Take No Chances

March 28, 2017
By Timothy Neal

Timothy Neal, MS, ATC, is Assistant Professor and Clinical Education Coordinator of the Athletic Training Education Program at Concordia University Ann Arbor. He can be reached at: timothyneal1957@gmail.com. 


Risk is a part of life. However, in the world of athletic training, risk management is a way of life. The certified athletic trainer is a licensed medical professional in 49 states. Part of being in this profession is that the public has a higher expectation for the standard of care provided. Whenever an expected outcome is not realized, and it is perceived to be a result of not meeting that standard, risk of liability is accelerated. Therefore, athletic trainers should be committed to assessing and managing risk in their own practice.

Areas that should be considered in a risk management assessment for sports medicine departments include but are not limited to:

• Departmental mission statement and approach to providing care: The sports medicine department mission statement, which is to be reviewed and approved by institutional administration, should include the statement that the sports medicine department is exclusively empowered to make all medical decisions and makes those decisions with the best interest of the athlete’s long-term well-being. The athletic trainer and team physicians’ approach to providing care should not focus on how quickly the athlete returns from an injury, but on the quality of the care provided. If the quality of care is at a high standard, safe and appropriate return to participation is best served with fewer complications and within the mission statement of looking out for the athlete’s long-term well-being.

• Staffing: Athletic training staffs should collect and place into the employee record the up-to-date certification, licenses, and Board of Certification (BOC) Continuing Education Certificate of each full-time, certified athletic trainer. This establishes that each athletic trainer is in professional compliance. In the event of a poor outcome, it also ensures that the athletic trainer was practicing legally and within their respective state's practice acts.

Best practices in many areas have established present standards of care. The sports medicine staff should annually review the NCAA Sports Medicine Handbook and all NATA position and consensus statements to evaluate if their respective policies and procedures are in compliance.

• Assignments: Most institutions do not employ an ideal number of certified athletic trainers given the amount of responsibility and workload that is required. Thus, consideration should be given in making sport assignments. Athletic training assignments should be made with sound reason and consider data on injury trends, as well as what sports pose the greatest potential risk for catastrophic injury. Ideally, the head athletic trainer isn’t assigned a sport. Rather, they supervise and lead younger staff, review the work and outcomes of other certified athletic trainers, and manage risk to the student-athlete and department.

• Policies and procedures: Best practices in many areas have established present standards of care. The sports medicine staff should annually review the NCAA Sports Medicine Handbook and all NATA position and consensus statements to evaluate if their respective policies and procedures are in compliance. For example, the emergency action plan, CPR/AED policy, concussion policy, and athlete mental health policy should be fully reviewed and updated each year. In addition, make sure that all policies and procedures are reviewed by the team physician, risk manager, and legal counsel before implementation. A signed agreement by the team physician regarding the standard operating procedures (SOPs) permitted by the athletic training staff should be reviewed and updated annually. All SOP orders are to meet respective state practice acts.

• Continuing education: Care in sports medicine evolves rapidly. The certified athletic trainer needs to stay current on the spectrum of care and risk management. Attending continuing education sessions is a must.

• Facilities: Sports medicine departments should conduct a facilities evaluation to ensure compliance with safety. Utilizing the BOC Facilities Principles evaluation tool is recommended for all facilities. Additionally, having all electrical modalities serviced and checked by a certified technician annually is a must for safety. Keep the modalities recertification on file in the event of a modalities incident involving a student-athlete.

• Summer camps: This is an area fraught with potential liability. First, summer campers are minor children for the most part. This means that there must be parental notification and involvement in injuries other than life-threatening conditions. Secondly, summer campers are only on campus for a day or number of days, and their full medical history may not be known to the athletic trainer providing coverage to the camp. A thorough medical history and parental consent for care must be in place, and any follow-up questions should be settled before the camper is permitted to participate.

• Meeting with risk manager and general counsel annually: It is recommended that the head athletic trainer meet annually with the risk manager and general counsel to review the end of the year report and discuss any needed challenges in care or liability. It’s better to be proactive and include these entities as partners in helping address a problem instead of being judged after an incident has occurred.

• Mental health plan: Athlete mental health and wellness is a priority. Sports medicine staffs should obtain and use the two NATA sponsored Inter-Association Consensus Statements (2013 for college and 2015 for secondary schools) on developing a plan to recognize and refer student-athletes with psychological concerns. The consensus statements are valuable in helping educate athletic trainers, physicians, student-athletes, coaches, and administration on mental health disorder prevalence, recognizing signs and symptoms of mental health disorders, and offering steps on referring student-athletes for a mental health care professional evaluation and treatment.

The bullets outlined here are good starting points to focus on in addressing risk in a sports medicine department. Additional efforts to assure safety and reduce risk are enhanced by working with school risk managers, legal counsel, and instituting best practices in your policies and procedures. Leadership by certified athletic trainers with their staff and open communication helps top off efforts to reduce risk and ensure quality care to student-athletes.

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