Saturday, July 27, 2013

Best Practices for Sports Medicine Management: A Consensus Statement

Not too long ago, guest blogger, Mike Carroll spent time talking to you about how to advocate for getting an athletic trainer hired at your high school.  You can check out that blog post HERE.  What if you already have an athletic trainer available?  How can you be assured that you children are receiving the best medical care possible while participating in sports?  For those of you who have children participating at the high school and college level the answer to that question has recently arrived in the form of a Inter-Association Consensus Statement.

The National Athletic Trainers' Association along with other 10 other associations has developed a statement intended for school and athletic program administrators, athletic trainers and physicians.  This statement focuses on best practice for the administration of a sports medicine program at the secondary and collegiate level.  The statement makes recommendations in these five areas:
  1. Define duties of the athletic trainer and team physician
  2. Define supervisory relationships and chain of command with sports medicine team members
  3. Delineate decision-making authority for student-athlete participation, injury management, and return-to-play
  4. Delineate administrative authority for hiring, renewal and dismissal of  related medical personnel
  5. Make available performance appraisal tools for the sports medicine team
Each person who reviews this statement will have a different motivation and different area of focus, but I would like to draw your attention to a few areas and expand on them further.  The first, is the area of athlete-centered medicine.  We live in a culture where physicians and other health-care professionals are now trained to care for the whole person when treating an injury or illness.  This means not simply diagnosing the condition and providing the most current treatment, but considering the wants, needs and values of the patient when providing treatment options.  This is true for any patient, including those athletes who become ill or injured while participating in sports.  

The particular challenge in the sports medicine arena is that sometimes patient values are in direct conflict with the most appropriate course of treatment given the illness or injury.  One of the most challenging parts of being an athletic trainer (and I suspect a sports medicine physician) is the decision-making process around allowing athletes to participate following an injury or illness that may not be completely resolved.  Let me be clear, the first priority for an athletic trainer (and physician) when treating an athlete/patient is their health and well being.  I would never return any athlete to play who would clearly further endanger their own health or safety despite their desire to return to play, but we all know that sometimes these decisions are not obvious or clear.  Additionally, pressure from coaches or parents to return an athlete too quickly can make these decisions even more challenging.  Having a clear definition of the roles of the AT and team physician and designating the ultimate decision-maker (typically the team physician) can make these situations much easier to manage and allow the sports medicine team to protect all athletes.  Even if that means protecting them from themselves or their parents or coaches.  In the end, people will not always like the decision made, but if the outlined process is followed, often times all parties will be satisfied that they were treated fairly and understand that the health of the athlete is most important.

Another important component to a successful sports medicine program is understanding the lines of communication and making sure that all relevant parties communicate regularly.  One of the most influential factors in the ability of all parties to communicate is clearly defining the supervisory relationships and delineating the chain of command.  There are a variety of models out there at both the high school and college levels and each has their advantages and disadvantages.  I encourage anyone who has a system already in place to review that system and evaluate how effective the model has been for providing consistent, high-quality sports medicine services to its athletic population.  If the model is effective, why?  If the model is not effective, why not?  Is the model so ineffective that perhaps it needs to be altered, if so, to what type of model should you move?  If you're looking to employ and athletic trainer and team physician for the first time, how do you decide on which model to use?  There is no right or wrong answer to these questions, just the most appropriate model for your organization.  Every effort should be made to maximize the advantages while minimizing the disadvantages.

One of the most valuable parts to this newly issued statement is that it specifically addresses many of the common sports medicine models currently in place throughout the United States at the high school and college levels.  For each model it describes the key relationship(s) in the model and well as the advantages and disadvantages of each.  Every school system is unique and not all models will fit all school systems, but this information is easily accessible and provides administrations the opportunity to easily discuss all of the most popular options before deciding on a final plan.  In the end, no matter the final decision, I believe it is important that this information is now available.  The more educated administrators, athletic trainers, physicians and parents are the better the sports medicine program will be.

So, go ahead, click the statement link and take a look.  See where your program stacks up and lets keep working to make sure that the sports medicine programs at all levels are utilizing best practices when it comes to program management.  Just remember, you need solid professionals working in a well administered sports medicine program to be the most successful, not just solid professionals or a well administered program.  

If you'd like to learn more about the organizations who have endorsed these recommendations to date, just click on their link:

Submitted by Heather L. Clemons


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