Emerging Settings: Advanced Knowledge and Skills

The skills and knowledge acquired in professional education translate to treating clients and patients effectively in a variety of employment settings. As employment in the emerging settings has increased, we have started to identify additional skills and knowledge that are beyond our entry-level education and specific to that setting. Identification of this specific content will help athletic trainers identify related continuing education and improve their ability to provide excellent care.

The following information was compiled by subject matter experts in the emerging settings. Athletic trainers can use these as a reference to guide their continuing education and improve their practice as it relates to that setting. Athletic trainers are not required to possess these skills in order to be employed in these settings, but such additional and advanced expertise would be advantageous.

These advanced skills and knowledge assume that the athletic trainer has acquired all of the skills and knowledge identified in the Board of Certification Role Delineation Study/Practice Analysis 6th Edition, and if the athletic trainer graduated from a CAATE-credentialed program, has successfully completed the 5th Edition Athletic Training Education Competencies. The athletic trainer must also appropriately apply those skills and knowledge to the respective emerging setting.

Clinical Setting Knowledge and Skills

  • Justify the value of an athletic trainer, including return on investment and value of the BOC credential in the business world. 
  • Understand the effects of cash flow to a business and its importance for long-term business success.
  • Understand the following basic business concepts: balance sheet, revenue vs. expenditures, cost of living raises, staff evaluations.
  • Identify marketing and promotional strategies for a work setting (e.g. referrals, customer service, follow-up with past customers, educational outreach).
  • Understand the importance of activities of daily living and functional rehabilitation, and related insurance limitations regarding progression of care. 
  • Assess patient activities of daily living to establish skilled care for a patient, including short and long-term goals regarding range of motion, strength, function, balance, and gait.
  • Appreciate business skills related to leadership qualities, conflict resolution, and time management.

Hospital Setting Knowledge and Skills

  • Describe the structure and components of an Athletic Training initial evaluation and re-evaluation specific to a rehabilitation visit. (CPT codes 97005 and 97006) Identify information which needs to be documented to satisfy third-party payers.
  • Identify the available types of diagnostic procedures that may be associated with a physician office visit and specify reasons for which orthopedic and sports medicine conditions they would be used.
  • Demonstrate the ability to apply and remove casts for common upper extremity (short arm, long arm, thumb spica) and lower extremity fractures (short leg - NWB, short leg – weight bearing, long leg).
  • Demonstrate appropriate sterile procedures for both the orthopedic/sports medicine clinic and operating room environments.
  • Demonstrate the ability to take and present a concise patient history to a physician in a clinical setting.

Occupational Health Setting Knowledge and Skills

  • Having a complete understanding of orthopedic injuries, confidant evaluation skills, and a complete understanding of orthopedic protocols for acute, chronic and post surgical rehabilitation.
  • Have a thorough understanding of the job tasks that are performed within a company and be able to recognized safety issues.
  • Describe kinesiology and ergonomics, and their roles in injury etiology and prevention. Perform an ergonomic assessment of both static and dynamic activities, including interactions with tools or workstations. Interpret the results, and identify individual positive and negative behaviors relative to sustaining an injury or acquiring an illness.
  • Fit employee with proper personal protective equipment (PPE), tool belt, climbers, and other donned equipment or tools.
  •  Develop a line of communication when dealing with an employee incident (i.e., workplace accident) including union stewards, worker compensation representatives, safety managers and the treating medical professional.
  •  Develop and record an accurate assessment of job duties by which necessary functional capacity exam standards can be established. Describe organization and administration of a basic functional capacity exam. Instruct a prospective employee to properly perform various tasks associated with a functional capacity exam.
  • Become familiar and knowledgeable in regards to the company’s established safety guidelines in additional to familiarization of OSHA guidelines, OSHA reporting, and any corporate injury reporting procedures.
  • Be able to professionally research a given topic, create a presentation and present material to pertinent parties, whether it be employees, safety committee members or management.

Military Setting Knowledge and Skills

  • Collect and analyze injury data (compare with previous injury surveillance) for a given military training activity/cycle.  Brief the chain of command and medical assets regarding recommendations for decreasing/minimizing injuries and risks. Suggest alternate training scenarios, while maximizing existing training methods.
  • Plan, organize, and implement an Injury Prevention Program to reduce injuries to soldiers undergoing basic training.  The following areas should be addressed:
  1. Identification of individuals predisposed to injury
  2. Alternate training
  3. Communication with command and planning staff
  4. Soldier re-assignment and attrition
  • Set up and organize a temporary field medical facility/site where acute training injuries can be evaluated and triaged.  Consideration should be given to:
  1. Immediate treatment
  2. Evacuation
  3. Communication
  4. Equipment and supplies
  5. Allied health support
  • Provide justification and rationale for retention and/or additional athletic trainer assets within a specific military setting.  This should address the following areas:
  1. Return of investment
  2. Reduction of injury and enhanced productivity
  3. Reduced attrition and re-assignment
  4. Cost-avoidance
  • Conduct periodic classroom presentations and provide educational materials/media to new service members in the following areas:
  1. Proper hygiene
  2. Sexually Transmitted Diseases
  3. Tobacco use
  4. Supplements
  5. Drugs and alcohol
  6. Boot fit
  7. Injury prevention

Performing Arts Setting Knowledge and Skills

  • Identify occupational/ergonomic factors that impact performing artists including the following: musical instruments, costumes, footwear, lighting, floors, circus apparatus and performance props.
  • Demonstrate basic knowledge of intrinsic and extrinsic risk factors that could play a role in acute and repetitive use injuries in various performing arts.
  • Understand core and postural stability measures in regard to repetitive use injuries. Demonstrate and effectively instruct performing artist in appropriate core and postural control exercises in relation to the performer’s specific functional activities.
  • Demonstrate a basic understanding of the performing arts, including physical demands and general culture associated with each art. Explain the unique psychological impact of injury on the performing artist.
  • Identify general performing arts terminology as it directly relates to injury or illness.
  • Understand the demands and risk factors associated with rehearsal, theater, and touring.
  • Identify theater safety and emergency procedures with an understanding that protocols may vary between venues.
  • Appreciate current professional and legal issues in performing arts medicine.
  • Understand the importance of aesthetics in the performing arts and its impact on the artist as it relates to body image. Know how to recognize and refer artists with eating disorders.
  • Conduct, score, and document specific tests to evaluate the physical status and ability based on an artist’s specialty. Identify and describe specific training programs.

Physician Practice Setting Knowledge and Skills

  • Understand the management of a Durable Medical Equipment program, including measuring and fitting devices, documenting for possible reimbursement, and measuring the value of the product to both the patient and the program.
  • Express understanding of patient education as it relates to post-procedure wound care. Demonstrate appropriate usage of instruments and supplies for wound careand suture / staple removal.
  • Demonstrate the ability to safely apply and remove casts and splints for upper and lower extremities.
  • Determine and respond to patient needs and concerns based on the diagnosis and treatment plan provided. Provide and explain patient education materials and other documentation (excuse notes, restrictions, worker’s compensation forms, etc.) in a manner that is understandable to the patient.
  • Demonstrate understanding of basic operating room policies and procedures (sterile vs. non-sterile, scrubbing in, patient positioning, patient transfers, etc).

Practice Administration Knowledge and Skills

  • Describe CMS guidelines for clinical documentation, including evaluation and management, physical medicine, and procedure reporting.
  • Apply HCPCS II guidelines and instructional notes to select services, procedures, drugs and supplies that require coding including, but not limited to, durable medical equipment, casting supplies, and viscosupplements.

Public Safety Setting Knowledge and Skills

  • Develop an understanding of the command structure of law enforcement, fire and rescue and where the athletic trainer fits in.
  • Become familiar with the Incident Command Structure (ICS) and the National Incident Management System (NIMS) utilized in Public Safety.
  • Know the common injuries found in public safety personnel. Instruct a public safety employee to complete a series of tasks related to skills needed to complete day-to-day tasks.  This includes proper techniques lifting heavy loads and carrying equipment in one hand while performing tasks with the opposite extremity.
  • Acquire a familiarity with the Critical Incident Stress Management Model utilized in Public Safety.
  • Know how to establish effective lines of communication for public safety personnel to follow regarding in-the-line-of-duty injuries and illness. This should include:
  1. Department command reporting guidelines (e.g., Staff reports to Lieutenants , Lieutenants to Captains, Captains to Deputy Chiefs, Deputy Chiefs to Chiefs);
  2. Human resource policy and procedures for sick or injured workers;
  3. Policies and procedures for workers comp claims;
  4. Role of department Medical Director.
  5. Role of the worker’s compensation panel of physicians
  • Know the basics of the worker’s compensation system, third party administrator (payor) and the relationship of both with agency risk management (and occupational health staff if applicable).
  • Develop the ability to analyze proper posture, seat position, seatbelt attachment, loads of required safety equipment and attire, proper lifting for police, fire and EMS:  utilizing a basic ergonomic scale; provide the employee with specific guidelines to remedy the causal agent.