Chapter 1:
The Athletic Trainer and the
Sports Medicine Team
Jennifer L. Doherty, MS, LAT, ATC
Academic Program Director, Entry-Level ATEP
Florida International University
Acute Care and Injury Prevention
Sports Medicine
• Broad field of medical practices related
to physical activity and sport
• Involves a number of specialties
involving active populations
• Typically classified as relating to
performance enhancement or injury
care and management
Human
Performance
Injury
Management
Exercise Physiology
Practice of Medicine
Biomechanics
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage
The Players on the Sports
Medicine Team
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Physicians
Dentist
Podiatrist
Nurse
Physicians Assistant
Physical Therapist
Athletic Trainer
Massage Therapist
Ophthalmologist
Dermatologist
Gynecologist
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Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning
Specialist
Social Worker
Neurologist
Osteopath
Psychiatrist
Growth of Professional Sports
Medicine Organizations
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International Federation of Sports Medicine (1928)
American Academy of Family Physicians (1947)
National Athletic Trainers Association (1950)
American College of Sports Medicine (1954)
American Orthopaedic Society for Sports Medicine (1972)
National Strength and Conditioning Association (1978)
American Academy of Pediatrics, Sports Committee
(1979)
• Sports Physical Therapy Section of APTA (1981)
• NCAA Committee on Competitive Safeguards and Medical
Aspects of Sports (1985)
National Athletic Trainers’
Association (NATA)
• Purpose:
– To enhance the quality of health care for
athletes and those engaged in physical
activity, and to advance the profession of
athletic training through education and
research in the prevention, evaluation,
management and rehabilitation of injuries
• 30,000 members
Purpose of Professional
Sports Medicine
Organizations
• Promote involvement of various health
related professions
– Dentistry, podiatry, chiropractic medicine
• Focus on athletic health and safety
• All bodies have worked towards the
reduction of injury and illness in sport
Sports Medicine Journals
• A variety of publications exist, providing
excellent resources to the sports
medicine community
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Journal of Athletic Training
Journal of Sports Rehabilitation
International Journal of Sports Medicine
Physician and Sports Medicine
Clinics in Sports Medicine
American Journal of Sports Medicine
The Athletic Trainer
• Charged with injury prevention and health
care provision for the athlete and physically
active population
– Consists of athletic, recreational or competitive
activities
– Requires physical skills and utilizes strength,
power, endurance, speed, flexibility, range of
motion and agility
• Athletic trainer deals with the athlete and
injury from its inception until the athlete
returns to full competition
Roles and Responsibilities:
Performance Domains
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Prevention of athletic injuries
Clinical evaluation and diagnosis
Immediate care of injuries
Treatment, rehabilitation and
reconditioning of athletic injuries
• Health care administration
• Professional responsibilities
Personal Qualities of ATCs
• Stamina and Adaptability
– Prevents burnout
• Empathy
– Ability to detect stress with a desire to
minimize that stress
• Sense of Humor
– Helps relieve tension and promote
relaxation
Personal Qualities of ATCs
• Ability to Communicate
– Oral and written communication is
necessary
• Intellectual Curiosity
– Lifelong commitment to learning
• Ethics
– High standard of conduct and integrity
The ATC and the Athlete
• Major concern for the ATC = athlete
• All decisions impact the athlete
• The injured athlete must always be
informed
– Be made aware of the how, when and why
that dictates the course of injury
rehabilitation
The ATC and the Athlete
• The athlete must be educated about
injury prevention and management
• Instructions should be provided
regarding training and conditioning
• Inform the athlete to listen to his/her
body in order to prevent injuries
The ATC and Parents
• ATC must keep parents informed,
– Particularly in the secondary school setting
• The parents decision regarding
healthcare must be a primary
consideration
• Insurance plans may dictate care
– Selection of physician
The ATC and Parents
• ATC, physician and coaches must be
aware and inform parents of Health
Insurance Portability and Accountability
Act (HIPAA)
– Regulates dissemination of health
information
– Protects patient’s privacy and limits the
people who could gain access to medical
records
The ATC and the
Team Physician
• ATC works under the direct supervision
of a physician
• Physician and ATC must be able to
work together
– Have similar philosophical opinions
regarding injury management
• Helps to minimize discrepancies and
inconsistencies
Roles and Responsibilities of the
Team Physician
• Compiling medical histories and
conducting physical exams
– Pre-participation screening
• Diagnosing injury
• Deciding on disqualifications
– Based on medical knowledge and
psychophysiological demands of the sport
Roles and Responsibilities of the
Team Physician
• Attending practice and games
• Commitment to sports and athletes
• Potentially serve as the ATEP Medical
Director
– Provides input into educational content
– Provides programmatic instruction
The ATC and the Coach
• Must understand the role of the ATC
• Coach must clearly understand the
limits of their ability to function as a
healthcare provider
• Directly responsible for injury prevention
– Appropriate conditioning programs
Roles and Responsibilities of the
Team Physician
• Coach must be aware of risks associated with
the sport
• Provide appropriate training and equipment
• Must have knowledge of CPR and first aid
• Must have thorough knowledge of skills,
techniques, and environmental factors
associated with sport
• Develop good working relationships with staff,
including athletic trainers
Athletic Training
• Where have we been?
• Where are we now?
• Where are we going?
Athletic Training:
Where have we been clinically?
• Traditional employment settings deal
exclusively with an athletic population:
– Colleges
– Secondary schools
Athletic Training:
Where are we now clinically?
• Today, ATCs work in a variety of settings
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Professional sports
Hospitals
Clinics
Industrial settings
The military
Equipment sales
Physician extenders
Athletic Training:
Where are going clinically?
• Employment opportunities are
becoming increasingly diverse
– Dramatic transformation since 1950
– Due largely in part to the efforts of the
NATA
• More employment settings will include:
– Research
– Administration
Athletic Training:
Where are we going clinically?
• Evolution of the profession has led to:
– Recognition of ATC’s as healthcare
providers
– Increased diversity of practice settings
– Passage of practice acts
– Third party reimbursement for athletic
trainers
– Constant revision and reform of athletic
training education
Athletic Training:
Where have we been educationally?
• Formerly there were two types of
athletic training education programs
– Accredited education programs
• Competency-based education
– Internship education programs
• Quantity-based education
Athletic Training:
Where are we now educationally?
• In 1998, the NATA - Education Council was
established to dictate the educational
preparation for the athletic training student
• Focus has shifted to competency based
education at the entry level
• Education Council has significantly expanded
and reorganized the clinical competencies
and proficiencies
Athletic Training Education
Competencies
Twelve Content Areas
– Risk management
– Pathology of injuries and
illnesses
– Assessment and evaluation
– Acute care
– Pharmacological aspects of
injury and illness
– Therapeutic modalities
– Therapeutic exercise
– General medical conditions
and disabilities
– Nutritional aspects of injury
and illnesses
– Psychosocial intervention
and referral
– Organization and
administration
– Professional responsibilities
Athletic Training:
Where are we now educationally?
• June 1990 – the AMA officially recognized
athletic training as an allied health profession
• Committee on Allied Health Education and
Accreditation (CAHEA) was charged with
developing the guidelines for academic
programs to use in preparation of individuals
for entry into profession through the Joint
Review Committee on Athletic Training (JRCAT)
Athletic Training:
Where are we now educationally?
• June 1994 - CAHEA dissolved
• Replaced immediately by the Commission on
Accreditation of Allied Health Education
Programs (CAAHEP)
– Recognized as an accreditation agency for allied health
education programs by the U.S. Department of Education
• Entry level college and university athletic training
education programs at both undergraduate and
graduate levels are currently accredited by
CAAHEP
Athletic Training:
Where are we going educationally?
• In 2003, JRC-AT became an
independent accrediting agency
– New name: Commission on the
Accreditation of Athletic Training Education
(CAATE)
• CAATE will accredit athletic training
education programs without
– No involvement from CAAHEP
Athletic Training:
Where are we going educationally?
• CAATE will seek affiliation with CHEA once it
is fully independent
– CHEA is a private nonprofit national organization
that coordinates accreditation activity in the United
States
• Recognition by CHEA will put CAATE on the
same level as other national accreditors, such
as CAAHEP
• CAAHEP accreditation will be discontinued in
2006; CAATE will begin in 2007
Athletic Training:
Where are we going educationally?
• Specialty Certifications
– Build on entry level knowledge
• NATA is in the process of developing
specialty certifications
– Further enhance professional development
– Aid in expanding scope of practice
Athletic Training:
Where are we going educationally?
• Seven proposed specialty certifications
– Business practice, medical care
management, occupational health,
wellness, pediatric/adolescent health,
adult/geriatric health, special health
populations
• Candidates will have to complete
experiential requirements and pass a
standardized examination
Requirements for Certification
as an Athletic Trainer
• Must have extensive background in
formal academic preparation and
supervised clinical experience
• Upon meeting the educational
guidelines applicants are eligible to sit
for the Board of Certification (BOC)
examination
BOC Examination
• Examination consist of the following:
– Written portion
– Practical portion
– Written simulation
• Exam assesses the 6 domains
– Prevention of injuries
– Evaluation and diagnosis
– Immediate care of injuries
– Treatment, rehabilitation & reconditioning
– Organization and administration
– Professional responsibility
BOC Examination
• Upon passing BOC examination, you
are a BOC certified athletic trainer
– Credential of ATC
• BOC certification is a prerequisite for
licensure in most states
Continuing Education
Requirements
• Continuing education is a requirement
to maintain the ATC credential
• Ensure ongoing professional growth
and involvement
• Requirements that must be met to
remain certified
– 80 CEU’s over the course of three years
• Purpose:
– To encourage ATC to obtain current
professional development information
– To explore new knowledge in specific
areas
– To master new athletic training related skill
and techniques
– To expand approaches to effective athletic
training
– To further develop professional judgement
– To conduct professional practice in an
ethical and appropriate manner
• CEU’s are awarded for:
– Attending symposiums, workshops,
seminars
– Serving as a speaker or panelist
– Certification exam model
– Participating in the USOC program
– Authoring a research article;
authoring/editing a textbook
– Completing post-graduate work
– Obtaining CPR and first aid certification
State Regulation of the
Athletic Trainer
• During the early-1970s NATA realized
the necessity of obtaining some type of
official recognition by other medical
allied health organizations of the athletic
trainer as a health care professional
• Laws and statutes specifically governing
the practice of athletic training were
nonexistent in virtually every state
• Athletic trainers in many individual
states organized efforts to secure
recognition by seeking some type of
regulation of the athletic trainer by state
licensing agencies
• To date 40 of the 50 states have
enacted some type of regulatory statute
governing the practice of athletic
training
• Rules and regulations governing the
practice of athletic training vary
tremendously from state to state
Licensure
• Regulation may be in the form of
Licensure
– Limits practice of athletic training to those
who have met minimal requirements
established by a state licensing board
– Limits the number of individuals who can
perform functions related to athletic training
as dictated by the practice act
• Most restrictive of all forms of regulation
Certification
• Regulation may be in the form of
Certification
– Does not restrict using the title of athletic
trainer to those certified by the state
– Can restrict performance of athletic training
functions to only those individuals who are
certified
Registration
• Regulation may be in the form of
Registration
– Before an individual can practice athletic
training he/she must register in that state
– Individual has paid a fee for being placed
on an existing list of practitioners but says
nothing about competency
Exemption
• Regulation may be in the form of
Exemption
– State recognizes that an athletic trainer
performs similar functions to other licensed
professions (e.g. physical therapy), yet still
allows them to practice athletic training
despite the fact that they do not comply
with the practice acts of other regulated
professions
Future Directions for the ATC
Determined by the efforts of the NATA
and its membership…
• Ongoing re-evaluation, revision and reform of athletic
training education
• CAATE will become an accrediting agency
• Third party billing will gradually become the rule, not
the exception for ATC’s
• Standardization of state practice acts
• ATC’s will seek specialty certifications
– Expanding breadth and scope of practice
Future Directions for ATC
• Increase in secondary school employment
• Increase in recognition of ATC as a physician
extender
• Potential for expansion in the military, industry,
and fitness/wellness settings
• With general population aging, there may be
increased opportunity to work with aging
physically active individuals
• Continue to enhance visibility through research
and scholarly publication
Future Directions for ATC
• Continue to be available for local and
community meetings to discuss healthcare of
the athlete
• Increase recognition and presence
internationally
• Most importantly, continue to focus efforts on
injury prevention and to provided high quality
healthcare to physically active individuals who
are injured while participating in sport