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
Tuesday, September 30, 2014
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.
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
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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!
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