Archive for May, 2014

Education in the Heat Index Policy

Tuesday, May 27th, 2014

With the summer months and temperatures upon us, special care must be taken to ensure that athletes practicing and working out in hot, humid conditions properly hydrate. The Southwestern Conference (SWC), a high school conference in the St. Louis Metro East area with athletics and activities in the IHSA Illinois High School Association, uses the following policy to determine how to handle situations when the heat index rises to potentially unsafe levels. This policy will be used to advise on all extracurricular activities within the SWC.

This policy uses a progressive system of recommendations, warnings and limitations that increase as the heat index rises. The amount of limitations and recommendations for the heat index values, hydration amounts and overall safety for the student-athletes involved in all extracurricular activities are taken from other state high school associations, National Federation of State High School Associations standards and the NATA. Additionally this policy was reviewed and approved by the SWC attorney.

Heat index is an index that combines air temperature and relative humidity in an attempt to determine the human-perceived equivalent temperature — "how hot it feels."

WHITE ZONE UNDER 95 Heat Index

Provide ample amounts of water for all athletes and make sure it is readily available.

BLUE ZONE BETWEEN 95 – 99 Heat Index

Provide ample amounts of water for all athletes and make sure that it is readily available. Allow athletes to consume as much water as desired. Re-check the temperature and humidity every 30 – 45 minutes or as needed to make decisions on games or practices. Have cool down methods available for athletes as needed. Monitor athletes carefully for signs of Heat Illness. Water breaks at a minimum every 20 30 minutes.

YELLOW ZONE BETWEEN 100 – 104 Heat Index

Games - When the heat index is between 100 and 104, administrators, coaches, Athletic Trainers and officials will work together to allow additional breaks for water and cooling during game play as needed.

Practices –If possible, consider changing practice times to allow for a safer level of play. If practice times can not be altered, then non-necessary practice equipment (i.e. shoulder pads, helmets, etc.) should be removed when not needed for safety. Also, consider moving outdoor practices inside if possible. Water breaks should occur at a minimum every 15-20 minutes. White and Blue zones guidelines apply.

RED ZONE GREATER THAN 105 + Heat Index

When the heat index is at or above 105, all outdoor games and practices should be postponed or suspended until the HI has dropped to an acceptable level for return. The same considerations should be made for indoor activities when A/C is not available.

TESTING METHODS / PROCEDURES

There are a few different testing methods available for determining when it’s "too hot." There are a multitude of options, so budget should not be a limiting factor in whether you can have a policy in place or not. Each tool has its benefits, but finding one that works best for your situation is important.

  • Digital Sling Psychrometer
  • Hand-held device used to take temperature and humidity readings on the playing surface or a comparable location.
  • Use Online or Web-Based Resources
  • Oregon High School Athletic Association http://www.osaa.org/heatindex/
  • This allows you to type in your zip code and check the exact HI for that time and specific recommendations for practices and games.
  • Weather.com or other online websites
  • It also allows you to see a timeline and predictions for the HI at your specific zip code.

Why did we implement this policy?

The purpose of Heat Index policy is to protect our student athletes from the potential for heat illnesses, but developing one unified policy would do this and much more. This policy would allow all eight high schools who make up the SWC to have one unified policy that all eight school administrators and athletic directors voted unanimously on. This would allow the SWC high schools to have the same policy for cancelling or changing game times / practices as needed, an increased level of protection from liability situations since all eight area schools have the same policy (previously there was six different policies in place out of the eight area schools).

Common Questions / Issues

Does this policy apply to all sports, i.e. golf?

– Yes, we applied this policy to all extracurricular activities on the campuses at the eight area high schools in the SWC. Football, tennis, band, golf… They all follow the same policy so that we don’t set ourselves up to be liable for making different recommendations based on the perceived toughness of any given sport.

Does this policy apply to all playing surfaces?

Yes, this policy was adopted for all playing surfaces whether it be turf on a football or baseball field, grass or tennis courts. The Heat Index values remain the same.

What about when you are the away or traveling team?

This policy is in place for the SWC schools whether or not we are the home or away team. Each school talks to the teams on their schedule and lets them know ‘our’ policy and tries to work with and accommodate the home team’s respective policy.

Exception- For post-season events we follow the IHSA policy and will not follow the SWC guidelines. We leave that decision up to the IHSA and how they want to handle the specific event(s) in question.

Negative Feedback – Because the SWC instituted our policy we have forced area high schools to follow our policy during certain games or events because the SWC schools refuse to travel to away events when the potential heat index will be over 105. Also, parents / fans become upset when games or events are cancelled or postponed because of the 105 heat index value.

Positive Feedback – Taking a unified stand puts the safety of our student athletes at the utmost importance in the SWC and provides a stepping off point for our area schools and conference to develop and work on programs together to improve the safety and well-being of our student-athletes.

Written By:

Aaron Kremmel, MS, ATC, LAT, CSCS
Belleville East High School - Athletic Trainer
akremmel@bths201.org  

 

Increased Ankle Mobility

Friday, May 23rd, 2014

May is National Physical Fitness and Sports Month. When evaluating athletes for lower extremity injuries, it is remarkable how many have tight calves and lack range of motion in dorsiflexion. This lack of mobility is an adaptation that our athletes’ bodies have made in response to requirements of running and cutting. It can lead to changes in force absorption that can contribute to shin pain, foot pain or even anterior knee pain. A lot of these athletes can benefit from some mobility work to improve their active range of motion.

Here are a couple of resources with simple, self-performed exercises that athletes can do on their own to improve that motion: Mike Boyle and Sports Medicine Research Blog.

The first involves driving the knee forward over the ankle as a self-mobilization technique, and the second is a PNF contract/relax technique to increase overall range of motion. Both can be performed quickly and simply and can assist with improving motion at the ankle.

Though athletes likely do not spend much time thinking about ankles, increasing their mobility — along with using proper equipment — will have a positive impact.

Written By:
Tim Koba, ATC, CSCS, PES, CES, CMT
tkoba@CAYUGAMED.org

Physical Fitness Can Help Decrease Burnout in Athletic Trainers

Monday, May 19th, 2014

Every Athletic Trainer (AT) knows the benefits of physical activity (reduce risk of heart disease and diabetes, reduce blood pressure, maintain healthy bones, muscles, and joints, etc.). A recent study has shown that there also is a relationship between exercising and decreasing the symptoms of burnout, something that an estimated one-third of ATs deal with.

Participants in this 2013 study, who exercised for up to one hour, 2-3 times a week for 12 weeks, showed a decrease in feeling emotional exhaustion and expressing less depersonalization. They also had an increase in personal accomplishment and a decrease in perceived stress and depression.  All of these are issues that ATs deal with while coping with burnout.

May is National Physical Fitness and Sports Month. ATs should try to incorporate aerobic activity into their life. It isn’t always easy to do, but here are a few ways to do it.

  • Schedule exercise time into your daily schedule (Example, 8-10 Treatments, 10-11 Off/Exercise Time, 11-12 Pre-practice, 12-2 Practice, etc.)
  • Find a workout partner who will keep you motivated and keep you on track
  • Utilize your surroundings. Use the campus recreational center or go for a run around campus
  • Use your planning/lunch period to workout
  • Don’t sacrifice this time; say no to things

Not only will engaging in physical activity make you healthier, it could also make you better AT and keep you from getting burnt out.

How do you find time to work out?

Written By:
Brian Bradley, MS, ATC, LAT, CSCS
brian@orlandosportsmedicine.com

ETHICS IN ACTION: TO REPORT OR NOT TO REPORT – THAT IS THE QUESTION!!

Wednesday, May 14th, 2014

Athletic Trainers (ATs) have very little personal time and are typically considered (at least historically) to be on call at all times. ATs are bound by the NATA Code of Ethics and BOC Standards of Professional Practice.  Each of these documents either explicitly or tacitly expresses that ATs should not partake in illegal drugs.

Consider these issues in light of the case below.

As an AT in a collegiate setting, you are aware that one of your colleagues partakes in marijuana on his free time.  He has never come to work impaired nor has he ever utilized the drug on a workday.  Since this colleague has not been impaired during the time in which he performs his job duties, it is difficult to judge whether or not it is within the scope of your duties to report social drug use.  The other challenge is to determine if this should be reported exclusively to the boss and/or to the BOC and other regulatory agencies.  Do you report him for unethical behavior as an AT?

  • Do you report him?  If so, to whom and why?
  • Which of your personal, professional and organizational values led you to the decision to report or not report?
  • Would it be any different if the drug were heroin or cocaine rather than marijuana?
  • Is there a line between personal and professional activities when you are in a profession (and setting) that requires 24/7 access to the patients?

Written By:
Kimberly S. Peer, EdD, ATC, FNATA
kpeer@kent.edu

Dr. Peer is an Associate Professor at Kent State University. She holds a Doctorate in Higher Education Administration with a Cognate in Health Care Management. Kimberly was recently appointed as the editor-in-chief for the Athletic Training Education Journal and serves on the Commission on Accreditation of Athletic Training Education Ethics Committee as well as the NATA Committee on Professional Ethics. Her national contributions include service to the BOC, NATA, JAT and REF in multiple capacities. Her statewide service includes the Governor’s appointment to the Ohio licensure board and over 12 years of service to the OATA.

 

Motherhood and Athletic Training

Sunday, May 11th, 2014

Happy Mother’s Day to those who are BOC Certified Athletic Trainers (ATs) while carrying the Mother credential! In 1908, Anna Jarvis began a campaign to honor mothers nationally, and in 1914, President Woodrow Wilson signed a bill declaring Mother's Day a national holiday, making this the 100th anniversary of Mother's Day.

Women working in the athletic training profession balance many roles, which may include mother, caretaker and spouse as well as Athletic Trainer. Many times, as ATs, you may act as a mother to student athletes or those studying to become an AT. Mothers in the profession provide support and care to both their own children and extended family of patients.

Usually ATs know just as much about the team’s personal lives as they do of injuries. One of the most challenging situations an Athletic Trainer could face, is also a scenario of when an athlete tells you that she is pregnant. Do you have a policy to turn to for help in this case? This article from Training and Conditioning tackles questions with the expertise of several ATs, physicians and other specialists who have cared for pregnant athletes.

The BOC thanks AT mothers for your hard work and dedication to your families, patients and the profession.

Written By:

Brittney Ryba
BrittneyR@bocatc.org

This Baseball Season, Strike Out the Peanuts: Food Allergies Pose Real Threat

Thursday, May 8th, 2014

Matusz and Berardini are in the same league: Athletes with peanut allergy.

When Baltimore Orioles’ relief pitcher Brian Matusz bit into the tuna tartare he ordered for dinner March 9 at a Sarasota, Florida restaurant, he didn’t realize it had been prepared with peanut oil until his trachea began to swell.  A severe food allergy veteran (diagnosed as a child), Matusz immediately recognized he was experiencing an anaphylactic reaction, injected himself with epinephrine, took a Benadryl and called his mom.  The 27-year-old left-hander went to a local hospital, where he suffered a second, more severe reaction and required advanced care.

Matusz is one of an estimated 15 million Americans with food allergies, and his recent trip to a hospital was one of the more than 200,000 annual emergency room visits for food reactions.1 Because he didn’t delay treatment, Matusz recovered and returned for his next spring training appearance two days later.

National Food Allergy Awareness Week is May 11-17. As the nation is now well into baseball season, it’s a good time to re-think "buy me some peanuts and Cracker Jack." Athletic Trainers must be prepared to recognize anaphylaxis and deliver life-saving care. We’re also critical to minimizing the risk of serious food reactions among the patients we serve.

Incidence is escalating and costly

With every potential to be deadly, food allergies are on the rise in developed countries worldwide. A 2013 study by the Centers for Disease Control and Prevention revealed food allergies among American children jumped 50% from 1997 to 2011. Today one in every 13 children in the US has one or more food allergies - an average of two kids in every classroom. Experts can’t explain this increase.

A JAMA Pediatrics survey shows the national financial impact of children’s food allergies is $25 billion each year, which includes hospital and doctor visits, medications, special foods and lost parental work productivity.

Anaphylaxis signs and symptoms

Typically occurring within minutes of ingesting a problem food, symptoms can involve the skin, airway and/or gastrointestinal tract:

  • Difficulty breathing (brohchospasm)
  • Wheezing, chest pain/tightness
  • Skin reaction: hives, itchiness, flushing
  • Swollen lips, itchy tongue/mouth
  • Reduced blood pressure, weak pulse
  • Nausea, vomiting, diarrhea, abdominal cramping
  • Dizziness, confusion, loss of consciousness

Less frequently, the onset of symptoms occurs hours later. As Brian Matusz experienced, 20 to 25% of patients suffer biphasic anaphylaxis - a second "reaction wave" hours after initial symptoms have subsided.

Ninety percent of all food reactions are attributed to eight foods: milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish. Even trace amounts of a food allergen can cause a reaction. Cross contamination of foods during preparation or packaging and "hidden" sources of food allergens (in food or non-food items) also pose a threat.

Using the Epi-Pen

Do you know that an auto-injector does not cure anaphylaxis? It reduces symptoms for 10 to 15 minutes, during which you must access definitive hospital emergency care. Administration of an epinephrine auto-injector is a required competency for all entry-level certified Athletic Trainers. Depending on the type of injector prescribed, you should review the manufacturer’s demo video (Epi-Pen, Auvi-Q, Adrenaclick) and practice with a trainer injector.

Discussion

Matusz and Berardini are in the same league: Athletes with peanut allergy.

My 5-year-old son, a rising T-Ball star with the Orange Phillies, has severe peanut allergy. Could I trust you to be his Athletic Trainer?

  • How do you prepare for team travel with a food-allergic athlete? Consider airline and restaurant risk management tactics.
  • What are some of the hidden sources of peanuts and tree nuts?
  • What is your emergency action plan for athletes with severe food allergies? Do you review and practice your plan? Who should approve your plan?
  • Are you aware of state and federal laws, including your athletic training practice act, regulating the storage, transportation and administration of epinephrine auto-injectors?

Resources

1 Food Allergy Research & Education (FARE). Provides downloadable education/tools for healthcare providers, schools, colleges, etc. Sample Anaphylaxis EAP.

Bastic, Jordan. Allergies a concern for athletic trainers. NATA News. October 2009.

Profit, Amy. Stay a step ahead of food allergies. NATA News. October 2009.

Peanut allergy links Orioles reliever Brian Matusz with young fan (Baltimore Sun)

Orioles’ Matusz gets a scare (Herald-Tribune)

Feeding a Traveling Youth Sports Team with Food Allergies (Outside the Lines blog)

Celebrities with food allergies (ABC News)

__________________________________

Written by:

Kelly Berardini, MHA, ATC
klberardini@gmail.com

 

Program Director Highlights: Jackie Williams

Monday, May 5th, 2014

Program Director Highlights from the Spring 2014 PD Update Program Director – Jackie Williams
Slippery Rock University in Slippery Rock, Pennsylvania

1) What is the name of your institution?

Slippery Rock University in Slippery Rock, Pennsylvania

2) How long have you been a PD at this institution?
I have been the PD for 4 1/2 years at Slippery Rock University.

3) How many students are currently in your program(s)?
There are 68 in the professional clinical strand of the athletic training program, which includes sophomores, juniors and seniors.

4) Do you teach any class(es)? If so, which one(s)?

I teach a variety of the athletic training major courses including:

  • ERS 427 Mastery in Athletic Training
  • ERS 407 Healthcare Administration in Athletic Training
  • ERS 317 Therapeutic Modalities Theory & Technique
  • ERS 497 Clinical Synthesis in Athletic Training
  • INDS 101 FYRST Seminar

5) Do you use the BOC Self-Assessment Exam(s) as tools to assist your students in preparing for the exam? How?

In ERS 427 Mastery in Athletic Training, one activity I do is to have each student purchase and complete one of the BOC Self Assessment Exams.  This activity is tied into program and university assessment.  While taking the exam, students are asked to develop questions about the process, how the questions are written and any topic they are unsure of after reviewing the questions posed in the exam.

Prior to this activity, we spend a considerable amount of time visiting the BOC website.  As a group, we review the various exam preparation tools, work through the sample exam questions and review how the exam is developed and scored.  I try to reduce any fear they might have about the process and set-up of the exam. This activity helps them when they do take the self assessment exam.

Students are further encouraged to purchase more exams closer to when they sit for the examination.

6) How do you prepare your students for the BOC exam?

The students begin preparing for the BOC exam during their first athletic training major courses. The curriculum allows for sequenced courses to build on each other, providing reinforcement of the knowledge and skills necessary to be an Athletic Trainer (AT).

At SRU, each of our clinical experience courses have cumulative final examinations that are given via an online learning management system. The examinations are leveled according to the specific clinical experience course and what previous athletic training courses the students have completed.  Several other athletic training major course final examinations utilize this system. Allowing students to become familiarized with a computerized examination helps reduce some of the anxiety when taking the BOC exam.

ERS 427 Mastery in Athletic Training is a capstone course that prepares students to enter the next phase of their career. Part of the course is used to review the content areas and prepare the students for the BOC examination.  We review the content outline in the BOC Role Delineation Study/Practice Analysis. Students participate in multiple activities that expose them to questions that reinforce ways to review topics.  Small and large group discussions occur throughout the activities to help identify any weaknesses in content knowledge. A final cumulative examination of all content areas is given prior to any student taking the BOC examination.

7) What study materials do you recommend to your students? 

Currently, we use Van Ost’s Athletic Training Exam Review and the NATA Statements for ERS 427 Mastery in Athletic Training for practice questions. The class also uses all of the textbooks from previous courses.  I also literally haul many of my personal office library textbooks to each class depending on the topic of the day. Many of the textbooks we use to study are listed on the BOC website.

8) Please provide some tips for how you prepare your students for entering the real world (e.g. completing the BOC paperwork post-exam; state licensure/registration/certification; NPI numbers).

The second half of the capstone course is used to prepare students for the real world. Class activities have included polishing cover letters and resumes, completing mock interviews, identifying what is needed for job/graduate school applications, and examining the various state licensure/registration/certification process (BOC website used extensively for this). In regard to the process of reporting CEUs, I show them how to actually report CEUs using my BOC account.

Because of the lengthy process that students encounter when completing all of the necessary state licensure paperwork, the "pink paper" was created. Students are strongly encouraged to keep the "pink paper" accessible after they graduate.  This handout assists students when completing the state licensure application, obtaining an NPI number and completing self-queries. When I receive emails and phone calls asking for assistance in the licensure process, the first question I ask is, "Do you have your pink paper?" This document has helped many former students go through the process.

9) Do you have any tips, suggestions or questions for other PDs?

Utilize your resources! Contact other PDs to ask for insight. Use the BOC, NATA and CAATE websites. Spend the extra time with the students going through real life situations, especially CEU reporting and licensure/registration/certification.

If you are a PD who would like to be considered for inclusion in the Featured Program Highlights, please submit an email with your interest to StacyA@bocatc.org.

 

Be a Bench Leader, Not a Bench Warmer

Thursday, May 1st, 2014

As a young and relatively new full-time employee of the athletic training profession, I’ve begun to pay more attention to the news blurbs from the NATA and my state organization about supporting bills and government initiatives that impact the profession.  My first experience with and exposure to the political side of athletic training was when I attended the Hit the Hill Day in 2008 to advocate for the ATEAM Bill.  Going into the event I knew absolutely nothing about the bill, and furthermore I did not know what law (if any) existed for Athletic Trainers (ATs).  As I listened to others talk, the importance of the bill was all a foreign language to me.  However, being a participant and a body in Washington, DC, that Monday meant one thing: I was no longer a bench warmer, but I was becoming a bench leader.

It is easy to sit back and let others take the lead on matters that we, as healthcare professionals, may not be as well-versed or familiar with.  Politics, and understanding how progress is made on the legislative front of our profession, has never been a particular interest of mine; however, the more involved you become the more you begin to understand why it is so important.  Without the support of our state and federal legislators, our profession would be at an endless stalemate within the healthcare world.  The laws and face of healthcare in our country are changing daily, and guess what . . .  we need to do the same.

Regardless of the amount of credentials behind a name, experience on a resume or awards hanging on the wall, people know one thing: ATs are hard workers.  Our hard work can often go unnoticed as we are the people quietly sitting on the end of the bench just waiting for something to happen or finding the right moment to step in and help others.  The bench has been kept warm and toasty since before 1950.  It doesn’t matter if you are a young professional or someone who has been in the profession for 40 years, we can all take those small but ever important steps to becoming a leader for our profession.

How?

Here is one small and easy way to start: show up.  Attending and being an active body at an event is probably one of the most underestimated means of support any group can have.  Numbers matter.  After attending and listening, it will be easier to understand what your role might be in order to be the biggest bench supporter and leader the profession can have.  Even if your role is to just show up, at least you are doing your part. Learn more about Governmental Affairs and find resources on the BOC website.

Written by:

Elizabeth Wolfe EWolfe@tuftsmedicalcenter.org