NATA BOC Role Delineation (modified)

 

II.      Classification System of Domains, Tasks, and Knowledge and Skill Statements

 

This section of the report contains the domains, tasks, and knowledge and skill statements as delineated by the role delineation study panel of experts and validated with data from the role delineation study survey described later in this report. Each domain begins with a summary of athletic training literature defining the domain and describing current practice and trends.

 

Domain I.            Prevention

 

Domain II.           Clinical Evaluation and Diagnosis

 

Domain III.          Immediate Care

 

Domain IV.         Treatment, Rehabilitation, and Reconditioning

 

Domain V.           Organization and Administration

 

Domain VI.         Professional Responsibility

 

 

Performance Domain I: Prevention

 

Prevention is defined as the ability to discern, evaluate, and communicate risk associated with participation in athletic and physical activities. In this sense, risk is defined as “exposure to the chance of injury or loss; a hazard.”130 Athletic activities have been classified by degree of risk,88, 31 and it is noteworthy that participants and/or their guardians must acknowledge that a certain degree of risk, termed the individual assumption of risk, that narrows the scope of prevention measures that can be employed by Athletic Trainers-Certified (ATC).44, 76

 

Basic human anatomy, physiology,57, 123 and biomechanics40, 58 serve as the cornerstone for understanding injury/illness risk and mechanisms. ATCs also require knowledge related to the epidemiology102 and pathophysiology53, 69 of common and catastrophic injuries and illness.48, 84, 137 Of particular importance, the catastrophic consequences of HIV, hepatitis, and other infectious diseases must be addressed and prevented.80, 97 Additionally, recent attention has been given to the detrimental physiological and psychological effects of overtraining120 as new theories124 support long-term consequences; and while they may not be catastrophic, must be prevented or at least minimized. Injury databases are helpful in communicating statistical probabilities to appropriate individuals.83, 101, 104

 

Recent attention to the catastrophic effects of neurological or brain injury in physical activities merits specific attention because some concepts relevant to the Prevention domain (such as risk,64, 138 return-to-play criteria,90 and second-impact syndrome39, 81, 139) are still subject to debate,33 and only one text is available that addresses sports neurology.65 Additionally, the sudden deaths of several well-known sports figures in recent years1, 100 emphasizes the need for ATCs to be aware of the risk and prevention of sudden death, typically because of cardiovascular failure. This means that ATCs need to know the recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities.5

 

The prevention of injury and illness challenges the ATC to understand and use preventive measures to ensure the highest quality of care for every individual athlete. While the knowledge and skills in prevention are broad and overlap somewhat with the other domains of athletic training, their designation as a separate domain in the Role Delineation Study reflects the importance of and priority given to the prevention of injury and illness.

 

Responsibilities in Prevention in the current Role Delineation Study differ from those of previous studies in that the scope of the activities has broadened considerably in recent years. This change reflects significant progress in sports and medical research and technology, including the expanded authority of governing bodies in today’s allied health professions, the increased participation of a wide variety of individuals (especially women), and expansion in the type of events, practices, and physical activity.88

 

A.  Educate the appropriate individual(s) about risks associated with participation and specific activities using effective communication techniques to minimize the risk of injury and illness.

 

At the same time, the variety of individuals with whom an ATC must communicate regarding risk and prevention has expanded. These individuals, termed “appropriate” in the domain, are associated with (1) the sports medicine team,31, 29, 126, 136 (2) the clinical setting,67 and (3) fitness facilities.11 ATCs also communicate risk because of legal considerations.30, 118

 

Communicating the risk of participation assumes knowledge of both common and catastrophic risk, as well as their mechanisms of injury or illness. While there is merit in separating the common from catastrophic in prevention, most text resources address both types, with more attention given to common injuries or illnesses involving the musculoskeletal, neurological, and respiratory systems.31, 50, 67, 75, 110, 115 A few noteworthy texts address the pediatric population.36, 66 134

 

The prevention of nutritional disorders12, 96, 133, 2, 10, 17 and use of dietary supplements87 among physically active individuals have become standard activities for ATCs. Likewise, ATCs need to understand substance abuse when used for both social98 and performance enhancement.8, 34 The use of pharmacological agents in the athletic training room has drawn considerable attention in risk management, whether from a safety,99, 103, 119 prevention,42, 79 or legal61 perspective. The ability to communicate these risks to appropriate individuals depends on knowledge of medical risk terminology,41, 51, 78 management strategies,30, 59, 67, 118 governing and legal bodies,35, 49 and most recently, federal privacy regulations94, 95, 111 and reimbursement issues.26

 

B.  Interpret preparticipation and other relevant screening information in accordance with accepted guidelines to minimize risk of injury and illness.

 

The Prevention domain categorizes risk into three general areas: (1) physiological or health related, (2) environmental (including facilities), and (3) equipment related. Each area requires a preparticipation evaluation based on existing guidelines and current state of practice.

 

Preparticipation health and fitness screening prior to physical activity has become one of the single most important prevention measures to reduce the incidents of catastrophic injury or illness.19 While the 2002 Arnheim & Prentice 31 text provides a general overview of the components involved in preparticipation screening as do other athletic training texts, only a few noteworthy references exist relating to disqualifying criteria121 and cardiovascular screening.116 The value of preparticipation examination information for children is addressed in journal articles.28, 37, 85, 86 Likewise, preparticipation criteria exist for special populations that require special considerations, including pregnant women,32 physically disabled athletes, 45 and individuals with chronic diseases and disabilities.22, 134 Cardiovascular,15, 77 respiratory,73, 122 diabetic,16 and drug74 screening guidelines have been published that specifically address these medical concerns in the athletic population, rather than in the general population.

 

C.  Instruct the appropriate individual(s) about standard protective equipment by using effective communication techniques to minimize risk of injury and illness.

 

D.  Apply appropriate prophylactic/protective measures by using commercial products or custom-made devices to minimize risk of injury and illness.

 

Risk associated with sport and physical activities can be addressed through the application of standard or commercial protective/prophylactic equipment and products. This aspect of prevention is well documented in most athletic training textbooks. However, other references supplement these texts and are discussed in the following paragraphs. Prevention requires that the ATC be knowledgeable about these products: their intended purpose,3, 27, 70, 114, 127 limitations,43, 128 and capabilities for protection in specific sports and physical activities;55 the rules governing their use; and the guidelines, standards,106 and/or recommendations for their use by a host of governing bodies. Additionally, the health63 and legal risks of using,125 reconditioning,56 and/or altering the structure35, 49 of these products in any way must also be identified.

 

 E.  Identify safety hazards associated with activities, activity areas, and equipment by following accepted procedures and guidelines in order to make appropriate recommendations and to minimize the risk of injury and illness.

 

ATCs have long had responsibility for identifying safety hazards in activity areas and equipment. Other professionals, such as athletic directors, facility and equipment managers, and game officials also share this responsibility.11, 91 Thus, policies and procedures for identifying and correcting hazards must be known by all ATCs.6 Knowledge of the facilities and/or equipment required for specific activities as well as the rules governing play or participation in those areas and with the equipment are required.102, 105 Common hazards, such as surface, obstructions, moisture, foreign bodies, lighting, and broken equipment, must be identified and corrected.31, 91 ATCs may soon be active in identifying safety hazards related to the newly popular sports of mountain biking71 and snowboarding.129 Transmission of infectious diseases is also included in this aspect of the Prevention domain.132

 

F.   Maintain clinical and treatment areas by complying with safety and sanitation standards to minimize risk of injury and illness.

 

Numerous local, state, national, federal, and institutional bodies have established standards and regulations to ensure safe and sanitary conditions in treatment and clinical areas used by ATCs and other healthcare professionals.97, 107, 108, 109, 112, 113 It is the responsibility of the ATC to know and comply with these standards and regulations. Additionally, ATCs are required to comply with the guidelines of any and all manufacturers of equipment used in those areas.24, 49 Safety standards are further enhanced with the recent availability of automated external defibrillators in health and fitness facilities.20

 

 G. Monitor participants and environmental conditions by following accepted guidelines to promote safe participation.

 

Environmental and ambient conditions can impose additional risk on individuals participating in outdoor activities.38 Risk is even greater when participants present with conditions that predispose them to environmental injury or illness.22, 122 ATCs must identify, monitor, and control the risk imposed by the environment, especially for at-risk participants. Established standards and policies and procedures can assist the ATC in this task.4, 7, 8, 89, 92, 93

 

H.  Facilitate physical conditioning by designing and implementing appropriate programs to minimize injury risk.

 

With an increase in the number of participants and activity events, and with the presence of ATCs in non-traditional roles, the importance of designing and implementing physical conditioning programs cannot be underestimated. This component of prevention is essential to reduce the risk of injury or illness, yet attention given this area may be declining with the advancing specialization of other healthcare professionals. ATCs are required to know the physiological adaptations to exercise38, 62 and the components of safe and effective physical conditioning13, 14, 19, 72 and strength training21, 25, 68, 117 programs. The ATC should also be aware of the potential for overtraining.47, 120 Knowing and complying with legal considerations for designing and implementing conditioning programs is also the responsibility of the ATC.60

 

I.    Facilitate healthy lifestyle behaviors using effective education, communication, and interventions to reduce risk of injury and illness and promote wellness.

 

Although individuals who participate in sports or regular physical activities are likely to improve their overall health, they may remain at risk for other leading causes of death because of non-healthy lifestyle behaviors. The negative influence of non-healthy lifestyle behaviors (such as smoking, poor diet, and stress on the cardiovascular system), may negate any positive changes made through regular exercise program participation. As a healthcare team member, ATCs are obligated to educate and encourage wellness and healthy lifestyle behaviors in the individuals they treat. Many nutrition and exercise-related texts are available;113, 133 however, publications specifically addressing methods for how the ATC should implement wellness promotion into daily practice are relatively less abundant.18, 54, 82 Intervention strategies for reducing substance abuse among clients are also available.46,52

 

I.          Prevention

A.     Educate the appropriate individual(s) about risks associated with participation and specific activities using effective communication techniques to minimize the risk of injury and illness.

Knowledge of:

1.                  Appropriate individuals (e.g., administrators, management, parents/guardians/family members, coaches, participants, and members of the healthcare team)

2.                  Common risks (e.g., musculoskeletal, integumentary, neurological, respiratory, and medical)

3.                  Catastrophic risk (e.g., cardiorespiratory, neurological, thermoregulatory, endocrinological, and immunological)

4.                  Behavioral risk (e.g., nutritional, sexual, substance abuse, blood-borne pathogens, sedentary lifestyle, and overtraining)

5.                  Mechanisms of common and catastrophic injury

6.                  Preventive measures (e.g., safety rules, accepted biomechanical techniques, ergonomics, and nutritional guidelines)

7.                  Epidemiology data related to participation

8.                  Effective communication techniques (e.g., multimedia videos, pamphlets, posters, models, handouts, and oral communication)

Skill in:

1.                  Identifying risks

2.                  Communicating effectively

3.                  Educating effectively

4.                  Identifying appropriate resources

 

B.     Interpret pre-participation and other relevant screening information in accordance with accepted guidelines to minimize the risk of injury and illness.

Knowledge of:

1.                  Preparticipation evaluation process and procedures

2.                  Established laws, regulations, and policies (e.g., institutional, state, and national)

3.                  Established guidelines for recommended participation

4.                  Privacy laws

Skill in:

1.                  Identifying conditions that may limit or compromise participation

2.                  Collecting and appropriately applying preparticipation screening information

3.                  Identifying appropriate resources

4.                  Identifying and applying established guidelines and regulations

C.     Instruct the appropriate individual(s) about standard protective equipment using effective communication techniques to minimize the risk of injury and illness.

Knowledge of:

1.                  Legal risks and ramifications of making equipment modifications

2.                  Rules pertaining to the use of protective equipment

3.                  Manufacturer’s guidelines regarding selection, fit, inspection, and maintenance of equipment

4.                  Established standards pertaining to protective equipment (e.g., NOCSAE and ASTM)

5.                  Intended purpose, limitations, and capabilities of protective equipment

6.                  Effective communication techniques

7.                  Effective instructional techniques

Skill in:

1.                  Educating individuals on the selection of standard protective equipment

2.                  Communicating effectively

3.                  Fitting standard protective equipment

4.                  Interpreting rules regarding protective equipment

 

D.     Apply appropriate prophylactic/protective measures using commercial products or custom-made devices to minimize the risk of injury and illness.

Knowledge of:

1.                  Commercially available protective products

2.                  Materials and methods for fabricating custom-made protective devices

3.                  Effective use of prophylactic/protective measures

4.                  Physical properties of the protective equipment materials (e.g., absorption, dissipation, and transmission of energy)

5.                  Mechanisms of injury

6.                  Legal and safety risks involved in the construction and use of custom protective devices

7.                  Legal and safety risks involved in use and modification of commercial devices

Skill in:

1.                  Identifying injuries, illnesses, and conditions that warrant the application of custom-made or commercially available devices

2.                  Fabricating and fitting custom-made devices

3.                  Selecting and applying commercial devices

 

E.      Identify safety hazards associated with activities, activity areas, and equipment by following accepted procedures and guidelines in order to make appropriate recommendations and to minimize the risk of injury and illness.

Knowledge of:

1.                  Hazards common to activities

2.                  Hazards common in activity areas (e.g., surface irregularities, obstructions, inadequate offsets, moisture and other foreign objectives, inadequate lighting, inadequate ingress and egress)

3.                  Hazards common to equipment (e.g., shoulder pads, goal posts, computer keyboards)

4.                  Emergency communication systems

5.                  Rules governing play and established standards and practices

6.                  Policies and procedures for addressing facility hazards

7.                  Corrective measures for facility hazards

8.                  Ergonomics

9.                  Policy statements and guidelines pertaining to safety hazards (e.g., NATA and NCAA)

Skill in:

1.                  Conducting inspections for hazards

2.                  Recognizing hazards

3.                  Recommending and implementing appropriate methods for addressing hazards

 

F.      Maintain clinical and treatment areas by complying with safety and sanitation standards to minimize the risk of injury and illness.

Knowledge of:

1.                  Situations and conditions that pose risk

2.                  Laws, regulations, and policies (e.g., institutional, state, and national) regarding safety and sanitation

3.                  Manufacturer’s guidelines for maintaining equipment and devices

Skill in:

1.                  Operating or applying therapeutic modalities and rehabilitation equipment

2.                  Recognizing noncompliance with safety and sanitation standards

3.                  Recognizing malfunction or disrepair of therapeutic modalities, rehabilitation equipment, or furnishings in clinical and treatment areas

4.                  Complying with manufacturer’s recommendations for maintenance of equipment

5.                  Maintaining a safe and sanitary environment in compliance with established standards (e.g., OSHA, universal precautions, local health department, and institutional policy)

 

G.     Monitor participants and environmental conditions by following accepted guidelines to promote safe participation.

Knowledge of:

1.                  Conditions of participants that predispose them to environmentally caused illness (e.g., prior heat illness, sickle cell trait, asthma, recent viral infection, use of medication, ergogenic aids, obesity, and dehydration)

2.                  Environmental conditions that create risk (e.g., heat, humidity, cold, altitude, pollution, weather extremes, insect swarms, infectious pathogens, and ergonomic conditions)

3.                  Policies and procedures for removing participants from environmental risk situations (e.g., heat index, lightning, and activity scheduling)

4.                  Monitoring techniques (e.g., weight charts, fluid intake, and body composition)

5.                  Established standards regarding environmental risks (e.g., governing body rules/regulations, NATA, NCAA, ACSM, etc.)

6.                  Methods for reducing risk from environmental conditions (e.g., activity scheduling, clothing selection, and fluid replacement)

7.                  Ergonomic and epidemiological factors as they relate to participation

Skill in:

1.                  Recognizing characteristics in participants that would predispose them to environmental and ergonomic risk

2.                  Using available resources to gather/interpret information regarding environmental data

3.                  Recognizing environmental and ergonomic risks

4.                  Facilitating appropriate action in response to environmental and ergonomic risk

 

H.     Facilitate physical conditioning by designing and implementing appropriate programs to minimize the risk of injury and illness.

Knowledge of:

1.                  Physiological adaptation to exercise (e.g., space and altitude)

2.                  Components of a physical conditioning program

3.                  Various conditioning stages and program intervals

4.                  Current strength and conditioning techniques

5.                  Ergonomics

Skill in:

1.                  Addressing the components of a comprehensive conditioning program

2.                  Educating appropriate individuals in the effective application of conditioning programs (e.g., guardian and administration)

3.                  Assessing appropriateness of participation in conditioning programs

4.                  Instructing in the use of appropriate conditioning equipment (e.g., bikes, weight machines, and treadmills)

5.                  Correcting or modifying inappropriate, unsafe, or dangerous activities undertaken in conjunction with physical conditioning programs

 

I.        Facilitate healthy lifestyle behaviors using effective education, communication, and interventions to reduce the risk of injury and illness and promote wellness.

Knowledge of:

1.                  Accepted guidelines for exercise prescription and sound nutritional practices

2.                  Professional resources for stress management and behavior modification

3.                  Nutritional disorders, inactivity-related diseases, overtraining, and stress-related disorders

4.                  Predisposing factors for nutritional and stress-related disorders

5.                  Appropriate use of exercise in stress management

Skill in:

1.                  Recognizing signs and symptoms of nutritional and stress-related disorders

2.                  Educating appropriate individuals on nutritional disorders, maladaptation, substance abuse, and overtraining

3.                  Accessing information concerning accepted guidelines for nutritional practices

4.                  Communicating with appropriate professionals regarding referral and treatment for individuals with nutritional and stress-related disorders

5.                  Addressing the issue of special nutritional needs in regard to competition or activity (e.g., pre- and post-game meals and nutritional supplements)

 

 


 

Performance Domain II: Clinical Evaluation and Diagnosis

 

The responsibilities of Athletic Trainers-Certified (ATC) in evaluation and diagnosis of injuries and conditions follow standardized clinical practice in the area of diagnostic reasoning and medical decision making. There are four basic types of evaluations described in the athletic training literature: 1) the preparticipation evaluation performed prior to physical activity to determine possible medical conditions that might limit or endanger the participant; 2) the on-field evaluation that emphasizes the immediate course of acute care and determination of emergency situations; 3) the off-field evaluation that involves a more detailed evaluation of the involved body part, typically performed in the athletic training room or clinic; and 4) a progress evaluation performed to determine the progress of the rehabilitative process or determination of return to play.1, 2 Understanding the pathomechanics and predisposing factors of an injury assists ATCs in their evaluation of the injury, illness, or condition.3-5 In the absence of a physician, the ATC’s diagnosis is critical to the proper management of the injury, illness, or condition.1, 2, 6

 

The literature uses the terms evaluation and assessment interchangeably. Assessment generally refers to the process of determining the nature and severity of an injury. By comparison, evaluation is the systematic process that allows the athletic trainer to make judgments during the assessment.1-7 Diagnosis is the determination of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test results, and procedures. Arriving at a diagnosis involves the application of the scientific method of formulating objective conclusion about the individual’s condition.8 The initial step in medical decision making process for the athletic trainer includes recognizing the site, nature, and severity of the injury.7 This step includes recognizing such matters as the mechanics of injury, the posture of the individual, and other external factors that may have an effect on the injury or condition. Recognition may take place prior to the formal assessment and continues throughout the entire process as various signs and symptoms are revealed.7

 

The literature supports the use of a standardized format for the process in the initial evaluation, whether it is the on-field primary assessment or off-field initial assessment.  Most sources suggest using the History, Inspection/Observation, and Palpation and Special Tests format in performing an evaluation leading to a diagnosis.1, 7, 9-11 Through this method, data is collected, hypotheses are formed, and objective conclusions are reached to accept or reject a possible diagnosis. It is possible to have more than one differential diagnosis until more data is collected using special tests, laboratory tests, etc. This list of possibilities may expand or contract during the evaluation.

 

The ATC is competent in the recognition, evaluation, and assessment of athletic injuries, illnesses, and conditions. This process includes the knowledge and ability to perform the following seven tasks.

 

A.  Obtain a history through observation, interview, and/or review of relevant records to assess the pathology and extent of the injury, illness or condition.

 

The medical history is one of the most important aspects of assessing an injury or illness.2, 11-13 The history should include an interview of the athlete to determine the chief complaint, areas and amount of discomfort or pain, any unusual symptoms, and whether there is a reduced ability to perform specific motor skills. 12, 14 Several authors indicate that acquiring knowledge of the specific mechanism of injury and understanding the mechanisms associated with the activity are the most important objectives during the history-taking process.1, 2, 13, 15 Recognizing various symptoms revealed during the history helps to guide the rest of the evaluation process.2, 7-8, 14-16

 

The on-the-scene history differs from the history taken in a controlled environment. On the scene, the individual may not always be able to give a coherent interview and an account may be needed from bystanders. A primary history should include the location of pain, presence of radicular symptoms, mechanism of injury, associated sounds and symptoms, and any relevant previous injury history to the body part.2

 

The history of general medical conditions requires a more thorough investigation into the symptoms, duration, and exacerbation of the condition. Cultural factors must also be taken into consideration when completing a medical history. 3, 4, 8, 14-16 Because the athletic trainer has taken on a greater role in the general healthcare of the athlete, ATCs must be familiar with evaluation of general medical conditions as well as orthopedic injuries. ATCs must also recognize the differences in injuries for various populations such as the adolescent participant, the female participant, the mature individual, and the disabled.17-23

 

B.  Inspect the involved area(s) visually to assess the pathology and extent of the injury, illness, or health-related condition.

 

Inspection or observation is important to determine the extent or potential pathology of the injury, illness, or condition.4,6 Both general observations and specific observations should be made when the individual initially enters the evaluation area.2,6 General observations may include posture, gait, abnormal movements, and structural anomalies.1,2,7,13 Specific inspection may include noting edema, discoloration, skin irregularities, symmetry, and atrophy.4,34

 

C.  Palpate the involved area(s) using standard techniques to assess the pathology and extent of the injury, illness, or health-related condition.

 

Palpation is the process of systematically feeling the affected areas to ascertain damage or conditions that may not be directly observable. Considerable information may be obtained through palpation including point tenderness, temperature, crepitus, swelling, trigger points, and symmetry.2, 3, 11 The ATC should palpate for both bony and soft-tissue structures in order to assess deviations. Extensive knowledge of anatomy is required for the ATC to distinguish normal versus abnormal structures of the injured area.24-28

 

D. Perform specific tests in accordance with accepted procedures to assess the pathology and extent of the injury, illness, or health-related condition.

 

Tools and tests used by the ATC are wide ranging, reflecting the body system being evaluated. For example, auscultation may be used to evaluate heart and lung sounds, an otoscope to evaluate the ear, a xyphygmomanometer to measure blood pressure, a vision card and penlight to assess vision and pupillary reflexes, a goniometer to measure joint range of motion, a handheld dynamometer to measure muscle function, or a series of questions designed to screen neurological status. Tools and tests of primary interest to the ATC include those that contribute essential information to the decision-making process regarding an individual’s readiness for safe participation.  Instrumented or non-instrumented tests of ligamentous joint laxity or numerous region-specific special tests also assist in the assessment and treatment planning process, and in measuring the extent that activity specific function has been restored.2, 3, 11, 24-26, 28-35

 

E.   Formulate a clinical impression by interpreting the signs, symptoms, and predisposing factors of the injury, illness, or health-related condition to determine the appropriate course of action.

 

Using information gathered through a comprehensive client assessment; knowledge of differences between non-impaired and impaired functional states; the nature and extent of the injury, illness, condition or disease state; and accepted practice standards and guidelines, the ATC formulates a clinical course of action or treatment plan and the timing of regular reassessments to determine the need for treatment plan modifications.2,3,36  The ATC also makes appropriate referrals to physicians or other healthcare team members as needed to best serve the client.

 

F.   Educate the appropriate individual(s) about the assessment by communicating information about the current or potential injury, illness, or health-related condition to encourage compliance with recommended care.

 

An essential component of the evaluation process is educating appropriate individuals about the extent of the injury or illness and the recommended care. For this and other reasons, ATCs possess knowledge of anatomy and medical terminology that is crucial to accurate communication and professional interaction with other members of the healthcare team. 5, 6, 16, 37 In the case of a minor, communication should be made such that both the individual and his/her family are educated about the condition and the proposed treatment options.16, 19

 

G.  Share assessment findings with other healthcare professionals using effective means of communication to coordinate appropriate care.

 

Communication to the other members of the healthcare team is essential. 11, 16 The ATC must communicate with the team physician(s) and other specialists, both orally and in writing. Using professional documentation strategies, proper medical terminology, and objective measurements is essential not only for communication to the healthcare team, but also for reimbursement purposes.2, 38 The athletic trainer must also adhere to federal privacy laws when communicating with these individuals.

 

II.        Clinical Evaluation and Diagnosis

A.     Obtain a history through observation, interview, and/or review of relevant records to assess current or potential injury, illness, or condition.

Knowledge of:

1.                  Pathomechanics of injury

2.                  Relationship between predisposing factors and injuries, illnesses, and health-related conditions

3.                  The body’s immediate and delayed physiological response to injuries, illnesses, and conditions

4.                  Signs and symptoms of injuries, illnesses, and conditions

5.                  Relationship between nutrition and injuries, illnesses, and conditions

6.                  Relationship between ergogenic aids and injuries, illnesses, and conditions

7.                  Relationship between medications and injuries, illnesses, and conditions

8.                  Communication techniques in order to elicit information

9.                  Infectious agents

10.              Standard medical nomenclature and terminology

11.              Medical records as a source of information

12.              Injuries, illnesses, and conditions associated with specific activities

13.              Biomechanical factors associated with specific activities

14.              Pathophysiology of illnesses and conditions

Skill in:

1.                  Identifying the extent and severity of injuries, illnesses, and conditions

2.                  Relating signs and symptoms to specific injuries, illnesses, and conditions

3.                  Obtaining and recording information related to injuries, illnesses, and conditions

4.                  Recognizing predisposing factors to specific injuries, illnesses, and conditions

5.                  Identifying anatomical structures involved in injuries, illnesses, and conditions

6.                  Interpreting medical records and related reports

7.                  Identifying psychosocial factors associated with injuries, illnesses, and conditions

8.                  Identifying nutritional factors related to injuries, illnesses, and conditions

9.                  Identifying the impact of supplements and prescription and nonprescription medications associated with injuries, illnesses, and conditions

10.              Interviewing and communication for the purpose of gathering information related to the condition

 

B.     Inspect the involved area(s) visually to assess the injury, illness, or health-related condition.

Knowledge of:

1.                  Bony landmarks and soft tissues

2.                  Signs of injuries, illnesses, and health-related conditions

3.                  Response to injuries, illnesses, and health-related conditions

4.                  Principles of visual inspection

5.                  Normal and abnormal structural relationships to the pathomechanics of injuries and conditions

Skill in:

1.                  Properly exposing the area in order to evaluate the involved area

2.                  Assessing immediate and delayed physiological responses to injuries, illnesses, and health-related conditions

3.                  Identifying bony surface landmarks and soft tissue abnormalities of specific/special injuries, illnesses, and health-related conditions

4.                  Identifying the relationship and severity of pathological signs of injuries, illnesses, and health-related conditions

5.                  Assessing pre-existing structural abnormalities and relating them to pathomechanics of injuries, illnesses, and health-related conditions

 

C.     Palpate the involved area(s) using standard techniques to assess the injury, illness, or health-related condition.

Knowledge of:

1.                  Human anatomy with emphasis on bony landmarks and soft tissue structures

2.                  Immediate and delayed physiological response to injuries, illnesses, and health-related conditions

3.                  Principles of palpation techniques

Skill in:

1.                  Locating and palpating bony landmarks, articulations, ligamentous structures, musculotendinous units, and other soft tissues

2.                  Recognizing severity of pathological signs and symptoms of injuries, illnesses, and health-related conditions

3.                  Assessing immediate and delayed physiological response to injuries, illnesses, and health-related conditions

4.                  Palpating appropriate structures in order to assess the integrity of human anatomical/physiological systems

 

D.     Perform specific tests in accordance with accepted procedures to assess the injury, illness, or health-related condition.

Knowledge of:

1.                  Mechanics, principles, and techniques of specific/special tests (ligamentous, neurological, manual, fracture, and functional tests)

2.                  Standard/individual special tests for range of motion, muscular strength, structural integrity, and functional capacity

3.                  Signs and symptoms of systemic requirements and failure during exercise

4.                  Signs, symptoms, and interpretations of specific/special tests

Skill in:

1.                  Assessing muscular strength through the use of manual or non-manual muscle tests

2.                  Assessing joint range of motion using test and measurement techniques

3.                  Identifying structural and functional integrity of anatomical structures

4.                  Identifying appropriate specific/special tests for particular injuries

5.                  Assessing neurological function

6.                  Identifying the signs and symptoms related to specific/special tests

7.                  Identifying location, type, function, and action of each joint

8.                  Using equipment associated with specific/special tests

9.                  Performing specific/special tests

10.              Interpreting the information gained from specific/special tests

 

E.      Formulate a clinical impression by interpreting the signs, symptoms, and predisposing factors of the injury, illness, or condition to determine the appropriate course of action.

Knowledge of:

1.                  Signs, symptoms, and predisposing factors related to injuries, illnesses, and health-related conditions

2.                  Basic pharmacological considerations

3.                  Pathomechanics of injuries and/or health-related conditions

4.                  Psychosocial dysfunction and implications associated with injuries, illnesses, and health-related conditions

5.                  Medical terminology and nomenclature

6.                  Indications for referral

7.                  Guidelines for return to participation

Skill in:

1.                  Interpreting the pertinent information from the evaluation

2.                  Synthesizing applicable information from an evaluation

3.                  Identifying appropriate courses of action

 

F.      Educate the appropriate individual(s) regarding the assessment by communicating information about the current or potential injury, illness, or health-related condition to encourage compliance with recommended care.

Knowledge of:

1.                  Communication skills and techniques

2.                  Patient confidentiality rules and regulations

3.                  Medical terminology and nomenclature

4.                  Commonly accepted practices regarding the care and treatment of injuries, illnesses, and conditions

5.                  Potential complications and expected outcomes

6.                  Appropriate treatment options

Skill in:

1.                  Using both verbal and written forms of communication

2.                  Interpreting medical terminology and describing the nature of injuries, illnesses, and health-related conditions in basic terms

3.                  Utilizing appropriate counseling techniques

 

G.     Share assessment findings with other healthcare professionals using effective means of communication to coordinate appropriate care.

Knowledge of:

1.                  Patient confidentiality rules and regulations

2.                  Medical terminology and nomenclature

3.                  Communication skills and techniques

4.                  Role and scope of practice of various healthcare professionals

5.                  Commonly accepted practices regarding the care and treatment of injuries, illnesses, and health-related conditions

Skill in:

1.                  Communicating with healthcare professionals

2.                  Collaborating with healthcare professionals

3.                  Using medical terminology and nomenclature

4.                  Directing a referral to other medical personnel


 

Performance Domain III: Immediate Care

 

The position of the on-field healthcare provider is unique to the profession of athletic training. As the work environment for Athletic Trainers-Certified (ATC) continues to expand from traditional settings (schools, universities, and professional sports) to clinical and industrial settings and physician practices, the scope of service pertaining to immediate healthcare has also evolved, but the provision of immediate care remains constant. Immediate care is the ability to provide “direct services rendered by members of health professions for the benefit of a patient.”44 The manner in which services are provided is ever changing with the influence of science and technology, such as computer applications, equipment design, new medications, and formalized protocols.45,22,24,25,30 Domain III focuses on the knowledge and skills needed by an ATC to provide standard immediate care procedures used in emergency situations, independent of setting.

 

A.     Employ life-saving techniques through the use of standard emergency procedures in order to reduce morbidity and the incidence of mortality.

 

Demonstrating and administering standard emergency care begins with recognition of life-threatening or other medical emergencies.2, 3, 4, 11, 18, 40, 41, 42 The initiation and implementation of an emergency action plan are necessary so that sequential care may be rendered by the healthcare provider 23, 27 in a timely manner. Regardless of the environment or setting, the ATC must develop and activate a comprehensive plan with clearly established roles and responsibilities and an effective chain of command. The ATC adheres to universal precautions and provides accepted standards of care.2, 22, 26, 28 Specific knowledge and skills are needed to provide cardiopulmonary resuscitation and advanced first-aid procedures.2, 3, 11, 33

 

In on-field emergency situations, ATCs are competent in the fitting of standard athletic equipment and devices and proper procedures used for the removal of emergency equipment.30, 38 It is the role and responsibility of the ATC to ensure safe equipment removal takes place so that further care may be provided. In the case of a medical emergency, the ability to select and use appropriate emergency equipment properly (such as spine board, blood pressure cuff and splints) is vital.2, 3, 42

 

B.     Prevent exacerbation of non-life-threatening condition(s) through the use of standard procedures in order to reduce morbidity.

 

ATCs implement proper techniques at the onset of care in order to manage medical conditions appropriately and to prevent further harm. The ATC’s ability to recognize and treat, including appropriate referral when necessary, is vital in preventing and/or managing general medical conditions.7, 8, 12,15, 17, 34, 36 Providing appropriate care to those who are injured also necessitates ensuring a safe environment.

 

The ATC’s on-site management of acute musculoskeletal conditions is vital to protect the participant from further injury or complication. Appropriate immediate care of musculoskeletal conditions requires the ability to recognize and properly manage the conditions(s).21, 30 Medical referral when necessary is vital in preventing and/or managing these conditions and to minimize the risk of further injury.12 The ability to recognize the nature and severity of injury assists in determining the ability to return to play. The ATC is the primary resource when decisions are made about a client’s ability to return to play or to resume physical activity. In such situations, the ATC’s recognition of the nature and severity of injury is essential if a safe determination on this matter is to be made. Also essential is the ATC’s understanding of the indications and contraindications for participation.35

 

The ability to use standard medical equipment, (e.g., blood pressure cuff, stethoscope, otoscope) is necessary in assessing the individual’s condition. Management of musculoskeletal conditions often necessitates appropriate pharmacologic usage and application of therapeutic modalities.34, 35, 37

 

The ATC is competent in the areas of human anatomy, physiology, and pathophysiology, in addition to pathology, which is essential to the assessment of joint mechanics and function. This knowledge is also required to determine the nature and scope of potential injury and the need for referral to medical specialists and other professionals.30, 31, 35

 

C.     Facilitate the timely transfer of care for conditions beyond the scope of practice of the athletic trainer by implementing appropriate referral strategies to stabilize and/or prevent exacerbation of the condition(s).

 

When dealing with active individuals and their injuries, it is important to recognize the psychological impact as well as other conditions of a physical nature that are outside the scope of practice for ATCs or beyond their individual training or experience.24, 43 The ATC recognizes that these types of conditions must be identified and require appropriate referral, as well as knowledge of various healthcare providers, their qualifications, roles, and responsibilities. The ATC is particularly well suited to refer cases of psychosocial issues or crisis to appropriate healthcare professionals. Communication skills are needed when making referrals, but ATCs also employ them to establish intervention strategies and subsequent consultation with other healthcare professionals for individuals in need.10, 12, 16

 

D.    Direct the appropriate individual(s) in standard immediate care procedures using formal and informal methods to facilitate immediate care.

 

The ATC must not only treat active individuals in distress, but effectively communicate instructions to other healthcare providers and individuals assisting in their care. Oral and written communication skills are essential for the progression of additional treatment. This function includes the application of universal precautions and standard medical practice.1, 5, 14

 

In addition, ATCs are often faced with the need to communicate with and educate clients, parents, and coaches. In such situations it is important to convey standards of care clearly as they relate to an individual’s injuries to the lay person, in addition to any trends and changes in the process.13, 16, 39

 

E.     Execute the established emergency action plan using effective communication and administrative practices to facilitate efficient immediate care.

 

The ability to communicate in a direct and clear manner is important when dealing with an emergency situation. It is critical for the ATC to convey vital information accurately to facilitate the further rendering of appropriate care by healthcare professionals. Established protocols should be developed, practiced, and implemented to ensure quality of care.45,46,23 It is also important for the ATC to determine the proper chain of command that will assist in the execution of care in an emergency situation. Establishing lines of communication and positive working relationships with healthcare professionals that will be part of the immediate care team are essential in achieving a positive outcome.

 

III.       Immediate Care

A.     Employ life-saving techniques through the use of standard emergency procedures in order to reduce morbidity and the incidence of mortality.

Knowledge of:

1.                  Human anatomy: normal and compromised structures

2.                  Human physiology: normal and compromised functions

3.                  Biomechanics/kinesiology: mechanisms of catastrophic conditions

4.                  Common life-threatening medical situations (e.g., respiratory, central nervous, and cardiovascular)

5.                  Appropriate management techniques for life-threatening conditions (e.g., respiratory and central nervous systems)

6.                  Emergency action plan(s)

7.                  Federal and state occupational, safety, and health guidelines

8.                  Standard protective equipment and removal devices and procedures

9.                  Appropriate use of emergency equipment and techniques (e.g., AED, CPR masks, and BP cuff)

Skill in:

1.                  Performing cardio-pulmonary resuscitation techniques and procedures

2.                  Implementing federal and state occupational, safety, and health guidelines

3.                  Removing protective equipment and using removal devices

4.                  Using emergency equipment

5.                  Implementing immobilization and transfer techniques

6.                  Implementing emergency action plan(s)

7.                  Managing common life-threatening emergency situations/conditions (e.g., evaluation, monitoring, and provision of care)

8.                  Transferring care to appropriate medical and/or allied health professionals and/or facilities

9.                  Measure and monitor vital signs

 

B.     Prevent exacerbation of non-life-threatening condition(s) through the use of standard procedures in order to reduce morbidity.

Knowledge of:

1.                  Human anatomy: normal and compromised structures

2.                  Human physiology: normal and compromised functions

3.                  Biomechanics/kinesiology: mechanisms of common, non-life-threatening conditions

4.                  Common non-life-threatening conditions (e.g., respiratory, general medical, central nervous, musculoskeletal, and cardiovascular)

5.                  Appropriate management techniques for non-life-threatening conditions (e.g., respiratory, general medical, central nervous, musculoskeletal, and cardiovascular)

6.                  Indications and contraindications for participation

7.                  Emergency action plan(s)

8.                  Federal and state occupational, safety, and health guidelines

9.                  Standard protective equipment and removal devices and procedures

10.              Appropriate use of standard medical equipment and techniques (e.g., BP cuff, spine board, cervical collar, splints, and stethoscope)

11.              Pharmacological and therapeutic modality usage for acute conditions

Skill in:

1.                  Implementing federal and state occupational, safety, and health guidelines standards and guidelines

2.                  Using standard medical equipment

3.                  Removing protective equipment and the use of removal devices

4.                  Implementing immobilization and transfer techniques

5.                  Obtaining vital signs

6.                  Managing non-life-threatening conditions (e.g., evaluation, monitoring, and provision of care)

7.                  Using standard medical equipment

8.                  Implementing emergency action plan(s)

9.                  Transferring care to appropriate medical and/or allied health professionals and/or facilities

10.              Determining appropriateness for return to activity

11.              Applying pharmacological and therapeutic modalities

 

C.     Facilitate the timely transfer of care for conditions beyond the scope of practice of the athletic trainer by implementing appropriate referral strategies to stabilize and/or prevent exacerbation of the condition(s).

Knowledge of:

1.                  Emergency action plan(s)

2.                  Conditions beyond the scope of the athletic trainer

3.                  Roles of medical and allied healthcare providers

4.                  Common management strategies for life- and non-life-threatening conditions

Skill in:

1.                  Implementing the emergency action plan(s)

2.                  Recognizing acute conditions beyond the scope of the athletic trainer

3.                  Communicating with other medical and allied healthcare providers

4.                  Managing life- and non-life-threatening conditions until transfer to appropriate medical providers and facilities

 

D.     Direct the appropriate individual(s) in standard immediate care procedures using formal and informal methods to facilitate immediate care.

Knowledge of:

1.                  Roles of individual members of the medical management team

2.                  Components of the emergency action plan(s)

3.                  Effective communication techniques

Skill in:

1.                  Communicating effectively with appropriate individuals

2.                  Implementing the emergency action plan(s)

3.                  Educating individuals regarding standard emergency care procedures

 

E.      Execute the established emergency action plan using effective communication and administrative practices to facilitate efficient immediate care.

Knowledge of:

1.                  Emergency action plan(s)

2.                  Communication techniques

3.                  Pertinent administrative practices

Skill in:

1.                  Communicating effectively

2.                  Identifying the need to implement the emergency action plan(s)

3.                  Implementing relevant administrative practices

 


 

Performance Domain IV: Treatment, Rehabilitation, and Reconditioning

 

To develop a treatment plan, the Athletic Trainer-Certified (ATC) determines appropriate treatment, rehabilitation and/or reconditioning strategies consistent with the clinical impression made during the assessment process and by considering age-specific criteria and psychosocial, community, family, and healthcare support system influences.11,14,43,51,59,74,78 The treatment plan takes ethical, moral, and legal issues into consideration while incorporating the principles of treatment, rehabilitation, and reconditioning to establish goals and objectives for a favorable outcome.11,22,38,43,56,74 Following implementation of this treatment plan, the ATC can determine the need for treatment modification, continuation, or discontinuation.10,13,38,96

 

Under the direction of a licensed physician and based upon a thorough evaluation (Domain II), the ATC establishes an individualized treatment plan.11,14,43,51,74,78,85,86 This plan is based upon the identified problems from the evaluation process, sound principles of rehabilitation,11,22,43,51,60,74,80 determination of specific objectives to treatment,11,14,43,51,74,78,85,86 and finally, the establishment of short- and long-term goals for restoring function and the timing of periodic re-evaluations.38,50,80,96

 

A.     Administer therapeutic and conditioning exercise(s) using standard techniques and procedures in order to facilitate recovery, function, and/or performance.

 

The treatment, rehabilitation, and conditioning process begins with a thorough understanding of the anatomy, physiology, and pathophysiology of the injury. The ATC applies the necessary rehabilitative techniques to facilitate recovery. This includes the application of flexibility and/or range of motion exercises,1,4,63,26 strengthening and muscular endurance exercises,9,13,18,24,32,36 and restoration of normal coordination and/or proprioception1,10,31,38,39,45,49,50,58,71,80 in order to restore normal function for the involved structures.

 

After restoration of normal function, the ATC has the unique ability to advance the rehabilitative process to include return to function that enables the individual to return to desired activities.10,38,92 The individual is progressed through an individualized program through an assessment of biomechanical needs for function, application of strength and conditioning principles, functional rehabilitation, and performance enhancement, all to allow for the safe return to activity.

 

The competent use of therapeutic and conditioning exercises requires a background in exercise physiology.12,17,23,62,73 The ATC is able to use that information along with knowledge of normal ambulation, posture, and body mechanics39,71 to help establish an appropriate rehabilitation program. This program includes therapeutic exercise,1,11,14,15,22,35,43,45,51,74,78,96 which incorporates range of motion and flexibility,1,4,63 muscular strength and endurance,8,13,18,24,32,36,65 and cardiovascular endurance13 to help restore normal function. Manual therapies20,33,41,74 are used in combination with these exercises while also incorporating proprioception,58 functional exercise,10,16,31,49,50,91,92 plyometrics,39 and the appropriate rehabilitative protocols.56 The ATC is also able to take into consideration age-specific criteria59,61,65,66,82 and the needs of special populations.36,59,82,90

 

B.     Administer therapeutic modalities using standard techniques and procedures in order to facilitate recovery, function and/or performance.

 

Therapeutic modalities are devices or apparatuses that have a curative effect.28 They are tools that the ATC uses as part of the rehabilitative process in an attempt to improve the recovery time for return to normal function following an injury. During the rehabilitation process the ATC applies therapeutic modalities to musculoskeletal injuries in an attempt to aid the recovery process. It is important to note that literature showing a direct correlation to application of modalities and expediting the healing/recovery process is sparse. These tools are used more as an adjunct to the application of therapeutic exercise to facilitate the timely restoration of function within the body’s own healing timeline, helping to creating an optimal environment for the body to heal itself.

 

The ATC possesses knowledge of therapeutic modalities from the electromagnetic spectrum of energy which includes thermal modalities,21,28,37,54,67,77,79,89 diathermies,21,28,30,37,77,79,89 electrotherapies,21,28,34,37,52,77,79,89 and laser.21,28,37,77,79,89 They possess knowledge of acoustical energies through the application of ultrasound21,28,29,37,77,79,84,89 and use mechanical energies21,28,37,77,79,89 to assist in the treatment process. The modalities can be used independently or in combination to facilitate recovery.

 

The use of modalities involves a thorough understanding of the physics behind their application. It is necessary to understand the indications, contraindications, and precautions for their administration, along with appropriate applications through standard operating procedures. This includes knowledge of the physiologic response to the application of the aforementioned energies to the body. With this comes the ability to determine the appropriate intensity, duration, and frequency of application at the appropriate time during the recovery process to aid in rehabilitation to restore function/performance.21, 28, 37, 77, 79, 89

 

ATCs interpret the legal aspects of modality application.28, 77, 79, 89 They have a thorough understanding of the pathology of tissue injury and repair, and assist in pain management related to neuromuscular control and function.28, 77, 79, 89 ATCs interpret the above to apply any of the common modalities that ATCs are qualified to use.

 

C.     Apply braces, splints, or assistive devices in accordance with appropriate standards and practices in order to facilitate recovery, function, and/or performance.

 

As part of the treatment, rehabilitation, and reconditioning process, ATCs recognize the need for the application of braces, splints, or assistive devices to facilitate recovery and protect against further injury or re-injury. These devices are used to augment the recovery process, allowing for a safe progression through the rehabilitation process and ultimately the return to function.

 

The ATC possesses the ability to identify the available devices, select the appropriate device, and fit it in accordance with manufacturer’s guidelines.5,25,72,76,87 In addition to knowledge about available commercial devices, the ATC also uses other available resources to fabricate braces, splints, or assistive devices properly through taping, padding, strapping, or use of available thermoplastics.5,25,72,76,87 In order for ATCs to apply these devices, they must understand the nature of the injury, the body’s response to healing, biomechanics of the injured body part, and how the device will affect the recovery process.

 

In addition to the knowledge required for selecting, fitting, and administering protective devices, ATCs also have knowledge of current rules and legal issues that pertain to the use of such equipment,5,25,72,76,87 including the activities the individual will be involved in, the reliability and durability of the device, and application to minimize functional interference. ATCs recognize that the prolonged use of braces, splints, and assistive devices may result in weakness of the injured body part, and they intervene appropriately with prescriptive therapeutic exercise.

 

Of key importance is the ATC’s participation as a member of the healthcare team. From this interaction the ATC obtains appropriate assistance from other healthcare professionals who may specialize in administering or fabricating such devices.5,25,72,76,87 The ultimate goal in the ATC’s use of assistive devices is to provide a safe, timely return to function without risk of injury or re-injury.

 

D.    Administer treatment for general illness and/or conditions using standard techniques and procedures to facilitate recovery, function and/or performance.

 

Typically, the population seen by ATCs is active, and the majority of conditions an ATC encounters and treats are musculoskeletal in nature. These conditions require appropriate treatment and rehabilitation as outlined in the preceding tasks. However, ATCs see a wide range of conditions in addition to musculoskeletal situations. Therefore, the ATC must recognize and offer appropriate treatment for many illnesses and conditions within the scope of athletic training services that involve multiple body systems (e.g., dermatologic, cardiovascular, respiratory, immunologic, genitourinary, gastrointestinal, endocrine, infections, and neurological).

 

In dealing with these conditions ATCs recognize that they are an integral part of a healthcare team.5, 25, 42, 55, 72, 76 With this recognition comes the ability to seek consultation with healthcare team members who can best assist in the identification of the problem, its impact on performance or function, treatment options, and a plan for return to activity. The ATC then assumes the role of assisting in treatment planning, carrying out the plan, and determining the goals for return to activity. The ATC understands pathophysiology47, 57, 64 and pharmacology as it relates to the disease state and restoration of normal function.61, 69, 81, 88 As a result, ATCs facilitate the use of all available resources to carry out their role in facilitating recovery and return to function within the healthcare team.

 

E.   Reassess the status of injuries, illnesses, and/or conditions using standard techniques and documentation strategies in order to determine appropriate treatment, rehabilitation, and/or reconditioning and to evaluate readiness to return to a desired level of activity.

 

During the rehabilitative process the ATC continually re-evaluates the injury/illness using the same tools and tests employed in the initial recognition, evaluation, and assessment. Through the re-evaluation process, the ATC is able to determine progress made toward the goals established in the treatment plan. Alterations to the plan are made, including progression of therapeutic exercise, reconditioning, changes in the administration of the therapeutic modalities, assessment of functional level, and development of new goals to meet to allow return to function.11,22,43,51,60,74,80

 

Through the re-evaluation process the ATC determines the readiness of the individual to return to the desired level of activity. This determination involves designing and implementing specific training programs, progressing functional activities that stress the appropriate systems, and determining readiness for return to activity without restrictions. Reassessment requires an understanding of functional outcomes, the ability to apply functional testing and related data in determining return to activity criteria, and the ability to correlate this information with the physiologic stages of healing as they relate for a safe timeframe for return to function without risk of re-injury.10, 13, 18, 24, 32, 36, 38, 66, 85, 86, 96

 

F.   Educate the appropriate individuals in the treatment, rehabilitation, and reconditioning of injuries, illness, and/or conditions using applicable methods and materials to facilitate recovery, function, and/or performance.

 

It is the role of the ATC to educate the individual about the extent of injury, the treatment plan, goals for treatment, and the plan for return to activity. This role is carried out using both verbal and nonverbal communication with all parties involved in the injury and recovery process. It involves the distribution of specific literature, direction to web sites for information, and the use of available references to aid understanding of the condition. It also involves a thorough explanation of the goals of treatment and the treatment plan. ATCs understand that it is best practice to include the individual in all planning related to their recovery. The ATC must also identify all individuals on the team who need to be educated on the process, which involves an interpretation of the age-specific criteria, and the individual support system, and needs.2,26,27,59,76,96

 

G.  Provide guidance and/or counseling for the appropriate individual(s) in the treatment, rehabilitation, and reconditioning of injuries, illnesses, and/or conditions through communication to facilitate recovery, function, and/or performance.

 

In dealing with injury and/or illness the ATC understands the impact of the grieving process on recovery for the individual. The ATC has the ability to recognize normal response in injury and/or illness and typical abnormal behaviors that may arise.2,26,27 The ATC then consults with or refers to other members of the healthcare team to support the recovery process more fully. Thus, the ATC has knowledge in psychology, sport psychology, and developmental psychology.2, 26, 27

 

The ATC also possesses knowledge about the role of nutrition and health on body function and their relation to recovery and normal function.9, 19 When good health and nutrition are lacking, the ATC can again involve qualified healthcare team resources to direct the individual to receive appropriate guidance for restoration of normal function.

 

IV.       Treatment, Rehabilitation, and Reconditioning

A.  Administer therapeutic and conditioning exercise(s) using standard techniques and procedures in order to facilitate recovery, function, and/or performance.

Knowledge of:

1.                  The structure, growth, development, and regeneration of tissue

2.                  Principles of adaptation and overload of tissues

3.                  Principles of adaptation of systems

4.                  Principles of therapeutic exercise (e.g., isometric, isotonic, isokinetic, work, power, and endurance)

5.                  Principles of strength and conditioning exercises (e.g., plyometrics, core stabilization, speed, agility, and power)

6.                  Neurology related to treatment, rehabilitation, and reconditioning

7.                  The inflammatory process related to treatment, rehabilitation, and reconditioning

8.                  Proprioception and kinesthesis related to treatment, rehabilitation, and reconditioning

9.                  Available equipment and tools related to treatment, rehabilitation, and reconditioning

10.              Adaptation of the cardiovascular and muscular systems related to treatment, rehabilitation, and reconditioning

11.              Indications and contraindications related to treatment, rehabilitation, and reconditioning

12.              Pharmacology related to treatment, rehabilitation, and reconditioning

13.              Surgical procedures and implications for treatment, rehabilitation, and reconditioning

14.              Age-specific considerations related to treatment, rehabilitation, and reconditioning

15.              Psychology related to treatment, rehabilitation, and reconditioning

Skill in:

1.                  Applying exercise prescription in the development and implementation of treatment, rehabilitation, and reconditioning (e.g., aquatics, isokinetics, and closed-chain)

2.                  Evaluating criteria for return to activity

 

B.  Administer therapeutic modalities using standard techniques and procedures in order to facilitate recovery, function, and/or performance.

Knowledge of:

1.                  Indications and contraindications for therapeutic modalities

2.                  Principles of mechanical, electromagnetic, and acoustical energy

3.                  Structure, growth, development, and regeneration of tissue

4.                  Inflammatory process related to therapeutic modalities

5.                  Available therapeutic modalities related to treatment, rehabilitation, and reconditioning

6.                  Physiological response to therapeutic modalities

7.                  Pharmacology related to therapeutic modalities

8.                  Theories of pain

Skill in:

1.                  Applying thermal, electrical, mechanical, and acoustical modalities

2.                  Applying manual therapy techniques

 

C.  Apply braces, splints, or assistive devices in accordance with appropriate standards and practices in order to facilitate recovery, function, and/or performance.

Knowledge of:

 

1.                  Commercially available soft goods

2.                  Materials and methods for fabricating custom-made devices

3.                  Pathomechanics of the injury or condition

4.                  Legal standards for bracing

5.                  Functions of bracing

Skill in:

1.                  Applying braces, splints, or assistive devices

2.                  Fabricating braces, splints, or assistive devices

 

D.  Administer treatment for general illness and/or conditions using standard techniques and procedures to facilitate recovery, function, and/or performance.

Knowledge of:

1.                  Pathophysiology associated with systemic illness, communicable disease, bacterial, viral, fungal, and parasitic infections

2.                  Structure, growth, development, and regeneration of tissue

3.                  Pharmacology related to the treatment of injuries, illnesses, and conditions

4.                  Medical and allied healthcare professionals involved in the treatment of injuries, illnesses, and conditions

5.                  Available reference sources related to injuries, illnesses, and conditions

6.                  Psychological reaction to injuries, illnesses, and conditions

Skill in:

1.                  Applying topical wound or skin-care products

2.                  Applying universal precautions

3.                  Referring to appropriate healthcare providers

4.                  Recognizing the status of systemic illnesses

5.                  Recognizing the status of bacterial, viral, fungal, and parasitic infections

6.                  Recognizing atypical psychosocial conditions

 

E.   Reassess the status of injuries, illnesses, and/or conditions using standard techniques and documentation strategies in order to determine appropriate treatment, rehabilitation, and/or reconditioning and to evaluate readiness to return to a desired level of activity.

Knowledge of:

1.                  Standard assessment procedures and techniques

2.                  Techniques and procedures to modify, continue, or discontinue treatment plans

3.                  Functional criteria for return to activity

4.                  Posture, biomechanics, and ergonomics

5.                  Appropriate documentation protocols

Skill in:

1.                  Interpreting assessment information necessary to modify, continue, or discontinue treatment plans

2.                  Applying functional criteria for return to activity

 

F.   Educate the appropriate individual(s) in the treatment, rehabilitation, and reconditioning of injuries, illnesses, and/or conditions using applicable methods and materials to facilitate recovery, function, and/or performance.

Knowledge of:

1.                  Available psychosocial, community, family, and healthcare support systems related to treatment, rehabilitation, and reconditioning

2.                  Applicable methods and materials for education

3.                  Learning process across the lifespan

4.                  Ethnicity and culture

Skill in:

1.                  Identifying appropriate individuals to educate

2.                  Communicating appropriate information

3.                  Disseminating information to individuals at an appropriate level

 

G.  Provide guidance and/or counseling for the appropriate individual(s) in the treatment, rehabilitation, and reconditioning of injuries, illnesses, and/or conditions through communication to facilitate recovery, function, and/or performance.

Knowledge of:

1.                  Psychological effects related to rehabilitation, recovery, and performance

2.                  Referral resources

3.                  Psychosocial dysfunction

Skill in:

1.                  Identifying appropriate individuals for guidance and counseling

2.                  Using appropriate psychosocial techniques (e.g., goal setting and stress management) in rehabilitation

3.                  Referring to appropriate healthcare professionals

4.                  Using effective communication skills

5.                  Providing guidance/counseling for the individual during the treatment, rehabilitation, and reconditioning process

 


 

Performance Domain V: Organization and Administration

 

Organization and Administration is defined as a series of plans, policies, and procedures by which Certified Athletic Trainers (ATC) organize the athletic training program to ensure responsive and efficient operations, in accordance with the BOC Standards of Practice42 and NATA Code of Ethics.36 The tasks of Organization and Administration are supported by significant professional reference materials.

 

The recognition of the ATC credential in job settings beyond the traditional64 requires additional skills to satisfy unique requisites generating their own set of organizational and management expertise to challenge the ATC. In spite of the varied settings, distinct commonalities regarding organization and administration such as institutional policy, fiscal management, legal and regulatory mandates, and the need for proper documentation exist in some manner in most settings.

 

A.  Establish action plans for response to injury or illness using available resources to provide the required range of healthcare services for individuals, athletic activities, and events.

 

Traditionally, the ATC provides routine healthcare services for active individuals in a multitude of settings. One such service revolves around the yearly preparticipation screening activities7,11,15,22,51,54,55,59,63 that are not only a required function of most institutions but a legal necessity in some states.5,8,18,53 These prescreening activities will often dictate that the referral of active individuals be made to appropriate medical specialists for an evaluation of their fitness for activity.9,17,20

 

The physical activities for which the ATC provides healthcare supervision6,22,30,4 require a working plan for local and out-of-area emergency medical procedures14,37 that may occur in the course of participation by physically active people. An integral part of that supervision plan requires a working knowledge of the healthcare service delivery demands made by the employer and/or local healthcare providers along with their ability and/or desire to receive third-party reimbursement for their services.31,40

 

Full preparedness for athletic training services demands an efficient staff10,16,58,62 upon which this responsibility falls. This responsibility includes preparation for environmental hazard pitfalls25,28,38 as well as knowledge of institutional substance abuse policies and other psychosocial concerns.23,44

 

B.  Establish policies and procedures for the delivery of healthcare services following accepted guidelines to promote safe participation, timely care, and legal compliance.

 

The myriad responsibilities of ATCs for active individuals are delineated through established written policies and procedures set forth in institutional, organizational, and governmental guidelines. Among those responsibilities are administration of an informed consent to active individuals,12,21,56,58 awareness of the impact of environmental hazards,6,25,38,39 the assurance of adequate healthcare delivery,16,30,47,50 having risk-management awareness5, knowledge of drug usage rules and regulations,1,44,23 cognizance of the specter of mental illness in the active person,32,57 the necessitation of participation prescreening,7,11,51,54,59,62 and the provision of legal compliance to the aforementioned.8,13

 

C.  Establish policies and procedures for the management of healthcare facilities and activity areas by referring to accepted guidelines, standards, and regulations to promote safety and legal compliance.

 

Safety and sanitation are constant concerns with respect to all areas for which the ATC has supervisory responsibility. ATCs should establish policies and procedures consistent with institutional and governmental guidelines for the maintenance of facilities,49,56,58 provision of safe therapeutic/rehabilitation equipment, and adherence to manufacturer’s operational guidelines,19,33 appropriate inspection procedures for all facilities,48,49 provision of safe playing and treatment environments,49 and all necessary documentation.2,3,34,46,58,61 Applicable Occupational Safety and Health Administration (OSHA) guidelines48,49,50 must be adhered to in all areas of responsibility.

Compliance can be achieved through the ATC’s knowledge of applicable, institutional, local, state guidelines and guidelines as they apply to federal safety48 and sanitation regulations [OSHA, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Commission on Accreditation of Rehabilitation Facilities (CARF)].35,49 These standards can be promoted by addressing the appropriate national organization and/or association guidelines for safety,42,49 including equipment manufacturers’ operation guidelines,19,33 the American Disabilities Act regulations,4 and institutional testing and substance abuse policies.1,23,44

 

D.  Manage human and fiscal resources by utilizing appropriate leadership, organization, and management techniques to provide efficient and effective healthcare services. 

 

This once obscure, but always present, component of a successfully managed athletic training endeavor is vital to the ATC’s success and includes using available human resources and personnel services10,27,58 plus proper budgeting and purchasing processes, and procedures for setting performance criteria.56,58 There are institutional, state,42 and federal 4 employment regulations to which to adhere.

 

Daily efficient management of patient flow, staff scheduling, and resource allocation has become more manageable with computer spreadsheet, word processing, and database applications.58,61

 

E.   Maintain records using an appropriate system to document services rendered, provide for continuity of care, facilitate communication, and meet legal standards.

 

Timely maintenance and security of records58 generated while performing athletic training duties is vital in this era of increased litigation8 and the need to retrieve references for services rendered to the active population.2,42 Sufficient documentation protocols,3,26,29,34,52,56,58 including institutionally required informed-consent records,12 must adhere to institution, local, state, and federal regulations. This includes control of confidentiality as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).46 HIPAA requirements, known as the National Standards to Protect the Privacy of Personal Health Information, present the ATC with increased demands for documenting patient contacts.

 

Increased involvement with third-party billing by ATCs dictates that accepted medical terminology and abbreviations (such as Current Procedural Terminology (CPT) and Healthcare Financing Administration (HCFA) coding,40,56,58) be used in all documentation. A variety of computer daily injury report systems offers a choice to ease the arduous tasks of accurate documentation58,61 and retrieval.

 

F.   Develop professional relationships with appropriate individuals and entities by applying effective communication techniques to enhance the delivery of healthcare.

 

Enhanced professional performance in any job setting depends largely upon the ATC’s ability to communicate with the individuals who facilitate cooperation, ensuring success in daily operations. Communication involves the sending and receiving of information between and among individuals and, for ATCs, it must be accurate, understandable, and timely. It frequently involves the use of open-ended questions in order to maximize the information received. Effective interaction with all involved (e.g., physicians and other members of the healthcare team) not only smoothes the path to better care, but it can ensure future cooperation from those same individuals.67,68

 

A mix of collegial and formalistic programs58 may be an ideal organizational pattern to foster effective communication, while Total Quality Management (TQM),56,58 for example, using a liaison management role66 can be applied to many healthcare organizations. Drafke’s65 description of verbal and written communication may be the most effective model for the practicing ATC.

 

 

 

V.        Organization and Administration

A.     Establish action plans for response to injury or illness using available resources to provide the required range of healthcare services for individuals, athletic activities, and events.

Knowledge of:

1.                  Organizational preparticipation screening policies and procedures

2.                  Institutional guidelines for referring individuals to healthcare services

3.                  Local and out-of-area medical services

4.                  Institutional and local hierarchy for delivery of healthcare services

5.                  Staff preparedness

6.                  Environmental hazards

7.                  Reimbursement issues

8.                  Institutional policies regarding substance abuse

9.                  Legal standards and scope of practice

10.              Relevant position statements (e.g., NATA, ACSM, AOASM, AOSSM, AMSSM, NCAA, NFHS, and NAIA)

11.              Appropriate medical equipment and supplies

12.              Relevant epidemiology studies

13.              Site-specific access issues

14.              Pre-existing conditions of individual participants

Skill in:

1.                  Organizing resources and personnel

2.                  Interacting with appropriate administration leadership

3.                  Obtaining appropriate policies, guidelines, and regulations

4.                  Interpreting regulatory policies

 

B.     Establish policies and procedures for the delivery of healthcare services following accepted guidelines to promote safe participation, timely care, and legal compliance.

Knowledge of:

1.                  Institutional review boards, policies, and procedures regarding informed consent guidelines

2.                  Guidelines and regulations for decreasing exposure to environmental hazards

3.                  Institutional, governmental, and appropriate organizational guidelines for safety, healthcare delivery, and legal compliance

4.                  Guidelines for development of risk management policies and procedures

5.                  Institutional risk management policies and procedures

6.                  Institutional and governmental regulations regarding drug use, substance abuse, and mental illness

7.                  Prescreening participation guidelines

8.                  Institutional drug testing and substance abuse policies

9.                  Relevant evidence-based and epidemiology studies

10.              Statutory, regulatory, and other legal provisions pertaining to delivery of healthcare services

11.              Relevant position statements (e.g., NATA, ACSM, AOSSM, AMSSM, NCAA, NFHS, and NAIA

Skill in:

1.                  Applying existing guidelines

2.                  Interacting with appropriate individuals

3.                  Completing the documentation process

4.                  Organizing policies and procedures in a logical fashion

5.                  Ascertaining appropriate policies, guidelines, and regulations

6.                  Applying evidence-based and epidemiology studies

7.                  Applying statutory, regulatory, and other legal provision

 

C.     Establish policies and procedures for the management of healthcare facilities and activity areas by referring to accepted guidelines, standards, and regulations to promote safety and legal compliance.

Knowledge of:

1.                  Institutional, professional, and governmental guidelines for maintenance of facilities and equipment

2.                  Manufacturer’s operational guidelines

3.                  Appropriate inspection procedures and documentation

4.                  Safe playing and treatment environments

5.                  OSHA guidelines

Skill in:

1.                  Complying with equipment manufacturer’s operational regulations/guidelines

2.                  Complying with institutional and governmental policies and procedures for maintenance of facilities and equipment

3.                  Applying OSHA standards

4.                  Recognizing potential safety and environmental hazards

5.                  Assuring compliance of involved staff

 

D.     Manage human and fiscal resources by utilizing appropriate leadership, organization, and management techniques to provide efficient and effective healthcare services.

Knowledge of:

1.                  Human resource management

2.                  Institutional budgeting and procurement process

3.                  Institutional and federal employment regulations (e.g., EEOC, ADA, Title IX)

4.                  Staff scheduling, patient flow, and allocation of resources

5.                  Credentialing systems and general requirements for pertinent professions

6.                  Appropriate computer software applications

7.                  Leadership styles

8.                  Management techniques

9.                  Strategic planning and goal setting

10.              Storage and inventory procedures

11.              Facility design and operation

12.              Revenue generation strategies

Skill in:

1.                  Managing human resources (e.g., delegating, planning, staffing, hiring, firing, and conducting performance evaluations

2.                  Managing financial resources (e.g., planning, budgeting, resource allocation, revenue generation)

3.                  Facility design, operation, and management (e.g., planning, organizing, designing, scheduling, coordinating, budgeting)

4.                  Using computer software applications (e.g., word processing, database spreadsheet, and Internet applications)

 

E.      Maintain records using an appropriate system to document services rendered, provide for continuity of care, facilitate communication, and meet legal standards.

Knowledge of:

1.                  Institutional informed consent policies and procedures

2.                  Documentation protocols

3.                  Accepted medical terminology and abbreviations

4.                  Computer technology as it relates to record keeping and documentation

5.                  Institutional, local, state, federal regulations/other legal provisions pertaining to medical records

6.                  Evidence-based practice and clinical outcomes assessment

Skill in:

1.                  Creating and completing the documentation process

2.                  Dictating medical records

3.                  Using computer applications for record keeping

4.                  Applying knowledge of medical terminology and abbreviations

5.                  Interpreting medical records

6.                  Adhering to legal requirements/procedures pertaining to medical records

 

F.      Develop professional relationships with appropriate individuals and entities by applying effective communication techniques to enhance the delivery of healthcare.

Knowledge of:

1.                  Various effective communication styles and techniques

2.                  Institutional chain of command

3.                  Confidentiality policies

4.                  Effective meeting planning

5.                  Appropriate professional behaviors

6.                  Credentialing systems and general requirements for pertinent professions

7.                  Community resources

Skill in:

1.                  Mitigating conflict

2.                  Planning meetings

3.                  Respecting diversity of opinions and positions

4.                  Interpreting medical terminology for appropriate individuals

5.                  Nurturing professional relationships

6.                  Using effective communication styles and techniques

7.                  Networking and recruiting qualified medical team members

 


 

Performance Domain VI: Professional Responsibility

 

Professional Responsibility as part of the role of the Certified Athletic Trainer (ATC) acknowledges that competent practice involves compliance with ethical, legal, and other professional standards whose purpose is to protect the public. The ATC is responsible for these professional issues in order to maximize the quality of care and to ensure that the full range of needs that individuals requiring healthcare services have can be addressed appropriately. For this reasons, it is important for ATCs to be aware of and comply with state regulations.

 

The BOC addresses professional responsibility in two significant ways: requirements for ethical practice and continuing education. The BOC defines and enforces ethical behavior on the part of the practicing ATC by requiring compliance with the BOC Standards of Professional Practice. Non-compliance with or violation of BOC requirements results in revocation of the credential. Recertification is contingent on fulfilling continuing education requirements in the three-year cycle. Failure to meeting continuing education requirements also results in revocation. With revocation comes the loss of the ability to practice as an ATC in most instances due to continuous communication between the BOC and state regulatory bodies.

 

A.  Demonstrate appropriate professional conduct by complying with applicable standards and maintaining continuing competence to provide quality athletic training services.

 

Standard of care is the level of medical sophistication and competence that must be demonstrated by someone who has similar education and training as other members of a particular group. In sports medicine the standard of care is somewhat difficult to establish due to the large number of healthcare professionals caring for clients.14, 28, 30, 33

 

The Code of Ethics of the National Athletic Trainers' Association has been written to make the membership aware of the principles of ethical behavior that should be followed in the practice of athletic training. The primary goal of the Code of Ethics is the assurance of high-quality healthcare. The Code of Ethics presents aspirational standards of behavior that all members should strive to achieve.9, 10, 14, 19, 28, 30

 

The Code of Ethics cannot be expected to cover all possible situations that may be encountered by the practicing ATC, but should be considered representative of the spirit with which ATCs should make decisions. The principles are written generally, and the specific circumstances of a situation will determine the interpretation and application of a given principle and of the Code of Ethics as a whole. Whenever there is a conflict between the Code of Ethics and law, the law prevails. The guidelines set forth in the Code of Ethics are subject to continual review and revision as the athletic training profession develops and changes.9, 10, 14, 19, 28, 30

 

The BOC Standards of Professional Practice is based on the Code of Conduct. The Standards of Professional Practice assures the public of the ATC’s ability to provide and meet athletic healthcare standards consistent with its mission. The BOC’s Professional Practice and Disciplinary Process includes a reporting procedure and requirements for investigating allegations made about ATCs concerning professional misconduct. BOC certification, thus, is contingent on continuous compliance with the Standards of Professional Practice.15,19,24

 

The purpose of continuing education for the ATC is to promote continued competence and development of current knowledge and future skills and to enhance professional skills and judgment beyond the level required for entry-level practice. These activities are essential to public protection. Continuing education activities directed toward professional ATCs focus on increasing knowledge, skills, and abilities in the practice of athletic training.10, 14, 17-25

 

B.  Adhere to statutory and regulatory provisions and other legal responsibilities relating to the practice of athletic training by maintaining an understanding of these provisions and responsibilities in order to contribute to the safety and welfare of the public.

 

Healthcare has changed dramatically in recent years and that change has caused payers, providers, and patients to assess and critique the healthcare delivery system from every aspect. The healthcare system has created opportunities for emerging providers to demonstrate their skills and value and to compete for their share of the healthcare dollar. The profession of athletic training has changed in the last 10 to 15 years almost as dramatically as the healthcare industry itself. Once almost exclusively employed in educational institutions and professional sports teams, 40 percent of today’s ATCs are employed in clinical settings treating clients and people of all ages involved in physical activity. Inclusive for the youth sports participants, to the weekend athlete, to the industrial worker, ATCs are providing effective and valued services to these varied populations.1, 2, 3, 6, 7, 12, 17-25, 28, 30, 33

 

Clearly, ATCs are extremely valuable providers in the industrial workplace providing injury prevention, early recognition and treatment of musculoskeletal injuries, expediting a safe and prompt return to work, and developing an overall effective and cost-saving injury management program. ATCs are an important part of the industrial healthcare team and provide services that benefit industry and employees.1, 2, 3, 6, 7, 12, 17-25, 28, 30, 33

 

ATCs have assumed a prominent role in the delivery of healthcare to physically active individuals. Employment of ATCs in sports medicine clinics and physician practices creates many challenges: ATCs employed in a sports medicine clinic setting treat a very wide range of patients, both with respect to age and physical condition, and ATCs faced hidden medical and pharmacological issues never before dealt with by our professional colleagues. Thus, it is more important than ever that ATCs attend to the legal framework for their practice in athletic training.1, 2, 3, 6, 7, 12, 17-25, 28, 30, 33

 

Herbert30 argued “that ATCs in every state are affected in some way by laws governing medical practice. Further, such laws emanating from public interest in self-protection, help to ensure that healthcare providers are competent. In states without state-sponsored credentialing, ATCs might be able to carry out their duties by having them legally delegated by a supervising physician.” Ray30 concludes by referencing Hawkins with the following caveat, “but this possibly varies among states, and even in states where delegation is allowed, the circumstances under which athletic training tasks may be delegated are often unclear and open to legal interpretation.”30

 

C.     Educate appropriate individuals and entities about the role and standards of practice of the athletic trainer through informal and formal means to improve the ability of those individuals and entities to make informed decisions.

 

The pursuit of continuing competence does not end with the acquisition of the ATC credential. It is a continuing effort to learn state-of-the-art applications within appropriate athletic healthcare standards for all spectrums of the athletic healthcare market including the entry-level athlete to the multimillion dollar professional. The astute ATC takes every opportunity to pursue further advancement in the profession at the same time as advancing the art and science of athletic training. It is only with this continued professional growth and responsibility that the truly competent ATC will become the doing-thinking ATC to meet the needs of the demanding consumer.1,6,7,8,10,13,14,28,30,34 As practice settings become more diversified, the ATC must become increasingly cognizant of issues related to client confidentiality and the appropriate management of personal client information as stated in HIPAA.

 

VI.       Professional Responsibility

A.     Demonstrate appropriate professional conduct by complying with applicable standards and maintaining continuing competence to provide quality athletic training services.

Knowledge of:

1.                  The BOC Standards of Practice

2.                  NATA Code of Ethics

3.                  Relevant policy and position statements of the NATA and other appropriate organizations (e.g., ACSM, AOASM, AOSSM, AMSSM, NCAA, NFHSA, NAIA, USOC)

4.                  Resources for continuing education (e.g., current and pertinent research, journals, courses, conferences)

Skill in:

1.                  Obtaining, interpreting, evaluating, and applying relevant research data, literature, and/or other forms of information

2.                  Obtaining, interpreting, evaluating, and applying relevant policy and position statements

3.                  Obtaining, interpreting, and applying the BOC Standards of Practice

4.                  Obtaining, interpreting, and applying NATA Code of Ethics

5.                  Applying evidence-based medicine (EBM)

 

B.     Adhere to statutory and regulatory provisions and other legal responsibilities relating to the practice of athletic training by maintaining an understanding of these provisions and responsibilities in order to contribute to the safety and welfare of the public.

Knowledge of:

1.                  State statutes, regulations, and adjudication that directly govern the practice of athletic training (e.g., state practice and title acts, state professional conduct and misconducts acts, liability and negligence)

2.                  Federal and state statutes, regulations, and adjudication that apply to the practice and/or organization and administration of athletic training (e.g., OSHA, DEA, Title IX, Civil Rights Act, HIPAA, Buckley Amendment, labor practices, patient confidentiality, insurance, record keeping)

3.                  State statutes, regulations, and adjudication governing other professions which impact the practice of athletic training (e.g., medicine, physical therapy, nursing, pharmacology)

4.                  Criteria for determining the legal standard of care in athletic training (e.g., state statutes and regulations, professional standards and guidelines, publications, customs, practices, and societal expectations)

Skill in:

1.                  Researching and applying state and federal statutes, regulations, and adjudications

2.                  Researching professional standards and guidelines (e.g., BOC, NATA, state organizations)

3.                  Researching practice methods and procedures

 

C.     Educate appropriate individuals and entities about the role and standards of practice of the athletic trainer through informal and formal means to improve the ability of those individuals and entities to make informed decisions.

Knowledge of:

1.                  Appropriate individuals and entities (e.g., employers, supervisor, administrators, governing boards, parents, participants/patients, coaches, other allied healthcare professionals, and other interested parties)

2.                  Communication techniques

3.                  The credentialing process and laws for athletic training

4.                  Scope of practice of the athletic training profession

5.                  Current healthcare issues relevant to athletic training

6.                  Accepted guidelines for different practice settings (e.g., appropriate medical care for secondary school-aged athletes, appropriate medical coverage in collegiate athletics)

7.                  Federal and state statutes, regulations, and adjudication which apply to the practice and/or organization and administration of athletic training (e.g., OSHA, DEA, Title IX, Civil Rights Act, HIPAA, Buckley Amendment, Fair Labor Standards Act)

Skill in:

1.                  Communicating information through various methods

2.                  Identifying the appropriate individuals and/or entities

3.                  Applying relevant information to specific employment and/or practice settings