You are WORTH it!... - PowerPoint Presentation

You are WORTH it!... Tools and Resources for the College-University Athletic Trainer April Reed, MS, ATC, CSCS Assistant Athletics Director, Head Athletic Trainer, Azusa Pacific University Carolyn Greer, MA ATC Associate Director for Sports Medicine, Head Athletic Trainer , University of San Diego Fran Babich , ATC Instructor, Butte College

CUATC FWATA REPRESENTATIVESApril Reed, Chair areed@apu.edu Fran Babich, CCDarin Voigt, NAIAMarilyn Oliver, NCAA DIII, ATEPJosh Davis, NCAA DIII, Assistant ATVanessa Yang, NCAA DIICarolyn Greer, NCAA DI AAMatthew Harrelson, NCAA DIYOU HAVE MAIL?SHOUT OUT TO US! CUATC INFORMATION

College-University Value ModelNATA AMCIA BOC Facility Standards CUATC 10/10 PresentationsDiscussionPRESENTATION OVERVIEW

HOW ARE YOU PERCEIVED AND HOW ARE YOU VALUED?

College University Value Model (CVM)

Created by NATA Committee on Revenue/ CUATC/ College Value Model WorkgroupMeant to help ATs maintain and improve their positionsMeant to create more AT jobs in college/university settingHelp ATs pair their value with institutional valuesExpand the knowledge of our jobs from “coverage” to “care” providedCollege- University Value Model (CVM)

Medical ServicesRisk Minimization Organizational/Administrative ValueCost ContainmentAT Influence on Academic SuccessCVM FIVE KEY CATEGORIES

Injury Evaluation and TreatmentInjury Rehabilitation and Reconditioning After hours/On-call consultation and injury/illness managementOutside Medical Provider ServicesTeam Physician ServicesDiagnostic TestingExclusive medical provider contractsInjury prevention programsAncillary medical services MEDICAL SERVICES

PREVENTION, EVALUATION Re-Evaluations, TREATMENT, REHABILITATION, PPE : Orthopedic, FMS, Gen Med. General Prevention: Orthopedic, GEN MED, Nutritional, etc..Coordination of MD, PT, Strength/ Conditioning, etc..On CallOthers on campus provided for: Coach, Admin, etc.MEDICAL SERVICES EXAMPLE: INJURIES, ETC

Injury Prevention & Care PoliciesEnvironmental monitoring Emergency Action PlansFunctional Movement Assessments/Assessment of pre-existing conditionsMental Health Counseling referralsNutrition suggestions and referralSafe Facilities Create/Maintain appropriate medical referral systemReview epidemiologic and current evidence-based research for clinical outcomes assessmentDesign and application of preventive and post-injury taping, bracing and padding RISK MINIMIZATION

Protective Equipment Selection, Fitting & UseRecommendations for sport rule changes Make appropriate play/no-play decisionsFirst Aid/CPR trainingInfection controlFacilitate PPEsPractice/event coverageKnowledge of and recommendations for institutional and governing body drug testingBudget management to provide adequate resources to purchase risk reduction suppliesUsing communication and interpersonal skills to create trust between student-athletes, coaches, administrators and the athletic training staff RISK MINIMIZATION cont.

Comprehensive medical screeningMovement ScreeningACL prevention programs Body Comp TestingConcussion Baseline/Neurocognitive TestingDental Protection: Custom mouth guardsPreventative Bracing Programs: Custom Knee, AnkleRISK MINIMIZATION EXAMPLE: Injury Prevention Programs

Injury recordsCredential maintenancePre-participation examination ( PPE)Sports Medicine Team relationsEmergency Action Plans (EAPs)InsuranceQuality ControlDrug TestingRisk ManagementEducation ORGANIZATIONAL/ ADMINISTRATIVE VALUE

PPEScheduling MDsCoordinating Team Rosters Scheduling Teams Sending out paperworkReceiving and processing paperworkSPORTS MEDICINE TEAM RELATIONSCoordinating designated team physicianCoordinating with OrthopedicsCoordinating with other Specialities: ENT, Opthomalogists, PTs, Dental, Chiropractic, Massage etc…. ORG/ADM. EXAMPLE: PPE & SPORTS MEDICINE TEAM RELATIONS

Insurance PremiumsStaffing and Workload Management Medical ServicesBudget ManagementFund RaisingAcademic SuccessContractsCOST CONTAINMENT

Advise athletic administrators, business office or other university staff on issues related to appropriate athletics insurance coverageMonitor utilization of athletic department insurance benefits Keep accurate records to assure insurance coverage and paymentAssist with creation of discount arrangements with outside medical/allied health services providers, and sometimes pro bono careCOST CONTAINMENT EXAMPLE: INSURANCE

Student Retention/APRLife SkillsConditions Affecting Learning/Psychological issuesCounselingAT INFLUENCE ON ACADEMIC SUCCESS

Recognition of potential problems and issues inhibiting student-athlete retentionTrouble in classes Issues with professorsDetermination of MajorLiaison and referral to campus services: career center, learning center, student life, academic advisorsImpartial observer whose jobs are not based on win/loss records. Student-athletes seek AT’s out for advice beyond injury managementEXAMPLE: STUDENT RETENTION/ APR

Mentoring as a role model and instructor in healthy lifestyle choicesRecognition of potential problems and issues related to life skills Communication issues ( Dating, roommates, family, friends, team dynamics) Conflict resolution issuesHousing IssuesDating/relationship problemsCareer decisionsJob/financial issuesGeneral Healthcare and well beingLife BalanceTime managementStress managementLife challenges/tragediesHomesicknessLiaison to campus services IE: career center, student life Treatment or assistance with care of non-sport related conditions that can affect play and continued academic engagement: Depression Eating disorders Self-mutilation Self-disclosed or t est-revealed substance use/abuse issues Life Skills

Customize it to your Institution and your needs Educate your administratorsFind out what they value, speak their languageEducate your staffEducate the next generation of ATsPair it with other tools (AMCIA, BOC, Hours Log)USE IT!!UTILIZATION OF THE CVM

AMCIA APPROPRIATE MEDICAL COVERAGE FOR INTERCOLLEGIATE ATHLETICS

The AMCIA document will help evaluate an institution’s ability to deliver health care to its student/athletes. Use of this document demonstrates that an institution has done due diligence with self-evaluation of the medical delivery system and that all stakeholders (AD, risk manager, CEO, athletic trainers, coaches and physicians) are on the same page and in agreement with the system in place.It is not meant to be a stand-alone document but to work in concert with each institution’s needs. Why Was It Created?

The trend in college athletes: more teams, more non-traditional seasons, more strength and conditioning, and more “captains” practicesThis equates to more exposures for the athlete AMCIA provides a tool to quantify the amount of medical care neededWHY AMCIA

More than basic emergency careEncompasses other health care services for ongoing daily health care, may include: PPE PreventionEvaluationRehabilitationPsychosocialAdministrationProfessional DevelopmentOther DEFINITION OF APPROPRIATE MEDICAL CARE

Committee recommendations came out in 2000 with revisions in 2003 and 2007Online worksheet was developed in 2011 with mentors to assistOriginal formula and revisions were made based on epidemiological studies that tracked injury rates and treatments in 50 colleges and universities across 5 divisions Currently being reviewed by the CUATC National Committee. AMCIA Development

Variables considered for the formula were related to the sport and:Likelihood of injurySeverity of injury Care required Other factors that affect the ATC’s timeTime = measured in HCU (Health Care Units) which is modeled from FTE (full-time equivalent for teachers)VARIABLES CONSIDERED

ConstantsEstimated health care load per AT is 12 health care units (HCU)Each sport has an assigned base Health Care Index (HCI): value derived from injury rates (IR) and treatments Each sport assigned base value also represents the risk of catastrophic injury (CI) APPLICATION OF HCU SYSTEM

VariablesTravelSquat SizeDays in Season % of Year Participating Administrative DutiesFormulaWorksheet that allows AT to enter institution specific information to determine needsAPPLICATION OF HCU SYSTEM

Be informed. Read the whole AMCIA document be able to answer questions Be conservative in your numbers, but make sure they fit your setting/institution Strategies for Using the document: Large Schools, Small Schools.. PDF onlineIn conjunction with Value Model, Recording of Hours, Etc. Maybe not more staffing, less expected coverageMentors available onlinenata.org/appropriate-medical-coverage-intercollegiate-athleticsSTRATEGIES FOR USE

FACILITY AND PATIENT CARE STANDARDS FOLLOWING STATE AND FEDERAL REGULATIONS FOR HEALTH CARE FACILITIES

The Evolution of Athletic Training FacilitiesBoard of Certification- Online evaluation tool Spring/Summer 2013 “The delivery of healthcare in the United States is heavily regulated. Numerous organizations, local, state and federal, are responsible, often overlapping, for ensuring the quality of facilities where healthcare services are delivered through the promulgation of regulations and standards.” Copyright © 2012 Board of Certification (BOC) FACILITY STANDARDS

Identified the need for the development of a document for athletic trainers and their healthcare deliveryJuly 2011: as part of the Vision Quest project of the BOC, CAATE, and the NATA developed an ad hoc group Experts chosen to develop educational materials and tools to ensure legal provision of athletic healthcare BOC INVOLVEMENT

REGULATING ORGANIZATIONS AND LAWS State licensure Athletic Training, Physician, Physical Therapy, Pharmacy State/Local Board of HealthAAAHC Accreditation Association for Ambulatory Health Care ACSM American College of Sports Medicine ADA Americans with Disabilities Act BOC Board of Certification, Inc. CAATE Commission on Accreditation of Athletic Training Education CARF Commission on Accreditation of Rehabilitation CDC Centers for Disease Control and Prevention CMS Centers for Medicare & Medicaid Services DEA Drug Enforcement Administration FDA US Food and Drug Administration FERPA Family Educational Rights and Privacy Act HIPAA Health Insurance Portability and Accountability Act JCAHO The Joint Commission NAIA National Association of Intercollegiate Athletics NATA National Athletic Trainers' Association, Inc. NCAA National Collegiate Athletic Association NFHS National Federation of State High School Associations NJCAA National Junior College Athletic Association OSHA Occupational Safety and Health Administration PPACA Patient Protection and Affordable Care Act Title IX Title IX, Education Amendments of 1972

Americans with Disabilities Act (ADA)Accessibility, non-discrimination Display of Licenses and Certifications Emergency Management(NATA, NCAA)EAPMeans of EgressEmployee Safety (CDC, OSHA)BBP; PPE, no open-toed shoesFacility/Personal hygieneWorkplace violenceFacility Safety (OSHA) Electrical Safety Fire Safety/prevention Walking/working surfaces Hazards Hazardous Materials (OSHA) Disposal: biohazard/sharps Storage/handling/MSDS Patient Safety and Supervision Supervision Reporting adverse events Records Storage ( FERPA , NATA, HIPPA ) Storage and dissemination of medical records including EMR ESSENTIAL FACILITY STANDARDS

Aquatic Safety (OSHA) Pools/therapy pools Medications (DEA, FDA) (OTC/Rx) Storage and documentationMedical DevicesLead Cord SafetyPublic SafetyPublic access AEDOSHA (includes but not limited to):ErgonomicsLightingRadiation safetyMachine safetyNoise exposure Plumbing Ventilation Private exam area ADDITIONAL FACILITY PRINCIPLES

Emergency planning (NATA, NCAA)Venue specific EAP’s Phone access Adequate and accessible Legal (BOC)Under direction of MDMalpractice insuranceOrganizational (NATA, OSHA)Policies and proceduresMaintenance of equipmentCooler cleaningPotable Water and HosesRecord keeping Paper and electronic Standards BOC Standards of Professional Practice State practice act (if applicable) PATIENT CARE PRINCIPLES

Available late spring/summerA resource that a template/checklist for athletic trainers to use as a resource to ensure that their facilities and their education meets industry standard BOCATC.ORG website or NATA.ORG Intended not only for the collegiate setting, but athletic training roomsFACILITY STANDARDS RELEASE

WHAT : Preset PPT, approx. 10 slides, meant to be delivered in 10 minutesWHO: Coaches, Administrators, SA WHERE: Found on the NATA website http://www.nata.org/access-read/member/10-10-presentations10/10 PRESENTATIONS

Asthma in AthletesConcussions in Intercollegiate Athletics Diabetes MellitusDrug Testing, Supplements, and Banned SubstancesEmergency Action PlanningEnvironmental ConsiderationsExertional Heat IllnessThe Female Athlete TriadPregnancy in Student-AthletesSickle Cell Trait and Intercollegiate AthleticsSudden Cardiac Arrest in Intercollegiate Athletics CURRENT TOPICS

Concussion Follow up- CDC Education Mental Health: Anxiety, ADHD, Mood Disorders, Depression Suicide Triage/PreventionRhabdo???FUTURE TOPICS

Add your policies, specific proceduresAdd your picsTweak them to fit the needs of your Institution/DepartmentPERSONALIZATION

Sudden Cardiac Arrest in Intercollegiate Athletics Are you prepared?

 Sudden cardiac arrest is the leading cause of death in exercising young athletes Sudden cardiac death occurs in 1:43,000 NCAA student-athletes per year The chance of survival decreases by  10% every minute after collapse The average EMS response time is 6-8 minutes The single greatest factor affecting survival is the time from cardiac arrest to defibrillation ( shock) AEDs improve survival through early defibrillation

Screening Student-athletes are required to have a pre-participation physical examination. The traditional screen includes:History (chest pain or passing out with exercise) Physical exam (blood pressure, heart sounds) Some schools perform EKG (electrocardiogram) to increase detection of athletes with at-risk conditions Appropriate experience and resources are important for EKG screening to be utilized effectively Insert institutional screening policy here if applicable

Emergency Planning Written Emergency Action Plan for SCA Emergency communication system Trained responders in CPR/ AED AED locations – all staff awareness (In Season and OUT) Access to early defibrillation (<3-5 min collapse to shock) Practice and review of the response plan at least annually Integrate AEDS into local EMS system

Location of AEDs on Campus FEC North West 1 st Floor- Wall Mount Weight Room - Wall Mount Sports Medicine Fall - FB, SOC Sports Medicine Spring - SB/TN(match), TK, BB Health Center Campus Safety Vehicles

Emergency Action Plan  Essential elements of an emergency action plan include: All venues have a specific plan, Know it, have it readily available Methods of communication Personnel requiring CPR and AED training Locations of AEDs for early defibrillation P ractice and review of the response plan

SAMPLE EAP : BASEBALL Emergency Personnel: ATC on site for games and in season practices. ATS / SMA on site for games and in season practices, when available. CPR/ AED Certified Head Coach on site for all games and practices Additional athletic training staff accessible from the Stadium athletic training room Emergency Communication: Cell phone as primary. Press box land line as back-up. Radio System Emergency Equipment: In Season Practice- Athletic Training Kit, Vacuum Splints/ Ambu Bag, Ice Off Season Practice- First Aid Kit Game- Athletic Training Kit, Ice, Spine board, Vacuum Splints/ Ambu Bag, Biohazard Kit Additional emergency equipment accessible from the Stadium athletic training facility 626-815-6000 Ext. 3212. AED available in atrium of Cougar Dome via wall mount. Roles of First Responders: 1. Immediate care of the injured or ill student-athlete 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) a. 911 call (provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested b. Notify campus safety at (626) 815-3256 or via an ATC radio on channel 4 4. Direction of EMS to scene a. Open appropriate gates b. Designate individual to "flag down" EMS and direct to scene c. Scene control: limit scene to first aid providers and move bystanders away from area Venue Directions: The baseball stadium is located APU’s Main Campus at 901 E. Alosta across the street from the McDonald’s on Alosta . Enter campus from Alosta . Citrus and Alosta are the nearest cross streets. Environmental Conditions: Lightning: Safe Shelter Location: Baseball Locker Room, Engstrom Hall, Cars (not convertibles or golf carts )

Early Recognition Early CPR Early AED Chain of Survival Improved Survival

Recognition of SCA  SCA should be suspected in any athlete who is collapsed and unresponsive SCA should be suspected in any non-traumatic collapse Brief seizure-like activity is common after collapse from SCA Seizure = SCA until proven otherwise Occasional gasping is not normal breathing… think SCA

Early CPR CPR can double or triple the chance of survival < 1/3 of SCA victims receive bystander CPR 2010 AHA guidelines Hands-only CPR Chest compressions Push hard, push fast (100 per minute)

AEDs in Sport AEDs provide a means of early defibrillation and the potential for effective management of SCA Athletes Students Staff Spectators Coaches Officials Visitors 2007

The Collapsed and Unresponsive Athlete Management of SCASuspect SCA in any collapsed and unresponsive athlete An AED should be applied as soon as possible for rhythm analysis and shock if indicated Drezner; Heart Rhythm 2007

  Steps in the Management of SCA   Recognize SCA Call for help / Call 9-1-1 Begin chest compressions (CPR) Retrieve the AED Apply and use the AED as soon as possible Continue CPR until EMS arrives

Resources Inter-Association Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement. Journal of Athletic Training 2007;42(1): 143–158 NCAA Health and Safety http://www.ncaa.org/wps/portal/ncaahome?WCM_GLOBAL_CONTEXT=/ncaa/ncaa/academics+and+athletes/personal+welfare/health+and+safety/raising+awareness+of+sudden+cardiac+collapse+in+sports

THANK THE NATA, CUATC NATIONAL COMMITTEE, VARIOUS COMMITTEESTHANK FWATA Let us know how we can help you!CLOSING