Thursday, October 16, 2014

Life of an ATC: Is It in You?

As many of us enter the working world as a young aspiring professional in our field, we tend to wonder what it would be like first rattle out of the cage.  We are afraid, excited, and yet somewhat apprehensive of it all.  Prior to entering the world of young professionals, our lives as young adults in college are spent in burning the late night oil trying to accomplish our one goal: graduating.  Afterwards, we seek out what we think would be the easiest thing-securing the job. But, we are still unsure of what to expect once we begin our career. I use to think that a day job would be easy. Though athletic trainers don’t really follow the typical 8am-5PM protocol of work, there is still a lot to say for what we do.  Here are a few reasons why I love being an athletic trainer:

1)  Every day is something new- In this line of work, you can expect the unexpected.  Whether it’s being on the sideline at a football game, sitting under a tent at a soccer match, or getting up close and personal on the basketball court, every day presents it’s own challenges.  I personally have witnessed a variety of injuries and issues that have been personally challenging for me.  At the end of the day, you have dealt with or seen an injury, a psychosocial issue with an athlete, dealt with a parent, or witnessed that big “W” from your favorite team. 

2) It keeps me young- It takes a special kind of person to do what we do. Being a former athlete myself, I couldn’t get enough play time.  Whether it was for myself, or for my father, there was never enough time for me to obtain all the play time that could satisfy me.  Sometimes I reflect back on what times where like when I was a kid- often wishing that I could go back in time and relive those glory days on the field.  I often watch kids catch the hail mary that allows them to score the winning touchdown in a game that separates the men from the boys. Seeing young student athletes achieve something that I would not consider a small feat, makes me feel like I’m a high school kid again.  Not to mention being around student athletic trainers who are half my age.  They alone keep me on my toes.

3) Personal satisfaction- I hate to admit it but there are those times when we all witness an athlete go down on the field. Whether it’s a sprained ankle, a subluxed shoulder, or a torn ACL, we are called on as a confidant and health care professional to use our skills and knowledge and utilize it to the fullest, so we can return that particular student athlete or “all star” back to full player’s status.  For me, there is nothing more rewarding then having a student athlete bounce back from such a horrific injury, only to score the highest percentage points in a district game.  Not to mention, there is always that  big “thank you” from the parent themselves J

4) You become a mentor-  Yes, yes, yes. I hate to admit it too, but I did have ill feelings towards school counselors and mentors when I was in school.  We used to think that all of those health and nutrition classes we took wouldn’t be necessary. Little did I know, I was wrong.  I cannot tell you how many times I have been asked about nutrition, health, or even weight training.  You will soon realize that after you develop a rapport with athletes, you will be the one that they come to in dire needs of advice. 

As you can see, there is a lot more to athletic training that just taping and give the typical “ice water” treatment.  Athletic trainers are what I always consider the step children of the athletic program.  Like musical composers, we are the ones who remain in the background and wait in the wings in case we there is a medical emergency.   We are underpaid and overworked but to me, there is nothing in the world like sitting in the dugout eating sunflower seeds and watching the game from an up close and personal view. In  my opinion, sometimes as the bench warmer, you not only get the best seat in the house, but also hold the most important position on the team.  

Tuesday, October 7, 2014

Annie's Advice

One group of young professionals that we like to give advice to are the recently graduated, and recently certified/licensed athletic trainers. We all remember our first year on the job, and the challenges we faced. I quickly learned that everything I learned in the classroom, was just a foundation for what was going to be thrown at me. Having a mentor with some tips to help along the way is a saving grace for many fresh athletic trainers. Below I have complied a list of “tips and tricks” to help the new athletic trainer get through the first few years in the profession.
-Get or Stay close to a mentor from the HS setting
-Know and learn your limitations
-Utilize fellow ATCs
-Be confident in your abilities
-Communicate with your team physician
-Evaluate the whole athlete, not just the suspected injury
-Don't be afraid to refer when necessary
-Work to educate your student athletes and others
-Be honest and straightforward with your athletes, parents, and coaches
-Don't be afraid to say NO
-Take time to have some fun
-Think of it as a marathon, not a sprint. Take everything one-step at a time
-Listen to the Kids
-Get to know the janitors and secretaries
-Set up reasonable protocols
-Introduce yourself to the other team's ATC
-Don't be afraid to a risk
-Listen to those that have more experience than you, but also your students
-You're not going to get everything right 100% of the time. Failing is a part of it. 
-Try not to take work home with you
-Don't be afraid to ask for help
-Talk to the kids like they are adults
-Get to know your AD

Good luck on your career as an athletic trainer! Take it one day at a time, lean on others for advice and assistance, and most importantly, Have FUN! Welcome to the best profession out there. 

Tuesday, September 30, 2014

How to cruise through speed bumps and avoid traffic jams of the secondary school ATR

I cannot emphasis enough my passion for the secondary setting however it often comes with professionals in the early phases of burn-out. When I see these professionals I want to shake them and help them speed through the chaos of the secondary traffic jams that usually occur from 6:30-9am and 1:30-9pm. I have found that when speaking to my colleagues that are in this situation they often times refuse to change their ways and believe burn-out, stress and extreme tiredness are all part of our profession that we have to accept. This is not true!
A close classmate of mine realized this the hard way. In a classroom setting round table discussion a group of Athletic Trainers from across the nation drilled him with questions often beginning with why, such as “why do you put out water”, “why do you work on Sundays”, “why are you juggling patients” after the intense questioning he broke down. His simple answer was, “I don’t know why, maybe it’s because I have always done it.” This response got me thinking, how could I help him…….?
After collaborating with dozens of secondary athletic trainers from across the nation here is a short and simple map to beginning the steps of avoiding burn-out, lowering your stress level and enjoying your job once again-
1. Make your presence known- yes it may take more time at the beginning however in the end you’ll stop chasing your tail
  a. Speak at booster club, PTA or open house meetings- parents need to know who you are and what your title is.
    i. This is the perfect time to correct vocabulary and emphasis our title as “Athletic Trainers NOT Trainers.”
    ii. Explain your treatment protocol, concussion policy, referral policy etc.
    iii. Communicate with parents, if they have a child that is an athlete they should know you just as if you where the Head Coach
  b. Speak to the faculty- Ask your principle for a 20 minute time slot during your teacher in-service. This again gives you the upper hand in informing the staff of your title and policies
  c. Speak to each of the sports teams- This step is crucial! Do not allow a coach to speak to their athletes about your treatment policies, title, and overall athletic training room procedures. When you allow someone else to inform the athletes you give room for error
2. Make the ATR a clinic- when speaking to your parents, faculty and athletes inform them that they will be treated in a clinic not a “room”. This helps the individuals understand what you are expecting such as:
  a. Schedule appointments with your patients- have your athletes sign an appointment book when they walk in, first come first serve mind-set.
    i. Require all patients to attend am clinical treatments and if needed they can schedule an additional appointment for lunch, athletic period or after school. This gives you the opportunity to create a schedule and provide space between each treatment.
    ii. Require a sense of etiquette within the clinic- low voices, no cell phones, no food, no shoes etc. This will help the athlete understand the importance of their treatment and provide a calming environment
    iii. Slow down- yes you have too many patients for the amount of time you have with them and yes you might not be able to do the entire treatment that you would like or would be beneficial, however you must slow down
1. Learn to prioritize your patients and their treatments- try to see your patients twice a day so that you have the opportunity to do two different treatments. This will provide you time between the treatments to reflect on your patient notes and research any new treatments you would like to do in the second treatment time
2. Stop running around the ATR like a crazy person, it freaks out your patients and causes them to become anxious. Instead take your time with each patient, ask about their day, the upcoming game etc.
3. Give away hydration- yes, this has been a part of our profession forever but when you are treating 30 athletes in a 45 minute window at a 6A high school, water should be the least of your worries. Your focus should be to treat, care, prevent and rehabilitate your patients like the medical professionals we are.
  a. Most high school sports have a manager, spend one class period teaching them how to clean coolers, location of all supplies and process of setting up for practice vs. games.
    i. This allows for more responsibility from the manager which is a skill all teenagers should learn and provides you time to treat patients. This allows for the coach to communicate any schedule changes to a student whom they already have in their class instead of calling you or you worrying about what practice will be like today.
4. Be a professional- This one is going to be the hardest but will make the most impact.
  a. Dress like a professional- Don’t dress like a coach, you are not a coach, you are a medical professional with an extensive background in sports medicine. Don’t be scared to wear something other than khakis. I choose a few years ago to start wearing scrubs in the clinic and for inside sports. I have them in school colors with a monogram of the schools logo and my title. I found that the patients, parents and faculty’s attitude changed remarkably in a positive way. I am treated with respect and curiosity because I have made my presence known that I am a medical professional. This curiosity comes from patients, parents and faculty wanting to know more about athletic training and our skills.
With these 4 easy steps I hope you are cruising through your day and avoiding all traffic jams that occur in the secondary setting. Of course there are countless ways to improve our setting however these have made the most impact on my setting and many others. Please pass along any other ideas that have worked in your setting so I can add them to the list, we are only as good as our weakest link

Thursday, September 25, 2014

Concussions- question your surroundings

This blog post is a challenge to you to enhance your practice of evidence based medicine and learn to question your surroundings-
Unlike most sports injuries, concussion are often referred to as an invisible injury1. Concussions are defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces2. An estimated 300,000 sports related concussions occur annually in the United States, which is nearly 20% of the 1.5 million head injuries recorded3. This invisible injury can occur with several symptoms, many that are subjective in nature. Typical symptoms of a concussion may include somatic complaints (e.g., headache, dizziness, and fatigue), neurocognitive deficits (e.g., concentration and attention problems, information processing, and memory dysfunction), and emotional signs and symptoms (irritability, anxiety, low motivation).4,5 The presentation of concussion symptoms varies considerably patient to patient and without a formal way to identify the patient reported symptoms clinicians are unable to treat the patient accordingly6.
In recognition of the need for better concussion management strategies, the International Ice Hockey Federation (IIHF), in conjunction with the International Olympic Committee (IOC) and the Federation Internationale de Football Association (FIFA), convened in Vienna in October of 2001 to evaluate the current status of concussion management guidelines and to draft practical recommendations for making return-to-play decisions (Aubry et al., 2002). It was during this conference that the recognition of utilizing a symptoms scale during return to play protocols and the importance of documenting the self-reporting symptoms of the concussion patient became evident. It became clear that symptom reporting scales where important in treating the patient and that several scales addressed the same symptoms, but there was not one scale that was viewed as the golden standard. To identify these symptoms the post-concussion symptom scale (PCSS) was developed to provide a formal method of documenting post-concussion symptoms, as perceived and reported by the patient7. The PCS scale items were constructed to reflect actual player reports rather than medical jargon7. The PCS scale measures the severity of patient reported concussion symptoms on a 0-6 Likert scale, while providing the clinician a formal way of documenting these post-concussion symptoms8-10. The PCSS includes the following 22 items: headache, nausea, vomiting, balance problems, dizziness, fatigue, trouble falling asleep, sleeping more than usual, sleeping less than usual, drowsiness, sensitivity to light, sensitivity to noise, irritability, sadness, nervous, feeling more emotional, numbness or tingling, feeling slowed down, feeling foggy, difficulty concentrating, difficulty remembering, and visual problems. The PCSS was developed to provide an adjunct to other tools, such as neuropsychological testing, and is commonly found within on-field concussion assessment tools (e.g., Sport Concussion Assessment Tool 2 [SCAT2]) and post-acute computerized neurocognitive tests (e.g., Immediate Post-concussion Assessment and Cognitive Test [ImPACT], CogSport)6.
The PCSS is found to be broken into four factors: seven cognitive symptom factors (e.g., concentration, attention, memory and reaction time), three sleep disturbance symptom factors (e.g., sleeping more or less than usual) four emotional symptom factors (irritability, nervousness, sadness, more emotional than usual) and eight somatic symptom factors (e.g., headache, dizziness, fatigue, nausea)6. This scale is scored as a total overall score that includes all four of the factors. The instrument is documented as having a low score if the patient reports 0, a borderline normal score if the patient reports 1-5, a borderline score if the patient reports 6-12, a very high score if the patient reports 13-26 and extremely high if the patient reports 27+. It is not understood or well researched what these different scores mean or how they should be treated. Kontos 2006, reports that as clinicians we should
not only look at the total score of reporting symptoms but the individual score of each of the four factors2; this would allow clinicians a more in depth way of a multidisciplinary clinical management approach, rehabilitation treatments and return to play protocols6.
Researchers have found, through factor analysis of the PCSS scale and multiple other symptom scales, that the emergent four factors may reflect different subtypes of concussions6. Researchers report that, as clinicians, we should not only look at the total score of reporting symptoms but the individual score of each of the four factors. This would provide clinicians with a more in-depth approach of analyzing and controlling rehabilitation treatments and return to play (RTP) protocols6.
So…….… My question to my colleagues is this- Have you ever researched the tools given to you and may be required of you to use with your patients? Have you or do you understand the foundation of the numerous concussion scales, test or policies you are treating your patients with? I understand that concussions are a hot topic, however I feel this line of questioning should be utilized in all areas of athletic training. I know that being in the secondary setting myself we become comfortable and I find myself stuck, not able to explain a treatment method on a foundational scientific level or concussion scale with supporting research evidence. Once I realized this speed bump I began questioning everything, as I challenge you to do as well.
Which brings me back to the PCSS that I find absolutely fascinating. I have watched numerous sports medicine professionals ask the symptoms check-list and leave the patient with a mindset of “yes they have symptoms” or “no they do not have symptoms”. Did you ever stop to think what each of those symptoms mean or where those symptoms are located in the brain? Did you stop to think of what the difference of somatic and cognitive symptoms could mean for your patient? I know I didn’t at first and then it all became clear. These symptoms mean something and that something is crucial for their return to play or return to learn. So I CHALLENGE you to take a closer look at your patients symptoms and figure out what they truly MEAN.
~Cathlene Webb MS, ATC, LAT
University of Idaho Doctoral Student
1. Bloom GA, Horton AS, McCrory P, Johnston KM. Sport psychology and concussion: new impacts to explore. British Journal Of Sports Medicine. October 1, 2004 2004;38(5):519-521.
2. Meehan WP, d’Hemecourt P, Comstock RD. High School Concussions in the 2008-2009 Academic Year. The American Journal of Sports Medicine. December 1, 2010 2010;38(12):2405-2409.
3. Kelly JP, Nichols JS, Filley CM, Lillehei KO, Rubinstein D, Kleinschmidt-DeMasters BK. Concussion in sports. Guidelines for the prevention of catastrophic outcome. JAMA : the journal of the American Medical Association. 1991;266(20):2867-2869.
4. Barr WB, McCrea M. Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. Journal of Neurophysiology. 2001;7:693-702.
5. McCrea M, KM G, SW M. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA : The Journal of the American Medical Association. 2003;290:2556-2563.
6. Kontos AP, Elbin RJ, Schatz P, et al. A Revised Factor Structure for the Post-Concussion Symptom Scale: Baseline and Postconcussion Factors. American Journal of Sports Medicine. 2012;40(10):2375-2384.
7. Lovell M, Iverson G, Collins M, et al. Measurement of Symptoms Following Sports-Related Concussion: Reliability and Normative Data for the Post-Concussion Scale. Applied Neuropsychology. 2006;13(3):166-174.
8. Iverson GL, Gaetz M, Lovell MR, Collins MW. Cumulative effects of concussion in amateur athletes. Brain Injury. 2004;18(5):433-443.
9. Echemendia RJ. Assessment and Management of Traumatic Brain Injury. Sports Neuropsychology. 2006.
10. Iverson GL, Lange RT. Examination of "Postconcussion-Like" Symptoms in a Healthy Sample. Applied Neuropsychology. 2003;10(3):137.

Tuesday, September 23, 2014

David Gish

Passing of David Gish
SWATA President

It is with great sadness that I announce the passing of our NATA District VI President, David Gish. David “fought like hell” just like he promised, but lost his battle with cancer overnight. David served his athletes, his students, and his members with professionalism, integrity, and character, and he will be severely missed. Though David’s tenure as President was very short, his impact and legacy to his colleagues, students, Board, and members was tremendous. He gave us the greatest gift of all, his time. A service to honor David’s life will be announced at a later date. Please keep his wife Karen, and his children Madison and Hayden in your thoughts and prayers.

Kathy I. Dieringer
District VI Director

Wednesday, September 10, 2014

AED “Expirations?”

This month, as I began my routine of checking all of the AEDs in our facilities, I noticed we had one in particular that was not cooperating.  Further investigation lead to the discovery that said AED was out of warranty, and it was recommended by the manufacturer that it be removed from use.  Obviously, this came as a shock to me.  I have never heard of an AED “expiring,” only the pads and batteries, which I replace regularly.  I also found it shocking that this warranty date was not posted on the AED itself, or on the manufacturer’s website.  How then, I questioned the customer service representative, does one know if their AED is out of warranty or not? 
All of us rely on the services of an AED at practices and competitions, regardless if we actually put them to use or not.  We should have confidence in the fact that when we need it, it will not fail.  It is, after all, a proven life-saving device.  No sane person would ever put a faulty device into rotation, so why then would a company not make this little tidbit known? 

The situation was quickly remedied with the purchase of a new machine, but it left lingering questions.  In addition to a mass inquiry as to when the remainder of our AEDs expire, I question the company’s lack of education on their products as well.  What is the standard practice here?  What is it that the FDA and American Heart Association recommend?  And is this something that needs to be brought to the attention of other practicing health care professionals?  I leave with posing you the question of how you would handle this situation at your jobsite, and yes, helpful comments are certainly welcomed!

Monday, June 2, 2014

Indy is Around the Corner!

Every year the members of the NATA YPC are responsible for various educational and social opportunities for their peers at the NATA convention.

"Your First Leadership Position: A Conversation with the Young Professional," a peer-to-peer session, is on Friday, June 27. When a YP assumes a leadership position, it can come with a unique set of challenges. Often the early struggles of management leave the YP wondering what they did wrong or how they could have done it better. This will be an open forum where members of the YPC will share  experiences and resources to help clinicians avoid pitfalls in their work environment and in their lives.

The YPC will also be hosting a financial planning workshop as a part of regular programming on Saturday, June 28, featuring both YPs and financial professional, discussing the needs of those trying to strike a balance between obligations and paychecks. This session is not designed just for the YP, but for any athletic trainer looking for financial guidance.

And as always, the Remembering our Roots and Forging our Future YP social. This annual event is always one of the highlights for me during the symposium.  It is a time for YPs, Hall of Farmers and other influential members of our profession to network and socialize in an easy atmosphere over a cocktail.

Don't forget the YPC Lounge any day of the convention if you need a place to sit, bring your lunch, or meet up with other YPs.

There is so much more planned for Indy and our profession that week. Hope to see you all there!

-summarized from the May 2014 issue of NATA News