Chapter 1 Prevention Sports Injuries

Clinical evaluation and diagnosis

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

What does the BOC do?

-Awards the ATC credential -Role Delineation Study -Standards of Professional Practice

Team Members

-Team physician -Primary care physician -Coach or sport supervisor -Physical activity participant -Physical therapist -Strength and conditioning specialist -Additional specialists (Exercise physiologist, nutritionist, biomechanist, EMT & paramedic)

Treatment and rehabilitation

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

Legal Defense Types

Assumption of risk Good Samaritan laws Comparative negligence

BOC

Board of Certification

Legal Liabilities Types

Failure to Warn Foreseeability to harm Informed consent Refusing Help Product Liability Confidentiality

Product Liability: Types of Warranty

Implied Expressed Strict

Governance

Licensure (state) --> most extensive Certification (group) Registration (online)

Standards of Professional Practice

The Professional Practice and Disciplinary Procedures of the BOC are intended to assist and inform the public, certificants, and candidates for certification of the BOC Standards of Professional Practice and the Disciplinary Procedures relative to professional conduct and disciplinary procedures.

Criteria to find a individual liable

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

Preventing Litigation

Understand and complete duty of care. Take steps to reduce risk of litigation. Know NATA position and consensus statements.

Battery

any unpermitted or intentional contact with another individual without his or her consent

Tort

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

NOCSAE

establishes minimum standards for football helmets

Negligence

failure to carry out legal duty

Tort

split into omission and commission

Biomechanist

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

Good Samaritan Laws

—The laws vary from state to state —Immunity generally applies only when the emergency first aider Acts during an emergency Acts in good faith to help the victim Acts without expected compensation Is not guilty of any malicious misconduct or gross negligence toward the injured party —Laws are easy to get around and should not be relied on by rescuers who erroneously believe the laws will protect them from litigation regardless of their actions.

Strict Liability

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

Role Delineation Study

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

Injury/illness prevention and wellness protection

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

What does NATA do?

-Establishes standards for professionalism, education, research, and practice settings -Entry-Level Athletic Training Clinical Integration Proficiencies -Code of Ethics

Immediate and emergency

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

Domains

-Injury/illness prevention and wellness protection -Clinical evaluation and diagnosis -Immediate and emergency care -Treatment and rehabilitation -Organization and professional health and well-being

Five Basic Principles

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

Organization and professional health and well-being

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

Negligence Tort Types: Legal Considerations

Malfeasance Misfeasance Nonfeasance Malpractice Gross negligence

NATA

National Athletic Trainers' Association

Act of Commission

an individual commits an act that is not his or her to perform or commits an act that is his or her duty to perform but carries out the wrong procedure, leading to injury or harm —Example: distributing prescription medication; failing to follow a physician's orders —Actions are measured against a standard of care provided by individuals who have a direct duty to provide care.

Act of Omission

an individual fails to perform a legal duty —Example: failure to warn athletes of the potential risks associated with participation; failure to assess a reported injury

Registration

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

Exercise Physiologist

—Can provide information pertaining to the physiological mechanisms underlying physical activity

Nutritionist

—Concerned with the role of proper dietary care in the prevention and treatment of illnesses —Can provide valuable input regarding the specialized needs of athletes and physically active individuals

Foreseeabilty to harm

—Exists when danger is apparent, or should have been apparent, resulting in an unreasonably unsafe condition —Can be identified during regular inspections of gymnasiums, field areas, swimming pools, safety equipment, and athletic training facilities —Examples: unpadded walls under the basketball hoops, slippery floors near a whirlpool, failure to follow universal safety precautions —Unsafe conditions should be identified and reported.

Informed Consent

—Implies that an injured party has been reasonably informed of needed treatment, possible alternative treatment, and advantages and disadvantages of each course of action —Valid consent can only be obtained from one who is competent to grant it—parent or over 18 years old. —Authorization to treat in the absence of the parent, or in the event the individual is physically unable to consent to treatment, should be obtained in writing prior to the beginning of sport participation. —Exclusionary clause—identifies conditions that will not be treated by the athletic trainer (e.g., injuries not associated with direct participation in sport) —Must be sensitive to cultural and religious beliefs and practices and honor those practices by providing appropriate care consistent with the wishes of the athlete; example: in some cultures, a woman may be taught not to undress or bare skin in the presence of a man other than her husband; in this case, it would necessary to refer the athlete to a female athletic trainer.

Primary Care Physician

—In absence of team physician, plays a more pivotal role —Administer preparticipation exams; provide initial clearance for sport participation; diagnose sport injuries; prescribe medications; clear individuals for sport participation after an injury

Failure to Warn

—Inform potential sport participants of the risks for injury during sport participation —Participants and parents of minor children should learn that risk for injury exists and must understand the nature of that risk so informed judgments may be made about participation. —Comprehending the nature of the risk is determined by the participant's age, experience, and knowledge of pertinent information about the risk. —Variety of methods: preseason meetings, post warning signs, require protective equipment

State Regulation Governance

—Intended to protect the public from harm by unqualified individuals; legal foundation to assure quality of care —Legal standards vary from state to state; it is the responsibility of the ATC credential holders to understand and satisfy the standards of scope of practice as defined in state statutes.

Implied Warranty

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

Standard of Care

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

Malpractice

—Occurs when an individual commits a negligent act while providing care

Misfeasance

—Occurs when an individual commits an act that is his or her responsibility to perform but uses the wrong procedure or does the right procedure in an improper manner —Example: If you suspect a neck injury and improperly secure the head and neck region to the rigid spine board, you could be held liable.

Malfeasance

—Occurs when an individual commits an act that is not his or her responsibility to perform —Example: If you suspect a neck injury and remove the football helmet, you could be liable.

Nonfeasance

—Occurs when an individual fails to perform their legal duty of care —Example: If you suspect, or should have suspected, a neck injury and failed to use a rigid back board to stabilize the individual, you could be held liable.

Gross Negligence

—Occurs when an individual has total disregard for the safety of others

Scope of Care

—Outlines the role and responsibilities of an individual in that profession RDS - BOC —Delineates what should be learned in the professional preparation of that individual Athletic Training Education Competencies—define the educational domains used in preparing entry-level athletic trainers; each domain is then further defined by a set of cognitive, psychomotor, and affective competencies. Risk management Assessment and evaluation Acute care General medical conditions and disabilities Pathology of injury and illness Pharmacological aspects of injury and illness Nutritional aspects of injury and illness Therapeutic exercise Therapeutic modalities Health care administration Professional development and responsibilities Psychosocial intervention and referral —Clearance for participation —Final authority in determining participation status is the supervising team physician, not the certified athletic trainer.

Physical Therapist

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

Comparative Negligence

—Refers to the relative degree of negligence on the part of the plaintiff and defendant, with damages awarded on a basis proportionate to each person's carelessness —Example: If the athlete was found to be 30% at fault for his or her own injury (contributory negligent) and the defendant 70% at fault, then on a $100,000 judgment, the defendant would be responsible for $70,000 in damages and the athlete (plaintiff) would assume an equivalent of $30,000 in damages

Refusing help

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

Confidentiality

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

Assumption of risk

—Require athletes to sign an assumption of risk form; this is not the same as a permission slip —By signing the form, the athlete acknowledges The material risks and appreciates, knowingly, and reasonably anticipating that other injuries and even death are possibilities Voluntarily participation in the activity and assumes all risks of injury or even death due to their participation —Assumption of risk form does not assume the risk that the professional will breach his or her duty of care

Participant

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

Coach or sport supervisor

—Should maintain current certification in cardiopulmonary resuscitation (CPR) and emergency first aid —In the absence of an athletic trainer, the coach must assume a more active role in providing health care to sport participants Evaluate the daily status of sport participants, properly fit and use quality safety equipment, teach proper skill development and technique, and reinforce the importance of safety and injury prevention Develop an emergency plan and practice implementing that plan —Advise participants and parents of risks of injury associated with participation —Utilize conditioning programs based on sound physiological principles and training techniques and be properly supervised

Strength and conditioning Specialist

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

Certification

—State certification differs from certification as an athletic trainer. —Indicates that a person has the basic knowledge and skills required in the profession and has passed a certification examination

Licensure

—Strictest form of state regulation —Government permission for an individual to practice a profession

Team Physician

—The final authority to determine the mental and physical fitness of athletes in organized programs —Should have a fundamental knowledge of emergency care regarding sporting events; should have a working knowledge of trauma, musculoskeletal injuries, and medical conditions affecting the athlete —Relative to athletic program Administer and review preseason physical exams Review preseason conditioning programs Assess the quality, effectiveness, and maintenance of protective equipment Diagnose injuries Dispense medications Direct rehabilitation programs Educate the athletic staff on emergency policies, procedures, health care insurance coverage, and legal liability Review all medical forms, policies, and procedures to ensure compliance with school and athletic association guidelines -be present at high risk competitions

EMT/Paramedic

—Three levels of emergency medical service providers: EMT-Basic, EMT-Intermediate, Paramedic. Provide out-of-hospital care in medical emergencies and may be the first to arrive on the scene.

Expressed Warranty

—Written guarantee that the product is safe for use —In football, there is an implied warranty that if fitted and used properly, the helmet can protect the head and brain from certain injuries.