Dealing with the note “rest for 2 weeks”

If you have ever worked in the secondary setting you have received this note, “no athletics for 1-2 weeks” or  “no physical activity for 1-2 weeks”

This phrase can be the most frustrating phrase you read as a student athlete, your patient, walks in the athletic training room not dressed out for practice and announces, “I went to the doctor and I can’t work out.”  What is even more frustrating is if you were never informed the student was injured, you did the evaluation and recommended modified practice, a treatment and rehabilitation regimen confident that you could get them back to playing very soon, or even better yet, the doctor on your sideline evaluated the student, along with yourself and recommended a plan spoke with the parent and they still went to a different doctor and got the 1-2 weeks rest note.

I find that this type of scenario tends to happen most often in off-season or sub-varsity sports. 

I always blame myself first, and ask the questions;

            Did I not take enough time in my evaluation, or explain the injury or the plan to the student and parent?  Why do they not trust me? Why do they not want to see the sports medicine orthopedic that works on our sideline every week?

Sometimes I find the answer to these questions and find that it was a lack of communication or the parents have a connection with a different doctor in town that they trust.  But the problem I am still left with a kid that thinks they can’t do anything for 2 weeks, oh how it would be so nice if the note read, “limited activity with the affected limb, continue cardiovascular fitness and progressive rehabilitative exercises” that way when I try to explain this to the student and parents they do not look at me like I am ignoring the note that says no activity. 

We try hard as athletic trainers to let our community know who we are and what we do.  At our school we encourage student athletes to come and tell us about injuries and pains, we tell them and their parents they can see any physician that they please, we try to suggest those that work closely with us as team physicians, and those that specialize in sports medicine and offer sports injury clinics.  We do all that we can not to have a student sitting on the sideline doing nothing.  I know that the physician that wrote the note usually expects the student to do rehabilitation exercises and that rest will allow time for the injury to heal and that they too have the best interest for their patient, so do we, the frustrating part is when the student athlete is content with not doing anything.  When the patient, a student athlete is content sitting on the sideline, I am so frustrated; I must work to put in the effort to motivate them to try to do something to get back in the game.

This is me on my soap box for the day, please feel leave a comment, a suggestion or idea.

Shout Outs!

It is now time to begin submitting names to the NATA for athletic trainers who deserve recognition for all their hard work and outstanding professionalism.  I know that everyone reading this knows of one YP who is worthy of an award, so please nominate him or her.

This summer at the NATAPAC breakfast, the guest of honor Dale Mildenberger, proclaimed that we need to banish the "unsung hero" title: that we work too hard and too tired and too passionately to be just someone happy to be in the background.  He felt that we should be proud of our education and our expertise as health care providers.  He felt that we are failing to get recognition in legislation because we fail to recognize our own special properties and celebrate those.  He encouraged us all to be our own advocate. I could not agree more.

So give the ultimate shout out, the ultimate pat on the back, and nominate those who you feel represent the strengths in our profession.  You can find all the information you need here: http://www.nata.org/young-professionals-committee-ypc-national-distinction-award

HIPAA and Social Media

We all love them…those gruesome injury photos from football practice or the soccer game yesterday.  And with today’s social media, our cool injury pictures can spread around the world in a matter of minutes.  I mean, there is even a twitter account made solely to disperse pictures of this sort (@injurypics).  Unfortunately, with all of this technology we could be incorrectly distributing the private health information of our athletes.

Yesterday, we had a local lawyer come speak to our staff and students about the Health Insurance Portability and Accountability Act (HIPAA) and social media.  One of our GA’s assignments for the year is to redo our website and she has gone above and beyond, creating about every account imaginable for us.  While the website is still in the works, we now have a Facebook page, a Twitter account, an Instagram, and a blog.  All of these things are great, but we thought it would be good to have someone go over the stipulations of HIPAA so we would know if we were violating any of its regulations. Our guest gave some great information to all of us and answered many of our questions.  While some of you may be experts in this area, I thought I would just pass along a little bit of the information that he gave to us as a reminder to think twice before we immediately post a picture to one of our accounts.

First of all, the section of HIPAA that we deal with is mainly the privacy rule which says that individually identifiable health information needs to be guarded.  This is not only to protect the rights of the individual, but also to promote quality health care.  HIPAA only applies to covered entities, but seeing as how athletic trainers are considered health care providers, we fall under this jurisdiction.  This means that if a passerby takes a picture of an injury, they can post it online and they would not be held accountable.  On the other hand, if any one of us did the same thing, we could get into some serious trouble.  We have the responsibility to disperse only health information that is needed to determine the course of treatment for our athletes.

Another point to consider is that most of us know not to plaster our players’ names and faces across the internet.  Therefore, we may spend time editing our pictures but even things that you may think are unidentifiable can still cause a problem.  For example, if there is something in the background of that picture that can cause identification of the individual, then you could still be in violation of HIPAA.

So what can you do?  Well, you can make sure that you always get permission from your athlete or patient before using or showing their picture.  Luckily, it does not matter whether the permission is verbal or written, but you might want to stick with the written form in order to protect yourself.  Also, you can talk to your school lawyer about the policies at your institution.  While you may get permission from the athlete, which will excuse you from any civil or criminal charges, you can still get into trouble with your employer if you are not following their rules.  Often times they will not want you disseminating information or photos because it is unprofessional and could look bad on the organization.

Obviously, having access to a variety of injury pictures through social media can be very educational.  For many of us, it may be the only time we get to see an injury of that sort.  We just need to be sure that we are taking the right steps and precautions.  Hopefully next time you go to post that awesome picture, you will think twice because protecting our athletes should always be our primary concern.

There's An App For That: Phone Apps for AT's

Have you ever come accross something while working in the training room or on the field and thought to yourself, "I wonder if there is an app for this?"  Well in many cases there is.  In today's world practically everyone has a cell phone on them, most of which are "Smart" phones such as an Iphone or a phone running on the Google Android operating system.  More and more companies have come to realize this and they are creating apps that work with their products.  Other companies are creating apps that fulfill some need that practically everyone has.  There are several apps out their that an Athletic Trainer would find to be helpful.

Lets start with weather apps; there are several out there and you pretty much can't go wrong with any you choose.  With this said, let me tell you of some of my favorites.  You can't go wrong with The Weather Channel App.  The Weather Channel has a free app that will get you pretty much everything you need for basic weather services, including a radar map.  The free app has banner ads, but they are really not noticable at all.  If you don't want those ads, you can buy the app for $3.99, plus you get some other features.  This app only really gets you the most basic of features, as an Athletic Trainer what are we really looking for? We need an app that not only gives us radar maps, but can also tell us about lightning.  The best app in this regard is probably the Telvent WX App.  Telvent has the reputation for reliability and accuracy.  The app itself is free, however, there is a catch and it's a big one.  You need to have a subscription to their weather service for the app to work.  The Telvent weather service, subscription is expensive, so most of us won't be using it. If your school district can afford it though, it is worth it.  There used to be an app on the market called Pinpoint Lightning.  This app cost $4.99 for a 1 year subscription.  This app would send you an Alert on your phone when lightning struck within a distance that you set.  It also had radar and weather forcasts.  Apps like this are a little controversial as some professionals say there is no research proving the reliability of this app.  I used it in combination with my ThunderBolt Lightning Device (also a little controversial for the same reason) and the combination of the two seemed to work well together.  Unfortunately, the company that made this app took it of the market last April, but they plan on re-releasing it as an "In-App" purchase for one of their other apps called the MyWeather App. So be on the lookout for when they re-release this app.  When the Pinpoint App went of the market I started using another called Lightning Finder.  This app will send you text messages when lightning hits within a preset distance also, but you have to turn it on and tell it to send those messages for a certain amount of time.  It also has no research proving its relaiblity, but outside of Telvent, this is probably the best you can get.

There are several healthcare apps out there that may be useful.  The first to talk about is one called Instant Heart Rate by Azumio.  This app can actually detect your (or one of your athlete's) heart rate.  The app works very much like a pulse oximeter, in that it detects your pulse by tracking the color change in the surface of your finger tips that occurs with each beat of the heart bringing in a rush of fresh new blood to the capillaries in the skin.  All you have to do is put your finger tip over the phone's camera and start the app.  Azumio has a disclaimer that this app is meant for "fun" and shouldn't soley be relied on.  I tested this app out with the phone on one hand and a pulse oximeter on the other and I received the same result, so that was good enough for me.  Another good healthcare app includes one simply called "Eyechart" or "Eyechart HD"  this app has a Snellen chart that you hold 4 feet away from the athlete and they read it to get their vision tested.  The chart can also be randomized so the athlete can't memorize any of the lines.  Other apps out there that may be useful include apps that track your workouts, such as the Nike running app or the miCoach App from Adidas.  Each of these apps track how far and how long you ran for.  The Adidas one even has a voice coach to choose from that include Derrick Rose or Reggie Bush.

Do you use the Impact concussion software at your facility?  Did you know that Impact has a couple apps out there to help you?  The first app they came out with is called the ImCAT or the Impact Concussion Awareness Tool.  This tool has a concussion education section that has a quiz about concussions, has information about what a concussion is, what mild traumatic brain injury means, and what can you do to help prevent a concussion.  The best part of this app however, is the common signs/symptoms section.  Here you can go through and fill out a form with an athletes information and fill out a checklist of certain signs and symptoms they may have.  Once the form is filled out it can be emailed to your email to check later or to another athletic trainer's email so they know what you saw when you evaluated their athlete.  Impact also just released another app called the Impact Mobile Costomer Center.  With this new app you can access your impact account from your phone and look up clinical reports, sideline reports, organization reports, injury reports, test statistics, etc.  The app also has a sideline evaluation tool.  You can access any athlete that has taken the impact test before and fill out information about a concussion while evaluating them on the sideline.  First, you can record what symptoms they may have. Next, it gives you memory tests to perform such as a reverse numbers test (where you give them a set of numbers then they repeat them in reverse order) or the 5 words test (where you give them 5 words to repeat back to you and remember to repeat them later).  Lastly, when you perform a Rhombergs test, Stork Stand test, tandem gait, and visual tracking tests you can record the results.  All of this information is then saved in your account as a sideline report that you can access later.  If you do not have an Impact account you can use the SCAT2 app as a sideline evaluation tool.  This app has you record symptoms and perform certain tests and record the results.  The results can then be emailed to your email or another athletic trainer's email.

These are the apps I have for now, if I come accross any other useful apps I will blog about them later.  If you have any apps that you would recommend please feel free to coment about them in this blog.
   

Taking Care of Yourself

As Athletic Trainers we are constantly taking care of others. We are available for our athletes before, during, and after practices. We assist athletes when they are sick, injured, or lend an ear when they need to talk. Most of us travel to away game with our athletes. We also keep medical records and a collection of other paperwork to keep our athletic training facilities and athletes running. But what about you? What are you doing to keep yourself running? Are you creating time to do the things you love, to workout, to eat healthy? Do we follow the advice we give to our student athlete's?

The longer I have been practicing athletic training the more important working out, eating healthy and finding time to do the things I love has become. Taking care of myself; has helped me take better care of my athletes. Sure summer is here and my list of to dos is just as long as it during the school year, but now is the time to start the habit of taking better care of myself.  Our athletes are always watching us and are more like to take our advice if they see us, following our own advice. It only takes 2 weeks to form a habit, so why not start now?

When is the last time you did something for yourself. Today I challenge you to take one small step and make time to do something to take care of you? Whether its taking the time to cook a good "healthy" meal, going for a run, scheduling a massage, going out with friends or my favorite hanging out at a coffee shop. Whatever you decide is up to you! In the words of Nike "Just Do It"

What Do You Want to Know About the Name Change Discussion?

In January of this year the NATA Board of Directors voted to officially investigate a potential name change for the profession of athletic training.

In February, the group's mission and composition were presented to the board and approved, and in March the announcement was made to the general membership via the weekly e-mail Range of Motion. I was added just prior to the first conference call in April as it was determined that the young professional population needed to be directly represented.

As you can tell from the announcement, this is intended to be a thorough investigation taking all factors into consideration before making a recommendation.

I want to address a few of the questions I'm getting most often in a series of informational posts. If you have any further questions or want any additional information on anything I've referenced, please don't hesitate to contact me.

**Hasn't the Association done this before?**Yes, in 2003-04, under President Julie Max there was a Nomenclature Task Force that investigated the ramifications of changing the name of the profession and the association.
It was determined then that the association should not change the name of the profession. They did not find that "athletic trainer" was an acceptable or descriptive title, but found the risks to outweigh the rewards.
Below, I've summarized their findings and outlined some of the reasoning behind their recommendations.


(DISCLAIMER:This is a summary of a much longer, comprehensive report)
*Legal/Legislative Implications
~Every state law governing the practice of athletic training would have to be opened in order to provide protection of a new title. (In 2004, 30 states had regulation, currently 48 states have regulation). Opening the practice acts could allow for our "competitors" to have a say in our scope of practice. If that were to take place, however, the bill could be withdrawn preventing any changes from being made.
~The second major concern outlined related to the cost of the effort which would be substantial. This cost would, as with other state legislative moves, be paid by the various state associations and its members.
~The final concern in this relates to compliance. In order for a name change to be successful, it must be comprehensive. Every athletic trainer in every state would have to agree to go by the new title. Any variance among states would greatly hinder any potential federal legislative gains.


Membership/Leadership Perceptions
~The membership argued with passion on both sides of the name question; with many younger members favoring a name change while older members were generally against it. They didn't find this to be a rule, however, with many younger members not feeling a change to be necessary. (They did not investigate based on setting) They determined that changing the name of the profession would be very divisive for the association.
~The leadership were found to have much more defined opinions with most committees being against a name change, save for the Committee on Reimbursement who was unanimously for it. Most notably against a name change were the Governmental Affairs Committee and The World Federation of Athletic Training and Therapy.


Reimbursement & Education
~The group investigated the assertion that a name change would result in higher rates of reimbursement and determined that 1) some progress was already being made on these fronts and 2) with no guarantee of advancement as it relates to reimbursement it makes it difficult to move on a "might" given the costs associated.
~Bear in mind that this investigation came on the heels of the significant educational reform that ended the internship route to athletic training certification.  Given that, it was determined that most of the education programs, public and private, were adamantly opposed to the name change.  Additionally, there would be cost associated for each institution to reflect a change.


Other Considerations
~Corporate sponsors did not tie the value of their relationship to NATA to the professions' title and were in support of any decision the association made.
~Those associated with the Journal of Athletic Training were opposed to a change that would cause a title change to our publication as negatively effect the indexing in Index Medicus
~Our Allied Groups (BOC and REF in 2004) would be negatively affected. They found the REF would be negatively impacted with regard to relationships it cultivates with current and prospective donors. While the BOC may have to run parallel processes (one for athletic trainers and one for whatever alternative name is chosen) for most of its programs since a name change could not be uniformly implemented in all 50 states simultaneously.

**Why is the NATA investigating this again?**
Many of the Board of Director's reasons are listed in the initial announcement and relate to the changes in the political, healthcare and education landscapes.  Health Care Reform is in full swing, there have been legislative gains with more state regulation as well as concussion legislation and with our recognition as a "health care provider" following the APTA lawsuit, the NATA feels that it is a good time to re-evaluate.
Additionally, our strategic partners, BOC, REF, CAATE are in support of the investigation at this time.


It is important to the group that this investigation be thorough, unbiased and transparent.  If you have any questions or concerns please express them.


If you are a young professional and haven't already, please fill out this survey and make your voice heard in this critical discussion!


Continue to check back as I will work hard to keep you informed on this ongoing discussion!

Are you in????

I know we all receive those emails with the surveys from graduate students looking to finish their research with the click of your mouse. We all see the SWATA and NATA eblasts come through our emails. We all secretly guess the injury during a game on TV and ignore when the broadcaster talks about the trainers and medical staff. We question in our heads or maybe out loud what the profession is doing for us or why our school or hospital or boss doesn't understand how important we are...

But, I may suggest, the question is really... ARE YOU IN? Are you taking part in the surveys to help out a graduate or are you the one complaining about the 5 minutes spent away from Twitter or Pinterest? Are you reading through the eblasts with the national news about your colleagues or are you complaining we do not get enough coverage? Are you clicking on our corporate sponsors' links or are you complaining your local rep isn't hooking you up like he use to? Are you communicating with the leadership in our associations or are you complaining that your dues don't mean anything? It doesn't take being on a committee or pledging 20 hours of volunteering at NATA. It takes the day to day involvement of filling out those surveys to help a next generation athletic trainer. It takes 5 minutes to explain to a parent who athletic trainers are and what we do. It takes talking to your administration to tell them why it is IMPORTANT to find money in the budget for your dues and CEU's. It takes making a phone call or sending an email to another athletic trainer who went through a rough injury or had a tragedy happen at their school. It take 5 minutes to email someone on the SWATA board with encouragement or suggestions. It takes banding together as a profession and knowing that many are stronger than a few.

We all have our ideals of what the profession should look like and what our organizations should do for us. What are we doing daily to promote our profession and ourselves as professionals?

Here is one of those surveys... written by your colleagues trying to find ways to help make things better for young professionals and all athletic trainers. We need to know what you like and what bothers you. We need suggestions on how to make YOUR associations more accessible. We need you to be in! Please take 5 minutes to fill this out.  We need YOU to be in!

 http://www.surveymonkey.com/s/B7B2C2B

Are we in? Are we commited to the profession or to our jobs? Are you in?