Inclement Weather

With a snowstorm hitting across the eastern US brings up the issue of practicing when school is  closed.  Standard practice at many schools is to hold practice, even though the school has deemed it too dangerous for students and staff to travel.  Of course, the athletic trainer must now be there to cover the activity.  Other situations arise when a school closes early and the athletic practices continue on normal schedule.  This flies in the face of common sense.  


If a educational institution has deemed it too dangerous to have students and staff traveling because of weather conditions why are athletes somehow exempt from those dangers.  While some students may live on campus, and be able to walk to athletic facilities, many do not.  While it may be nice for the coach to say attendance is contingent upon an athlete being able to safely travel, the reality is usually different.  Many athletes will first make the effort to travel to determine if the conditions are safe enough.  There is also the pressure from the coach.  If they can make it into the facility then why can't the athlete.


Along with the athletes you have many support people that are needed.  This will include student coaches, managers, equipment people, and of course the athletic trainer.  Athletic Trainers best approach to this dilemma is to look at it from a student safety issue.  Do we really want to put the athlete in this potentially dangerous situation.  The person on campus that will be an ally is the school's legal counsel.  If you put the question to them regarding the best policy I am sure they will be on your side.  Set up the policy in advance so that all parties are well aware the guidelines and there are no complaints when school is cancelled. This is a situation that in the middle of summer does not seem all that important until it is upon you and there is no time establish meaningful guidelines.  

Athletes and Casts

Oftentimes, in the course of a year athletic trainers are faced with an athlete who has a fracture.  Sometimes it is season ending, sometimes there is enough time for recovery and return.  Other times the athlete may continue, provided they meet certain criteria.  In the case of an athlete with a cast, the continued participation is usually dependent on the rules of that sport.  Being able to protect opposing players from harm is usually the number one consideration.  Athletes who can continue to participate present their own set of problems for the athletic trainer.  

While fiberglass casts where a great innovation, the underlying cotton padding and stockinette is the same system used for the old plaster casts.  While the actual fiberglass casting material is impervious to water the cotton padding cannot become saturated with water.  Doing so leads to the deterioration of the skin and possible infection.  An athlete practicing with a cast accumulates sweat and dirt over time, increasing the potential for a harmful outcome.  Over time the cast will become a petri dish for bacteria.  I had one athlete tell me that his cast smelled so bad that it woke him while he was asleep.


There are a couple of options that the athletic trainer can pursue to deal with this scenrio.  In both cases it takes a cooperative physician to accomplish.  


The Bivalve - After an athlete has been fitted for a cast and it begins to deteriorate ecologically, you send them back to the doctor for a new cast.  The doctor then bivalves the cast and a new one is applied.  The new cast is also immediately bivalved.  The athlete now has two removable casts.  The original and now smelly cast for practice and competition, and a new one which is now presentable in mixed company.  


This procedure requires a physician comfortable doing this and a fracture that is far enough along in its healing.  You also need a responsible athlete who will continue to wear the cast since they can now remove on their own.  The athletic trainer only needs to apply the casts at the beginning and conclusion of activity.  Tape is all that is usually required to join the two pieces for a stable device.


Cast Liner - The other option is to use some new products that make the underlying cast padding also water proof.  These products are applied just like the traditional cotton padding but are now water proof.  The athlete can practice in them and then go into the shower without any protective cover.  In fact that is preferably as the shower will help rinse out any accumulated dirt and sweat.  Many doctors do not carry this product because of reimbursement issues with insurance companies.  I have used the Gore Tex PROCEL cast Liner for a number of years.  I purchase this myself and when I have an athlete who is to be casted I send along some rolls of the material for my doc to use.  It works out well.


Besides PROCEL there are a couple of other products now on the market. PROCEL. Here are the links:


     Gore Tex PROCEL

    3M™ Scotchcast™ Wet or Dry Cast Padding

    BSN Deltra Dry

2010 NCAA Convention - DII "Life in the Balance Package" passed

I previously reviewed NCAA legislation that was up for a vote in Division II. Well, the legislation passed. I bring this up because the resulting legislation will not only make for a more balanced life for Division II student-athletes, but will also impact athletic trainers in a positive way. The main changes that were passed are: 

• Student-athletes in football, cross country, field hockey, soccer and volleyball report to school a week later. That will reduce the time that only student-athletes occupy campuses and, in turn, lighten the financial burden on the institutions to house and feed them.
• Pre-season practices in Cross Country, Soccer, Field Hockey, Women's Volleyball, will be limited to 6 hours of athletically related activity. (only 5 can be devted to physical activities).  Practices cannot last longer than 3 hours and there must be a 3 hour break in between sessions.
• Student-athletes in soccer and volleyball also will play two fewer contests (a two-game reduction in field hockey begins in 2011), and the Division II Football Championship will be played a week later than in previous years.
• Baseball and softball student-athletes also will spend less time on the diamonds through a six-game reduction for men and no more tournament exceptions for women. Golfers also get a three-contest-date reduction starting next year.
• The Balance package also affected basketball with a one-game cut for men and women. In addition, a seven-day dead period over the winter holidays (12/20 - 12/26) gives student-athletes and staffs alike some strategic down time.

Unrelated to the life in the balance initiative but of interest to AT's is the following:

• Head coaches and other full-time coaches to be certified in first aid, CPR and AED use.

This will make life a little easier at the Division II level.  You may even see AT's leaving town on vacations over Christmas.  A 5 day cruise would not be a bad idea.

Division II is not finished with their "Life in the Balance Initiative".  Phase II will examine the non championship segments and exempted contests.  Also to be considered is a change in the hourly limits (20 / 8 hour rules) for athletically related activities in and out of season.

Division II seems to have the right attitude regarding what makes for the best overall college experience for the student-athlete.  These initiatives also have a positive impact on the support staffs.  Let's hope it continues.

Terminology

The NATA and the BOC put out a clarification last spring on the use of our credential and the proper acronym use. 

From the BOC:

"ATC refers to the credential held by a Certified Athletic Trainer (AT). ATC should only be used when referring to the credential, and it should not be used in singular or plural form (ATC or ATCs) when referring to an individual Athletic Trainer (AT) or a group of Athletic Trainers (ATs)."

http://www.bocatc.org/index.php?option=com_content&task=view&id=172&Itemid=131

Proper Term Usage

ATC
1.	May be listed after the name of a Certified Athletic Trainer (without the registered trademark symbol)	Correct: John Doe, ATC
2.	May be used to refer to the credential (with the registered trademark symbol)	Correct: John Doe earned the ATC® credential.
3.	Should not be used to refer to the certified individual	Incorrect: John Doe is an ATC.

NATA Policy on ATC Terminology:

"NATA’s policy is not to use the ATC acronym as a noun. ATC is an acronym that describes a credential, not a person, and it should only be used following the name of a certified individual. Using the ATC acronym as a noun inhibits the Board of Certification’s ability to protect the ATC credential against misuse. In other words, NATA and the BOC cannot protect the copyright on the ATC mark if it becomes known as a common noun."

(Excerpt from Athletic Training Terminology, retrieved from the National Athletic Trainers’ Association website: http://www.nata.org/about_AT/terminology.htm, April 15, 2009)

One of the other recommendations is that we use either the term Athletic Training Clinic or Facility instead of Athletic Training Room. I can go along with this. It is a better representation of our work environment.

We should begin incorporating this terminology as soon as possible. People often complain about the term "trainer" . What better way to phase out the it's use than by referring to yourself and your colleagues as an AT. When we refer to other health care providers we usually use initials such as, PT, PA, EMT, etc. Eventually, our athletes, coaches, administrators and finally the public will associate the term to us.

NATA Think Tanks

I decided to check out the NATA Think Tanks section on their website. You need to log into the members section and follow the link on the left side. The registration process did not go well. I followed the link to register and was eventually sent an email directing me to another link to finish the registration process. The only problem was that the page that I was sent to was the original registration page. The email directed me to click on a link on the upper left corner. There was no link, I was just sent back to square one. I emailed the NATA staff member who sent the original email telling her that I was getting no where. She did respond back promptly that she would inform the tech people and they would get back to me. Well, a week goes by and no response from the NATA tech people. I then email the original contact and ask "what is going on"? She again responds back promptly and forwards my email to the tech guys again. They do respond back right away with a new link and instructions. I am finally registered.

I emailed back the tech guy and told him that everything was working fine. I also asked him how they expected people to participate in these Think Tanks if it so difficult to register. He stated that it has been a problem over the last couple of months and they may be looking at a different software vendor.

So anyway, I am finally in. The Think Tanks are divided into different areas of interest.

Clinical & Emerging Practices

Legislative-Regulatory/Revenue-Reimbursement
College/University 

Athletic Trainer Life Balance
Communications 

Meeting Planning
Diversity and Gender Issues 

Membership
Educator 

Public Relations
Ethics 

Secondary School
Fundraising 

Student
International 

Young Professional

You choose the areas that interests you but once registered you have access to all subject areas.  It looks like these forums began in September of 2008.  There are not many posts in many of them. Fundraising has 8 and Health Care Reform has 6.  The most traffic is in the Secondary School and College/University. 496 and 112 respectively.  Some threads are very entertaining, especially in the Secondary School discussion.  You will get a good laugh out of, Coaches ...... Who has the best story, Parents....who has the best story, or Athletes say/do the darndest things.  Great reads and of great educational value to entry level AT's or students.


Overall, I think the Think Tanks are a great idea, but it seems their execution is wanting.  Participation is key in a discussion forum and if it is difficult to sign up you will not end up with new subscribers you need to keep things interesting. I think the NATA needs to push these more.  

Product Review – Portable Smart Heat

Therapy Innovations

I would like to review a new product that I tried out this fall. It is the Portable Smart Heat by Therapy Innovations. I came across this in a catalog last spring and thought it was interesting. I am always looking for new products that will make my job easier. When I attended the NATA Convention this past summer I made a point of checking this product out.

Therapy Innovations makes two products, the Smart Heat System and the Portable Smart Heat. The Smart Heat System is designed for your use in a facility. I will review only the Portable Unit. The number one modality that AT’s use for heat is a Hydrocollator. They have been around for many years. Their chief drawback is you need to fill them with water and they have a long initial warm up time. This is okay in a facility where they are just kept on 24/7. When traveling it becomes a little difficult to carry a small Hydrocollator unit, fill it with water, and then wait for it to heat up. I have seen AT’s do this but it was not for me. Yes, you can use the home team facility, but with some sports this becomes unmanageable, i.e. football. You can also use this in your hotel. So when I saw this unit I thought this may be a great traveling unit for my athletes.

The unit comes in an insulated travel bag, with three pads that measure 12” x 12”. The plug goes into the wall and the other end has three connectors that plug into each pad. You can also purchase additional pads in oversize, neck or multi joint configurations. It takes about 10 minutes for the pads to heat up and each pad has a washable cover. When ready to use, unplug the pad and apply. When you are finished you just plug the pad back into the connector to reheat. It will reheat in approx. 3-5 minutes. You can place a moist towel between the pack and skin if you prefer moist heat.

I have found this modality very useful for road trips. The pads heat up quickly and provide a quick means of therapeutic heat while traveling. I also plan to also use these in the dugouts for baseball and softball games. In conclusion, I would recommend this product to athletic trainers.  It is a portable and efficient means of applying heat when the usual modalities are unavailable.