Apr 24, 2019

Appropriate Medical Care for the Secondary School Athlete

Larry Cooper, MS, LAT, ATC and Bart Peterson, MSS, AT

In 2001, the National Athletic Trainers’ Association (NATA), teamed with 16 other medical associations and sports governing bodies and began a two-year process to determine what schools and organizations should provide to students and athletes in middle schools and high schools. The resulting document, titled Appropriate Medical Care for the Secondary School Aged Athlete (AMCSSAA), provided guidelines for health-care professionals in school athletic programs.

The AMCSSAA provided 11 recommendations for organizations that sponsor athletic activities to ensure that appropriate medical care is provided for participants:

1. Determine the individual’s readiness to participate.
2. Promote safe and appropriate practice, competition and treatment facilities.
3. Advise on the selection, fit, function and maintenance of athletic equipment.
4. Develop and implement a comprehensive emergency action plan.
5. Establish protocols regarding environmental conditions.
6. Develop injury and illness prevention strategies.
7. Provide for on-site recognition, evaluation and immediate treatment of injury and illness, with appropriate referrals.
8. Facilitate rehabilitation and reconditioning.
9. Provide for psychosocial consultation and referral.
10. Provide for scientifically sound nutritional counseling and education.
11. Participate in the development and implementation of a comprehensive athletic health-care administrative system (e.g., personal health information, policies and procedures, insurance, referrals).

In addition, AMCSSAA defined the athletic health-care team (AHCT) as “… may be comprised of appropriate health-care professionals in consultation with administrators, coaches, parents, and participants. Appropriate health-care professionals could be: certified athletic trainers*, team physicians**, consulting physicians, school nurses, physical therapists, emergency medical services (EMS) personnel, dentists and other allied health-care professionals.”

Finally, AMCSSAA outlined the education required by the AHCT and school coaches and athletic personnel:

• Designated athletic health-care providers shall maintain expertise through continuing education and professional development.
• All coaches should be trained in first aid, CPR and AED, utilization of athletic health care team professionals, injury prevention and modification of training in response to injury and illness.

The AMCSSAA has worked well for the past 17 years, and great strides have been made in raising the level of athletic health care across the board. In fact, since 2001 there have been 60 peer-reviewed papers, consensus statements, inter-association statements, and other articles and documents written specifically for the secondary school-aged athlete.

Since 2001, we have also seen significant change in data collection regarding injury surveillance. The High School National Athletic Treatment, Injury and Outcomes Network (NATION), High School Reporting Information Online (RIO) and ATPRN have provided significant data and insight into athletic health care, including time-loss and non-time-loss injuries and the treatments and care provided for those injuries. In addition, The Athletic Training Location and Services (ATLAS) Project has mapped every secondary school in the United States and determined the type and quantity of athletic health care provided at each school.

It was believed that by tying together the various injury surveillance (qualitative) and ATLAS data (quantitative), it would be possible to predict the number of athletic health-care providers (AHCP) required at a school to provide appropriate athletic health care. Increasingly, the data shows that a single full-time AHCP is not sufficient to provide high quality athletic health care.

In June 2017, the National Athletic Trainers Association (NATA) Board of Directors approved a task force assigned with updating the AMCSSAA statement. This task force was directed to evaluate the 2003 document(s) and revise where appropriate. In addition, the task force was asked to create a tool whereby the end user could assess and update/create an athletic health-care program in compliance with the revised document. The group consisted of athletic trainers, researchers and lawyers.

The task force determined that any organization sponsoring athletic activities should provide the exact same level of care. Therefore, the focus of the task force was changed in title only – Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School Age Athlete (AMCS).

Starting from the original document, the task force began assembling the research and documents published since the 2003 publication. Upon review of all of the evidence, the original 11 standards were expanded to 12.

The New AMCS Standards

Based on the updated evidence, 12 standards were identified that comprise appropriate medical care.

Within each standard, there are multiple sub-standards and an annotation that includes supporting documentation, review of selected case law and resources a member of the AHCT or organization could use to implement the recommendations.

Standard 1: Athletes’ readiness to participate in activity is determined through a standardized pre-participation physical examination (PPE) screening process. Within this relatively self-explanatory standard, there are eight sub-standards. Much of this standard is modeled after the Pre-Participation Physical Examination, 4th ed. published by the AAP.

Standard 2: Practice, competition and athletic health-care facilities as well as equipment used by athletes are safe and clean. This standard includes the written policies, procedures and protocols for regular, scheduled cleaning and disinfecting, exposure control plan, posted hand-washing techniques, cleaning and sanitizing of equipment and athletic surfaces, inspection for hazards, designated clean are for QMP to perform duties, cleaning and sanitizing of hydration equipment/tools.

Standard 3: Equipment worn by athletes is properly fitted and maintained while instructions to use safely and appropriately are provided.

Standard 4: Protective materials and products used to prevent athletic injuries are safely and appropriately applied.

Standard 5: Athletic participation in a safe environment is ensured or activity is modified or canceled based on established environmental policies.

Standard 6: Education and counseling is provided for athletes on nutrition, hydration and dietary supplementation.

Standard 7: Wellness programs promote a safe progression of physical fitness and improve long-term health across an athlete’s lifespan.

Standard 8: Comprehensive athletic emergency action plan (EAP) is established and integrated with local EMS per athletic venue.

Standard 9: On-site prevention, recognition, evaluation and immediate care of athletic injuries and illnesses are provided with appropriate medical referrals.

Standard 10: On-site therapeutic intervention (pre-, post-, and non-surgical conditions) outcomes are optimized by developing, evaluating and updating a plan of care for athletes.

Standard 11: Comprehensive management plan for at-risk athletes with psychological concerns.

Standard 12: Comprehensive athletic health-care administration system is established to ensure appropriate medical care is provided. This standard is significant in that it addresses policy and procedures for the other 11 standards including:

• AHCT
• Formal agreements with supervising medical director/MD
• What qualifies as a qualified medical professional
• Annual calibration of medical devises
• Appropriate documentation and storage of records
• Resources, equipment, supplies
• Adequate funding to provide appropriate care
• Appropriate and adequate staffing

The Online Tool – PASS

The second charge for the task force was to develop a tool to assist organizations, assess and evaluate the care currently provided and plan for the implementation of any change determined necessary in the process. The online tool, or Program Assessment for Safety in Sport (PASS), will help each school/organization evaluate the current level of athletic health care provided currently. A report will show each standard and substandard and the associated level of completion for the organization. Users will upload evidence of completion and indicate to what extent they believe they have fulfilled the standard. (Not Implemented, In Planning, In Process, Implemented and Verifiable). Organizations will be able to benchmark their report to district and national level data once we have collected enough data. This threshold is 20% of the schools in the US. This is necessary in order to make valid statistical comparisons.

Users will be able to return to the tool and update the organizations profile continually. A special characteristic is that the organization will have a profile so that in the event there is personnel change the information will remain with the organization and the new employee will have access to guiding documents from the start. This way the new employee does not have to start from scratch and redo all of the protocols, policies and procedures.

Another feature is the ability to include stakeholders and supervisors to have access and help you to work towards completion of all of the standards. We feel this feature will assist in all areas of standard completion because of additional buy in from strategic personal in administrative positions.

We strongly believe these new standards and online tool will provide organizations with improved access and elevate their ability to provide high quality athletic health care.

Look for a Feature presentation on this topic at the NATA Annual Meeting and Clinical Symposium in Las Vegas on Wednesday, June 26, 2019 from 7:00 am – 9:00 am. The presentation is titled: Appropriate Medical Care in Secondary Schools – Implementing the Appropriate Care for Secondary School Aged Athletes Standards.