ATC as Partner

If you’re like most athletic directors, you’re looking to lower risks in your department. One simple solution is to get on the same page as your athletic trainer.

By Randy Bertin

Randy Bertin is the Director of Athletics at Stoneleigh-Burnham School, an independent boarding and day school for girls in Greenfield, Mass. He can be reached at: rbertin@sbschool.org.

Athletic Management, 17.5, August/September 2005, http://www.momentummedia.com/articles/am/am1705/atcpartner.htm

The seeds of this story were planted last year, as I listened to a presentation about Automated External Defibrillators (AEDS). The salesperson started his discussion with a statement that immediately caught my attention: “As directors of athletics, you are the primary managers of risk at your schools.”

As a certified athletic trainer, I was slightly irritated by these words. Before becoming the Director of Athletics at Stoneleigh-Burnham School in Greenfield, Mass., I had been employed as an athletic trainer in a variety of settings from Division I universities to an inner-city high school. I felt strongly that athletic trainers, not athletic directors, were the primary managers of risk at schools. After all, aren’t athletic trainers responsible for all aspects of healthcare of the athlete from prevention to rehabilitation of injuries?

As the salesperson spoke about his product, my mind was elsewhere. I wondered, do most directors of athletics believe that they are the sole managers of safety and risk at their schools? We do oversee every aspect of the department and are ultimately responsible for what happens. And we also have to educate our coaches on safety concerning facilities and coaching methods.

However, when it comes to preventing athletic-related injuries, in most cases, the athletic director is not the staff member with the most expertise—the athletic trainer is. The athletic trainer is the person who should know the most about assessing injuries, return-to-play criteria, and the latest injury-prevention ideas.

I juggled the conflicting views in my mind, and came to the conclusion that the athletic trainer and the athletic director need to both be primary managers of risk for an athletic department to ensure safety. (Yes, I missed the entire sales pitch for the AED, but our school already has them.) The next question was: How do two people share such a responsibility?

WORKING RELATIONSHIP
The first step in partnering with your athletic trainer to reduce risk is to understand their capabilities. Athletic training has been growing rapidly for 20 years. A rising percentage of high schools either have an athletic trainer on staff or contract with a clinic for these services. Most colleges have anywhere from one to a dozen athletic trainers on staff.

The profession has been elevated by new standards for certification and greater emphasis on professional development. Today’s athletic trainers are focusing on improving their communication, management, and leadership skills.

Ideally, you should feel comfortable making athletic trainers part of your management team. Even if they are contracted to work only a minimal number of hours a week with you, think of them as critical members of your staff—and not just people who tape ankles and provide emergency coverage.

Every athletic trainer I’ve ever met is as hardworking and dedicated to student-athletes as any coach. If you ask them to become more involved in the leadership of your department, they will respond with enthusiasm. If you ask for their opinions and suggestions, you will be impressed with their contributions. In the long run, these interactions will also help them become a better athletic trainer.

The next step is to figure out a communication strategy between yourself and the athletic trainer. Sometimes, finding the time to talk is the hardest part of this partnership. You are busy, and so are they. And if your athletic trainers are contracted from a clinic, their hours are probably being counted and tracked.

Even with this time crunch, I recommend scheduling weekly meetings with the athletic trainer. They can consist of a half-hour or an hour. This ensures you have uninterrupted time every week for dialogue on athlete safety.

I also suggest you attempt to have daily sideline conversations with your athletic trainer. As you check in on games and practices, visit the fields where the athletic trainer is, so you can take five minutes and chat.

These efforts will make him or her feel appreciated as a professional. In my experience, most athletic trainers would say the athletic director at their school has at best a fair understanding of exactly what they do on a daily basis. If you reach out to them, they will show more dedication to you.

ON THE AGENDA
What exactly should you be discussing with your athletic trainer? The first thing is to mutually understand their role in your athletic department. This will vary from school to school, so it’s critical that you both are in agreement about the athletic trainer’s duties and areas of responsibility.

Here at Stoneleigh-Burnham, our athletic trainer’s role is defined as the person who oversees all aspects of the sports medicine department. We further define the responsibility by breaking it down into four areas:

• prevention of injuries
• emergency care and initial assessment of injuries
• serving as the point person for rehab and return-to-play decisions
• managing the athletic training room.

It should also be clear who the athletic trainer’s supervisor is. At our school, I have direct oversight of this person. At other schools, a team physician or another administrator might oversee the athletic trainer.

If your athletic trainer’s role is defined loosely, you should discuss exactly where his or her energies should be focused. Sometimes, athletic trainers assume that rehab or injury evaluation should be their primary responsibility, but you see game coverage as their primary responsibility. Or vice versa. Either way, it’s important that you are both on the same page regarding what part of their job is most important.

On a daily basis, your conversations should center around updating each other and discussing athletic safety. Ideally, the athletic trainer should be providing the athletic director with a list of injured athletes and progress made during their rehabs. If this is unrealistic from a time perspective, the athletic trainer should at least be informing you about any serious injuries that occur. You should go over whether the injury might have been prevented with different policies in place, how the athletic trainer handled the initial injury assessment and treatment, and what the communication with the parents was like. The athletic director should also review the athletic trainer’s records of the incident.

You should also discuss general safety issues with the athletic trainer and encourage him or her to share their observations. These safety issues could include athlete behavior, facilities, field conditions, equipment problems, game rule enforcement, and practice concerns, to name a few. Since an athletic trainer is present at so many athletic events, he or she can be an invaluable set of eyes and ears to any athletic director.

Another topic of discussion should be new ideas and trends in injury prevention. For example, with research on return-to-play criteria after a concussion evolving rapidly, the athletic trainer’s role should be to keep up with the research and the recommendations from experts, then to bring the information to the athletic director for discussion. Together, the two should consider adjusting policy based on these discussions.

POLICY MANUAL
One of the best ways for an athletic director and athletic trainer to work together is to develop a policy and procedures manual for the athletic training department. This manual should be a set of rules and regulations for athletic trainers to follow. It should also detail every aspect of their daily jobs and exactly how those jobs should be performed.

At Stoneleigh-Burnham, we developed our manual by first looking at other schools’ procedures, taking the best pieces of each one, and forming them to fit our school’s needs. We included information on everything from emergency procedures to how to clean the athletic training room.

Our athletic trainer did the initial research on the manual, then she and I discussed the details. We spent a lot of time deciding the best process for assessing injuries and return-to-play decisions. We talked through different scenarios and hypothesized how athletes and parents might respond to the procedures. When we were satisfied with what we had written, we asked the school attorney and team physician to also look it over and provide any feedback.

If you are unsure on how to make final decisions on best practices for injury assessment and return-to-play decisions, don’t hesitate to use others as resources. Ask athletic directors you know and trust for their opinion, or contact the National Athletic Trainers’ Association, which has a host of information and research on such topics (see “Resource” box below).
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We now review the manual once a year. We like to think of it as a work in progress, which is updated as new situations arise and new research presents itself.

EDUCATING COACHES
It is not safe to assume that all coaches understand the actual job and expertise of a certified athletic trainer. Many coaches just want to be able to yell, “trainer!” when an athlete is not getting up and then expect the player to get “checked-out” and return to the game. Therefore, it’s important to educate your coaches on what the role of the athletic trainer is.

At Stoneleigh-Burnham, we review this information at our annual orientation for all coaches. First, I talk about what I see as the mission of our athletic trainer. I talk about how we all want success, how we’re all on the same team, and that the athletic trainer is part of our team. Her aim is not to have athletes sit out, but to get them back on the field or court as quickly as possible. I emphasize the benefits she brings to our program.

I also reiterate that under no circumstances should coaches attempt to diagnose injuries. Our athletic trainer is always on-site or close by during a practice or game and our coaches are required to call for her help for any type of injury. We emphasize not taking any unnecessary risks when we have expert help on hand.

I also ask coaches to respect our athletic trainer’s scheduling demands. Coaches are required to end practices on time and remain within the schedule they are given. If a late practice or extra session is needed, it must be approved by the athletic trainer and the director of athletics.

My talk about athletic training is followed by our athletic trainer herself getting up in front of the coaches and making a presentation. She starts by showing a 15-minute power-point presentation provided by the National Athletic Trainers’ Association, which provides an overview of what athletic trainers do and why they are beneficial (see “Resource” box below). This video provides research and quotes from prominent coaches about athletic trainers and their role.

Next, she talks about some of the procedures specific to our school and her rules in the athletic training room. She also answers coaches’ questions, which mainly revolve around when to send an athlete to the athletic training room and when not to.

THE NEXT STEP
With the athletic trainer’s role clear to all and communication systems in place, you are on your way to a safer athletic department. From there, consider taking injury prevention to the next level, which is examining injury trends at your particular school and developing strategies for increased prevention of those injuries. At the end of every season, the athletic trainer and athletic director can look for consistencies or red flags among injuries department-wide and by sport.

For example, if the number of ACL injuries is high, you might consider introducing an ACL-injury prevention program to coaches and athletes. If non-contact ankle injuries have increased on the softball team, you might want to more closely examine the field for bumps and divots. If gymnasts are complaining about sore backs, you might review the coach’s workouts.

You can also begin to educate the athletic trainer on what you, as the athletic director, look for to reduce risks, training them to be on the lookout for more than athletic-related injuries. For example, he or she can help you spot hazards such as inadequate buffer zones on fields and courts, lack of supervision on certain teams, and incorrect progressions in coaches’ strength and conditioning programs. However, be sure to tell the athletic trainer to bring any concerns with coaches to you as opposed to reprimanding the coach him- or herself.

I also turn to my athletic trainer as a source of information on any issues developing on specific teams and with the overall athletic program. For example, if the captains of a team seem to be overstepping their bounds or getting the team focused on the wrong things, she often spots this before the coach or I do.

Improvements can always be made to every aspect of any athletic department. As the old adage says, “consistency is the sure way to failure.” As athletic directors, we need to take charge as the leaders of our departments regarding safety. And we need to work closely with our athletic trainers on this goal.


Sidebar:
EVALUATING YOUR ATC
Because most athletic directors have little background in sports medicine, they are sometimes hesitant to conduct evaluations of their athletic trainers. However, it is important that the athletic trainer, just like a coach, is given a formal and thorough job review every year.

If the athletic trainer is subcontracted from a clinic, you may want to work with his or her supervisor at the clinic in performing a job review. You could possibly review the employee together, or just provide the clinic with your written notes after you’ve conducted the review.

Here at Stoneleigh-Burnham, our evaluation focuses on the following areas:

Record Keeping: It is critical that athletic trainers keep comprehensive records on every athlete they treat. Even if you don’t know how to read SOAP notes (treatment notes), you can look at whether the athletic trainer’s records are consistent, clean, and thorough. You can also ask your team physician to review the records.

Work Efficiency: We require an athlete to sign in whenever seeing the athletic trainer. From these sign-in sheets, I can see how many athletes our athletic trainer is treating in an afternoon. We aim for 12-15 athletes to be treated per day, about 10 percent of the athletes in our program, even if some of the appointments are just a quick check-in.

Prevention of Injuries: To evaluate this area, I look at our injury trends and assess whether our athletic trainer is being proactive about decreasing injuries. I also look at what the athletic trainer communicates with our coaches regarding the prevention of injuries.

Injury Assessment: It’s hard for an athletic director to effectively assess this area of expertise, but there are some indicators you can use. For example, is the athletic trainer making good decisions on when to send athletes to the hospital? Does the team physician find that the athletic trainer is on the mark when sending athletes to him or her?

Rehab: Are coaches satisfied with the manner in which their athletes are returning to the field after an injury? Is the athletic trainer trying new ideas if a certain athlete is not responding to a rehab protocol?

Working with Others: With coaches, the athletic trainer should be a good communicator, but not be confrontational. With athletes, he or she should be comfortable but not their friend. With parents, he or she should provide constant communication on an injured athlete and be sure to quickly answer any questions.

It can also be worthwhile to get feedback from the coaches and parents about the athletic trainer, as well as the team physician. They may provide small details on how he or she does her job that can be used in the evaluation.


Sidebar:
WHAT THEY DO
Many athletic trainers complain that their athletic directors do not understand their jobs. Athletic Management asked a sampling of athletic trainers: What do you wish your athletic director better understood about your role?

• “I wish my athletic director understood the time constraints of covering multiple sporting events and the training room as one individual. Many times, I work harder and longer than my coaches. In addition, ATCs never get a season off—while my head football coach is relaxing and enjoying being a spectator at basketball or baseball events, I’m working. Don’t get me wrong, I love my job, but sometimes the time demands are very intense.”

• “I would like my athletic director to understand that I’m a health care professional who is building a program, not just providing a service.”

• “That an athletic trainer is a highly educated individual who has passed a rigorous certification process and needs to maintain CEUs to retain their certification. That we have knowledge of many areas—biomechanics, kinesiology, nutrition, psychology, exercise physiology, risk management, and strength and conditioning—along with athletic training, and could be used as a good resource in those areas. An athletic trainer is part of the athletics department team—we want to work with the coaches to help athletes achieve their best performance.”

• “I wish they understood medical confidentiality and liability better. As much as you can educate them about this, sometimes they think they are an exception because they are the athletic director.”

• “That ultimately we look out for the best interest of the athlete and we understand injuries better than coaches. For example, an athlete could be doing really well with rehab exercises but have joint instability or muscular damage that makes it a high risk for them to return to play. It can be a huge challenge to convince coaches and athletic directors of the limitations of particular conditions.”

• “Athletic directors need to sit down and look at the schedules they make and think how they affect athletic trainers. Sometimes people forget that athletic trainers not only cover a game or practice, but they are there one to two hours before that game/practice and stick around afterwards for another two hours. We cannot be paid any overtime for our long hours of work but are expected to be on hand to cover athletic events that are scheduled from dawn to dusk.”

• “That we want to be treated with respect, appreciated, and helped. That we want to be asked, “What would make your job easier?” That we would really appreciate a new office chair, waterproof rain gear, and an hour for lunch. That we do a lot of things not in our job description, like transporting athletes to medical appointments, bringing them food after their surgeries, and looking at a coach’s bad back."

• “I wish that they would remember that athletic training is a one-on-one activity. Coaches can teach a drill to many at one time. I can only tape, evaluate, or rehabilitate one athlete at a time. If three to five coaches are required to coach a single team of 15 players, shouldn't more medical staff be provided to care for all 400 athletes?”


Sidebar:
RESOURCE
The National Athletic Trainers’ Association has many resources that athletic directors can use to better work with their athletic trainers: www.nata.org

You can find the video titled “All About ATCs,” which can be used to help coaches better understand the athletic trainer’s role in an athletic department, at this link: http://www.nata.org/video.