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Chapter 2: Health Care Administration in Athletic Training
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Chapter 2: Health Care Administration in Athletic Training

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  • 1. Chapter 2: Health Care Administration in Athletic Training
  • 2. System of Healthcare Management
    • Strategic Plan Development
      • Determine why there is need for such a program
      • Determine function of program within scope of athletic program
      • Decision of administrators will determine extent of health care program
      • Develop written mission statement to focus direction of program
  • 3.
    • Strategic Plan Development (cont.)
      • Strategic plan development must include administrators, student-athletes, coaches, physicians, athletic trainers, parents and community health leaders
      • Ongoing process that reviews strengths and weaknesses of program
  • 4.
    • Policy and Procedure Development
      • Creation of policies and procedures for all involved in health care of athletes necessary
      • To be covered throughout presentation
      • Abbreviated version of policies and procedures should be provided to athletes and parents (if financially feasible)
  • 5. Facility Design
    • Design will vary drastically based on number of athletes, teams, and various needs of the program
    • Size
      • Varies between settings
      • Must take advantage and manage space effectively
      • Interact with architect relative to needs of program and athletes
  • 6.
    • Location
      • Outside entrance (limits doors that must be accessed when transporting injured athletes)
      • Double door entrances and ramps are ideal
      • Proximity to locker rooms and toilet facilities
      • Light, heat and water source should be independent from rest of facility
    • Illumination
      • Well lighted throughout
      • Reflective ceilings and walls will aid in process
      • Natural lighting is a plus
  • 7.
    • Special Service Areas
      • Treatment Area : area that accommodates 4-6 adjustable treatment tables, 3-4 stools, and hydrocollator and ice machine accessibility
      • Electrotherapy Area : area that houses ultrasound, diathermy, electrical stim units, storage units, grounded outlets, treatment tables and wooden chairs, under constant supervision
      • Hydrotherapy Area: area with centrally sloping floor to drain, equipped with 2-3 whirlpools, shelving and storage space and outlets 5 feet above the floor
  • 8.
      • Exercise Rehabilitation Area: area that provides adequate space and equipment to perform reconditioning of injuries
      • Taping, Bandaging & Orthotic Area: 3-4 taping tables and storage cabinets to treat athletes with proximity to a sink
      • Physician’s Exam Room: space for physician to work which may hold exam table, lockable storage, sink, telephone, refrigerator
      • Records Area: space devoted to record keeping which may include filing system or computer based database, that allows access only to medical personnel
  • 9.
    • Storage Facilities
      • Training rooms often lack ample storage space
      • Storage in training room that holds general supplies and special equipment
      • Large walk-in storage cabinet for bulk supplies
      • Refrigerator for equipment, ice cups, medicine and additional supplies
    • Athletic Trainer’s Office
      • Space at least 10x12 feet is ample
      • All areas of training room should be supervised without leaving office space (glass partitions)
      • Equipment should include, desk, chair, tack board, telephone, computer (if necessary) and independent locking system
  • 10.
    • Additional Areas
      • Pharmacy Area: separate room that can be secured for storing and administrating medications (records must be maintained concerning administration)
      • Rehabilitation Pool: if space permits, must be accessible to individuals with various injuries, with graduated depth and non-slip surface
      • X-Ray Room: separate room with lead shielding in walls, large enough to house necessary equipment
  • 11.  
  • 12.  
  • 13. Athletic Training Program Operations
    • Scope of Program
      • Who will be served by program?
      • Athlete: to what extent and what services will be rendered (systemic illness, musculoskeletal injuries)
      • Institution: who else can be served medically and educationally and what are the legalities
      • Community: outside group and community organizations with legalities again being an issue
  • 14.
      • Clinical and Industrial Settings: patient care outside high school and collegiate athletes, with a broader scope of practice that could include:
        • Pediatric work
        • Work hardening
        • Orthopedic and neurological patients
      • Athletic trainers should be sure to work within their scope (physically active)
      • Fitness programming may also become an ATC’s responsibility in this setting
  • 15. Providing Coverage
    • Facility Personnel Coverage
      • Appropriate coverage of facility and sports
      • Setup of treatments, rehabilitation, game and practice coverage vary
    • Sports Coverage
      • Certified athletic trainer or at least a student should attend all practices and games (home and away)
      • Different institutions (including high schools) have different levels of coverage based on personnel and risks involved with sports
  • 16. Hygiene and Sanitation
    • Athletic Training Facility
      • Rules concerning room cleanliness and sanitation must be set and made known to population using facility
      • Examples
        • No equipment/cleats in training room
        • Shoes off treatment tables
        • Shower prior to treatment
        • No roughhousing or profanity
        • No food or smokeless tobacco
  • 17.
      • Cleaning responsibilities are divided between athletic training staff and maintenance personnel
      • Division of responsibilities
      • Maintenance crew
        • Sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste baskets
      • Athletic Training staff
        • Clean treatment tables, disinfect hydrotherapy modalities daily, clean equipment regularly
  • 18.
    • Gymnasium (general issues concerning facility and equipment cleanliness)
      • Facility
        • Cleaning of gymnasium floors
        • Drinking fountain and shower/locker facility disinfecting
        • Matted service cleaning (wrestling)
      • Equipment and clothing
        • Proper fitting equipment
        • Frequent clothing and equipment laundering
        • Appropriate equipment for weather conditions
        • Use of clean dry towels and equipment daily
  • 19.
    • Athlete
      • Promotion of good health and hygiene is critical
        • Athlete clearance to participate
        • Athlete insurance
        • Prompt injury and illness reporting
        • Follow good living habits
        • Avoid sharing clothes and towels
        • Exhibit good hygiene practices
        • Avoid common drinking sources
  • 20. Emergency Telephones
    • Accessibility to phones in all major areas of activity is a must
    • Should be able to contact outside emergency help and be able to call for additional athletic training assistance
    • Radios, cell and digital phones provide a great deal of flexibility
  • 21. Budgetary Concerns
    • Size of budget??
    • Different settings = different size budgets and space allocations
    • Equipment needs and supplies vary depending on the setting (college vs. high school)
    • Continuous planning and prioritizing is necessary to effectively manage monetary allocations to meet programmatic goals
  • 22.
    • Supplies
      • Expendable (supplies that cannot be reused- first aid and injury prevention supplies)
      • Non-expendable (re-useable supplies -ace wraps, scissors…etc)
      • Yearly inventory and records must be maintained in both areas
    • Equipment
      • Items that can be used for a number of years
      • Fixed (remain in the training room- ice machine, tables)
      • Non-fixed (crutches, coolers, training kits)
  • 23.
    • Purchasing Systems
      • Direct buy vs. competitive bidding
      • Lease alternative
    • Additional Budget Considerations
      • Telephone and postage expenses
      • Contracts for outside services
      • Purchases relative to liability insurance and professional development
  • 24. Developing a Risk Management Plan
    • Security Issues
      • Accessibility to training room (staff, physicians, student athletic trainers)
      • Supervision issues
    • Fire Safety
      • Post evacuation plan in case of fire
      • Smoke detectors/alarm system and fire extinguisher should be tested and in place
  • 25.
    • Electrical and Equipment Safety
      • Major concern
      • Be aware of power distribution system to avoid accidents
    • Emergency Injury Management
      • Accessing emergency personnel outside setting in the event of emergency
      • Include transportation of athletes to emergency facilities
      • Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care
  • 26. Accessing Community Based Health Services
    • Must have knowledge of local and community health services and agencies in the event of referrals
    • Referrals should be made with assistance from a physician
    • Parental involvement is necessary when dealing with psychological and sociological events
  • 27. Human Resources and Personnel Issues
    • The sports medicine team is only as good as the individuals in the group
    • Recruitment, hiring and retaining qualified personnel is necessary to be effective
    • Specific policies are established relative to hiring, firing, performance evaluations and promotions
      • Must adhere to these principals
  • 28.
    • Roles and responsibilities must be established
      • (job descriptions - job specifications, accountability, code of conduct, and scope)
    • Head athletic trainer must serve as a supervisor and work to enhance professional development of staff
    • Performance evaluations should take place routinely
  • 29. Record Keeping
    • Major responsibility
    • Rule not the exception - accurate and up-to-date
    • Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports
  • 30. Administering Preparticipation Examinations
    • Initial pre-participation exam prior to start of practice is critical
    • Purpose it to identify athlete that may be at risk
    • Should include
      • Medical history, physical exam, orthopedic screening, wellness screening
    • Establishes a baseline
    • Satisfies insurance and liability issue
  • 31.
    • Examination by Personal Physician
      • Yields an in-depth history and ideal physician-patient relationship
      • May not result in detection of factors that predispose the athlete to injury
    • Station Examination
      • Provides athlete with detailed exam in little time
      • Team of nine is ideal (2 physicians, 2 non-physicians and 5 managers/student athletic trainers)
  • 32.
    • Medical History
      • Complete prior to exam to identify past and existing medical conditions
      • Update yearly and closely review by medical personnel
      • Collect medical release and insurance info at the same time
    • Physical Examination
      • Should include assessment of height, weight, body composition, blood pressure, pulse, vision, skin, dental, ear, nose, throat, heart, lungs, abdomen, lymphatic, genitalia, maturation index, urinalysis and blood work
  • 33.
    • Maturity Assessment
      • Means to protect young physically active athletes
      • Methods
        • Circumpubertal (sexual maturity)
        • Skeletal
        • Dental
      • Tanner’s five stage assessment is most expedient
    • Orthopedic Screening
      • Part of physical exam or separate
      • Various degrees of detail concerning exam
  • 34.
    • Wellness Screening
      • Purpose is to determine if athlete is engaged in a healthy lifestyle
    • Sport Disqualification
      • Certain injuries and illnesses warrant special concern when dealing with sports
      • Recommendations can be made
      • American with Disabilities Act (1990)
        • Dictates that athlete makes the final decision
      • Potential disqualifying factors should be determined during the preparticipation exam
  • 35. Injury Reports and Injury Disposition
    • Injury reports serve as future references
    • Reports can shed light on events that may be hazy following an incident
    • Necessary in case of litigation
    • All reports should be filed in the athletic training room
  • 36. Treatment Log
    • Sign-in to keep track of services
    • Daily treatments can be recorded
    • Can be used as legal documentation in instances of litigation
    • Personal Information Card
    • Contains contact information for family, personal physician, and insurance information
  • 37. Injury Evaluation and Progress Notes
    • Injuries and progress should be monitored by athletic trainer and recorded
    • SOAP note format
      • S: Subjective (history of injury/illness)
      • O: Objective (information gathered during eval)
      • A: Assessment (opinion of injury based on information gained during evaluation)
      • P: Plan (short and long term goals of rehabilitation)
  • 38. Supplies and Equipment Inventory
    • Managing budget and equipment/supplies is critically important
    • Inventory must be taken yearly in order to effectively replenish supplies
  • 39.
    • Annual Report
    • Summary of athletic training room functioning
    • Can be used to evaluate recommend potential changes for program
    • Includes number and types of injuries seen/treated
    • Release of Medical Records
    • Written consent is required
    • Waiver must be signed for any release (include specifics of information to be released and to whom)
  • 40. Computer as Tool for Athletic Trainer
    • Indispensable tool
    • Can make the job more efficient with appropriate software
    • Must maintain security
    • Can also be used for other administrative tasks
  • 41. Collecting Injury Data
    • Accident - unplanned event resulting in loss of time, property damage, injury or death
    • Injury- damage to the body restricting activity
    • Case study- looks at specific incident of injury
    • Injury study falls under numerous categories
      • Age, gender, body part, occurrence in different sports
      • Contact vs. non-contact sports
  • 42.
    • Catastrophic Injuries
      • 98% of injuries requiring hospital emergencies are treat and release relative to sport
      • Sports deaths (struck with object, heat stroke)
      • Catastrophic injuries also include spinal cord trauma, cardiorespiratory injuries/problems
      • Most injuries are related to appendages
        • Strains, sprains, contusions, fractures, abrasions
  • 43.
    • Current National Injury Data-Gathering Systems
      • State of the art injury surveillance is still developing
      • Ideal situation
        • Epidemiological approach that studies relationship of various factors that influence frequency and distribution of injury in sport
        • Extrinsic factors (activity, exposure, equipement)
        • Intrinsic factors (age, gender, neuromuscular aspects, structural aspects….etc)
      • Number of different surveillance systems in place
  • 44.
    • Surveillance Systems
      • National Safety Council (general sports injury data)
      • Annual Survey of Football Injury Research (public school, college, professional, sandlot football injury data)
      • National Center of Catastrophic Sport Injury Research (Tracks catastrophic injuries in all levels of sports)
      • NCAA Injury Surveillance System (data collected on most major sports- ATC data collection)
  • 45.
      • National Electronic Injury Surveillance System (Monitor injuries relative to different products --consumer safety, determine if products are hazardous or defective)
      • National High School Sports Injury Registry (tracks injuries in specific sports at 150-200 high schools)