Chapter 1 The Athletic Trainer as a Health Care Provider
Chapter 1
Extended Lecture Outline
· Introduction
o Athletic Trainers are health care professionals who specialize in preventing, recognizing, managing and rehabilitating injuries.
o The Athletic Trainer is concerned with the well-being of the athlete and assumes responsibility for overseeing the total health care for the athlete.
o The Field of Athletic Training provides the major link between sports programs and the medical community for implementation of injury prevention; emergency care and rehabilitative procedures.
· Historical Perspectives
o Early History
§ Some evidence links Athletic Training to the early Greek and Roman civilizations
§ Athletic training came into existence during the late 19th century with the firm establishment of intercollegiate and interscholastic athletes in the U.S.
§ First Athletic Trainer’s possessed no technical knowledge – rubbed people down with counterirritants and used home remedies and poultices.
o Evolution of the Contemporary Athletic Trainer
§ Athletic trainer and trainer often used interchangeably and are confused with one another.
§ Evolution of athletic training occurred rapidly after WWI with appearance of the Athletic Trainer in intercollegiate athletics.
§ Dr. S.E. Bilik, had a major influence in developing athletic training – wrote “The Trainers Bible” in 1917.
§ In early 1920’s the Cramer family began producing liniment to treat ankle sprains.
§ In 1932, the Cramer family published “The First Aider” to enhance communication among coaches, athletic trainers and athletes.
§ 1947-1950, university athletic trainers organized themselves into separate regional conferences – later to become the districts within the NATA.
§ In 1950, 101 athletic trainers met in Kansas City and officially formed the NATA with the primary purpose of establishing professional standards for the athletic trainer.
§ In 1974 NATA members equaled 4,500 members. Today there are more than 32,000 members.
o The Changing Face of the Athletic Training Profession
§ Historically the work environment for Athletic Trainers was a “traditional setting”
§ 40% of Athletic Trainers today are employed in clinics and hospitals, or industrial/occupational settings
§ Other job opportunities found in “non-traditional settings” including NASCAR, rodeo, performing arts, law enforcement
§ Athlete refers to physically active individuals who participate in recreational or organized sport activities who are not currently injured
§ Patient refers to any individual who is ill or injured, who is being treated by an Athletic Trainer
· Sports Medicine and Athletic Training
o The Field of Sports Medicine
§ Sports medicine refers to a broad field of medical practice related to physical activity and sport.
§ Sports Medicine encompasses specialized areas under its umbrella concerned with performance enhancement
o Growth of Professional Sports Medicine Organizations
§ The 20th century brought the development of professional organizations dedicated to athletic training and sports medicine.
§ Goals of professional organizations
· Upgrade the field by devising and maintaining professional standards including a code of ethics
· Bring professionals together to exchange ideas, stimulate research and promote critical thinking
· To give individuals the opportunity to work as a group towards obtaining objectives
· Disseminate information to general public about safe participation in sport activities in the form of guidelines and position statements
· Employment Settings for the Athletic Trainer
§ Employment opportunities for Athletic Trainers are more diverse than in the past
· Clinics and Hospitals
· Physician Extenders
· Industrial/Occupations Settings
· Corporate Settings
· Colleges and Universities
· Secondary Schools
· School Districts
· Professional Sports
· Amateur/Recreational/Youth Sports
· Performing Arts
· Military and Law Enforcement/Government
· Health and Fitness Clubs
· Roles and Responsibilities of the Athletic Trainer
§ The Athletic Trainer
· Most responsible for all phases of health care
· The specific roles and responsibilities differ and are defined by the situation in which he/she works
§ Board of Certification Performance Domains
· Role delineation study – defines the profession of athletic training
· Roles of practicing athletic trainers are divided into five performance domains (Prevention, Clinical Evaluation and Diagnosis, Immediate Care, Treatment, Rehabilitation and Reconditioning, Organizational and professional health and well-being)
§ Domain I: Prevention
· Conducting Pre-participation physical examinations
· Developing training and conditioning programs
· Ensuring a safe playing environment by minimizing safety hazards
· Selecting, fitting, and maintaining protective equipment
· Explaining the importance of diet and lifestyle choices
· Using Medications appropriately
§ Domain II: Evaluation and Diagnosis
· Understanding the pathology of injury and illness
· Referring to medical care
· Referring to support services
§ Domain III: Immediate Care
· Should be trained in CPR and AED use by the American Red Cross
· Certified in first aid
· Have established, well-defined emergency action plans
§ Domain IV: Treatment, Rehabilitation and Reconditioning
· Designing rehabilitation programs
· Supervising rehabilitation programs
· Incorporating therapeutic modalities
· Offering psychosocial intervention
§ Domain V: Organizational and professional health and well-being)
· Record keeping
· Ordering equipment and supplies
· Supervising personnel
· Establishing policies for the operation of an athletic training program
· The athletic trainer and continuing education
· The athletic trainer as an educator
· The athletic trainer as a counselor
· The athletic trainer as a researcher
§ Education council competencies and clinical proficiencies
· Dictate the course of educational preparation for the student athletic trainer
· Overlap exists between the BOC performance domains and the 12 clinical competency domains
· The 12 Clinical Competencies
o Risk Management
o Pathology of Injuries and Illnesses
o Assessment and Evaluation
o Acute Care
o Pharmacological Aspects of Injury and Illness
o Therapeutic Modalities
o Therapeutic Exercise
o General Medical Conditions and Disabilities
o Nutritional Aspects of Injury and Illnesses
o Psychosocial Intervention and Referral
o Health Care Administration
o Professional Development and Responsibilities
· The Importance of Engaging in Evidence-Based Practice for the Athletic Trainer
o Five Steps in Evidence-Based Practice
§ Develop a clinical question
§ Search the literature
§ Appraise the evidence
§ Assess the outcomes
o PICO
§ Patient condition
§ Interventions
§ Comparison
§ Outcome
· Professional Behaviors of the Athletic Training
o Personal Qualities
§ Stamina and Ability to Adapt
§ Empathy
§ Sense of Humor
§ Communication
§ Intellectual Curiosity
§ Ethical Practice
§ Professional Memberships
· The Athletic Trainer and the Athlete
o The athletic trainer and the Athletes parents
· The Athletic Trainer and the Team Physician
o Roles and Responsibilities of the Team Physician
§ Ultimately responsible for directing the total health care of the athlete
§ Supervisor and advisor to the athletic trainer
§ Compiles medical histories
§ Diagnosing injury
§ Deciding on disqualifications and return to play
§ Attending practices and games
§ Commitment to sports and the athlete
§ Academic program medical director
· The Athletic Trainer and the Coach
o Roles and Responsibilities of the Coach
§ Directly responsible for preventing injuries by seeing that athletes have undergone a preventative injury conditioning program
§ Ensures sports equipment is of high quality and fitted properly
§ Maintenance of protective equipment
§ Certified in first-aid and CPR
§ Thorough understanding of the skill techniques and environmental factors affecting athletes
§ Needs to be involved in decision making process concerning athletes in conjunction with the team MD and athletic trainer
· Referring The Athlete to Medical and Non-Medical Support Services and Personnel
o A variety of support health services and support personnel may be utilized by a sports program
§ Nurses, School health services, Dentists, Podiatrist, PA’s, Physical therapists etc. (See text for list and definitions)
· Recognition and Accreditation of the Athletic Trainer as an Allied Health Professional
o In June 1990, the AMA officially recognized athletic training as an allied health profession
o The AMA’s Committee on Allied Health Education and Accreditation (CAHEA) responsible for developing the requirements for athletic training academic programs
o 1994, CAHEA was replaced by the Commission on Accreditation of Allied Health Education Programs (CAAHEP)
o 2003, JRC-AT (The Joint Review Committee on Athletic Training) became an independent accrediting agency
o 2006 JRC-AT officially became the Committee for Accreditation of Athletic Training Education (CAATE)
o 2007 CAATE was officially recognized by the Council for Higher Education Accreditation (CHEA). Through recognition by CHEA, CAATE will be in the same context/level as CAAHEP and other national accreditors.
· CAATE Accredited Entry-Level Athletic Training Education Programs
o December 2007 – 350 institutions across United States offered entry-level athletic training education programs (340 bachelors and 12 masters)
o Education Council Competencies and Clinical Proficiencies
o Foundational Behaviors of Professional Practice
o Post-certification Graduate Athletic Training Education Programs
o Specialty Certifications
· Requirements for Certification as an Athletic Trainer
o Certification Examination
§ As of 2004, the only way an individual can become certified is by completing an entry-level athletic training education program
§ In 2007, all sections of the examination became a computer based exam (CBE)
§ The examination tests knowledge from all six domains
o Continuing Education Requirements: encourage athletic trainers:
§ To continue to obtain current professional development information
§ To explore new knowledge in specific content areas
§ To master new athletic training-related skills and techniques
§ To expand approaches to effective athletic training
§ To further develop professional judgment
§ To conduct professional practice in an ethical and appropriate manner
o Certified ATCs must document a minimum of 75 CEUs during each 3 year recertification period, and must demonstrate proof of current CPR/AED certification
· State Regulation of the Athletic Trainer
o 44 of the 50 states have enacted some type of regulatory statutes governing the practice of athletic training.
o Rules and regulations vary from state to state and may be in the form of certification, registration, licensure, or exemption
§ Licensure limits the practice of athletic training to those who have met minimal requirements established by a state licensing board
§ Certification by a state indicates that a person possesses the basic knowledge and skills required in the profession and has passed a certification exam
§ Registration means that before an individual can practice athletic training, he/she must register in that state and pay a fee to practice
§ Exemption means that a state recognizes that athletic trainers perform functions similar to those of other licensed professions (e.g. PT’s) yet still allow them to practice athletic training despite the fact they do not comply with the practice acts of other regulated professions
· Future Directions for the Athletic Trainer
o Ongoing re-evaluation, revision and reform of athletic training curriculum programs
o Recognition of CAATE by the Council for Higher Education Accreditation will further enhance the credibility of athletic training
o Athletic trainers continue to actively seek third-party reimbursement
o Eventually every state will regulate the practice of athletic training, with more standardized practice acts
o Athletic trainers will seek and achieve specialty certifications.
o More secondary schools will employ certified athletic trainers
o Increase in the use of athletic trainers as physician extenders
o Expansion of athletic trainers in the military
o Increased opportunities for athletic trainers to work in industrial and corporate settings.
o Opportunities for athletic trainers to work in fitness and wellness settings
o To work w/children and teenagers as sport performance specialists
o Increase in the opportunities for athletic trainers to work with the elderly physically active population
o Continue to increase public awareness through research and scholarly publications
o Athletic trainers will become recognized internationally
o Most importantly athletic trainers will continue to focus on injury prevention and to provide appropriate, high-quality health care to the physically active individuals who are injured while participating in sport
Prentice, Principles of Athletic Training , 15e LO-1 | 1