Knowledge Based Comps

PHP-47 Describe contemporary weight management methods and strategies needed to support activities of daily life and physical activity.

Energy measurementEnergy balanceThe difference between energy input and energy outputCalories burned each dayEquation of calories in-calories outEnergy intake estimationEnergy Intake much come from the 3-essential energy-producing nutrients- proteins, carbohydrates, and fatsCarbohydrates should be 55%-70% of total caloric intake for athletes12 g per kilogram maximumProtein should be 8%-10% depending on the type of exercise and level of activityFats consumption in athletes should not be less that 15% of their caloric intakeAthletes approximately intake 30%The average is 20%-25%Daily caloric intakeBased on lean body mass, desired body composition, goal weight, and sport or activity requirementsOther factors include: body size, fat mass, FFM, age, sex, and expenditure of energy for activity, height, weightNeed to find basal metabolic rateBasal Metabolic Rate FormulasMen BMR = 66.4730 + (13.7516 x weight in kg) + (5.0033 x height in cm) - (6.7550 x age in years)Women BMR = 655.0955 + (9.5634 x weight in kg) + (1.8496 x height in cm) - (4.6756 x age in years) To determine caloric needs, multiply BMR by activity factorIf you are sedentary (little or no exercise): Calorie-Calculation = BMR x 1.2If you are lightly active (light exercise/sports 1-3 days/week): Calorie-Calculation = BMR x 1.375If you are moderately active (moderate exercise/sports 3-5 days/week): Calorie-Calculation = BMR x 1.55If you are very active (hard exercise/sports 6-7 days a week): Calorie-Calculation = BMR x 1.725If you are extra active (very hard exercise/sports & physical job or 2x training) : Calorie-Calculation = BMR x 1.9 Body composition assessments should be used to determine safe body weight and body composition goals Healthy weight lossDecrease in energy intake and increase physical activity levels will result in weight loss (negative energy balance).Loosing 1-2 pounds per weekIncreasing energy expenditure vs energy intakeBurning at least 500-1,000 calories more than what you consume daily Healthy weight gainincrease in energy intake with an decrease in expenditure will result in weight gain (positive energy balance)eat more frequentlychoose nutrient rich foodstry smoothies and shales If you have a small appetite, eat five to six times a day. Drink fluids before and after meals, but not with them. This helps leave more room for food. Top your usual foods with some concentrated calories, such as grated cheese on a cup of chili. Spread peanut or almond butter on a whole-grain muffin. Avoid "lite" or "low-calorie" versions of foods and go for the full-fat or traditional options. Prepare hot oatmeal or other cereal with milk, not water. Add powdered milk, honey, dried fruits or nuts after cooking. Garnish salads with healthy oils such as olive oil, whole olives, avocados, nuts and sunflower seeds. Pump up soups, casseroles, mashed potatoes and liquid milk with 1 to 2 tablespoons of dry milk powder. Make an appointment with a registered dietitian nutritionist to develop an eating plan that will help you gain weight in a healthy way with the foods you enjoy

PHP - 17 Exertional Sickling

Exertional sickling is a medical emergency occurring in athletes carrying the sickle cell trait. When the red blood cells(RBC) change shape or "sickle" this causes a build up of RBCs in small blood vessels, leading to decreased blood flow. The drop in blood flow leads to a breakdown of muscle tissue and cell death, known as fulminant rhabdomyolysis. HOW DO YOU PREVENT EXERTIONAL SICKLING? Screen all athletes for sickle cell trait and counsel athletes who are identified as having the trait Mandate Preparticipation exams to ensure athletes are healthy for activity Acclimatize all athletes by slowly increasing intensity when conditioning or lifting Modify drills for sickle cell trait athletes by avoiding timed runs and implementing breaks between runs Have water readily available during all activity Limit activity if any type of illness is present Educate athletes, parents, and coaches about the signs, symptoms, and treatment of exertional sickling Be aware of predisposing factors: Sickle cell trait Heat Dehydration High altitude Asthma Illness Unacclimatized High intensity exercise with short rest intervals LOOK FOR THESE SYMPTOMS IN ATHLETES WHEN EXERTIONAL SICKLING IS SUSPECTED: Common Signs and Symptoms of an Exertional Sickling episodeCrampingMuscle weakness that exceeds muscle pain Athlete "slumps" to the ground rather than a sudden collapse (rules out cardiac) Able to speak Muscles look and feel normal (rules out heat cramps) Rapid breathing, but pulmonary exam reveals normal air movement (rules out asthma) Rectal temperature less than 103oF (rule out heat stroke) Exertional sickling is most common when exercise is high intensity and has short or small amounts of recovery time between drills. Sports settings common for exertional sickling collapse are: Football conditioning Basketball training Cross-country racing University track tryout Golden Gloves boxing bout WHAT ELSE COULD THIS BE? Exertional heat illness Dehydration Heat syncope Asthma attack Cardiac conditions HOW DO YOU TREAT AN INDIVIDUAL WITH EXERTIONAL SICKLING? Stop activity Check vital signs (Heart rate, blood pressure, breathing) Activate Emergency Medical Services and prepare for CPR Administer high-flow oxygen (15L/min) Cool athlete if necessary Call ahead to hospital and tell staff to expect explosive rhabdomyolysis Extended care will be needed to assess body damage (kidneys, liver, etc.) WHEN CAN THE INDIVIDUAL RETURN TO ACTIVITY? Physician clearance Gradual return to play based on level of sickling and severity of symptoms. RECOMMENDED EQUIPMENT LIST Emergency action plan Cell phone Supplemental oxygen Rectal thermometer Blood pressure cuff and stethoscope Wrist watch

CE-2. Describe the normal anatomical, systemic, and physiological changes associated with the lifespan. (KIN 315)

Anatomical changes with aging Altered motility patterns Degenerative changes occur in many joints and this, combined with the loss of muscle mass, inhibits elderly patients' locomotion. Loss of bone density, cartilage thins over time with use and arthritis within joints is common this can also make joint more susceptible to injury. Ligaments and tendons become less elastic causing the typical stiffness in joints described by the elderly. Healing in general becomes slower due to systemic changes in circulation and blood vessels described below which means less nutrients circulated to tissues and cells required for healing to occur. Vision and hearing also diminish due to exposure to loud sounds over time and the thickening/stiffening of the lens. Systemic changes with aging Changes occur in the gastrointestinal system with senescence, atrophic gastritis and altered hepatic drug metabolism. Progressive elevation of blood glucose occurs with age on a multifactorial basis and osteoporosis is frequently seen due to a linear decline in bone mass after the fourth decade. Lean body mass declines with age and this is primarily due to loss and atrophy of muscle cells. Systemically, the elderly's metabolism is altered, changes occur in response to commonly used drugs make different drug dosages necessary and there is need for rational preventive programs of diet and exercise in an effort to delay or reverse some of these changes. Digestion slows as the esophagus contracts less forcefully. The number of nerve cells decreases as well as levels of neurotransmitters and receptors which may affect memory vocabulary, ability to learn new material and recall. Number of nerve endings in the skin decreases, the fat layer beneath skin decreases and when it does wrinkles are more likely to develop as tolerance for cold also decreases. Physiological changes with aging Cardiac output decreases, blood pressure increases, arteriosclerosis develops, lungs show impaired gas exchange, a decrease in vital capacity and slower expiratory flow rates. The creatinine clearance decreases with age although the serum creatinine level remains relatively constant due to a proportionate age-related decrease in creatinine production. The epidermis of the skin atrophies with age and due to changes in collagen and elastin the skin loses its tone and elasticity. The liver shrinks and less blood flows through it so liver enzymes that process drugs work less efficiently. Growth hormone levels decrease leading to decreased muscle mass. Aldosterone levels decrease making dehydration more likely. Insulin is less effective which means the body takes longer after a meal to have blood sugar levels in the blood to return to normal. Infections become more common and severe in the elderly due to immune cells reacting more slowly.

PS-14. Describe the psychological and sociocultural factors associated with common eating disorders. (ATEP 306)

Anorexia Nervosa Clinical eating disorder Engage in caloric restriction and exercise excessively (may also binge and purge at times) Excessive weight loss—refuses to maintain healthy body weight Obsessed with body weight Distorted body image Fear of gaining weight or being "fat" Can result in amenorrhea Most common in females, however, males can also suffer from it Bulimia Nervosa Clinical eating disorder Engages in recurrent episodes of binge eating followed by compensatory behaviors (may also restrict caloric intake and exercise excessively) Compensatory behaviors—self-induced vomiting, laxatives, fasting Overly concerned about body weight and shape Appears as being of average body weight and size Feelings of guilt after binge eating Anorexia Athletica Athletes engage in caloric restriction and/or exercise excessively Engages for performance enhancement rather than for body appearance May only engage in disordered eating habits during their athletic season Binge Eating Disorder Engages in recurrent episodes of compulsive binge eating Do not purge body of excessively consumed calories

HA - 28 Understand the role of and use diagnostic and procedural codes when documenting patient care. (ATEP 407)

Diagnostic and procedural coding is key for reimbursement for sports medicine and other medical services to third-party payers. Diagnostic coding is required for all forms of third-party billing. The International Classification of Diseases (ICD-10-CM) is a book that specifies the coding for injuries or conditions athletic trainers treat. The Current Procedural Terminology (CPT) is a list of codes published by the American Medical Association (AMA) that helps label medical procedures. Athletic trainers should be familiar with these coding systems when they seek reimbursement from third-party payers for their services.

HA - 26 Describe the criteria for selection, common features, specifications, and required documentation needed for secondary, excess accident, and catastrophic health insurance. (ATEP 407)

Secondary coverage (also known as excess insurance)A type of health, medical, or accidental insurance that begins to pay for covered expenses only after all other sources of insurance coverage, including the athlete's personal medical insurance, have been exhausted.Advantages:Personal insurance companies share the risk with secondary coverage and therefore, secondary coverage can be as much as 60% lower than the cost of primary coverage.Can help develop a sense of shared responsibility for safety in athletic programs.It encourages athletic administrators to find ways to reduce and control medical costs.Disadvantages:Longer claims process.Substantial time and energy are spent communicating with parents and their insurance carriers to move claims along.Require more communication and understanding of the shared responsibility for paying medical costs.Ethical dilemmas may also arise. Catastrophic InsuranceA type of accident insurance designed to provide lifelong medical, rehabilitation, and disability benefits for athletes who have suffered long term or permanent disabilities as a result of athletic injuries.Usually takes effect after the first $75,000 (in some cases $90,000) in medical bills has been reached

HA - 4 Describe the conceptual components of developing and implementing a basic business plan. (ATEP 407)

The business plan is needed so the bank can project whether the business will succeed or not. It must contain: A statement of the activities that the clinic will engage in. A market analysis detailing the clinics competitive advantages, competition analysis, pricing structure, and marketing plan. The credentials of the owners and operators of the clinic. Historical and projected financial statements of both cash flow and income. Breakdown of costs associated with the project based on the schematics developed by the architect. The amount of personal equity being committed by the athletic trainer. The amount of the loan being requested.

PHP - 38 Describe nutritional principles that apply to tissue growth and repair.

Tissue growth and repair requires an intake of carbohydrates, protein, fats, vitamins, minerals, and water. Calorie intake is typically higher than normal, since the body requires energy from food to promote healing. A consumption of 15 to 20 calories per pound of body weight is recommended as a daily intake. Water is also very important for the healing process. At least 8 cups of water should be consumed a day, enough to keep the body properly hydrated as it repairs itself. During the healing process, the body will require more calcium and protein. Eating a well-balanced diet would be helpful to get all the nutrients, keeping in mind the recommended calorie intake. Multi-vitamins and minerals are also beneficial to aid in the growth and repair of the body's tissue. Vitamins A, C, D, and K assist in bodily functions such as bone healing, wound healing, and growth of connective tissue. Calcium and zinc are also important for bone and muscle growth and wound healing.

EBP - 12 Describe the types of outcomes measures for clinical practice (patient-based and clinician-based) as well as types of evidence that are gathered through outcomes assessment (patient-oriented evidence versus disease-oriented evidence). (ATEP 490C)

Types of outcomes: - Patient based (what they tell you they were able to do) - Clinician based (what we observe test for an outcome) Types of assessment: - Patient-oriented evidence (outcomes relate to the patient "Reduces pain" VS. disease oriented evidence "Certain treatments work well for a certain disease/condition" - Generic (overall wellness questionnaire) - Disease specific (specific questions for a condition "Asthma questionnaire) - Region specific (goes over a specific region of the body "arm disabilities" - Dimension specific (focus on one aspect of health "McGill pain questionnaire)

PHP-5. Explain the precautions and risk factors associated with physical activity in persons with common congenital and acquired abnormalities, disabilities, and diseases.

Hypertension Etiology - increased vascular resistance Arterial hypertension is the condition of persistent elevation of systemic blood pressure (BP). BP is the product of cardiac output and total peripheral vascular resistance. There is no known pathogenesis for this condition but it is proposed that genetic, behavioral, and environmental factors play a role in contributing to the condition. Some of these factors include: urban living, diet, obesity, chronic stress, smoking, alcohol, and drug use. Hypertension can also be caused secondary from the following conditions: renal, hormonal, or metabolic disorders. Characteristics The guidelines, in a nutshell, state that normal blood pressure is under 120/80, whereas before normal was under 140/90. Now, elevated blood pressure (without a diagnosis of hypertension) is systolic blood pressure (the top number) between 120 and 129. That used to be a vague category called "prehypertension." Stage 1 high blood pressure (a diagnosis of hypertension) is now between 130 and 139 systolic or between 80 and 89 diastolic (the bottom number). Stage 2 high blood pressure is now over 140 systolic or 90 diastolic. The measurements must be obtained from at least two careful readings on at least two different occasions. Exercise precautions While regular aerobic exercise at 60-70% of maximum heart rate is beneficial at reducing resting blood pressure in mild hypertension, strenuous exercise should be avoided if the patient has a more severe case of hypertension as blood vessels can be harmed and heart complications can occur. Obesity Etiology - genetic and/or environmental Characteristics Body mass index of 30 or above Other associated chronic conditions Exercise precautions Increased hyperthermia with exercise May begin non-weight bearing and progress as tolerated Increased risk for orthopedic injuries Osteoporosis Etiology - low bone mass caused by systemic skeletal disease Characteristics Skeletal fragility Skeletal fractures Postural changes Exercise precautions Explosive exercises Excessive trunk flexion Dynamic abdominal exercises Twisting motions Postural deviations change center of gravity Balance deterioration Paraplegia Etiology - varied causes, for example, chronic disease, trauma, and birth abnormality Characteristics Paralysis of the legs and lower body, typically caused by spinal injury or disease. This will include loss of sensation and motor function. Exercise precautions Medical clearance is needed in order to ensure nerve damage doesn't occur. Poliomyelitis Etiology- viral infection that affects the central nervous system and can cause temporary or permanent paralysis. Characteristics Nonparalytic polio Some people who develop symptoms from the poliovirus contract a type of polio that doesn't lead to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses. Signs and symptoms, which can last up to 10 days, include: Fever Sore throat Headache Vomiting Fatigue Back pain or stiffness Neck pain or stiffness Pain or stiffness in the arms or legs Muscle weakness or tenderness Paralytic polio This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other signs and symptoms appear, including: Loss of reflexes Severe muscle aches or weakness Loose and floppy limbs (flaccid paralysis) Post-polio syndrome Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people years after having polio. Common signs and symptoms include: Progressive muscle or joint weakness and pain Fatigue Muscle wasting (atrophy) Breathing or swallowing problems Sleep-related breathing disorders, such as sleep apnea Decreased tolerance of cold temperatures Exercise precautions Strenuous exercise should be avoided to prevent damage to weakened muscles Exercise should be supervised Moderate aerobics are recommended Steady progression should be followed Pregnancy Etiology - gestational condition resulting from fertilized egg implant Characteristics Increased weight gain Changes in hormonal levels Altered center of gravity Exercise precautions Avoid abdominal trauma risks Increased carbohydrate intake in last trimester Avoid static standing Dehydration risk Thermoregulatory risk Heart rate decreases to heavy submaximal conditioning Sedentary women may start exercise in second trimester with medical approval Altered metabolic and cardiopulmonary functions Hypermobility (related to hormones) may contribute to joint dysfunction Pulmonary disease Etiology - lung obstruction or restriction conditions Characteristics Lung disease is any problem in the lungs that prevents the lungs from working properly. There are three main types of lung disease: Airway diseases -- These diseases affect the tubes (airways) that carry oxygen and other gases into and out of the lungs. They usually cause a narrowing or blockage of the airways. Airway diseases include asthma, COPD and bronchiectasis. People with airway diseases often say they feel as if they're "trying to breathe out through a straw." Lung tissue diseases -- These diseases affect the structure of the lung tissue. Scarring or inflammation of the tissue makes the lungs unable to expand fully (restrictive lung disease). This makes it hard for the lungs to take in oxygen and release carbon dioxide. People with this type of lung disorder often say they feel as if they are "wearing a too-tight sweater or vest." As a result, they can't breathe deeply. Pulmonary fibrosis and sarcoidosis are examples of lung tissue disease. Lung circulation diseases -- These diseases affect the blood vessels in the lungs. They are caused by clotting, scarring, or inflammation of the blood vessels. They affect the ability of the lungs to take up oxygen and release carbon dioxide. These diseases may also affect heart function. An example of a lung circulation disease is pulmonary hypertension. People with these conditions often feel very short of breath when they exert themselves. The most common lung diseases include: Asthma Collapse of part or all of the lung (pneumothorax or atelectasis) Swelling and inflammation in the main passages (bronchial tubes) that carry air to the lungs (bronchitis) COPD (chronic obstructive pulmonary disease) Lung cancer Lung infection (pneumonia) Abnormal buildup of fluid in the lungs (pulmonary edema) Blocked lung artery (pulmonary embolus) Exercise precautions Heavy lifting or pushing. Chores such as shoveling, mowing, or raking. Pushups, sit-ups, or isometric exercises, which involve pushing against immovable objects. Outdoor exercises when the weather is very cold, hot, or humid. Walking up steep hills. Rhabdomyolysis Etiology - medications, supplements, trauma, toxins, and other disease state or genetic Characteristics Hyperkalemia Dark urine Cramping Cardiac arrhythmias Acute renal failure Clotting cascade failure Exercise precautions Assure proper hydration Modify with supervision or pull from physical activity if symptoms arise Sickle cell trait Etiology - genetic Characteristics Malformed RBCs Decreased oxygen binding to RBCs Exercise precautions Thermoregulatory deficiency Avoid high intensity exercise Hypotension Tachycardia Muscle cramping Hyperventilation Ischemia Spina bifida Etiology - congenital neural tube defect where the vertebral bones don't fully cover the spinal cord Characteristics weakness or paralysis in the legs urinary incontinence bowel incontinence a lack of sensation in the skin a build up of cerebrospinal fluid (CSF), leading to hydrocephalus, and possibly brain damage Exercise precautions Be aware of signs and symptoms related to associated conditions such as shunt malfunction, tethered cord, Arnold Chiari malformation. Tetraplegia (quadriplegia) Etiology - varied causes, for example, chronic disease, trauma, and birth abnormality Characteristics Partial or complete inability to move any part of the body below the neck. Depressed reflexes Loss of bladder control Inability to walk Lack of motor control Unusual stiffness or tightness of the muscles Limp muscles that lack firmness Exercise precautions Clearance from medical doctor is needed to prevent any further nerve damage Visual impairment Etiology - varied causes, for example, chronic disease, trauma, and birth abnormality Characteristics Low visual acuity Visual field limitation Progressive eye disease Cortical visual impairment Exercise precautions Vision correction should be addressed before allowing participation such as glasses, goggles, or contact lenses.

PD-6. Explain the process of obtaining and maintaining necessary local state and national credentials for the practice of athletic training (ATEP 490A)

National Credentials to Practice Athletic Training: To become a certified athletic trainer, a student must graduate with bachelors or master's degree from an accredited professional athletic training education program and pass a comprehensive test administered by the Board of Certification (BOC). Once certified, he or she must meet ongoing continuing education requirements in order to remain certified. Athletic trainers must also work in collaboration with a physician and within their state practice act. Eligibility for the BOC exam is contingent upon completion of a program accredited by the Commission on Accreditation of Athletic Training Education (CAATE) that must instruct the Competencies within the curriculum. Passage of the certifying examination is a requirement for licensure in most states. The credibility of the BOC program and the ATC® credential it awards are supported by three pillars: (1) the BOC certification examination; (2) the BOC Standards of Professional Practice, and Disciplinary Guidelines and Procedures; and (3) continuing competence (education) requirements. The BOC traditionally conducts annual examination development meetings during which athletic trainers and recognized experts in the science of athletic training develop, review and validate examination items and problems. The knowledge, skills, and abilities required for competent performance as an entry-level athletic trainer fall into three categories: Understanding, applying, and analyzing Knowledge and decision-making; Special performance abilities. BOC-certified athletic trainers are educated, trained and evaluated in five major practice domains: Injury and illness prevention and wellness promotion Examination, assessment and diagnosis Immediate and emergency care Therapeutic intervention Health care administration and professional responsibility Continuing Education Continuing education requirements are intended to promote continued competence, development of current knowledge and skills and enhancement of professional skills and judgement. These activities must focus on increasing knowledge, skills and abilities related to the practice of athletic training. As information continually changes, it is important for professionals to learn the latest about athletic training. Continuing education requirements are meant to ensure ATs continue to: Stay on the cutting edge in the field of athletic training. Obtain current professional development information. Explore new knowledge in specific content areas. Master new athletic training-related skills and techniques. Expand approaches to effective athletic training. Further develop professional judgment. Conduct professional practice in an ethical and appropriate manner. NATA provides athletic trainers with a range of continuing education opportunities through workshops, webinars, home study courses and the Clinical Symposia & AT Expo. Maintaining Local State Credentials To see which agency you have to go through to get your state licensure you can go to the NATA website under Athletic Training State Regulatory Boards it will provide you with a direct link, email, phone number, and address of which place to contact. 49 states and District of Columbia require a state license except California.

EBP - 4 Describe a systematic approach (eg, five step approach) to create and answer a clinical question through review and application of existing research.

Step 1: Formulating answerable clinical questions One of the difficult steps in practicing EBM may be the translation of a clinical problem into an answerable question. When we come across a patient with a particular problem, various questions may arise for which we would like answers. These questions are frequently unstructured and complex, and may not be clear in our minds. The practice of EBM should begin with a well formulated clinical question. This means that we should develop the skill to convert our information needs into answerable questions. Good clinical questions should be clear, directly focused on the problem at hand, and answerable by searching the medical literature. A useful framework for making clinical questions more focused and relevant has been suggested by Sackett et al. They proposed that a good clinical question should have four (or sometimes three) essential components: the patient or problem in question; the intervention, test, or exposure of interest; comparison interventions (if relevant); the outcome, or outcomes, of interest. Thus an answerable clinical question should be structured in the PICO (Patient or Problem,Intervention,Comparison,Outcome/s) or PIO (Patient or Problem,Intervention,Outcome/s) format. Step 2: Finding the evidence Once you have formulated your clinical question, the next step is to seek relevant evidence that will help you answer the question. There are several sources of information that may be of help. Traditional sources of information such as textbooks and journals are often too disorganized or out of date. You may resort to asking colleagues or "experts" but the quality of information obtained from this source is variable. Secondary sources of reliable summarized evidence which may help provide quick evidence based answers to specific clinical questions include Archimedes (http://adc.bmjjournals.com/cgi/collection/archimedes),Clinical Evidence (http://www.clinicalevidence.com/ceweb/conditions/index.jsp), and BestBets (http://www.bestbets.org/index.html). Other important sources of evidence include the online electronic bibliographic databases, which allow thousands of articles to be searched in a relatively short period of time in an increasing number of journals. The ability to search these databases effectively is an important aspect of EBM. Effective searches aim to maximize the potential of retrieving relevant articles within the shortest possible time. Studies have shown that, even in countries where hospitals have facilities for internet access allowing health care personnel access to a number of electronic databases, many people are not familiar with the process of carrying out efficient searches and often conduct searches which result in too few or too many articles. It is therefore important for health care professionals to undergo basic training in search skills, either through their local library services or through the attendance at formal courses. Step 3: Appraising the evidence After you have obtained relevant articles on a subject, the next step is to appraise the evidence for its validity and clinical usefulness. Although there is a wealth of research articles available, the quality of these is variable. Putting unreliable evidence into practice could lead to harm being caused or limited resources being wasted. Research evidence may be appraised with regard to three main areas: validity, importance, and applicability to the patient or patients of interest. Critical appraisal provides a structured but simple method for assessing research evidence in all three areas. Developing critical appraisal skills involves learning how to ask a few key questions about the validity of the evidence and its relevance to a particular patient or group of patients. Such skills may be learnt within small tutorials, workshops, interactive lectures, and at the bedside. Several tools for appraising research articles are available. I like the tools developed by the Critical Appraisal Skills Programme (CASP), Oxford, UK. These include tools for appraising randomized controlled trials, systematic reviews, case-control studies, and cohort studies. The CASP tools are simple, easy to use, and freely available on the internet. A detailed discussion of the critical appraisal of randomized controlled trials and systematic reviews will be provided in the next two articles of the series. Step 4: Applying the evidence When we decide after critical appraisal that a piece of evidence is valid and important, we then have to decide whether that evidence can be applied to our individual patient or population. In deciding this we have to take into account the patient's own personal values and circumstances. The evidence regarding both efficacy and risks should be fully discussed with the patient or parents, or both, in order to allow them to make an informed decision. This approach allows a "therapeutic alliance" to be formed with the patient and the parents and is consistent with the fundamental principle of EBM: the integration of good evidence with clinical expertise and patient values. The decision to apply evidence should also take account of costs and the availability of that particular treatment in your hospital or practice. A practical illustration of issues to consider before applying research evidence will be provided in the fourth article of the series. Step 5. Evaluating performance As we incorporate EBM into routine clinical practice, we need to evaluate our approach at frequent intervals and to decide whether we need to improve on any of the four steps discussed above. As Strauss and Sackett have suggested, we need to ask whether we are formulating answerable questions, finding good evidence quickly, effectively appraising the evidence, and integrating clinical expertise and patient's values with the evidence in a way that leads to a rational, acceptable management strategy. Formal auditing of performance may be needed to show whether the EBM approach is improving patient care.

HA - 25 Describe common health insurance models, insurance contract negotiation, and the common benefits and exclusions identified within these models. (ATEP 407)

Types of Managed Care Plans Health Maintenance Organization (HMO)Contract between insurance company and providersPredefined service deliveryPrepaid plan—expenses covered in advance of servicesDesignated providers administer careSelected primary care physician manages careCare sought outside of HMO is at a cost to the patient Preferred Provider Organization (PPO)Insurance company has negotiated reduced rates with providersCare sought outside of PPO costs more to the patient Point-of-Service (POS) PlanCovers treatment of an HMO provider as with an HMO planPermits patient to seek care outside the HMO plan for higher copayment Exclusive Provider Organization (EPO)Providers have contract with insurance company, employer, or other entityProviders agree to fixed level of reimbursementConsumers must seek care from within the EPOEPO providers are often forbidden to deliver care to patients outside the plan MedicareFormed by Title XVIII of the Social Security Act 1965Federal health insurance plan first postulated by President Harry S. Truman (1945)Insurance for people 65 years and older, qualified disabled people, and people with Social Security or Railroad RetirementSpecific requirements for filing claimsHospital Insurance (Part A)—inpatient careSupplementary Medical Insurance (Part B)—outpatient chargesPrescription medication plansPolicies often dictate reimbursement of services by private insurersManaged by Centers for Medicare and Medicaid Services (CMS) MedicaidFormed by Title XIX of the Social Security Act 1965Joint venture between federal and state governments (CMS and state)Federal funds exist but states given authority to devise eligibility criteriaAids low-income families with children in getting medical careAssist with low-income disabled medical care Other key termsCurrent procedural terminology codesEncourage standard descriptors and terms in documenting procedures in medical recordsAllow easy transmission of information to insurersStandardize outcomes researchPublished by the American Medical Association (AMA)97005—Current Procedural Terminology (CPT) code for athletic training evaluation97006—CPT code for athletic training reevaluation Coordination of Benefits (COB): is the process of determining which of two or more insurance policies will have the primary responsibility of processing/paying a claim and the extent to which the other policies will contribute. Copayment: a payment made by a beneficiary (especially for health services) in addition to that made by an insurer. Portion of payment that the patient is responsible for a given visit up front. Usually a set value based on type of insurance coverage that depends on appointment type (specialist vs primary care physician) Deductible: (in an insurance policy) a specified amount of money that the insured must pay before an insurance company will pay a claim. Explanation of Benefits (EOB) Forms provided to patients and insurers Most insurers will not reimburse providers without an Explanation of Benefits (EOB) Identifies services, charges, date of service, provider, and claims denials/reductions Required to have contact information of provider and appeals information Health information management (HIM): is information management applied to health and health care. It is the practice of acquiring, analyzing and protecting digital and traditional medical information vital to providing quality patient care. Health Insurance Portability and Accountability Act (HIPAA)Effective: 2001, with compliance by 2003Entitlement: Portability of insurance as jobs change; standardize procedural codes and billing; secure personal health care informationEnforced: United States Department of Health and Human Services Independent medical evaluation (IME): occurs when a doctor, psychologist, or other licensed healthcare professional conducts an examination of an individual to help answer specific legal or administrative questions related to a variety of situations, e.g., a disability claim; workers' compensation case; a personal injury lawsuit (tort claim); impaired professionals program; or sexual harassment in the workplace. International Classification of Diseases (ICD)Published by the World Health Organizations (WHO)Tenth edition is currently usedInternational comparability of mortality statisticsFormat for cause of death reportingMedical codingUsually three to five-digit codes, for example, 410.92—acute myocardial infarction Joint Commission on Accreditation of Healthcare Organizations (JCAHO): is a private, not for profit organization established in 1951 to evaluate health care organizations that voluntarily seek accreditation. ... The Joint Commission also evaluates and accredits health plans and health care networks. National Provider Identifier (NPI): The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Workers compensation (WC): is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue their employer for the tort of negligence.

HA- 27. Describe the concepts and procedures for revenue generation and reimbursement. (ATEP 407)

third party reimbursement - process by which health care practitioners receive reimbursement from a policyholder's insurance company for services they perform - athletic training services are rarely reimbursed because of the amount of care that goes into athletic training over the course of the season, it will be costly for the insurance company, but this is slowly changing as the profession progresses third party - defined as a person, in this case a medical vendor, who has no binding interest in a particular contract (the insurance policy) types of insurance - medical insurance - type of insurance that a patient purchases in the form of a policy from a health insurance company for the purpose of covering medically related expenses (illnesses and injuries) health insurance - generally more comprehensive than medical insurance because it often includes provisions for maintaining good health rather than simply paying for illnesses and injuries athletic accident insurance - type of policy most educational institutions buy for their student-athletes intended to supplement a student's family insurance plan and reimburse the cost of athletic accidents only 3 types: primary coverage, secondary coverage, and self-insurance catastrophic insurance - 4th type of insurance which takes effect after the first $75,000 (in some cases $90,000) in medical bills has been reached and provides lifetime medical, rehabilitation, and disability coverage for athletes who have suffered long-term or permanent disabilities as a result of athletic injuries members of NCAA have received said insurance since 1991 also available to non-NCAA institutions and high schools through their national governing organizations disability insurance - designed to protect athletes against future loss of earning because of a disabling injury or sickness that occurred while they were engaged in sport activities to be eligible, an individual must have suffered irrevocable loss of speech, hearing in both ears, sight in both eyes, use of both arms, use of both legs, or use of one arm and one leg, or have severely diminished mental capacity caused by a brain stem or other neurological injury such that a person is unable to perform normal daily functions Types of third party payers Health Maintenance Organization (HMO) - provide participating health care practicitioners with a fixed fee for services rendered to members a capitation (per person) system usually, but not always, determines fees patients insured by an HMO must use a primary care provider that participates in the HMO a modest copayment is usually charged some HMOs provide services at medical facilities, whereas others provide care through a network of individual medical practitioners (individual practice associations, or IPAs) Preferred Provider Organization (PPO) - allow a greater choice of health care providers and pay medical vendors on a fee-for-service rather than a capitated basis allow policyholders to choose any health care provider they wish, but offer financial incentives for policyholders to use providers identified by the PPO When patients choose to see a medical provider who does not belong to the PPO, they can expect to pay for a greater percentage of the cost of the services Exclusive Provider Organization (EPO) - a hybrid insurance plan whereby a primary care provider is not necessary, although health care providers must be seen within a predetermined network out-of-network care is not provided, and visits require preauthorization Point-of-service plan - similar to PPO primary difference is that POS plans assign primary care physicians, who act as gatekeepers by coordinating patient care most PPOs do not Tricare - U.S. government health insurance plan for all military personnel Medicare - A federal program of health insurance for persons 65 years of age and older Medicaid - A federal and state assistance program that pays for health care services for people who cannot afford them. Reimbursement is based on the coding system used when submitting claims to third-party payers. Two kinds of codes: International Classification of Diseases (ICD-10-CM) specifies the code that should be applied to every injury or condition that athletic trainer or other health professionals treat consists of 3 volumes Volume 1 is a numerical listing of all diagnoses using a five-digit code Volume 2 is an alphabetical listing of the diagnoses using the same five-digit codes Volume 3 is a listing of inpatient or in-hospital procedure codes the system defines each condition as a five-digit code that must be entered on all claim forms The Current Procedural Terminology (CPT) a list of codes published by the American Medical Association that represents the vast majority of medical procedures the person completing a claim form for sports medicine services selects the most appropriate code for each of the services rendered

PD-12. Identify mechanisms by which athletic trainers influence state and federal healthcare regulation. (ATEP 490A)

Athletic trainers influence state and federal health care regulation by getting bills approved to increase our scopes of practice and level of health care. An example of this would be the Hit the Hill event held every year in Sacramento by the NATA to approve liscensure in California for the athletic training profession. With this event, we combine those (young and old) in the profession to help and learn how to justify the rights of our education and profession.

PHP - 40 Explain the physiologic principles and time factors associated with the design and planning of pre-activity and recovery meals/snacks and hydration practices. (NUTR132)

Dietary goals for an athlete: 1. provide energy for training demands 2. provide nutrients for training & health 3.promote recovery Must include: Variety High CHO Low fat Adequate protein Adequate dietary fibre Adequate fluids Adequate vitamins & minerals 12-25% from protein 45-65% from carbohydrate 15-30% from fats with no more than 10% of this coming from saturated fats Percentage may vary depending on athlete's need for specific sport/ position or depending on the season that the athlete is in. The macro percentage should change if athlete is in preseason compared to in season. Carbohydrates: Carbohydrate stored as glycogen is an easily accessible source of energy for exercise. How long this energy supply lasts depends on the length and intensity of exercise and can range anywhere from 30 to 90 minutes or more. To avoid running out of energy during exercise, start with full glycogen stores, replenish them during exercise and refill them after exercise to be ready for the next workout. Carbohydrates may enhance performance in prolonged aerobic exercise, maintains blood glucose and provides energy to muscles. 1. Pre-event meal: 1-4g/kg BW eaten 3-4hrs pre event 2.Pre-event snack 1-2g/kg BW eaten 1-2hrs pre event 3. During prolonged mod-high intensity exercise 1g/min or 60 g/hr 4. Post event 1g/kg BW within 30mins (rapid recovery post exercise, or multi-events esp. when there's < 8hrs until next session). Protein: Adequate carbohydrate intake also helps prevent protein from being used as energy. If the body doesn't have enough carbohydrates, protein is broken down to make glucose for energy. Because the primary role of protein as the building block for muscles, bone, skin, hair, and other tissues, relying on protein for energy (by failing to take in adequate carbohydrate) can limit your ability to build and maintain tissues. Additionally, this stresses the kidneys because they have to work harder to eliminate the byproducts of this protein breakdown. However, we need to include protein in most meals/snacks throughout the day Include 10-20g protein in post training snack (ideally within 30-45mins) RDI for protein: 0.75g/kg for adult women, 0.84g/kg for adult men Fat: During long, slow duration exercise, fat can help fuel activity, but glycogen is still needed to help breakdown the fat into something the muscles can use. The dietary reference intake (DRI) for fat in adults is 20% to 35% of total calories from fat. That is about 44 grams to 77 grams of fat per day if you eat 2,000 calories a day. It is recommended to eat more of some types of fats because they provide health benefits. Hydration: Performance is significantly impaired with a body fluid deficit of as little as 2%. This is only a 1.4kg loss for a 70kg athlete. Dehydration can cause general fatigue and reduces mental function, affecting your decision making, concentration, motor skills and muscle endurance.\ As a general rule, consume 35-40ml per kg of body weight, plus fluid losses. Fluid Guidelines: 300-600ml with pre-event meal 150-300ml every 15-20 mins up to 45 mins before the event Take pre and post body weight to work out fluid losses Loss of 1 kg = Loss of 1L fluid Psychological/ Other Factors That should be considered: Optimizing eating patterns for maximum performance can increase for eating disorders or disordered eating in vulnerable athletes. Weight management and diet is important when it comes to an athlete's performance, but it should be done with extreme strategies to attain one's goal. These disorders are more commonly noticed in athletes participating in sports such as swimming, diving, wrestling, and weightlifting. It is common among athletes participating in these sports because they have to psychological challenge of watching do and don't eat to hit a certain body weight to perform. Other Factors: Athletes due to health or personal reasons may live a certain dietary lifestyle. They may be vegan, vegetarian, pescatarian, or etc. It is important to provide athletes the best meal plan that fits their restrictions while providing them the necessary nutrients for optimal performance.

PS - 17 Describe the psychological and emotional responses to a catastrophic event, the potential need for a psychological intervention and a referral plan for all parties affected by the event. (ATEP 306)

General adaptation syndrome - alarm stage - body's initial response to trauma; fight-or-flight stage: body's initial sudden reaction to a change in homeostasis - blood is sent to areas of trauma, heart rate/stroke volume increases, vasoconstriction of vessels to shunt blood to damaged area, cortisol is released into the bloodstream reistance stage - body continues to adapt to stimulus, longest phase of GAS, individual achieves physiological resistance Exhaustion stage - body can no longer resistance the stimulus given = injury/pathology Maslow's hierarchy of needs - Maslow's hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid. Needs lower down in the hierarchy must be satisfied before individuals can attend to needs higher up. From the bottom of the hierarchy upwards, the needs are: physiological, safety, love and belonging, esteem and self-actualization. Self-actualization - achieving one's full potential, including creative activites (self-fulfillment need) Esteem needs: prestige and feeling accomplishment (psychological need) Belongingness and love needs: intimate relationship, friends (Psychological need) Safety needs: security, safety (a basic need) Physiological needs: food, water, warmth, rest (a basic need) https://www.simplypsychology.org/maslow.html Prochaska's stages of change - Precontemplation (Not yet acknowledging that there is a problem behavior that needs tobe changed)Contemplation (Acknowledging that there is a problem but not yet ready or sure ofwanting to make a change)Preparation/Determination (Getting ready to change)Action/Willpower (Changing behavior)Maintenance (Maintaining the behavior change) andRelapse (Returning to older behaviors and abandoning the new changes)http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf Kubler-Ross stages of dying - Denial, Anger, Bargaining, Depression, Acceptance Denial - at first the patient doesn't believe the injury is severe and will return in a day or two Anger - reality of the injury sets in and it causes the patient to become angry due to the hardship and inability to play - realize that the athlete is angry at the circumstances and not you - it is futile to try and rationalize with the athlete as they need to release this frustration within reason, make attempts to prevent them from causing more harm to themselves - you should be a sounding board for the athlete to express this anger and frustration without judgement Bargaining - Bargaining - athlete begins to bargain with the physician, other health care providers, or even God - usually looks like, "if you let me do this (something the athlete wants to do)...then I'll do this (something you want the athlete to do) - stand your ground and prevent the athlete from returning too quickly to prevent further injuryDepression - the athlete begins to accept the reality and it causes them to lose self worth - the patient feels they have no physical or emotional control - it is during this time when compliance is at the lowest - rehabilitation becomes difficult due to lack of patient complianceAcceptance - the final stage - athlete begins the battle of fighting the physical limitations and psychological downswing experienced during the previous stage less

HA-2. Describe the impact of organizational structure on the daily operations of a healthcare facility. (ATEP 407)

Operational plans define the activities of the program for a short period, usually no more than two years. The goal is to effectively translate the strategic vision for the program into a useful operational plan. Three types of operational plans are: Policies: A policy is an organized plan that addresses a specific program or action. Policies are broad statements of intended action promoted by boards empowered with the authority to govern the operation of the organization. Processes: The incremental and mutually dependent steps that direct the most important tasks of the facility. Each process should relate to at least one, and possibly many, of the policies that govern the program. Procedures: Procedures provide specific interpretations of processes for athletic trainers and other members of the sports medicine team. They are not abstract. They should be written in clear and simple language so that different people will interpret them in the same way. Procedures are the lowest level of the planning hierarchy. Vision statement: A brief, succinct description of what the organization should eventually become. The vision statement should be both ambitious and compelling, spelling out the hopes and dreams of the facility. Mission statement: A mission statement broadly defines an organization's core purpose and function. It is a statement of purpose and normally remains unchanged for an extended period of time. The mission statement should help the athletic trainer accomplish three things: direct resources toward accomplishing specific tasks, inspire athletic trainers to do a good job, stimulate a change in behavior.

HA-29. Explain typical administrative policies and procedures that govern first aid and emergency care. (ATEP 407)

Policy and procedures of first aid :The training program should be designed for the specific worksite and include first-aid instructions for the management of the following: ■ Wounds • Assessment and first aid for wounds including abrasions, cuts, lacerations, punctures, avulsions, amputations and crush injuries• Principles of wound care, including infection precautions • Principles of body substance isolation, universal precautions and use of personal protective equipment. ■ Burns • Assessing the severity of a burn• Recognizing whether a burn is thermal, electrical, or chemical and the appropriate first aid• Reviewing corrosive chemicals at a specific worksite, along with appropriate first aid. ■ Temperature Extremes • Exposure to cold, including frostbite and hypothermia• Exposure to heat, including heat cramps, heat exhaustion and heat stroke. ■ Musculoskeletal Injuries • Fractures• Sprains, strains, contusions and cramps• Head, neck, back and spinal injuries• Appropriate handling of amputated body parts. ■ Eye injuries • First aid for eye injuries• First aid for chemical burns. ■ Mouth and Teeth Injuries• Oral injuries; lip and tongue injuries; broken and missing teeth• The importance of preventing aspiration of blood and/or teeth. ■ Bites and Stings • Human and animal bites• Bites and stings from insects; instruction in first-aid treatment of anaphylactic shock.Policy and procedure of emergency care:The training program should be designed or adapted for the specific worksite and may include first-aid instruction in the following: ■ Establishing responsiveness■ Establishing and maintaining an open and clear airway■ Performing rescue breathing■ Treating airway obstruction in a conscious victim■ Performing CPR■ Using an AED■ Recognizing the signs and symptoms of shock and providing first aid for shock due to illness or injury■ Assessing and treating a victim who has an unexplained change in level of consciousness or sudden illness■ Controlling bleeding with direct pressure■ Poisoning • Ingested poisons: alkali, acid, and systemic poisons. Role of the Poison Control Center (1-800-222-1222)• Inhaled poisons: carbon monoxide; hydrogen sulfide; smoke; and other chemical fumes, vapors, and gases. Assessing the toxic potential of the environment and the need for respirators• Knowledge of the chemicals at the worksite and of first aid and treatment for inhalation or ingestion• Effects of alcohol and illicit drugs so that the first-aid provider can recognize the physiologic and behavioral effects of these substances■ Recognizing asphyxiation and the danger of entering a confined space without appropriate respiratory protection. Additional training is required if first-aid personnel will assist in the rescue from the confined space. ■ Responding to Medical Emergencies • Chest pain • Stroke• Breathing problems• Anaphylactic reaction• Hypoglycemia in diabetics taking insulin• Seizures• Pregnancy complications• Abdominal injury• Reduced level of consciousness• Impaled object

HA-4. Describe the conceptual components of developing and implementing a basic business plan. (ATEP 407)

The business plan is needed so the bank can project whether the business will succeed or not. It must contain: A statement of the activities that the clinic will engage in. A market analysis detailing the clinics competitive advantages, competition analysis, pricing structure, and marketing plan. The credentials of the owners and operators of the clinic. Historical and projected financial statements of both cash flow and income. Breakdown of costs associated with the project based on the schematics developed by the architect. The amount of personal equity being committed by the athletic trainer. The amount of the loan being requested.

HA - 16 Describe federal and state infection control regulations and guidelines, including universal precautions as mandated by the Occupational Safety and Health Administration (OSHA), for the prevention, exposure, and control of infectious disease, and discuss how they apply to the practicing of athletic training. (ATEP 407)

Universal precautions mandated by OSHA · Prevention o Healthcare providers should also always wear gloves, masks, goggles, other personal protective equipment (PPE) and use work practice controls to limit exposure to potential bloodborne pathogens. o Wearing PPE significantly reduces the transmission of bloodborne pathogens by creating a barrier between germs and the human body. · Exposure o all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens o vigorously washing hands before and after exposure to blood and other body fluids · Control of infectious disease o Ensure appropriate patient placement in a single patient space or room if available in acute care hospitals. In long-term and other residential settings, make room placement decisions balancing risks to other patients. In ambulatory settings, place patients requiring contact precautions in an exam room or cubicle as soon as possible. o Use personal protective equipment (PPE) appropriately, including gloves and gown. Wear a gown and gloves for all interactions that may involve contact with the patient or the patient's environment. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens. o Limit transport and movement of patients outside of the room to medically-necessary purposes. When transport or movement is necessary, cover or contain the infected or colonized areas of the patient's body. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the transport location. o Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient. o Prioritize cleaning and disinfection of the rooms of patients on contact precautions ensuring rooms are frequently cleaned and disinfected (e.g., at least daily or prior to use by another patient if outpatient setting) focusing on frequently-touched surfaces and equipment in the immediate vicinity of the patient. · Practice applicable to Athletic Training o Like other health care providers, athletic trainers must be aware of and take universal precautions against the spread of infectious diseases and bloodborne pathogens. It has always been important for the athletic trainer as a health care provider to be concerned with maintaining an environment in the athletic training clinic that is as clean and sterile as possible. In our society, it has become critical for everyone to take measures to prevent the spread of infectious diseases. Failure to do so may predispose any individual to life-threatening situations. The athletic trainer must take every precaution to minimize the potential for exposure to blood or other infectious materials. o Due to the nature of competitive sports, there is increased risk for the spread of infectious diseases, such as impetigo, community acquired methicillin-resistant staphylococcus infection (MRSA) and herpes gladiatorum (a form of herpes virus that causes lesions on the head, neck and shoulders). These diseases are spread by skin-to-skin contact and infected equipment shared by athletes, generally causing lesions of the skin.

PHP - 34 Describe contemporary nutritional intake recommendations and explain how these recommendations can be used in performing a basic dietary analysis and providing appropriate general dietary recommendations. (NUTR 132)

Nutrition recommendations based on 2015-2020 Dietary Guidelines for Americans there are 5 overarching guidelines: Follow a healthy eating pattern across the lifespan. Eating patterns are the combination of foods and drinks that a person eats over time. Focus on variety, nutrient-dense foods, and amount. Limit calories from added sugars and saturated fats, and reduce sodium intake. Shift to healthier food and beverage choices. Support healthy eating patterns for all. According to these guidelines a healthy diet includes the following, while limiting salt, saturated and trans fats and added sugars: A variety of vegetables: dark green, red and orange, legumes (beans and peas), starchy and other vegetables. Fruits, especially whole fruit. Grains, at least half of which are whole grain. Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages. A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, and nuts and seeds. Oils, including those from plants: canola, corn, olive, peanut, safflower, soybean, and sunflower. Oils also are naturally present in nuts, seeds, seafood, olives, and avocados.

HA-30. Describe the role and functions of various healthcare providers and protocols that govern the referral of patients to these professionals. (ATEP 407)

Referring patients and support services o School health services: It provides treatment for illnesses and injuries, gynecological consultation and treatment, prescriptions, medications, immunizations, and other preventive services. Students who pay the per-semester fee can access care at no additional charge. o Nurse Registered nurse: provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members. Nurse practitioner: coordinate patient care and may provide primary and specialty health care. The scope of practice varies from state to state. May be found working with athletic trainers in various settings with the capacity to medically diagnose and order images and medications o Physician primary care physician: provide both the first contact for a person with an undiagnosed health concern as well as continuing care of various medical conditions. PCPs ecamine patients; tale medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. In athletic environments, PCPs often serve as the team physician. orthopedic surgeon: a surgeon who has been educated and trained in the diagnosis and preoperative, operative, and postoperative treatment of diseases and injuries of the musculoskeletal system. Often serves as a team physician in an athletic setting, and the athletic trainer works under his or her direction. o Dentist: diagnose and treat problems with patients' teeth, gums, and related parts of the mouth. They provide advice and instruction for taking care of the teeth and gums and for dietary choices that affect oral health. May also assist with custom mouth guards for sport and activity. o Podiatrist: provide medical care for people with foot, ankle, and lower-leg problems. They diagnose illness, treat injuries, and perform surgery involving the lower extremities o Physician Assistant: enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Physical therapists may be part of the rehabilitation o Strength and conditioning specialist: apply scientific knowledge to train athletes for the primary goal of improving athletic performance. o Biomechanist: collect samples and perform tests to analyze body tissues and structures. o Exercise physiologist: develop fitness and exercise programs that help patients recover from chronic diseases and improve cardiovascular function, body composition, and flexibility. Exercise physiologists may work with athletic trainers to establish baseline testing and performance capabilities of athletes. o Dietitian: expert in the use of food and nutrition to promote health and mange disease. They advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal. o Sports psychologist: focus on the psychological factors that affect performance and how participation in sport and exercise affect psychological and physical factors. Sport psychologists work closely with athletic trainers and athletes, especially during extended or prolonged phases of rehabilitation. o Massage therapist: treat clients by using various manual therapies to the soft tissues of the body. Massage therapists may be found on staff or work with athletic trainers through consultation. o Occupational therapist: treat injured or ill patients or patients with disabilities through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed fir daily living and working. While not commonly seen working closely with athletic trainers, in some settings, OTs and ATs are found on the same health care team o EMT and paramedic: Along with paramedic, respond to emergency calls, perform medical services and transport patients to medical facilities. EMTs often are on-site at major sporting events and work closely in event planning with the athletic trainer staff. o Sports chiropractors: treat patients with health problems if the neuromusculoskeletal system. Chiropractors use spinal adjustments and manipulation and other techniques to manage patients' health concerns, such as back and neck pain. o Orthotist/prosthetist: design and fabricate medical supportive devices and measure and fit patients for them. These devices include artificial limbs (arms, hands, legs, and feet), braces, and other medical or surgical devices. o Equipment personnel: has access to all equipment. o Referee: have control of game. Athletic trainers should have conversation about EAP with refs prior to games. o Social worker: community provider who facilitates the welfare of communities, individuals, families, and groups. Social workers may assist and athletic trainer in unique cases when a family may need to be involved in a situation.

HA-3. Describe the role of strategic planning as a means to assess and promote organizational improvement. (ATEP 407)

Strategic planning components 1. Mission Statement/Purpose This is a single sentence or paragraph that states the purpose of the organization. Why are you in business? What is your business? What difference do you intend to make? What is your unique niche? 2. Core Values These are the prioritized guiding principles or credo for everyone in the organization as to how they should operate, what is important to always be or do. Core values are the 3-5 values that are so fundamental to the organization and deeply held that they govern the choices made even to the point of a competitive disadvantage, Core values are independent of what is popular, "universal", or competitive. 3. Long-term Vision This is the picture of what it will be like when you get there. It is a statement of accomplishment or condition you are seeking. It may be stated with a timeframe. 4. Strategic Agenda the strategic agenda is not restricted only to projects that move the company toward its vision, expand its client base, etc. The agenda also encompasses those internal projects that "fix" the organization and give it the ability to approach its long-term goals. 5. Project Plans For each of the projects in the approved strategic agenda, a project plan should be developed. Each project plan should include the following list of elements. · One year target for accomplishment for the project; a result or condition to be achieved · Two or three year target for accomplishment on projects that will take more than a year to implement · Metric: the measure that will show whether the project is having its intended impact or not. · Milestones: to reach annual target. What are the major steps or milestones that must be completed to reach the target? Most projects have 3-10 major steps. Management should be spell out what each step is and when it will be accomplished during the year in order to reach the target by year end. · Accountability. A member of management should be assigned accountability for each milestone or major step on every project in the strategic plan. This individual is committing to see the milestone through to completion, not necessarily to do all the work. 6. Annual Budget The budget for the year is the financial map for accomplishing this year's objectives described in the strategic plan. The strategic plan makes clear what the priorities are and where resources should be concentrated. The budget outlays the use of resources to complete objectives and goals. 7. Capital Expenditures Plan This is the plan leadership puts in place for replacement of facilities and equipment as needed. The reason for such a plan is that if equipment suddenly breaks down and must be replaced, the money has to come from reductions in funding for operations, unless you have already planned for the replacement. This can be disruptive to the financial condition of the organization and thus to operations. WOTS UP SWOT A SWOT analysis is a strategic planning method that assesses an organization's Strengths, Weaknesses, Opportunities and Threats, which summarizes the abbreviation. SWOT analysis provides the foundation for effective strategic management through a flexible, if somewhat vague, framework. Sometimes, the abbreviation appears as TOWS or "WOTS up" analysis. Regardless, the elements in each abbreviation are the same.

PD-3. Describe the role and function of the Board of Certification, the Commission on Accreditation of Athletic Training Education, and state regulatory boards. (ATEP 490A)

-Board of Certification: incorporated in 1989 as a not-for-profit credentialing agency to provide a certification program for the entry level athletic training profession. -it established both the standards for the practice of AT and the continuing education requirements for BOC ATCs. -also works with state regulatory agencies to provided credential information, professional conduct guidelines and regulatory standards on certification issues -State regulatory boards: Regulate the practice of athletic training. Individuals must be legally recognized by the appropriate state regulatory agency prior to practicing athletic training. The BOC exam is recognized by all Athletic Trainer state regulatory agencies to meet their exam requirement. -Compliance with state regulatory requirements is mandatory and the only avenue to legal athletic training practice. -CAATE: a non-profit organization currently incorporated in Texas. Its mission is to define, measure, and continually AT education

CE-4 Describe the principles and concepts of body movement, including normal osteokinematics and arthrokinematics. (KIN 300)

-Body movement skills: stability makes the body maintain a desired shape in a stationary position, Locomotion are those used to move the body from one point to another Manipulation involve giving force towards an object and being able to control it. Concepts of body movement: Body awareness- knowing what body parts are moving and in what way Spatial Awareness- where your body is at a given time Effort Awareness- how does the body move Relationship- with whom (objects, people, and space) or what does your body move Osteokinematics: branch of biomechanics concerned with the description of bone movement when a bone moves through a range of motion around the axis in a joint (flexion, extension, abduction, adduction, internal rotation, external rotation) -important to understand the normal ranges for different ROM's in different joints to ensure normal osteokinematics (goniometer) Arthrokinematics: general term for specific movements of joint surfaces (rolling, gliding, spinning) -rules of concavity and convexity -each joint has 2 body surfaces, one that's convex and one that's concave -if concave surface is fixed, the convex surface moves on it and slides or glides in opposite directions -if convex surface is fixed, the concave surface moves on it and goes in the same direction -can manipulate arthrokinematics through the use of joint mobilizations

PD-4. Explain the role and function of state athletic training practice acts and registration, licensure, and certification agencies including (1) basic legislative processes for the implementation of practice acts, (2) rationale for state regulations that govern the practice of athletic.

1. Licensure: limits practice to those who have met minimal requirements established by a state licensing board. Limits the number of individuals who can perform functions related to AT as dictated by the practice act; most restrictive 2. Certification: does not restrict using the title of "athletic trainer", can restrict performance of AT functions to only those individuals who are certified 3. Registration: before practicing AT he or she must do this in state; individual pays a fee for being placed on an existing list of practitioners; says nothing about level of competency 4. Exemption: state recognizes ATCs perform similar functions to other licensed professions; allows ATCs to practice despite the fact that they do not comply with the practice acts of other regulated professions. State regulation is desired for public protection. Requires that all ATs have earned the ATC credential through BOC. It also gives the BOC someone at the state level to communicate if there are disciplinary issues (if an AT violates BOC standards, state regulation allows BOC to suspend or revoke certification. *BOC has to contact state regulatory board to suspend or revoke *have authority to "cease and desist", which means AT cannot practice until board lifts that order Provides legitimacy to the profession, making it easier to receive third-party reimbursement And protection as a healthcare provider under state law if they volunteer their services or assist in an emergency Certification: States get authority authority to certify athletic trainers from a credentialing law passed by the state legislature and signed by the governor, the same process that gives them the authority for licensure. Only protects title and not the specific tasks. Cannot call themselves ATC, but can perform tasks. Registration: Required to register with the state before practicing.

PHP-42. Explain how changes in the type and intensity of physical activity influence the energy and nutritional demands placed on the client/patient. (ATEP 306)

A person's activity type and intensity will definitely influence the nutritional demands placed on a client/patient. The type of sport/activity is important as demands are tailored based on the type of athlete one helping. A endurance type athlete will have very different nutritional needs compared to a strength/power type athlete or an activity that relies on aerobic exercise compared to anaerobic exercise. Anaerobic exercise is the type of exercise that requires little to no oxygen to produce energy. Physiological sources for energy for this type of activity include: ATP available, Creatine-Kinase production, and lactic acid system. These sources of energy can last from a couple of second up to a minute. Examples of anaerobic exercise/sport are weightlifting, powerlifting, and short distance sprints Aerobic exercise is the type of exercise that requires oxygen to produce energy in the form of ATP. Sources for this type of activity would by glycolysis and lipolysis. These sources kick in after anaerobic sources of energy are depleted and are long lasting over 3 hours. Examples of aerobic activity/sport would include swimming, jogging, race walking, and biking. Energy/Nutritional demands of endurance athletes Because the bulk of energy comes from breaking down available and stored carbohydrates, carbohydrates are not to be overlooked by the endurance athlete. It is recommended that an athlete should intake anywhere from 7-12 grams of carbohydrates per kilogram of body mass. If the athlete trains/competes for over an hour to 3 hours, it is recommended to consume 30-60 grams of easy to digest carbohydrates every hour. Fluid and electrolyte replacement is important for the endurance athlete. It is important that an athlete does not lose more than 2 percent of body weight per workout, as it is a sign of dehydration. Energy/Nutritional demands of body builders The biggest focus of body builder or any anaerobic exercise athlete would be maximizing short duration energy sources and consuming the necessary amount of proteins to rebuild broken down muscle after workouts. The liver and kidneys will produce up to half of the necessary creatine. But can be fulfilled through consuming fish, eggs, meat, or from creatine supplements. More important than creatine is the amount protein consumption. Athletes should consume about 1-1.5 grams of protein per kilogram of body mass. However, more advanced/elite athletes should consume about 1.5-2.2 grams of protein per kilogram.

HA-18: Describe the basic legal principles that apply to an athletic trainer's responsibilities. (ATEP 407)

According to the NATA there are 4 principles that athletic trainer's must follow: 1. Members shall practice with compassion, respecting the rights, well-being, and dignity of others. 1.1 Members shall render quality patient care regardless of the patient's race, religion, age, sex, ethnic or national origin, disability, health status, socioeconomic status, sexual orientation, or gender identity. 1.2. Member's duty to the patient is the first concern, and therefore members are obligated to place the well-being and long-term well-being of their patient above other groups and their own self-interest, to provide competent care in all decisions, and advocate for the best medical interest and safety of their patient at all times as delineated by professional statements and best practices. 1.3. Members shall preserve the confidentiality of privileged information and shall not release or otherwise publish in any form, including social media, such information to a third party not involved in the patient's care without a release unless required by law. 2. MEMBERS SHALL COMPLY WITH THE LAWS AND REGULATIONS GOVERNING THE PRACTICE OF ATHLETIC TRAINING, NATIONAL ATHLETIC TRAINERS' ASSOCIATION (NATA) MEMBERSHIP STANDARDS, AND THE NATA CODE OF ETHICS 2.1. Members shall comply with applicable local, state, federal laws, and any state athletic training practice acts. 2.2. Members shall understand and uphold all NATA Standards and the Code of Ethics. 2.3. Members shall refrain from, and report illegal or unethical practices related to athletic training. 2.4. Members shall cooperate in ethics investigations by the NATA, state professional licensing/regulatory boards, or other professional agencies governing the athletic training profession. Failure to fully cooperate in an ethics investigation is an ethical violation. 2.5. Members must not file, or encourage others to file, a frivolous ethics complaint with any organization or entity governing the athletic training profession such that the complaint is unfounded or willfully ignore facts that would disprove the allegation(s) in the complaint. 2.6. Members shall refrain from substance and alcohol abuse. For any member involved in an ethics proceeding with NATA and who, as part of that proceeding is seeking rehabilitation for substance or alcohol dependency, documentation of the completion of rehabilitation must be provided to the NATA Committee on Professional Ethics as a requisite to complete a NATA membership reinstatement or suspension process. 3. MEMBERS SHALL MAINTAIN AND PROMOTE HIGH STANDARDS IN THEIR PROVISION OF SERVICES 3.1. Members shall not misrepresent, either directly or indirectly, their skills, training, professional credentials, identity, or services. 3.2. Members shall provide only those services for which they are qualified through education or experience and which are allowed by the applicable state athletic training practice acts and other applicable regulations for athletic trainers. 3.3. Members shall provide services, make referrals, and seek compensation only for those services that are necessary and are in the best interest of the patient as delineated by professional statements and best practices. 3.4. Members shall recognize the need for continuing education and participate in educational activities that enhance their skills and knowledge and shall complete such educational requirements necessary to continue to qualify as athletic trainers under the applicable state athletic training practice acts. 3.5. Members shall educate those whom they supervise in the practice of athletic training about the Code of Ethics and stress the importance of adherence. 3.6. Members who are researchers or educators must maintain and promote ethical conduct in research and educational activities. 4. MEMBERS SHALL NOT ENGAGE IN CONDUCT THAT COULD BE CONSTRUED AS A CONFLICT OF INTEREST, REFLECTS NEGATIVELY ON THE ATHLETIC TRAINING PROFESSION, OR JEOPARDIZES A PATIENT'S HEALTH AND WELL-BEING. 4.1. Members should conduct themselves personally and professionally in a manner that does not compromise their professional responsibilities or the practice of athletic training. 4.2. All NATA members, whether current or past, shall not use the NATA logo or AT logo in the endorsement of products or services, or exploit their affiliation with the NATA in a manner that reflects badly upon the profession. 4.3. Members shall not place financial gain above the patient's well-being and shall not participate in any arrangement that exploits the patient. 4.4. Members shall not, through direct or indirect means, use information obtained in the course of the practice of athletic training to try and influence the score or outcome of an athletic event, or attempt to induce financial gain through gambling. 4.5. Members shall not provide or publish false or misleading information, photography, or any other communications in any media format, including on any social media platform, related to athletic training that negatively reflects the profession, other members of the NATA, NATA officers, and the NATA office.

HA-13. Define state and federal statutes that regulate employment practices. (ATEP 407)

Affirmative actionEffective date: Executive Order 10925 on March 6, 1961 made by Pres, John F. KennedyEntitlement: A set of procedures designed to eliminate unlawful discrimination among applicants, remedy the results of such prior discrimination, and prevent such discrimination in the future. Applicants may be seeking admission to an educational program or looking for professional employment. In modern American jurisprudence, it typically imposes remedies against discrimination on the basis of, at the very least, race, creed, color, and national origin.Enforced by: U.S. Department of Labor's Office of Federal Contract Compliance Programs American with Disabilities ActEffective date: July 26,1990Entitlement: Prohibits discrimination on the basis of disability by public accommodations and requires places of public accommodation and commercial facilities to be designed, constructed, and altered in compliance with the accessibility standards. It is the Nation's first comprehensive civil rights law addressing the needs of people with disabilities, prohibiting discrimination in employment, public services, public accommodations, and telecommunications.Law applies to: Any kind of facility including public & private educational institutions, health care facilities, and other places of business.Enforced by: The U.S Equal Employment Opportunity Commission (EEOC) enforces Title I of the ADA. Equal Employment Opportunity CommissionEffective date: July 2,1965Entitlement: Administers and enforces civil rights laws against workplace discrimination. The EEOC investigates discrimination complaints based on an individual's race, children, national origin, religion, sex, age, disability, sexual orientation, gender identity, genetic information, and retaliation for reporting, participating in, and/or opposing a discriminatory practice.Enforced by: Leaders are appointed by the President and confirmed by the Senate. Fair Labor Standards ActEffective date: June 14, 1938Entitlement: Sets minimum wage, overtime, and minimum age requirements for employers and employees. The law is intended to protect workers of certain unfair pay practices or work regulations.Enforced by: The Wage and Hour Division of the U.S. Department of Labor administers and enforces FLSA Family Medical Leave ActEffective date: February 5, 1993Entitlement: entitles eligible employees who work for covered employers to take unpaid, job-protected leave for specified family and medical reasons.Enforced by: The Wage and Hour Division of the U.S. Department of Labor Federal Educational Rights Privacy ActEffective date: July 23,1992Entitlement: federal law that affords parents the right to have access to their children's education records, the right to seek to have the records amended, and the right to have some control over the disclosure of personally identifiable information from the education records. When a student turns 18 years old, or enters a postsecondary institution at any age, the rights under FERPA transfer from the parents to the student ("eligible student")Enforced by: Family Policy Compliance Office in the U.S. Department of Education HIPAAEffective date: April 14, 2003Entitlement: Privacy Rule is composed of national regulations for the use and disclosure of Protected Health Information (PHI) in healthcare treatment, payment and operations by covered entities. Enforced by: The Department of Health and Human Services' Office for Civil Rights OSHAEffective dateEntitlement: Mission is to ensure that employees work in a safe and healthful environment by setting and enforcing standards, and by providing training, outreach, education and assistance. Requires employers to keep their workplace free of serious recognized hazards.Enforced by: United States Department of Labor Section 504 of Rehabilitation ActEffective date: September 26,1973Entitlement: prohibits discrimination based upon disability, Section 504 is an anti-discrimination, civil rights statute that requires the needs of students with disabilities to be met as adequately as the needs of the non-disabled are metEnforced by: Office for Civil Rights Sexual HarassmentEffective date: Title VII of the Civil Rights Act of 1964Entitlement: Title VII is a federal law that prohibits discrimination in employment on the basis of sex, race, color, national origin, and religion, and it applies to employers with 15 or more employees. The law also makes it illegal to retaliate against a person because the person complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. It applies to federal, state, and local governments, as well as employment agencies and labor organizations. Sexual harassment describes unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct. The behavior does not have to be of a sexual nature, however, and can include offensive remarks about a person's sex. Enforced by:U.S. Equal Employment Opportunity Commission Title IX of Education AmendmentEffective date: June 23,1972Entitlement: Prohibit discrimination on the basis of sex in any education program or activity that is federally funded. void the use of federal money to support sex discrimination in education programs and to provide individual citizens effective protection against those practices.Enforced by: The U.S. Department of Education's Office for Civil Rights

PS - 14

Anorexia Nervosa Clinical eating disorder Engage in caloric restriction and exercise excessively (may also binge and purge at times) Excessive weight loss—refuses to maintain healthy body weight Obsessed with body weight Distorted body image Fear of gaining weight or being "fat" Can result in amenorrhea Most common in females, however, males can also suffer from it Bulimia Nervosa Clinical eating disorder Engages in recurrent episodes of binge eating followed by compensatory behaviors (may also restrict caloric intake and exercise excessively) Compensatory behaviors—self-induced vomiting, laxatives, fasting Overly concerned about body weight and shape Appears as being of average body weight and size Feelings of guilt after binge eating Anorexia Athletica Athletes engage in caloric restriction and/or exercise excessively Engages for performance enhancement rather than for body appearance May only engage in disordered eating habits during their athletic season Binge Eating Disorder Engages in recurrent episodes of compulsive binge eating Do not purge body of excessively consumed calories less

PHP-17 Explain the etiology and prevention guidelines associated with the leading causes of sudden death during physical activity, including but not limited to: PHP-17b: Asthma

Asthma is a chronic inflammatory disorder of the airways characterized by variable airway obstruction and bronchial hyper-responsiveness. Airway obstruction can cause recurrent episodes at night or in the morning of wheezing, breathlessness, chest tightness, and coughing. A person's airways becomes inflamed, narrow and swell and produce extra mucus, which makes it difficult to breath. Know the following: Exercise-induced asthma: Made worse by cold and dry air Occupational asthma: triggered by workplace irritants such as chemical fumes, gases or dust Allergy-induced asthma: triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pet Prevention and ScreeningAthletes who may have or are suspected of having asthma should undergo a thorough medical history and physical examination.Athletes with asthma should participate in a structured warmup protocol before exercise or sport activity to decrease reliance on medication and minimize asthmatic symptoms and exacerbationsThe sports medicine staff should educate athletes with asthma about the use of asthma medications as prophylaxis before exercise, spirometry devices, asthma triggers, recognition of signs and symptoms, and compliance with monitoring the condition and taking medication as prescribed Recognition The sports medicine staff should be aware of the major asthma signs and symptoms (ie, confusion, sweating, drowsiness, forced expiratory volume in the first second (FEV1) of less than 40%, low level of oxygen saturation, use of accessory muscles for breathing, wheezing, cyanosis, coughing, hypotension, bradycardia or tachycardia, mental status changes, loss of consciousness, inability to lie supine, inability to speak coherently, or agitation) and other conditions (eg. vocal cord dysfunction, allergies, smoking) that can cause exacerbations. Spirometry tests at rest and with exercise and a field test (in the sport-specific environment) should be conducted on athletes suspected of having asthma to help diagnose the condition. An increase of 12% or more in the FEV1 after administration of an inhaled bronchodilator also indicates reversible airway disease and may be used as a diagnostic criterion for asthma. Treatment For an acute asthmatic exacerbation, the athlete should use a short-acting ~2-agonist to relieve symptoms. In a severe exacerbation, rapid sequential administrations of a ~2-agonist may be needed. If 3 administrations of medication do not relieve distress, the athlete should be referred promptly to an appropriate health care facility. Inhaled corticosteroids or leukotriene inhibitors can be used for asthma prophylaxis and control. A long-acting ~2-agonist can be combined with other medications to help control asthma. Supplemental oxygen should be offered to improve the athlete's available oxygenation during asthma attacks. Lung function should be monitored with a peak flow meter. Values should be compared with baseline lung volume values and should be at least 80% of predicted values before the athlete may participate in activities. If feasible, the athlete should be removed from an environment with factors (eg, smoke, allergens) that may have caused the asthma attack. In the athlete with asthma, physical activity should be initiated at low aerobic levels and exercise intensity gradually increased while monitoring occurs for recurrent asthma symptoms. Asthma TriggersStimuli include:AllergensPollen, dust mites, animal dander etc.PollutantsCarbon dioxide, smoke, ozone etc.Respiratory infectionsAspirinNonsteroidal anti-inflammatory drugs (NSAIDs)Inhaled irritantsCigarette smoke, household cleaning fumes, chlorine in pools etc.Particulate exposureAmbient air pollutants. Ice rink pollutionExposure to cold & exercise Peak Flow Zones for Asthma ManagementGreen zone PEF values are between 80% and 100% of personal bestNo asthma management changes are necessary at this timeYellow zonePEF values are between 50% and 80% of personal bestCaution is warranted; use of medications is requiredRed zonePEF values are less than 50% of personal bestDanger: emergency action is needed, including medications or hospital visit Know the Signs & SymptomsShortness of breath Chest tightness or pain Trouble sleeping caused by shortness of breath, coughing or wheezing A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children) Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu Know when Signs of Asthma are getting worseAsthma signs and symptoms that are more frequent and bothersomeIncreasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)The need to use a quick-relief inhaler more often Seek Emergency TreatmentRapid worsening of shortness of breath or wheezingNo improvement even after using a quick-relief inhaler, such as albuterolShortness of breath when you are doing minimal physical activity Prevention of Asthma Attacks: Follow asthma action plan that is formulated with a doctor Get vaccinated for influenza and pneumonia Identify and avoid asthma triggers Monitor breathing Identify and treat attacks early Take medication ad prescribed Pay attention to increasing quick-relief inhaler use If athlete does not return to normal after maximum 2 rounds of rescue inhaler use , activate EMS and refer them out for further evaluation and treatment

HA-1. Describe the role of the athletic trainer and the delivery of athletic training services within the context of the broader healthcare system. (ATEP 407)

Athletic trainers are responsible for services under the supervision of a physician including primary care, injury and illness prevention, wellness promotion and education, emergent care, examination and clinical diagnosis, therapeutic intervention and injury rehabilitation. They also serve as a liason between players, coaches, parents, other healthcare professionals and athletic trainers, administrators, and physicians. These relationships help improving the functionality of an athletic training program and maintaining goodwill relationships between different departments of a shared organization and outside parties.

PHP-43. Describe the principles and methods of body composition assessment to assess a client's/patient's health status and to monitor changes related to weight management, strength training, injury, disordered eating, menstrual status, and/or bone density status. (KIN 301)

Body Comp A number of methods have been used to determine body composition. These methods include: Hydrostatic weighing Skinfold measurements Potassium 40 counting Near-Infrared Reactance (NIR) Bioelectrical Impedance Dual Energy X-Ray Absorptiometry (DXA) Body Fat Percentage Body Fat %: ratio of fat mass to fat free mass Fat Mass Visceral Fat (Essential) Covers our organs Subcutaneous Fat (Nonessential) Fat we store from excess calories Fat Free Mass/Lean Body Mass Muscle, Bone & Organs Plasma, Blood & Water Unhealthy/Unsafe Men: <5% Women: <13% BMI Body mass index (BMI) has largely replaced the height/weight charts. BMI is a relative measure of weight measured in kg) to height2 (measured in meters). It is calculated by the following equation: BMI = W/H2 = Weight (kg) / Height2 (m2) Elevated values for BMI have been associated with obesity and increased risk for other diseases such as cardiovascular disease and type II diabetes. For the general population there is a good correlation between BMI and percent body fat (r 0.70). However for specific populations such as athletes, the BMI is not a good indicator of body fat. A major limitation of height/weight tables and BMI and is that they do not provide information with regard to the relative composition of an individual's body weight. Due to the inadequacies of standard height-weight tables, the assessment of body composition has become an important method for determining a desirable body weight in adults and athletes. Pros Easy way to assess general population Assess risk for disease Con Not good for determining fat from muscle Skinfold Materials: Skinfold calipers | Calculator | Marking pen | Tape Measure Procedures: 1. Locate and mark all skinfold sites. Make all skinfold measurements on the right side of the body. 2. The skinfold is picked up between the thumb and index finger so as to include two thicknesses of skin and subcutaneous fat without any muscle tissue. 3. Apply calipers 1.0 cm above fingers holding the skinfold. The depth of the calipers should be equal to the fold. The caliper tips should be directly on the mark which specifically identifies the anatomical location. 4. Due to tissue compressibility, the skinfold measurement should be determined <3 seconds after the calipers have been placed into position. 5. Take all measurements in rotational order, following the natural folding pattern of the skin. 6. Take 3 measurements at each skinfold site. If >2 mm difference, take a 4th measurement. Average the 3 closest scores for each site. Calculations: Calculate the following for the 7 site skinfold equation and place your results in the summary table below: 1) Find body density (X) = sum of all seven skinfold sites; Age in years: Men, 7 Site: Body Density (kg/l) = 1.112 - 0.00043499(X) + 0.00000055(X2) - 0.00028826(Age) Women, 7 Site: Body Density (kg/l) = 1.097 - 0.00046971(X) + 0.00000056(X2) - 0.00012828(Age) 2) % Body Fat (%BF) where: %BF = ([4.95/Body Density] - 4.50) x 100 3) Fat Mass (FAT) where FAT = Body Mass x (%BF/100) 4) Fat-Free Mass (FFM) = Body Mass - FAT § Pros § Easy & Cheap § Accurate (if person knows how!) § Cons § Very variable (if inexperienced) Assumes 50% of BF is subcutaneous

PHP-32 Describe the role of nutrition in enhancing performance, preventing injury or illness, and maintaining a healthy lifestyle

Diet is a key component in an athlete's life that factors in with the performance that they achieve. Every athlete's dietary requirements are different due to the different physical demands every sport has. Dietary strategies that aim at enhancing performance are mainly seen focusing on optimizing intakes of macronutrients, micronutrients, and fluids, including the composition and spacing throughout the day. 1 common dietary strategy seen is carbohydrate loading which aims at maximizing an athlete's glycogen stores prior to endurance exercises lasting longer than 90 minutes. It has been proven that this technique result in a delayed onset of fatigue (20%) and a 2-3% improvement in performance. The recommendations currently for athletes that exercise for longer than 90 minutes state that athletes should consume 10-12g of carbs per kg of body mass per day in the 36-48 hours prior to exercise. For exercise lasting less than 90 minutes, 7-12 g of carbs/kg of body mass should be consumed 24 hours before competition. It is important to hydrate as well before and during competition. Hydrating ensures that the athlete's thermoregulation and performance do not decrease. It has been shown in research that properly planned hyperhydration prior to an event may reset fluid balance and increase fluid retention which improves heat tolerance, but it can also increase the risks of hyponatremia and negatively impact performance. It is important to maintain hydration levels because it has been studied that a 2% loss of fluid in body mass impairs performance. Another important component of enhancing performance is the intake of protein following competition. Protein consumption after exercise has been shown to increase muscle protein synthesis by increasing mitochondrial protein fraction with endurance training and myofibrillar protein fraction with resistance training. It is recommended that 20g of high-quality protein is sufficient to maximize MPS at rest, following resistance, and after high-intensity aerobic exercise. With these in mind, nutrition plays an important role in preventing injury by insuring that the athlete is the most prepared for competition. When the athlete is physiologically prepared for bouts of exercise, there is a decreased risk in the occurrence of injury due to the adequate nutritional intake that is demanded from the sport. Having a well-balanced diet is not only important for athletes, but it is important to live a healthy lifestyle. According to the FSC, a balanced diet for an average adult consists of : 50 grams of protein 70 grams of fat 24 grams of saturated fatty acids 310 grams of carbohydrates 90 grams of sugar 2.3 grams of sodium 30 grams of dietary fibers This is based on an average adult diet of 8,700kJ. However each individual is different and requires different values of these nutrients based on their lifestyle and the physical demands they encounter on a day-to-day basis.

PHP - 47 Describe the method of appropriate management and referral for clients/ patients with disordered eating or eating disorders in a manner consistent with current practice guidelines

Eating disorder treatment depends on your particular disorder and your symptoms. It typically includes a combination of psychological therapy (psychotherapy), nutrition education, medical monitoring and sometimes medications. Eating disorder treatment also involves addressing other health problems caused by an eating disorder, which can be serious or even life-threatening if they go untreated for too long. If an eating disorder doesn't improve with standard treatment or causes health problems, you may need hospitalization or another type of inpatient program. Having an organized approach to eating disorder treatment can help you manage symptoms, return to a healthy weight, and maintain your physical and mental health. Where to start Whether you start by seeing your primary care practitioner or some type of mental health professional, you'll likely benefit from a referral to a team of professionals who specialize in eating disorder treatment. Members of your treatment team may include: A mental health professional, such as a psychologist to provide psychological therapy. If you need medication prescription and management, you may see a psychiatrist. Some psychiatrists also provide psychological therapy. A registered dietitian to provide education on nutrition and meal planning. Medical or dental specialists to treat health or dental problems that result from your eating disorder. Your partner, parents or other family members. For young people still living at home, parents should be actively involved in treatment and may supervise meals. It's best if everyone involved in your treatment communicates about your progress so that adjustments can be made to treatment as needed. Managing an eating disorder can be a long-term challenge. You may need to continue to see members of your treatment team on a regular basis, even if your eating disorder and related health problems are under control. Setting up a treatment plan You and your treatment team determine what your needs are and come up with goals and guidelines. Your treatment team works with you to: Develop a treatment plan. This includes a plan for treating your eating disorder and setting treatment goals. It also makes it clear what to do if you're not able to stick with your plan. Treat physical complications. Your treatment team monitors and addresses any health and medical issues that are a result of your eating disorder. Identify resources. Your treatment team can help you discover what resources are available in your area to help you meet your goals. Work to identify affordable treatment options. Hospitalization and outpatient programs for treating eating disorders can be expensive, and insurance may not cover all the costs of your care. Talk with your treatment team about financial issues and any concerns — don't avoid treatment because of the potential cost. Psychological therapy Psychological therapy is the most important component of eating disorder treatment. It involves seeing a psychologist or another mental health professional on a regular basis. Therapy may last from a few months to years. It can help you to: Normalize your eating patterns and achieve a healthy weight Exchange unhealthy habits for healthy ones Learn how to monitor your eating and your moods Develop problem-solving skills Explore healthy ways to cope with stressful situations Improve your relationships Improve your mood Treatment may involve a combination of different types of therapy, such as: Cognitive behavioral therapy. This type of psychotherapy focuses on behaviors, thoughts and feelings related to your eating disorder. After helping you gain healthy eating behaviors, it helps you learn to recognize and change distorted thoughts that lead to eating disorder behaviors. Family-based therapy. During this therapy, family members learn to help you restore healthy eating patterns and achieve a healthy weight until you can do it on your own. This type of therapy can be especially useful for parents learning how to help a teen with an eating disorder. Group cognitive behavioral therapy. This type of therapy involves meeting with a psychologist or other mental health professional along with others who are diagnosed with an eating disorder. It can help you address thoughts, feelings and behaviors related to your eating disorder, learn skills to manage symptoms, and regain healthy eating patterns. Your psychologist or other mental health professional may ask you to do homework, such as keep a food journal to review in therapy sessions and identify triggers that cause you to binge, purge or do other unhealthy eating behaviors. Nutrition education Registered dietitians and other professionals involved in your treatment can help you better understand your eating disorder and help you develop a plan to achieve and maintain healthy eating habits. Goals of nutrition education may be to: Work toward a healthy weight Understand how nutrition affects your body, including recognizing how your eating disorder causes nutrition issues and physical problems Practice meal planning Establish regular eating patterns — generally, three meals a day with regular snacks Take steps to avoid dieting or bingeing Correct health problems that are a result of malnutrition or obesity Medications for eating disorders Medications can't cure an eating disorder. They're most effective when combined with psychological therapy. Antidepressants are the most common medications used to treat eating disorders that involve binge-eating or purging behaviors, but depending on the situation, other medications are sometimes prescribed. Taking an antidepressant may be especially helpful if you have bulimia or binge-eating disorder. Antidepressants can also help reduce symptoms of depression or anxiety, which frequently occur along with eating disorders. You may also need to take medications for physical health problems caused by your eating disorder.

HA-14. Describe principles of recruiting, selecting, hiring, and evaluating employees. (ATEP 407)

Equal Employment Opportunity Commission The U.S. Equal Employment Opportunity Commission (EEOC) is a federal agency that administers and enforces civil rights laws against workplace discrimination. The EEOC investigates discrimination complaints based on an individual's race, children, national origin, religion, sex, age, disability, sexual orientation, gender identity, genetic information, and retaliation for reporting, participating in, and/or opposing a discriminatory practice. Hiring practices recruiting: Actively recruiting professionals for full time or part time positions at an institution Advertised nationally, but certain individuals who are uniquely qualified may be encouraged to apply Recruiting individuals to serve as volunteers or consultants limited to a geographic region allows immediate access and allows the necessary consultation in only periodic, geographic proximity Licensure the granting or regulation of licenses, as for professionals. Dress code In the athletic training rooms - your required minimum dress will be: i. Footwear - Athletic type shoes should be worn during athletic training room hours (closed-toe). ii. Pants - Khaki colored slacks, or shorts; neat jeans or neat jean shorts; neat wind pants or neat athletic shorts are permissible

PHP-36. Describe current guidelines for proper hydration and explain the consequences of improper fluid/electrolyte replacement. (ATEP 304)

Hydration before exercise: at least 500 mL 2 hours before exercise Hyperhydration in extreme heat conditions may be beneficial when fluid intake cannot match sweat loss Rehydration during exercise: aim to drink to equal to sweat and urine loss At least handle >1 L/h Can use CHOs and electrolytes to replace fluid Do not lose more than 2% of body weight 15-20 mins of exercise = 3-5 oz of water 16-24 oz of water per pound lost Rehydration after exercise: Include sodium in post exercise for increased fluid volume and desire to drink Fluid intake = 150% of weight loss is optimal 6 hours after exercise

EBP - 11 Explain the theoretical foundation of clinical outcomes assessments (eg, disablement, health-related quality of life) and describe common methods of outcomes assessment in athletic training clinical practice (generic, disease-specific, region-specific, and dimension-specific outcomes instruments) (ATEP 490C)

I main point is that clinical outcomes are the end result of health care services. Clinical outcomes assessment is based on the conceptual framework of disablement models and serves as the measurement method for the collection of patient-oriented evidence, a concept central to evidence-based practice. A description is: clinical outcomes management refers to the use of outcomes measures in the course of routine clinical care and provides athletic trainers with a mechanism to assess treatment progress and to measure the end results of the services they provide. Outcomes measures can be classified as either clinician based or patient based. Clinician-based measures, such as range of motion and strength, are taken directly by clinicians. Patient-based measures solicit a patient's perception as to health status in the form of questionnaires and survey scales. Clinician-based measures may assist with patient evaluation, but patient-based measures should always be included in clinical assessment to identify what is important to the patient. Evidence-based athletic training practice depends on clinical outcomes research to provide the foundation of patient-oriented evidence. The widespread use of clinical outcomes assessment, based on the disablement model framework, will be necessary for athletic trainers to demonstrate the effectiveness of therapies and interventions, the provision of patient-centered care, and the development of evidence-based practice guidelines.

PHP - 35. Describe the proper intake, sources of, and effects of micro- and macro-nutrients on performance, health, and disease. (NUTR 132)

Macronutrients o Carbohydrates - -Fruits, vegetables, grains, sugars, dairy (also has protein and fat!) Purpose - for replenishing glycogen stores in muscle and liver before and after activity; recommended daily value depends on the type of training Make more than 50% of carbs consumed be whole grain Choose whole fruit and vegetables over juices and smoothies because eating whole ensures fiber content is intact Frozen fruits and vegetables are just as good as fresh because the freezing process keeps nutrient content in food Carbohydrates are necessary to make glucose readily available as the prime energy source for muscle and our brain Saccharides (sugars/ starches) 4 different types: Monosaccharides The simplest carbohydrate that cannot be made any smaller Important for fuel and building blocks of nucleic acids Disaccharides Sucrose, lactose and maltose Oligosaccharides Glucose, fructose, galactose Polysaccharides Starch, cellulose, glycogen Simple vs complex o Fats Lipids - 1.As exercise duration increases and intensity decreases, endogenous fat stores contribute a greater percentage of total energy 2.Fat intake may fluctuate daily to help meet energy demands of periodization 3.Chronic fat restriction can cause low energy availability results in poor performance 4.Metabolic adaptations do occur in response to high fat feeding but the claim that high fat and low carb improve performance is not proven Types of fatty acids - monounsaturated fatty acids (MUFA) - canola oil, olive oil, avocado ; polyunsaturated fatty acids (PUFA) - soy, corn, nuts and seeds, fish ; Omega 3 fatty acid - fatty fish, salmon, walnut, canola oil, flaxseed More MUFA's and PUFA's than saturated fatty acids that are found in animal products like steak and eggs; saturated fats are the bad fats that deposit cholesterol and clog arteries; receive your fats from plant and fish sources Triglycerides - how fats are stored for energy to be later broken down into glucose for energy usage once fasting or during low intensity high duration exercises like jogging - triglycerides are 3 fatty acid molecules attached to a glycerol backbone LDL (low-density lipoproteins) - "lazy" because they deposit cholesterol in blood vessels which clog arteries /HDL (high-density lipoproteins) - "healthy" because they pick up cholesterol found in arteries to prevent blood vessel disease like atherosclerosis - HDL carry cholesterol molecules back to the liver o proteins o Source - Meats, meatless options, beans, legumes (also carbs!) o Purpose - 1.Intake of protein is fundamental to facilitate the repair, remodeling, or accretion of muscle protein and to maintain muscle throughout life 2.Essential amino acids are primary stimulators of muscle protein synthesis rate Micronutrients Nutrition intake for athletes o CHO intake - For moderate exercise (~1 hr/day) 2.5-3 grams of carbs per pound per day* For endurance exercise (1-3 hr/day) 2.5-4.5 grams of carbs per pound per day* For extreme exercise (4-5 hr/day) 3.5-5.5 grams of carbs per pound per day* o Fat intake o Protein intake - a.Consume protein within 4 hours of recovery, but within 24 hours is okay because no optimal window b.No evidence that ingest isolated protein powders/suppl. is necessary to enhance MPS a.Resistance: 1.6 - 1.7g/kg b.Endurance: 1.2 - 1.4g/kg o Vitamin and mineral intake o Fluid intake

PHP-5 Explain the precautions and risk factors associated with physical activity in persons with congenital and acquired abnormalities, disabilities, and diseases.

Physical activity has been well researched and proven that it produces well-known beneficial effects on health, such as decreased risk of chronic diseases and an improved quality of life. It may even reduce the risk of chronic diseases and comorbidities and improve disease-related symptoms such as high blood pressure and low strength. Rheumatoid Arthritis Exercising brings tremendous benefits with those suffering from RA. It helps relieve pain, improves joint stiffness, improves range of motion and flexibility, and boosts morale. Exercises to avoid: Strenuous exercises or exercises that cause pain (high impact exercises that put excessive strain on joints). Everybody is different so it is important to understand which exercises affect your body negatively. Common exercises for those with RA include walking, stretching, pilates, water exercises, flowing movements (tai chi and yoga), cycling, and hand exercises. However those with RA need to understand that they need to be consistent with their exercising, choose things that will allow them to exercise more comfortably such as comfortable running shoes, avoid exercises that increase symptoms, to focus not only on large muscle groups but small muscle groups such as the hand muscles, and to adjust according to the symptoms they are experiencing. Chronic Obstructive Pulmonary Disease Exercising can improve the symptoms of COPD such as shortness of breath. Also, inactivity with someone who has COPD can result in a decline in cardiovascular function and muscle mass which can result in a drastic increase in symptoms. Exercising helps with symptoms by improving physical endurance and by strengthening respiratory muscles. It is important to check with your doctor before you begin your exercise program with this condition. Exercise options that result in the best results for people living with COPD include aerobic or cardiovascular exercises as well as upper-body resistance or weight training because these focus on strengthening the heart, lungs, and surrounding respiratory muscles. People living with COPD should aim at keeping their heart rate at 50-80% of their maximum heart rate which is found by subtracting your age to 220. Before exercise it is important to get a proper warm up followed by a cool down following physical activity. These people should also be aware of the symptoms they are experiencing and terminate their workout if their breathing becomes significantly worse or feel the onset of other symptoms. Common exercises that are good options for those with COPD include: Walking Jogging Jumping rope Bicycling Skating Low-impact aerobics Swimming And resistance training (hand weights or bands)

PS-11 Describe the role of various mental healthcare providers (eg psychiatrists counselors psychologists social workers) that may compromise a mental health referrals network.

Psychiatrist- attend medical school and earn an MD or DO degree. Can attend residency to specialize but primarily focuses on biological aspects of mental illness. Psychologists- attend graduate school in psychology. The American Psychological Association recognizes the doctoral degree as the minimum educational requirement for psychologists; these degrees include the Ph.D. (Doctor of Philosophy), Psy.D. (Doctor of Psychology), or Ed.D. (Doctor of Education). 4-6 years academic preparation followed by 1-2 years of supervised work Counselor- offers guidance to individuals or groups dealing with mental health issues. Typically work holistically using a wellness model which highlights a patient's strengths. Usually rehires a bachelors degree in counseling, psychology, sociology or social work and two years of post grad supervised work between 2,000-4,000 Social worker- assist clients that deal with neglect, abuse, domestic violence and mental health and parental substance abuse. Involve teaching skills and developing mechanisms for patients to rely on to better their lives and experiences. Requirements are bachelors degree in psychology, sociology or other related fields and obtain a BSW or CSWE.

HA - 6 Explain components of the budgeting process including: purchasing, requisition, bidding, request for proposal, inventory, profit and loss ratios, budget balancing, and return on investments. (ATEP 407)

Purchasing The process that athletic trainers use to implement the budget plan Request for quotation (RFQ) (bid) A document that provides vendors with the specifications for bidding on the sale of goods and services. Assess bid Determine vendor Request purchase order Place order—negotiate freight and warranties Requisition A type of formal or informal communication, usually written, used for requesting authorization to purchase goods or services Bidding A process whereby vendors provide cost quotations for goods and services they want to sell. Request for proposal Notice from internal and external funding sources announcing the details of a grant program. Inventory A list of items made to record current available items as well as the items running low to be ordered. Profit and loss ratios Refers to the size of the average profit compared to the size of the average loss per trade. Budget balancing A budget in which revenues are equal to expenditures, which means that neither a budget deficit nor a budget surplus exists (the accounts "balance"). Return on investments Measures the gain or loss generated on an investment relative to the amount of money invested. ROI is usually expressed as a percentage and is typically used for personal financial decisions, to compare a company's profitability or to compare the efficiency of different investments. Budget Operational plan Coordinates resources and expenses Equates mission statement into financial terms Selected Types of Budgets Fixed Line item Lump sum Spending ceiling Spending reduction Variable Zero based Fixed Budget Monthly projections dictate budget Allows program to estimate cash flow No variability of unforeseen expenses Line-Item Budget Type of fixed budget Financial allocations based on program categories Cannot transfer money between categories No variability for unforeseen expenses in a given category Common categories Capital equipment Expendable supplies Minor equipment Lump-Sum Budget Type of fixed budget Program given a total amount of money for all needs Program administrator determines allotments within the services provided Allocations based on program needs Spending Ceiling Budget Also known as the incremental model Must provide justification for expenses over previous spending cycle Spending Reduction Budget Used when the program is experiencing financial distress Administrators require spending to reduce by a certain percentage to balance the budget Variable Budget Based on monthly assessment of resources Expenses do not exceed revenue Zero-Based Budget Type of performance budget Justification required for every expense Previous budget cycle has no impact on current budget cycle

CE - 23 Describe current setting-specific (eg, high school, college) and activity-specific rules and guidelines for managing injuries and illnesses. (ATEP 306)

RTP for concussion NATA states a concussion should be evaluated using a SAC (Standardized Assessment of Concussion) test; concussed athlete should not return to play on the day of the injury Athlete must be cleared by physician to begin concussion protocol and 24 hours asymptomatic prior to starting return to play protocol Once gone through specific exertional RTP protocol (specific to the school's/team's policy) without any symptoms, Athlete can't return to play until cleared by a physician and the post-concussion findings are similar to the athlete's baseline CONCUSSION RTP PROTOCOL EX. 1. No activity a. Symptoms limited physical and cognitive rest b. Objective: recovery 2. Light aerobic exercise a. Walking, swimming, or stationary cycling. &lt;70% intensity. b. Objective: increase HR 3. Sport specific exercise a. Ex. Skating drills in hockey, running drills in soccer. No head impact activities b. Objective: add movement 4. Noncontact training drills a. Progression to more complex drills. Ex. Passing drills in football. May start progressive resistance training. b. Objective: Exercise, coordination, and cognitive load 5. Full contact practice a. Need medical clearance. Participate in normal training activity b. Objective: restore confidence and assess functional skills by coaching staff 6. Return to play a. Normal game play. *If symptoms occur at any stage, fall back to stage before. *RTP protocol may vary depending on clinical setting. Managing Injury during a game varies from activity and/or game, but some general guidelines do apply Make sure the scene is safe and play has stopped; in some sports like soccer, you can't enter onto the field until referee calls you out As you are going out to the athlete, your primary survey has started as you are checking for movement until you arrive to the athlete to further rule out life threatening injuries. Check ABC's. Airway, Breathing and Circulation, if you have determined the scenario life threatening, alert EMS and continue to monitor vitals every 3 mins until EMS arrives Once you have assessed vitals and ruled out life threatening injuries, continue into your more specific on-site evaluation of chief complaint When assessing orthopedic injuries, rule out fracture first and then determine soft tissue and other structural concerns. On field assessments shouldn't be long once you have ruled out a life-threatening injury. Rule out fracture and then remove the athlete from the field safely

PD - 2 Describe the role and function of the National Athletic Trainers' Association and its influence on the profession. (ATEP 490A)

Recognizing the need for a set of professional standards and appropriate professional recognition, NATA has helped to unify certified athletic trainers across the country by setting a standard for professionalism, education, certification, research and practice settings. Since its inception, NATA has been a driving force behind the recognition of the athletic training profession. Purpose: - educate the public about Athletic Training - enhance the quality of Athletic Training - protect the interests of all Athletic Training Have released important documents such as: - position statements: Position statements are scientifically based, peer reviewed research recommendations developed by a team of authors who are experts on the subject. The NATA Foundation Pronouncements Committee has oversight of position statement development. Recently published position statements include Management of Acute Skin Trauma and Preventing and Managing Sport-Related Dental and Oral Injuries. - code of ethics: states the principles of ethical behavior that should be followed in the practice of athletic training. It is intended to establish and maintain high standards and professionalism for the athletic training profession. - educational competencies & proficiencies: Approximately 28 percent of CEUs earned through the end of the 2015 reporting period were from NATA professional development offerings, including the clinical symposia and Professional Development Center. NATA is among the top providers of BOC evidence-based practice category CEUs. NATA professional development offerings include: convention programming, Athletic Training Educators' Conference, webinars, home study courses, workshops and iLEAD. - Official statements are brief statements that give NATA's official stance on timely topics. - Support statements illustrate support between NATA and outside organizations on a particular topic. - Consensus statements are the products of inter-association task forces spearheaded by NATA. The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues was recently published. Those currently underway include: Organization and Administration of Athletic Health Care Administrative Services in Colleges/Universities, Managing Prescription and Non-Prescription Medications. Convention: - Average number of attendees at NATA Convention: 11,000 (includes members, exhibitors and guests) - Average number of exhibiting companies: 325 - Attendees can earn 25 CEUs for general registration; additional CEUs may be earned (advanced track, pre-conference workshops, mini-courses), and EBP CEUs are available.

HA-5: Describe basic healthcare facility design for a safe and efficient clinical practice setting.

Size Size of the facility is depending on needs of how many athletes are coming in or are expecting to come in. Secor has a formula that he developed and still has some relevance in the profession. (Number of patients at peak/ 20 per table per day x 100 square feet = Total square footage). It provides a good starting point and can be adjusted due to type of setting (secondary school, hospital, college), age of patients (youth, geriatric), total number clients using the facility, types of services provided, equipment needed, and projected growth of the program. Location Sports medicine center locations that serve general populations should be near other health care facilities to have easy access for labs, X-rays, or other services. Traditional athletic training clinics that are school-based for student athletes should be located close to locker rooms and possible playing/practice venues. This is to make sure injured athletes have to travel the least amount to get to the clinic or avoiding having to go through multiple doors if carrying in/transporting an athlete with an injury Illumination Lighting should be adequate to fit the needs of the facility with certain parts of the facility requiring more lighting than others. Areas of taping, wound care, and bandaging require more lighting than most areas and areas for physical examination and treatment of athletes requiring the most lighting. There's natural and artificial lighting than can be used to fulfill the needs of the facility. Artificial lighting meaning standard lights that can be turned on and off while natural lighting can come from windows and skylights that can be controlled with blinds but only available during certain hours of the day. Special service area Specialized service areas include office, taping and bandaging, hydrotherapy, general treatment, rehabilitation, storage, lavatory, and private examination area. The amount of space/funds devoted to these areas will be dependent on the types of sports/clients served, number of athletes served, qualifications of the staff, and budget availability. Treatment area/E-stim Treatment area generally includes treatment tables and electrotherapy equipment, which requires the most amount of space in the facility. The design of this area should be based on workload throughout the day, peak caseload, and treatment tables necessary fit the needs of working with athletes/patients at the same time. About 30 inches is required between each table and there should be an outlet close to each treatment table for electrotherapy and any other device that requires to be plugged in. Electrotherapy units can be placed on wheeled carts or counters if facing the treatment tables. Treatment tables should be adjustable to each injury need such as being able to elevate certain body parts. Treatment tables can be used to store equipment or supplies to maximize space. Hydro Hydro areas should be separated from the rest of the facility which will be a separate room connected to the facility. Glass "walls" are ideal to be used to contain noise from the turbines while being able to keep everything visible. Hydro rooms are designed to contain spills/floods, heat, noise, and humidity. Flooring is different to prevent any slipping with ceramic tiles. Hydro rooms will store hydrotherapy tanks, steam pack units, ice machines, freezers, paraffin baths, and in school settings it will also have water coolers and portable ice chests. Exercise Exercise/Rehab area is another space demanding area and in private clinics, it might take up most of the space. Equipment such as isokinetic machines, treadmills, ergometer, stair climbers, and isotonic weight machines can take a great deal of space and should be accounted if having these in the facility. Space between these machines should adequate enough to be safe of accidents. To save space, athletic training clinics can be housed close to the weight room to use their machines to not store space-demanding equipment such as that. Necessary open space should be accounted for exercise/rehab. Taping In school settings, taping/bandaging can be the busiest area so it is important to have sufficient space depending the needs of the facility/program. Taping stations can be individual tables or large platforms that can accommodate multiple people at once. Taping tables should be a minimum of 36 inches (3 feet) off the ground. Cupboards and drawers are needed to secure short-term supplies needed regularly. Physician's examination room Private examination rooms are necessary to be used in certain situations by athletic trainers or by physicians. These rooms don't have to be large but have enough space to be comfortable for the patients and the examiner. Supplies needed by the physician should be stored in this room. Records Records can be stored in the same facility or in adjacent locations to keep records within easy access. Storage facilities Storage area/rooms is often overlooked but a critical to a design. Ideally, storage areas should be close to taping/bandaging area for easy access in the case of depleted items. Storage rooms are helpful in keeping tape and other times away from warm and humid environment to prevent deterioration. Storage rooms should have plenty of shelves and cupboards. Storage rooms can be used to store prescribed and over-the-counter medications to comply with laws. AT office Athletic trainer's offices should serve multiple purposes. It can house records, medical files, budget information, insurance information, product information, and educational materials for students and patients. This office can be used for meetings and to meet the privacy needs of the athletic trainer, especially if on a conference call or any other privacy-demanding occation. Athletic trainer's offices can be used as a private examination room if there is limited space available.

PHP - 17 General Prevention Principles: Anaphylactic shock

Summary: Anaphylaxis is caused by an overreaction of your immune system to an allergen, or something your body is allergic to. In turn, anaphylaxis can result in anaphylactic shock. Long-term preventive measures include the recognition and management of risk factors for anaphylaxis in general, as well as measures directed to the specific triggers in particular. It is important to identify and manage comorbid conditions that increase the risk of a severe anaphylactic reaction when poorly controlled. These include asthma, cardiovascular disease, and mastocytosis or mast cell activation syndrome. Furthermore, administration of certain medications such as beta-blockers may interfere with the therapeutic response to epinephrine as previously mentioned. Young children may not be able to recognize and report early symptoms of anaphylaxis, leading to a delay in administration of epinephrine. Adolescents and young adults often display risky behavior with regards to food avoidance and poor compliance in carrying the epinephrine autoinjector. A few ways to prevent anaphylaxis is: Allergen Avoidance: To prevent anaphylaxis, it is important to avoid the allergen that causes the reaction. That may not be easy since stinging insects can find their way indoors and allergenic foods can be concealed in a wide variety of food products. If certain exercises trigger anaphylaxis, you may have to avoid those forms of exercise and/or modify them in consultation with your allergist-immunologist. Allergy Shots (Immunotherapy): For many people, allergy shots can help lower the risk of anaphylaxis and decrease the severity of reactions. For example, allergy shots for bee, wasp, hornet and yellow jacket stings give effective protection 98 percent of the time. There is some risk when an individual with past episodes of anaphylaxis is injected with an allergen, and the doctor's office should be ready to treat any anaphylaxis reaction. Medication Testing and Changes: If allergy shots are not practical or available for a particular allergen, the doctor has other options. For example, if someone has experienced an anaphylactic reaction to penicillin, the physician might order skin tests before giving certain other types of antibiotics. In most cases, different classes of antibiotics are available. People with a history of severe reactions to medicines should take a new medication orally (by mouth) whenever possible because the risk of anaphylaxis is higher with an injection. Rarely, someone may get an infection that requires treatment with an antibiotic known to cause anaphylaxis in that individual. In this case, your allergist/immunologist may perform a procedure called desensitization. This involves administration of rapidly increasing oral (by mouth) doses of the antibiotic under carefully controlled conditions

HA-24 Describe the plan to access appropriate medical assistance on disease control, notify medical authorities, and prevent disease epidemics.

To access appropriate medical assistance on disease control and to prevent disease epidemics. Athletic Trainers must plan playing their roles in disease prevention every time they are in the clinic. Following the three stages of disease prevention. Primary prevention: which involves nutrition, regular physical activity, and reducing overall risk of future diseases. Secondary prevention: the early detection of illness or disease and preventing or reversing the progression of disease. Tertiary prevention: limiting the adverse effects of an already established disease and restore to the highest level of function. In terms of notifies medical authorities, it is important for the Athletic Trainers to have good open communication with the team physician or any physician who the patients care is under. Plan to allow documentation as a good source of communication between all the medical authorities involved in the care of the patient.

PHP-39. Describe changes in dietary requirements that occur as a result of changes in an individual's health, age, and activity level. (NUTR 132)

· Dietary requirement change with age For youth athletes, they need more calcium, protein and vitamin D and B12 consumption than Adults due to growth. The variety of nutrients and calorie intake are also recommended for their growth. Young adults tend to have maximum muscle mass and the highest basal metabolic rate in their life, so adding to the variety of nutrients intake, they need more calorie consumption than other age groups. As you aged, total muscle mass tends to decrease but total body fat tends to increase due to decrease of basal metabolic rate. Thus, generally, older adults need lower calories than younger adults. · Dietary requirement change with health Dietary requirement should be adjusted to health condition. It varies by the conditions which patients have. For example, sugar intake should be well managed for a patient with diabetes. see 490D - KBC folder for corresponding image