibility, range of motion, speed, or stamina
Lacrosse Helmets
-Lacrosse helmet are highly variable -Cascade is leading company -Most do not wear the helmet properly fitted
Throat Protection
-Laryngotracheal injuries, while uncommon can be fatal -Baseball catchers, lacrosse goalies and ice hockey goalies are most at risk --Should be mandatory in these sports
Sovereign Immunity
-Legal doctrine that holds neither governments nor their agents can be held liable for negligent actions -Becoming less acceptable defense -Gov't can't be sued... b/c one, if criminal case, can't have gov't against gov't .... If civil, if you sue the gov't and win, taxpayers have to pay to collect all of that money to pay person so can't do that
Who is responsible for directing? (NC AT Licensing Act)
-Licensed physician in NC -What is meant by "written protocol"? --Most physicians use a kind of contract saying what can and can't do
Licensure
-Limits the practice of AT to those who have met minimal requirements by a state licensing board -Requirements vary from state to state --> challenging when move from state to state! -Most restrictive form of regulation
Principle 3:
-Maintain & promote high standards in the provision of services --Recognize need for continuing education and participate in continuing education --Be fair, considerate, and equitable when evaluating performance of other staff members (have an established criteria) --Share evaluations of other staff members with those individuals --Educate those you supervise (AT px & ethical px) --When possible, participate & support research and education --Researchers or educators are responsible for maintaining & promoting ethical conduct in those settings ** NEED CONTINUING EDUCATION!
Shoe fitting
-Measure both feet, as there will be slight differences -Approximate conditions of use -Fit at the end of day due to gradual increase in volume due to weight bearing -Should be snug but allow ample movement of foot and toes -Should break at widest part, coinciding with ball of foot -Must also consider width of shank, non-yielding nature of sole and function of arch support
Principle 2:
-Members shall comply with laws & regulations governing athletic training --Local, state, & federal laws & institutional guidelines --Be familiar & adhere to all NATA guidelines & ethical standards --Report illegal or unethical practice pertaining to athletic training --Avoid substance abuse **Must be familiar with local and state laws/guidelines and Local licensure laws!!
Principle 1:
-Members shall respect the rights, welfare, and dignity of all individuals --No discrimination --Commitment to competent care consistent with requirements & limitations of profession --Preserve confidentiality of privileged information and do not release such information to a 3rd party not involved in patient's care, unless consent is given
Legal & Ethical Considerations
-Most common situations in which an AT may be involved in an unethical situation --Breach of Confidentiality --Conflict of Interest --Exploitation
Mouth Guards
-Most dental injuries can be prevented with appropriate customized intraoral mouth guards -Protect teeth, minimize lip lacerations, absorb shock of chin blows, and prevent concussions -Should fit comfortably, not impede speech or breathing -Should extend back as far as last molar -Constructed of flexible resilient material formed to fit teeth and upper jaw -Do not cut down mouth guard as it voids warranty for dental protection and could become dislodged and disrupt breathing -Three types --Stock --Commercial (formed following submersion in water) --Custom (fabricated from dental mold) -Mandated use in high school and collegiate levels
Ear Guards
-Most sports do not use -Wrestling, water polo and boxing utilize to prevent ear irritation and ultimate deformity of ears
When is it OK to discontinue services?
-Must provide adequate time to find alternative services -Jointly terminate relationship (full recovery) -Patient voluntarily terminates treatment (documentation)
Breach
-Must show that the individual breached the duty owed the patient --Did not provide the standard of care
Baseball Batting Helmets
-Must withstand high velocity impacts -Research has indicated that helmet does little to dissipate energy of ball -Possible solution would be to add additional external padding -Helmet must still carry NOCSAE stamp (similar to football label) -Facemasks not necessarily required
Position Statements
-NATA Pronouncements Committee --Responsible for selecting position statement topics --Recruit an expert in the area to chair the paper (ATC or non-ATC) --Chair of paper recruits other experts in the topic area (ATC or non-ATC) --Pronouncements committee edits & revises paper until ready for publication in JAT
The 70's - Reorganization & Developing Standards
-NATA reorganized to function more efficiently and improve member services -- Clarified responsibilities for administration & governance -- Created committees to address special issues *Board of directors would accept/reject for implementation -- Separation of position (1973) - President - oversaw athletic training side, was an ATC - Executive director - ran the business, didn't have to be an ATC -President - 2 year terms, could be re-elected -Executive Director - unlimited
Football Helmets
-National Operating Committee on Standards for Athletic Equipment (NOCSAE) develop standards for football helmet certification -Must be protective against concussive force -While helmets must be certified, they may not always be fail-safe -Athletes and parents must be aware of inherent risks -Each helmet must have visible exterior warning label --Label indicates that helmet should not be used to strike an opponent due to risk of injury --Also indicates risk of injury accidentally and that athlete plays at own risk while using helmet -Athlete must be aware of risks and what label indicates --Athlete reads and signs statement regarding warning label -There are a number of helmet manufacturers, and even more have closed due to lawsuits and liability cases *Kevin says there are only limited things we can do to protect someone from concussive forces.... Egg is your head and yolk is brain --> can do anything to protect shell or skull, but still shaking up the egg or brain
Thigh and Upper Leg
-Necessary in collision sports -Pads slip into ready made uniform pockets -Customized pads may need to be held in place with tape and/or wraps -Neoprene sleeves can also be used for support of injuries
Eye and Glasses Guards
-Necessary in sports with fast moving projectiles -Athletes not wearing glasses should wear closed eye guards to protect orbital cavity -While eye guards afford great protection, they can limit vision -Polycarbonate eye shield have been developed for numerous pieces of head gear
What is the importance of education reform and standardization?
-Needs to stay up to date -Everyone needs to have the same education
The 90's - Recognition as an Allied Health Profession
-New committees to address strategic issues -Revised by-laws, now called Policies & Procedures -June 1990 - AMA recognizes athletic training as an allied health profession*** -CAHEA takes over education program accreditation from NATA* -- Developed guidelines & review procedures -New employment opportunities (clinic setting) -Revised code of ethics -Athletic training educational competencies are implemented (1999 role delineation study)* (Education council)
Education
-No formal education during early years -1916 - first known publication on athletic training education -- Dr. Sam Bilik: Pre-med student working as a "trainer" *Regarded as the "Father of Athletic Training" -- Publications: "Athletic Training" and "The Trainers Bible"
NATA BOC Committees
-Nominating Committee -Standards Committee -Professional Practice and Disciplinary Committee -Role Delineation & Research Committee -Exam Administration Committee -Exam Development Committee
Good Samaritan
-Not able to be used by AT in work setting -May be possible to use in volunteer setting --No duty to person in volunteer setting *What happens if a fan is injured during a home game? -You probably have duty (may be in your contract). At least call 911
Shoe selection
-Number of options for multiple activities -Guidelines for selection --Toe Box - space for toes (1/2 to 3/4 inch of space from toes to front of shoe) --Sole - provide shock absorption and durable *Spongy layer to absorb force *Midsole that cushions midfoot and toes *Hard rubber which contacts the ground --Heel Counter - prevents medial and lateral roll of foot (why don't put foot in w/o untying) --Shoe Uppers - top of shoe made with combination of materials, designed for appropriate ventilation, drying and support --Arch Support - durable but soft and supportive to foot --Price- due to impact on performance and injury prevention, may be worth the extra investment **Need to replace shoes every 300-400 miles
Domain II - Recognition, Evaluation & Assessment
-Obtain Hx (history) to assess pathology and extent of injury -Inspect involved areas ..... -Palpate involved areas ..... -Perform special tests ...... -Form clinical impression by interpreting Sx & Sy -Educate patient about assessment & injury -Inform health care team members to facilitate care
Off the Shelf vs. Custom Protective Equipment
-Off the shelf equipment --Pre-made and packaged --Can be used immediately *Neoprene sleeves, inserts, ankle braces --May pose problem relative to sizing -Customized equipment --Constructed according to the individual --Specifically sized and designed for protective and supportive needs
Shin and Lower Leg
-Often overlooked -Commercially marketed, hard molded shin guards are used in field hockey and soccer
Cause
-Once breach of duty has been shown the plaintiff must show "cause" -Two types of cause must be shown -Actual Cause: The degree to which the AT's actions are associated with the adverse outcomes of a patient's care --Severable liability: several people contributed to harm and % of harm is distributed among people involved --Joint liability: several people contributed to different levels, all people pay the same -Proximal Cause: The degree to which the harm caused by the AT was forseeable
Socks
-Poorly fit socks can cause abnormal stress on the foot -Should be clean, dry and w/out holes -Different types for different activities -Composition --Cotton can be bulky --Cotton/poly blend are lighter and dry faster
Reducing Risk
-Preparation for Activity --Administer PPEs --Monitor fitness levels --Assess activity areas (safety) --Monitor environmental conditions -Conduct of Activity --Maintain equipment --Proper instructional techniques --Adequate work-rest intervals -Injury Management --Physician supervision --Evaluate & treat injuries correctly & promptly --Supervise ATSs -Records Management --Document physician orders --Document Tx plan --Document Tx record --Document pt progress
NATA BOC Board of Directors
-President -Vice-President -Secretary/Treasurer -Athletic Trainer Director (3) (clinical person) -Physician Director -Corporate/Educational Director -Public Director (just member of public - no relation to athletic training) -Executive Director
Why regulation?
-Protect the public --not being allowed to perform certain things that could harm others -Protect the profession --In line with other health / medical professions = respect --Name protection --Service protection -Cons of regulation? --Limited scope of practice --Restrictive
Code of Ethics
-Purpose: --Establish the principles of ethical behavior that should be followed in the practice of athletic training --Primary goal: establish high quality health care -Four basic principles
What can the AT do to avoid breach of confidentiality and conflict of interest situations?
-Refer the athlete to a counselor --Preferably not affiliated with the institution or team
Types of Braces
-Rehabilitative: --widely used following surgery --Allows controlled progressive immobilization --Adjustable -Functional: --Used during and following rehab to provide functional support --Ready-made and customized -Neoprene (w/ medial and lateral support) --Used by those that have sustained collateral ligament injuries --Some are also used to provide support in those that have patellofemoral conditions
Hips and Buttocks
-Required in collision and high-velocity sports -Boxing, snow skiers, equestrians, jockeys and water skiers -Girdle and belt types -Football and ice hockey b/c prevent hip pointers
NATA Foundation Committees
-Scholarship Committee -Research Committee --Grants --RFP Development --Free Communications --Awards --Public Relations
Special cases in NC
-School units --"Local school administrative units may hire persons who are not licensed under this Article. The persons hired may perform the activities of athletic trainers in the scope of their employment but may not claim to be licensed under this Article. The persons hired may not perform the activities of athletic trainers outside the scope of this employment unless they are authorized to do so..."
Protective Sports Equipment
-Selection, fitting and maintenance of protective equipment are critical in injury prevention -Athletic trainers must have knowledge of protective equipment available for different sports and proper fitting procedures -Protection is critical in contact and collision sports
Neck Protection
-Serve primarily as a reminder to athlete to be cautious rather than providing definitive restrictions
What should AT do to ensure that conditions are met for assumption of risk?
-Signed documentation -Allow time for questions -Seek legal advice -Communicate with all interested parties (e.g. parents)
Sports Bras
-Significant effort has been made to develop athletic support for women -Most designed to minimize excessive vertical and horizontal movements that occur with running and jumping -To be effective, should hold breasts to chest, preventing stretching of Cooper's ligament -Non-supportive bras, can cause rubbing and abrading of skin and nipples due to construction -Types available --Compressive (bind breasts to chest wall - recommended for medium size breast) --Support (heavy duty with additional upward support for larger breasts) --Lightweight elastic (compression and support not as critical for smaller breasts)
Groin and Genitalia
-Sports involving high velocity projectiles -Require cup protection for male participants -Stock item that fits into jockstrap or athletic supporter
Regulatory Documents
-Standards of Practice --See NATABOC lecture notes -Code of Ethics -Position Statements -Licensure laws -Appropriate medical coverage guidelines
What is the main concern and is why we do PPEs?
-TO KNOW THAT THEY ARE NOT GOING TO DIE! -really need to know history, but more importantly any abnormalities that could be detrimental
What are the potential impacts of education reform & standardization?
-Take education level and rise it -This will move profession forward!
Does the AT have a duty to care for individual's injured during intramurals or PE courses (non-athletes)?
-The legal origin of an AT's duty is found in contract -Depends upon the AT's contract
Thorax Protection
-Thorax protectors and rib belts -Protect against external forces -Air-inflated interconnected cylinders (jacket design)
Football Shoulder Pads
-Two types 1.Cantilevered - bulkier and used by those engaged in blocking and tackling 2.Non-cantilevered - do not restrict motion (quarterback and receivers) -Rules of fitting --Width of shoulders must be measured --Inside of pad should cover tip of shoulder in line with lateral aspect of shoulder --Epaulets and cups must cover deltoid and allow motion --Neck opening must allow athlete to raise arms over head w/out pads sliding forward and back --With split clavicle pads, channel for top of shoulder must be in proper position --Straps underneath arms should hold pads firmly in-place, w/out soft tissue restriction
Negligence
-Type of tort in which an AT fails to act as a reasonably prudent AT would act under the circumstances -How is this determined? --Regulatory acts (e.g. licensure) --Standards (role delineation study) and professional values (code of ethics) --Position statements --Etc...... *can also be negligent by doing something back **REASONABLY PRUDENT.... With the same level of education - phrase that is usually put in there
Ice Hockey Helmets
-Undergone extensive testing in an effort to upgrade and standardize -Must withstand high velocity impacts (stick or puck) and high mass low velocity impacts -Helmet will disperse force over large area and decelerate forces that would act on head (energy absorption liner) -Helmets must be approved by Canadian Standards Association **Mid 80s before NHL ever required helmets (grandfathered into requirement)
Act of God
-Unforeseen happenings that are unable to be predicted -Tough to prove
Exploitation
-Use of another person for selfish purposes --Bribing of athletes --Manipulating athlete to play when injured --Selling of items (legal/illegal) to athletes for financial gain
Knee Braces
-Used prophylactically to prevent injuries to MCL -AOSSM has expressed concerns to efficacy in doing so -May positively influence joint position sense
Process of gaining regulation
-Varies from state to state -Long process -Involves working with state government --Find legislators who understand
Breach of Confidentiality
-Violation of a commitment to privacy and protection of information or communications
What are the legal duties of an AT?
-What are the legal duties of an AT? --Provide or obtain reasonable medical assistance --Maintain confidentiality of medical records --Provide adequate and proper supervision and instruction *Use established protocols --Provide safe facilities and equipment --Fully disclose information about the individual's medical condition to the individual *Long term consequences
Helmet Fitting
-When fitting head/hair should be wet to simulate sweat -Follow manufacturer's directions -Must routinely check fit --Snug fit (credit card test) --With change in altitude bladder helmets must be rechecked --Chin straps (2, 4, or 6 strap systems) --Jaw pads are essential (prevent lateral rocking) -Certification is of no avail if helmet is not fit and maintained
Conflict of Interest
-When the interests of one individual or group are in competition with those of another individual or group -What are some examples of conflict of interest for ATs? --Discussing private information with another party (pt best interests vs. your job-breach of confidentiality) --AT receiving financial gain to utilize a particular product --Allocation of resources for head/supervising AT
Comparative Negligence
-When the plaintiff contributed (contributory negligence) to the damage -What are some examples? --Failing to follow instructions - DOCUMENT --Failing to perform rehabilitation - DOCUMENT -Court determines the degree (%) to which the AT and plaintiff contributed to the harm --Plaintiff recovers the % of how much the defendant was to blame for negligence
Elbow, Wrist and Hand Protection
-While the elbow is less commonly injured it is susceptible to instability, contusions, and muscle strain -A variety of products are available to protect the elbow -Wrist, hand and finger injuries are often trivialized but can be functionally disabling -Susceptible to fracture, dislocation, ligament sprains and muscle strains -Gloves and splints are available for protection and immobilization
Statute of Limitations
-ex. Someone has repetitive concussion or kidney failure and failure results 10 years from now b/c AT gave too many NSAIDS and certain amount of time that patient can't go back and blame but DOCUMENT AND SAVE IT!!! *criminal case - no statute of limitations
Lacrosse Equipment
...don't usually even wear this much padding... Leading helmet brand for lax is Cascade... Cascade started out as helmet producer for kayakers
2 Main Areas of Law
1. criminal law 2. civil law
5 elements must be proved for negligence
1.Conduct -Must link that AT to the case 2.Duty -whether or not owe duty 3.Breach -did you breach that duty? standard of care... 4.Cause 5.Damage
What are the different performance domains?
1.Prevention of athletic injuries 2.Recognition, evaluation, & assessment of injuries 3.Immediate care of injuries 4.Treatment, rehabilitation, & reconditioning of athletic injuries 5.Health care administration 6.Profession development & responsibility
FOOTBALL HELMET FITTING
1.Read and explain to the player the warning label on the back of the helmet. Have the player sign the form acknowledging these dangers have been explained to him. Keep this signed form on file. 2. Determine the normal hair length of the athlete. 3. Try to wet the athlete's hair prior to fitting the helmet. 4. Note any possible irregularities of the head. 5. Take the player's head measurement to determine the proper shell size. Measure the circumference of the head approximately one inch above the eyebrow. 6. Put the helmet on and Inflate the liner and fit the helmet to "snugness" rather than "too loose" or "too tight." 7. Check to see if player's ear openings are in center of helmet ear openings or below center 8. Check to see that the eyebrows are approximately 1-1-1/2" below the helmet's front rim 9. Try to rotate the helmet side-to-side. 10. Check the crown adjustment of the helmet. 11. Check the forehead pressure and back-to-front fit 12. Check the jaw pads to see that they fit correctly. They should be neither undersized nor oversized. They should follow the contours of the cheeks. 13. Check the chin strap fit. The function of the chin strap is to hold the helmet in place. 14. Check the faceguard. There should be adequate spacing between the faceguard and the tip of the nose. Generally, three finger widths from the tip of the nose is acceptable. 15. Check the fit in the rear of the helmet. The occipital lobe should be covered by the shell. The rear of the helmet should cradle the neck. It should not chafe from a tight fit, nor leave a large gap from a loose fit. 16. Check the player's vision, both peripherally, as well as up and down. Peripherally, the player should be able to track a finger about 180 degrees, up and down to about 75 degrees.
12 Current Positions Statments
1.Skin Diseases in Athletics 2.Acute management of the cervical spine-injured athlete 3.Environmental Cold Injuries 4.Emergency planning in athletics 5.Exertional heat illnesses 6.Fluid replacement for athletes 7.Lightning safety for athletics and recreation 8.Management of asthma in athletes 9.Management of sport-related concussion 10.Management of the Athlete with Type 1 Diabetes Mellitus 11.Preventing, Detecting, and Managing Disordered Eating in Athletes 12.Preventing Sudden Death in Athletes
How many districts make up the NATA?
10 districts
Currently, how many performance domains are there?
6
World Delineation Study
80s sent out survey to ATs and asked what ATs do and what they should know... what scope of practice first defined by
POSITIONS STATEMENTS GRADING:
A - you better be doing it b/c lots of evidence and research B&C - what we recommend, but not a whole lot of research and evidence... what we have done and what works, but not a whole lot to support positions
CAATE
A Commission on Accreditation of Athletic Training Education
Origins of Athletic Training
Ancient Greece 19th century
National Athletic Trainers' Association
Board of Directors District Organizations State Organizations Councils Committees Task Forces Other Groups
Who is currently responsible for accrediting education programs?
CAATE (NATA's own body)
NATA Committees
Clinical/Industrial/Corporate Athletic Trainers' Committee College/University Athletic Trainers' Committee Committee on Reimbursement Convention Committee District Secretaries/Treasurers Committee Finance Committee Governmental Affairs Committee Graduate Review Committee History & Archives Committee Honors & Awards Committee Journal Committee Memorial Resolutions Committee Placement Committee Pronouncements Committee Public Relations Committee Secondary School Athletic Trainers' Committee Women in Athletic Training Committee
2000 & Beyond
Continued education reform: 2001 - ACI requirement (had to teach in a clinical or whatever setting by approved clinical instructor) 2001 - Last class to start internship route 2003 - new competencies must be implemented 2004 - internship students no longer able to sit for exam w/o degree in athletic training
AT Curriculum
Did not have to be an approved program - Internship route available -- Extra clinical hours No specific set of educational competencies or proficiencies - Very generalized
Head Protection
Direct collision sports require head protection due to impacts, forces, velocities and implements
What governing body is responsible for creating the performance domains?
Education Council (name changes often)
Who is the current executive director of the NATA?
Eve Becker-Doyle (been there around 20+ years)
When is it acceptable to breach confidentiality?
Exceptions to the Rule of Confidentiality -When there is a clear and imminent danger to the client -When there is a clear and imminent danger to the other person -When legal requirements demand that confidential information be released *Anytime they confide in you they have done something illegal, you have a legal obligation to tell higher authority (for us, tell ACI and get out of your hands and let upper people handle it)
What defines a profession?
Formal education Hands-on experience Success Need for job Governing body Unique Ethics Specific skills Evaluation Title
NATA gold level sponsors
Gatorade, Cramer, Tenactin
First football game
Harvard vs. Princeton in late 1800s
What is the purpose of the different regulatory documents in athletic training?
Importance of regulatory documents: professional protection from other professions, establish the minimum standard of care, establish ethical practice of athletic training
What to look for in a state regulatory act?
Key Elements: -Who is responsible for directing you? -How are athletic training services defined? -On what type of individuals are you allowed to perform athletic training services? -In what settings are you allowed to perform athletic training services? -Do you have service protection? -Do you have name protection? -
What if your budget doesn't allow you to provide the standard of care? (e.g. can't afford a standard piece of equipment)
Lack of budgeting is not an excuse if it is reasonable for AT to have certain equipment or # staff
Pinky's major accomplishments
Major Accomplishments: 1956 - Journal of NATA 1957 - NATA recognized by NCAA 1957 - Code of ethics adopted 1959 - First proposal for formal athletic training education 1965 - Began steps toward certification 1967 - AMA recognizes importance of athletic trainer in athlete health care 1969 - 4 schools meet NATA requirements for undergraduate education Mankato State U. , Lamar U., U of New Mexico, Indiana State U. 1969 - Professional advancement committee 1970 - First certification examination
Who are the current and past (most recent) presidents of the NATA?
Marjorie J. Albohm (past) Jim Thorton (soon-to-be current) Chuck Kimmel (before Marj)
The 70's Milestones
Milestones: - Females enter into athletic training* -- San Diego State University - early 70s - first female - Continuous review of educational standards - 1972 - first graduate curricula in athletic training -- University of Arizona and Indiana State University - 1974 - continuing education becomes a priority - 1974 - definition of athletic training "the art & science of prevention & management of injuries at all levels of athletic activity." - 1979 - CEU requirements implemented* - Mid 70's - first discussion on gaining licensure -- Blocked by APTA for violation of practice act
Is an AT able to discontinue medical care for those individual's they have begun treating at any time?
NO, This would be abandonment
Which district is North Carolina located?
Name - Mid-Atlantic Athletic Trainers' Association Other states - SC, VA, WV, MD, DC
Exemption
No formal practice acts
In what settings are you allowed to perform athletic training services? (NC AT Licensing Act)
No limitation
What happens if all elements of negligence are found, except for damage?
Nothing....Plaintiff must prove that damage has occurred
Other Statements
Official statements Consensus statements Support statements
The 80's Milestones
Other Milestones: - 1986 - membership grows to 10,000 (only 127 in 1950) - 1982 - National Commission for Health Certifying Agencies (NCHCA) grants membership to NATA -- Sign of respect from other health professions -- First to credit as health profession
How does this factor into court of law?
Position statements go on to define scope of practice which is what a reasonable, imprudent AT would do ... if positions statements not followed, then could be held liable for injuries **Positions statements not rules, but are guidelines
CAATE Members
President Vice president Treasurer Members at large Administrative member Public member AAP Representative AAFP Representative AOSSM Representative NATA Representative Executive Director Office staff
NATA Board of Directors
President Vice-President Secretary/Treasurer District 1 Director District 2 Director District 3 Director District 4 Director District 5 Director District 6 Director District 7 Director District 8 Director District 9 Director District 10 Director
NATA Foundation Board of Directors
President Vice-President Treasurer District 1 Chair District 2 Chair District 3 Chair District 4 Chair District 5 Chair District 6 Chair District 7 Chair District 8 Chair District 9 Chair District 10 Chair Membership Fund Development Committee Chair Public Relations Committee Chair Research Committee Chair Scholarship Committee Chair Sponsorship Development Committee Chair Liaison At Large
Ancient Greece
Referred to as "paidotribes" "boy rubbers" Performed massage for competing athletes - First real therapeutic treatment for athletes
CAATE Committees
Review committee Site visit committee Ethics and professional standards committee Annual report committee Technology committee
Who are the 2 major football helmet producers?
Ridell and Schutt
Standard of care
The legal duty to provide health care services consistent with what other health care practitioners of the same training, education, and credentialing would provide under similar circumstances
What is the purpose of position statements?
To have everyone on the same page when in certain situations and how we are to respond to them.
Identifying Risks
Two ways to identify risks in athletics -Real world observation --Most basic method --Make inferences based on clinical px and experience --Discovery of cause-and-effect relationships between hazardous practices and the subsequent results -Controlled experiments --Set up an actual study to determine if a cause-and-effect relationship exists --More difficult to implement
NATA Other Groups
Webmaster's Advisory Group World Federation of Athletic Training and Therapy Liaisons
Are position statements legally binding?
YES. They develop the standard of care and you are responsible for your actions. **It is evidence-based, NOT arbitrary!!
Do standards of care ever change?
Yes, must stay up to date with profession and literature *continuing education
When does an AT working in the school setting owe a duty to an injured individual?
You have a duty to provide services to those actively engaged in the institution's athletic programs
Criminal law
consequences prison or death penalty and/or money; the government brings the suit and is the plaintiff and if federal case federal attorney and if state case then state or district attorney beyond a reasonable doubt (may still be some doubt, but beyond reasonable) criminal - not guilty
Consensus Statements
group of allied health members get together --> this is very hard to do!! **This is stronger than positions statements b/c consensus across a large number of health professions
Civil law
just money; personal against entity or person versus person burden of proof equally responsible, preponderous of evidence means one party more responsible than other when one party more guilty than other, so not really based on amount of evidence beyond reasonable doubt Can be involved w/ both simultaneously i.e. OJ Simpson Civil - guilty