Source: National Athletic Trainers' Association DALLAS, July 16, 2013 - The National Athletic Trainers' Association released today inter-association task force recommendations titled "Best Practices for Sports Medicine Management for Secondary Schools and Colleges." The statement is believed to be the first of its kind that focuses on specific protocols to ensure effective and efficient sports medicine procedures in these school settings. A copy of the complete statement is available at http://www.nata.org/sites/default/files/SportsMedicineManagement.pdf. There are more than 7.6 million students participating in organized secondary school athletics in the United States. Last year more than 420,000 student athletes represented their colleges in athletic participation. It is estimated that more than 1.4 million injuries occur annually to secondary school athletes; and approximately 209,000 yearly at the collegiate level across 25 NCAA sports. These statistics take into account both practices and games. The task force's recommendations are designed to provide superintendents of schools, secondary school athletic directors, college/university athletic department administrators, athletic trainers and team/school physicians with important considerations regarding: 1) duties and responsibilities of each athletic health care team member; 2) supervisory relationships and the chain of command within the team; 3) decision making authority related to approval for participation of student athletes; 4) administrative authority for selection, renewal and dismissal of related medical personnel; and 5) performance appraisal tools for the sports medicine team. "These guidelines were developed for a variety of reasons. Institutions are hiring athletic trainers for the first time and uncertainties exist regarding the administrative authority and supervision of the athletic trainer. There are also wide variances in the administration of the sports medicine program, the chain of command and the selection and evaluation of the sports medicine team," says task force co-chair Michael Goldenberg, MS, ATC, director of athletics and athletic trainer at the Lawrenceville School in New Jersey and member of the NATA board of directors. "Putting these practices into play ensures a cohesive, collective effort and athletic health care team approach to sports safety," adds Ron Courson, ATC, PT, NREMT, CSCS, also co-chair of the task force and senior associate athletic director for sports medicine at the University of Georgia. "These best practice recommendations serve as a roadmap for anyone involved in secondary school or collegiate sports." Consensus Statement Recommendations To ensure best practices in the secondary school and college/university sports settings, the inter-association task force recommends the following guidelines: 1. Establish an "athlete-centered medicine" approach to care. The physician or athletic trainer is often faced with dilemmas about return to play when an individual's best medical interests conflict with expectations of a coach, parent or others. The legal decision to allow an injured athlete to return to play is ultimately made by the licensed physician. In many cases, that physician may authorize an athletic trainer to determine the rate at which the athlete is exposed to progressively increasing physical demands. The statement includes a set of 10 principles to guide organizations on appropriate policies and procedures. 2. Create specific duties and responsibilities of the athletic trainer and team physician. Anyone involved in the primary care of an athlete and his or her short- and/or long-term health should be involved in the creation of that institution's athletic health care team job descriptions. This should also include and are not limited to:ü Develop an emergency action plan;ü Establish criteria for safe return to practice and play;ü Determine which venues require the on-site presence of the athletic trainer and team physician; andü Set guidelines for the fit, function and maintenance of all athletic equipment. 3. Establish supervisory relationships and a chain of command within the high school and college/university sports medicine team. There should be a clear delineation of responsibilities, particularly in cases where the athletic trainer may have responsibilities other than medical care (administrative and academic). Supervisory relationships should also be defined so that potential role conflicts are minimized and medical care is not sacrificed. Regardless of the model utilized, in no case should there be a supervisory relationship where members of the sports medicine team report to a coach due to both perceived and real conflicts of interest. The athletic trainer should report to the team or school physician. 4. Determine the decision making authority relating to approval for participation as well as injury management and return to play in the high school setting. Athletic trainers in the high school setting work in conjunction with team physicians who should be actively involved in the athletic health care programs, across all teams, throughout the year. Students must undergo a comprehensive physical examination before participating in sports to determine pre-existing conditions. When the athletic trainer is able to document evidence of functional levels insufficient to ensure the athlete's safety, the athletic trainer should express his/her concerns both to the treating physician and to the team physician. Whether or not the treating physician agrees, authority for the final decision on the athlete's return to play should remain with the team physician. 5. Establish decision-making authority relating to approval for participation of athletes as well as injury management and return to sport participation status following injury/illness in the college/university setting. Irrespective of level of play, there is immense pressure toward medical clearance for sport participation. Owing an obligation to athlete welfare, the institution must establish a clear line of unchallengeable authority to the team physician and athletic trainer. 6. Create policy and procedure recommendations for the hiring, renewal or dismissal of athletic trainers in the college/university and high school environments. In college, the sports medicine staff should have final authority for the health and welfare of the athletes. The athletic trainer should be appointed as a senior athletic administrator to provide for the health and safety of the student athlete: the athletic director shall not cede authority over sports medicine or sports medicine providers to a coach. The athletic trainer should be directed and supervised in regard to administrative tasks by the athletic director. If there is an athletic trainer on the high school staff, he or she should have significant responsibility in the hiring process within the school's policies and procedures. Renewal of the athletic trainer's job should be based on fair and comprehensive criteria. The team physician should evaluate athletic training services, and all non-medical duties, such as administrative responsibilities, should be assessed by the athletic director and/or principal designee. 7. Establish performance appraisals for athletic trainers in the college/university and high school settings. This helps provide a framework and set of resources that enable administrators to evaluate the performance of the sports medicine staff including program evaluation; individual staff performance; teaching; promotion and remediation plans and athletic training service metrics. "Each of these steps requires rigorous attention to policy and procedure and a full commitment from the sports medicine staff and institution," adds Courson. "With a dedicated team approach, we can and will reduce injury, prevent catastrophic outcomes and enjoy the academic and athletic benefits that come from sports participation in the high school and college and university settings." The task force was spearheaded by NATA* and included representatives from the following organizations: American Academy of Pediatrics; American College Health Association*; American Medical Society for Sports Medicine*; American Orthopaedic Society for Sports Medicine*; College Athletic Trainers' Society*; National Association of Collegiate Directors of Athletics*; National Association of Intercollegiate Athletics*; National Collegiate Athletic Association; National Federation of State High School Associations* and National Interscholastic Athletic Administration Association (* endorsed the statement, as of July 12, 2013) For more information please visit www.nata.org or www.athletictrainers.org.
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