Nov 2, 2017On-Screen Appointment
This article first appeared in the November 2017 issue of Training & Conditioning.
What happens when an athlete gets injured, but their school doesn’t have an athletic trainer on-site to treat them? Missouri high schools now have a solution for this problem — athletes can simply pull out their smartphones and video chat with a sports medicine clinician. It’s part of a new virtual athletic trainer program offered by the Cox Health network.
“We wanted to take what we do and make it more accessible,” says Greg Gilmore, MS, LAT, ATC, Athletic Training Services Coordinator at Cox Monett Hospital in Monnett, Mo. “How can we keep athletes in their sport, help them have a great experience, and positively impact the communities we serve?”
The program is also an affordable option for schools that can’t offer athletic training services on campus due to budgetary constraints. To have access to an athletic trainer via video chat from noon to 3 p.m., four weekdays per week, the cost is $50 per month. From there, prices increase to extend the hours until 6 p.m. or 9 p.m. Schools can pay the fee on a monthly basis, in a lump sum, or twice a year, depending on their purchasing policies.
The only equipment needed to take part in the program is a smartphone, tablet, or computer with a webcam. When an athlete is injured, a school administrator uses the device to sign into Direct Connect, a Cox Health application, and they are placed in a virtual waiting room. While the administrator can be anyone approved by the school, it is usually someone affiliated with the athletic department, such as a coach or athletic director. Parents can then log on, too, helping to improve communication among parent, medical provider, and child.
Next, Gilmore or one of Cox Health’s other athletic trainers will receive a notification that they have a patient waiting. If the designated on-call person is busy, Direct Connect has a chain system that will call the next athletic trainer in line.
“From there, I join the athlete in the virtual room,” Gilmore says. “If I see there’s an emergency, I am going to tell them to hang up and dial 911. Otherwise, they talk to me just as if we were in an exam room together-only it’s through a camera.”
After the athlete explains their injury and how it occurred, Gilmore asks a variety of questions to diagnose the problem and determine a course of action. He may have the athlete move a certain way, show him exactly what hurts, or do specific tests.
“For example, to rule out a muscle strain in the elbow, I might ask the athlete to place their arm on a solid surface, bring their wrist up into flexion, and have the administrator add resistance through the range of motion,” says Gilmore. “I do my best to mimic what I want through the camera, so the athlete can see exactly what I am looking for.”
Once the tests are complete and a diagnosis is given, Gilmore works with the athlete, administrator, and parent to decide on a treatment. If a physician’s care is needed, Gilmore refers the patient to their doctor. If not, he prescribes rehab exercises and sets a time to follow up later with the athlete via Direct Connect.
Last year, Cox Health piloted the program in two area schools. Although the process went smoothly overall, the lack of physical contact between the injured athlete and athletic trainer raised some challenges. To meet them, Gilmore and his staff learned a new assessment approach.
“I sat in on phone calls with several of our occupational medicine physicians who have been using video conferencing for years,” says Gilmore. “They taught me to ask as many questions as I needed and to be comfortable asking the same questions in different ways, if necessary.
“For instance, an athlete may say that they have never hurt their foot before,” he continues. “But if I rephrase my inquiry as, ‘Have you ever turned it, or done this or that to it?’ they might say, ‘Oh wait, now that you mention it…’ When you ask a question in a different way, it gives them a chance to think about it, and you can get more accurate information.”
Gilmore and his staff also have monthly meetings where they discuss interview strategies or practice different scenarios together. “This is a learning process, and each of us functions a little differently,” he says. “The best teacher I’ve found so far is repetition on the camera and adjusting as you go.”
This year, one school has signed up for the program so far, and Gilmore hopes to have at least three more join. “They are responding really well,” he says. “The best part is when an athlete, parent, or administrator calls back to thank us for helping. It’s what my former supervisor called the ‘other paycheck’ — hearing that the athlete is doing great and back in action.”