NATA Now

January 3, 2017 by Beth Sitzler

By Shelly Jones, ATC

Last spring, I received a message from our school district office that struck immediate fear and elicited some tachycardia. “I’d like to meet with you regarding concussions.” After double checking my record keeping and return-to-play clearances, I called them back and set an appointment. Once we had a quick policy chat that made me diaphoretic, I was surprised to hear, “We’re hosting a school safety officers meeting and we’d like you to present on concussions.” I was delighted to realize not only was I not being sued, but I apparently would get to keep my job.

After learning that the school safety officers were not the campus security guards nor the school resource police officers, they actually worked with the school district risk manager, I began creating my presentation. In getting to know my audience, I researched their website and didn’t find a single article on concussions, so I kept my presentation fairly basic including concussion education and some policy best practices.

Upon arrival to their conference meet-and-greet barbecue, I immediately realized I had greatly underestimated their knowledge. Throughout our casual conversations I realized that these folks were very well-versed in liability and some were in charge of handling insurance claims, accident reports as well as lawsuits. They clearly already knew about failure to warn and the need for a thorough paper trail. I quickly gobbled down my dinner and head straight back to my room to increase the content of my presentation.

My previous interactions with risk management were vastly different than this group. Early in my career, I heard that both ImPact testing and even purchasing AEDs would increase the risk to the district. We had concerns with pre-participation physicals limiting athletes to “practice only: no cervical flexion or rotation allowed.” Risk management responded with, “We don’t allow restricted clearances … that would be like allowing athletes to participate in casts.” I agreed that the athlete’s participation was indeed a substantial liability, however, we routinely padded casts for football. I remember looking at my athletic director confused and seeing him scowl and scratch his head in disgust. However, the largest head scratcher was when they allowed an athlete to sign a waiver to participate in contact sports that included the phrase, “I realize I am at an increased risk of cardiac death.”

In contrast, I continued to be impressed with this group and their conference agenda including discussions of water quality testing for lead, maintaining safe turf fields and threat assessments. They discussed when to close facilities due to heat, dragging the turf with magnets to clear the playing surface from any metal fragments (I now know where all missing bobby pins go) and how to determine the likelihood that a threat may be carried out.

During lunch, I had a great conversation with our school district risk management department that resulted in help funding our new discus cage netting and moving our softball field fence due to safety hazards in the outfield. From there, they volunteered to help with a significant revision of our emergency action plans to standardize them throughout the district and include our middle school athletic facilities as well as off-campus aquatic facilities, cross country courses and golf courses. As athletic trainers, we routinely initiate policy changes, but without the district risk manager it would have been much more difficult. They facilitated building keys for our high school coaches who practice at the middle schools in case of lightning evacuation or needing the AED located inside. They also suggested posting the EAP on our website and have links to it on our facility rental agreements so any entity using our facility would have access to the information even during the summer months when we are not on campus.

The risk manager was further helpful and in turn forwarded our EAP draft to the school district’s attorney. We had very productive conversations attempting to strike the delicate balance of limiting the district’s liability, but still including what would be helpful in an emergency. Be sure to keep this in mind and involve risk management when you are writing your policies and procedures. Their legal perspective might prefer that you leave some directives out because in the event things don’t go as planned, you can inadvertently set yourself up for a lawsuit.

As school district employees the relationship between athletic trainers and risk management becomes even more crucial. As the district’s designated medical provider, we keep track of injury statistics and complete any and all incident reports for athletic injuries. When injured athletes don’t present to the training room for evaluation and treatments there isn’t a record that the injury occurred nor a report on file for the school district. When these incidents were on the rise our risk manager delivered a mandate stating that coaches were not to evaluate, treat, perform rehabilitation, nor refer athletes to outside medical providers. The mandate included the phrase, “Failure to follow this may result in discipline up to and including termination.” As you can imagine, incidents declined and our statistics and reporting improved greatly.

Lastly, the school district wanted incident reports completed online of any injury we evaluate. This would have doubled our documentation. Due to the relationship we had with our risk manager, we were able to show what we already document and they in turn agreed to only require the additional reports to be done on athletes seeking further care.

The relationship between the athletic trainer and the risk manager is a symbiotic one. Both professions help to protect the district and each other. If you too have had the misfortune of two athletes getting hit by discus lining up for the 1,500m, risk management can help. If you’ve got a clearance note or a waiver that keeps you up at night, a great relationship with your risk manager can help. Don’t want to document each injury twice? Show your injury reports to your risk manager and they just might lighten your workload. They really can be a great advocate with parent, coach and even athletic director issues. It’s nice to know someone at the district office will stand behind your policies and support you in your day to day operations. When your policies get tested it will likely be the risk manager that will be the final say either supporting or reversing your decision. If you don’t know your risk manager yet, now is the time to meet them and establish a relationship. After all, it’s risky business not to.

 

About the Author

Shelly Jones, ATC, works as an athletic trainer for the Beaverton School District at Aloha High School in Beaverton, Oregon. She is a sports medicine advisor for the Oregon School Activities Association and she currently serves as the District Ten Secondary School Athletic Trainers’ Committee representative.

She began her career at Century High School in Hillsboro, Oregon, as its first athletic trainer through a partnership with Tuality Healthcare. She still works on call for the hospital. She recently completed her last term as past president of the Oregon Athletic Trainers’ Society, ending 10 years of service on the executive board. She represented Oregon at the first two Collaborative Solutions for Safety in Sport Meetings. She has been honored to lobby on behalf of athletic trainers and athletic health care, helping pass the practice act governing athletic training in Oregon. She also was active with the Oregon Department of Education in passing its concussion law. She recently partnered with the Governor’s Brain Injury Task Force to standardize a return-to-learn protocol throughout Oregon.

She is the medical director for Rugby Oregon and implemented the first comprehensive concussion management plan in U.S. youth rugby. She was instrumental in developing similar concussion management programs and emergency action plans in both the Hillsboro and Beaverton school districts. Outside of her other responsibilities, she enjoys serving as a clinical preceptor for students from three athletic training education programs. In her free time, she enjoys volunteering at the Dove Lewis Animal Hospital and running 5Ks and 10Ks with and without her basset hound, Princess Buttercup. Jones can be reached at ms.shellyjones@gmail.com.

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