Connecting Safely

January 29, 2015
From texting to social media, information can be exchanged today in the blink of an eye. That's why every athletic trainer needs a well thought-out plan for electronic communication.

Leadership

BY JAMES MALSEED

James Malseed, MEd, ATC, RAA, is Athletic Trainer and Chair of the Department of Health and Physical Education at Archmere Academy in Claymont, Del. He is a founding member, former president, and a Hall of Fame inductee in the Delaware Athletic Trainers Association and received a 2013 NATA Athletic Trainer Service Award. He can be reached at: jmalseed@archmereacademy.com.


You're spending a rare Friday night at home. The wrestling team is at an invitational and the boys' and girls' basketball teams will host a double header tomorrow. You settle in for a movie and popcorn with your family when the cell phone rings.

It's a text message from the host athletic trainer at the wrestling meet to tell you that your 103 pounder, a state runner up last year, has a possible ACL tear. The text includes the description of the injury, the name of the athlete, what first aid has been given, and the name of the physician at the meet.

You don't think twice about how this information was relayed. Maybe you should.

Another scenario to think about: Your star volleyball player lands on another player's foot during a practice drill and now has a softball-sized edema on the lateral side of her ankle. Teammates and athletes from other sports are taking pictures of the injury and posting them to Instagram, as well as sending them in text messages. One student-athlete takes a short video and excitedly announces she's posting it on Vine.

You may laugh and shake your head at how the world has changed. Or you may wonder if there is a problem with injury photos being quickly shared. In truth, you should do more than just wonder.

We all use electronic media as part of our daily lives. It's fast, easy, and how people communicate today. But as health care providers working in educational settings, what do we need to think about before we hit "send?"

PROBLEM AREAS
For most of us in athletic training, electronic media is woven into our operations. Here at the Archmere Academy in Claymont, Del., both my associate athletic trainer and myself use e-mail and text messages as our primary method of communication with our team physicians, the athletic training students we serve as preceptors for, athletic trainers from other institutions, coaches, and parents. We also use it extensively between ourselves.

However, we use these tools very carefully. We've put a lot of thought into how and when we will use these tools and we follow very specific rules governing their use. There are so many landmines--some very well hidden--in using electronic communication that it's critical to understand the ramifications of what we are doing. Here are some areas to think about:

Privacy Laws: Protecting the privacy of a patient is the law, which we may break when we casually relay medical information through a text or e-mail. The wrestling example above could be a HIPAA violation since medical information is provided and a FERPA issue since a student is involved.

The main solution we have devised at our school is to add a disclaimer to any of our e-mails that contain patient information. We've all seen examples of this on messages from physicians and other members of the health care profession. Ours includes the following:

This e-mail and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this e-mail in error please notify the system manager and sender. The evaluation of the athlete named is the opinion of the sender and may not be completely correct. This evaluation should be used to determine only if further medical evaluation and treatment should be provided.

Our text messages are kept general, with no identifying information about an athlete allowed. For example, a text sent to the athletic trainer at an opposing school about an injury states only that one of their athletes has been hurt and an e-mail will follow detailing the injury.

We are also helped by our state's high school athletic association, which has a specific policy on communication among health care providers. As part of the annual physical required for all athletes, parents and athletes are asked to sign a statement that they understand the policy on the sharing of health information. This policy allows licensed health care providers associated with the school the student attends and any school where a contest takes place to communicate about an athlete regarding an injury or other health-related issue. The legal council for the state athletic association, who is also a member of the state attorney general's office, has reviewed these rules and says they comply with all applicable state and federal laws.

Furthermore, our school policy states that all injuries are reported to our team physicians. Athletes and parents sign a statement that they have read and understand school and state association policies, which are included in our athletic department handbook.

It also is a good idea for athletic trainers to periodically read their state laws regarding patient privacy. They vary from state to state and must be thoroughly understood.

Posting Photos: As relayed in the example of the volleyball athlete's ankle sprain, it's easy--and typical--for today's student-athletes to take photos of anything and everything. They don't hesitate to point their phones, capture an image, and post it for all to see. But is it okay for an athlete's injury to become public?

The answer is that this is not okay, and you must take steps to prevent it. As the athletic trainer, you are the person in charge of the injured athlete and distributions of the pictures taken in your athletic training room are your responsibility. Allowing the photos could put you in violation of federal law, state law, or your state practice act.

Communicating with Parents: When an athlete is injured, one of our first communications is with his or her parents. Because news spreads quickly today, it's imperative not to delay when informing parents of an injury. You don't want them to hear from you 15 minutes after they already found out through a friend's text that their son or daughter was injured.

For major injuries, we talk with the parents in person or over the phone. For other injuries, we use e-mail as our primary communication, with the disclaimer always at the bottom. The e-mail is a form letter we fill in with specifics about what the injury appears to be, what we did, what we recommend they do, and how we will follow up. We have received a lot of positive feedback about this system because it provides the parents all the information they want to know.

If an athlete from a visiting school is injured at one of our home games, we notify the athletic trainer from their school via e-mail. The Delaware Athletic Trainers Association gathers e-mail addresses of its members each fall. We are hoping that the state athletic association may soon provide us with e-mail addresses of the parents of all student-athletes in the state so we can contact parents from visiting schools directly.

Oversight: If you serve as a preceptor for athletic training students from a local college, this story will hit home: One of the students tweets about an unusual injury they see. Within an hour, the tweet is re-sent to over 100 other people, including the injured athlete and members of their family. You receive phone calls from the athletic director, the athlete's family members, and even the local press.

You are in deep trouble, even if no names were mentioned. As the preceptor, you are responsible for this information becoming public. It does not matter that the name of the athlete or the school is never disclosed--you have allowed information about one of your patients to be distributed.

To make sure this does not happen, we tell athletic training students that they cannot share information about any of the student-athletes. If they want to use an injury from our athletic training room as a case study paper, then they must get permission of the athlete and parents using their college or university release.

Sharing Information: With a 65-acre campus to cover here at Archmere, keeping in touch with everyone can be a challenge. It helps a lot that we can all communicate by text message, and we frequently do. I constantly trade texts with the other athletic trainer on staff, coaches, and the athletic director. It allows for instant communication about injuries, progress of injured athletes as they return to practice, game score updates, weather information, and schedule changes.

This is allowable since we are all employees of the school and responsible for the care and treatment of athletes. Even so, we have spent a lot of time developing guidelines to avoid running into any problems.

The situation is more complicated when it entails sharing information among athletic trainers at different schools. It's important to know if any state laws or association rules allow this. If not allowed by the state association or by state law in some manner, only phone or personal contact should take place.

When our teams compete out of state we depend on our coaches to notify us of any injuries before they return to school. Depending on the situation, we may meet the team when they arrive. In cases of the athlete being hospitalized, we notify the parents as soon as possible.

A different type of sharing is when we text, e-mail, or post on Facebook a complaint or negative message. Maybe we witness a display of poor sportsmanship by a coach and vent about it to friends on Facebook. Or we post to an athletic training mailing list about something unprofessional. It can even be tempting to complain to a co-worker through a text about our boss. But even when we think a message is private, it's so easy for anything relayed over electronic communication to get in the hands of someone it's not intended for. The consequences can be career damaging.

Electronic communication may feel like uncharted waters. But you can't just casually swim through them. You need to navigate them by putting guidelines in place to protect your patients, your employer, and most of all yourself. Without the proper safeguards, depending on your state law, your license could be in jeopardy.

GOOD PRACTICES
Being careful with our use of electronic communication doesn't mean we need to think of it as a negative. In fact, the opposite is true. There are so many ways it can be helpful in athletic training, and it should be embraced. We have tried to do this at our high school with great results. We find it elevates our program, aids us in communicating, and educates others. Here are some ways it has helped us:

Public Relations: We have a Facebook page for the athletic training program, "Archmere Auks Athletic Training," and use it as a way to educate our parents, athletes, and other interested individuals about prevention of injuries and current trends in the profession. We post video clips, links to Web sites, article links, and any information we think others would find helpful. To inform people about the page, mass e-mails, word of mouth, and the school newsletter are used.

As a way to liven up the Facebook page, we also post game results and give "shout outs" to both individuals and teams that have received special honors and awards. We encourage individuals to comment on what we post to the page, but remove any posts that discuss individual injuries, notifying the person who left the comment as to why.

On the athletic department's Web site, there is a link to our athletic training page, where we post a new blog monthly about a topic in sports medicine. Issues we've covered include hydration, the dangers of energy drinks, proper weight loss, and what an athletic trainer is. There is also a page on the site that gives the background information on the athletic medicine staff.

Important News: Electronic media is also fantastic for disseminating information. For example, say the state athletic association issues new guidelines for athlete physicals near the end of the academic year. We can easily let parents know through a broadcast e-mail, mass text messages, and our Web site and Facebook page.

Quicker Treatment: We have found electronic media to be a great way to get athletes treated as quickly as possible. For example, an athlete trips down the steps at home and you would like to get him seen as soon as possible by your team orthopedic. He is in surgery in the morning, and has limited availability in the afternoon. A quick text can state that you need the doctor to see an athlete as soon as is convenient and possible. Remember that you will need to have the permission of the athlete and parents to discuss the problem in anything more than a general way.

Help From Others: You are rehabbing a patient post surgery and have reached a point where she is not making any progress. You have discussed the situation with the physician who performed the surgery, but this has not helped. A post on a rehabilitation blog, private state athletic training Facebook page, or a tweet, all stating the problem in a very general way such as "I have a patient who had ACL surgery and still has very limited ROM three months post surgery" will get you some new ideas and hopefully move the process forward. However, names or other identifying information should never be used.

Continuing Education: For some of us, budget cuts are limiting the type and number of continuing education programs we can attend. The use of Webinars, teleconferences, and live chats via Skype, Twitter, and other methods are a great way to go. In the case of Webinars, some presenting individuals or sponsor groups offer both live and archived materials to help you obtain CEU credits.

Keeping Connected: Some of the high school athletic trainers in my state are looking for ways to have monthly Web chats. The items to be discussed could be common problems of working on the secondary school level and trends treating certain injuries. It might also be just a nice opportunity for social interactions among fellow professionals.

BOLD NEW WORLD
Facebook, texting, e-mail, Tweeting, and other electronic media have become an everyday fact of life for me as an athletic trainer. They have allowed me to reconnect with mentors and friends from college, meet new colleagues, learn about different ways of working with my athletes, and ultimately become a better athletic trainer.

But there is a dark side to be very aware of. Everyday I read things posted by my fellow professionals that could lead to major problems for them down the road. Making light of something done or said in the athletic training room, blogging about the attitude of a coach or other department member, and sending out pictures or videos of injuries could have unintended consequences. And once something is posted, it never really goes away. Even if it's removed later, it can be mined and cause a problem long after we have forgotten the initial post or message. These things can lead to loss of respect from those we work with, loss of confidence from those we treat, and even the loss of a job.

Electronic media has its place in athletic training, but where and how it's used is a subject that needs to be discussed with your staff, athletes, parents, athletic training students, and even your physician. Without proper knowledge and guidelines, the use of these new tools in the practice of athletic training could be a violation of your school policies, governing body regulations, or state and federal laws.


SIDEBAR: QUICK RESPONSE
While electronic media can sometimes seem like a monster to tame, it can also be an angel that saves the day. We recently had a situation where an athlete at our school was diagnosed with a highly communicable disease. We received the information in the athletic training department via e-mail and quickly worked with athletic administrators to put a communication plan in place.

To start, we sent text messages and e-mails to notify coaches and team physicians of the situation. Next, Web searches were done to educate ourselves more thoroughly on the signs and symptoms of the disease. We then sent another text to our team physicians outlining the procedures we were taking to disinfect the locker room and equipment that the athlete had contact with.

From there, we drafted a letter to parents about the illness along with symptoms to look for in their child. We had the letter reviewed by a team physician who received it via e-mail, and then responded via text that it was good to go. At the same time, it was looked over by an athletic trainer who was away from campus. Once approved, the letter was quickly sent out via e-mail. Printed copies were later distributed to the student-athletes.

Within half an hour of becoming aware of this health concern, everyone involved could take a deep breath as parents had been notified, the locker room and equipment were disinfected, and things returned to normal. The Web, text messages, and broadcast e-mail saved the day. The future isn't coming, it's here.