Everyone on the Same Page

by: Jerry Kolowski, ATC
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In the absence of a certified athletic trainer, the head coach or coaches have many responsibilities as it relates to an injured athlete. During the course of a game, as one can imagine, all coaches are very involved with focusing on the next play, making the right substitutions, calling or signaling the right signs and searching for a way to win the game. One of the most difficult responsibilities for a coach is when an athlete is injured and his or her attention has to be refocused on ensuring that the athlete's safety and well being are given utmost priority.

First and most important, the biggest problem for a coach is that many are not qualified to handle such injuries. Sure, some have received through their education a basic first-aid class or an introduction to an athletic training course. But a coach in that situation, along with all of their other responsibilities, may not always be prepared to handle the injured athlete.

Unfortunately, there are still many coaches and schools without the services of a certified athletic trainer, and because of that, it is important that administrators and coaches make themselves as prepared as possible in the event of an injury.

First and most important, the administration should afford each coach with a job description that details his responsibilities as they relate to athletic injury or illness. It is also good practice for an attorney to review this information to ensure that a coach is qualified or certified to provide such services. In addition, the administration should provide each coach and/or staff member with educational programs or seminars to have them certified or at the least, teach them basic skills needed to attend to athletic injuries or emergencies. This should include an annual basic first-aid and athletic injury course or seminar. All coaches, administrators and staff members who are required to be at games should be certified and re-certified annually in CPR training and basic first-aid. The administration should require that there is a written emergency plan in place for all athletic venues and rehearse the plan each and every year.

PRE-PARTICIPATION MEDICAL HISTORY QUESTIONNAIRE:

For effective treatment, when an athlete is injured, one of the first ways to handle communication regarding the injury or illness is to insure the athlete completes a pre-participation medical history questionnaire and receives a complete pre-participation physical examination.

Each coach or administrator should develop and require every athlete to complete a comprehensive historical medical questionnaire. The questionnaire can be completed by the parent and/or athlete but the key to its' success is that there is a follow-up with the parent and/or athlete regarding any questions that arise as a result of the information provided. Not only does this give the school a complete medical history on each athlete, but it also affords the coaches an opportunity to have a better understanding of each athlete's medical background, predisposition to certain types of athletic related injuries or illnesses (i.e. prone to heat cramps, asthmatic, allergies, etc.) and establishes a medical baseline for each athlete for years to come.

Once the medical information is collected and the pre-participation exam is complete, each coach can thereafter record each athlete's medical conditions and keep them available in the event of an injury or illness to a particular athlete. Too many times in the heat of battle, an athlete is injured or becomes ill, and historical medical information is not readily available, for a physician or paramedic and, therefore, may not be considered as part of the solution or treatment.

INJURY REPORTS AND MEDICAL REFERRALS:

Once an injury occurs, the next line of communication must begin with injury reporting. Keeping in mind that about sixty-percent of injuries to athletes occur in practice, there needs to be a chain of communication from the time the injury happens until the time the athlete returns homes. Injury reporting is essential to maintain a continuum of care for each injured athlete. As soon as an injury occurs, no matter how minor or severe, an injury report should be completed. The injury report should include the following:

Subjective information: A subjective description of the injury and anything surrounding that injury that may be important to a parent or physician. What is the athlete telling you? How did the injury occur? What did the athlete feel? What does the examiner notice about the site of injury? And, any other pertinent information the person filling out the report can write down.

Objective information: This is a more detailed description with objective information regarding the injury including such medical information defining the injured body part, the area of injury, point tenderness, swelling, bleeding, deformity, or any other objective description regarding the injured body part.

Assessment: For a coach, this may not be an easy task. However, the injury or medical condition must be assessed. In game situations, the use of paramedics or an attending physician on site can assist with assessing the injury. But, at practice, the coach will be required to provide a descriptive assessment or description of the injury. (i.e: left knee, second degree sprained medical collateral ligament and possible meniscal tear).

Plan: The final phase of the injury report includes a treatment plan. A description of what needs to be done to correct the problem. The reporter should be as descriptive as possible and detail exactly what is expected from the athlete and the parent.

The injury report should also include basic information such as the athlete's name, address and telephone numbers, to allow both the coach and physician to use the form to monitor the athlete's progress.

Injury reporting forms should be in triplicate so that a carbon can be sent to the parents and another can be sent to the attending physician. The original copy should be kept on file. Each athlete should have an individual medical file where all injury reports are stored and kept for a minimum of seven years.

Another good idea is to use the back of the injury report to document progress notes, contacts made to the parent or physician or any other information pertinent to the monitoring process.

In addition to completing the injury report, a medical referral form is necessary in the event an athlete is being treated by a physician. This form can be completed at the time of injury or sent home with the parent. Since athletes utilize many different physicians, the parent or athlete can fill out the medical referral and present it to the attending physician. This will provide the physician a document to transcribe his/her recommendations to both the parent and school. Once again, a carbon copy should be returned to the coach or administrator and kept in the student's file.

FOLLOW-UP:

Probably the most time consuming part of the injury is post injury follow-up. To ensure that the athlete is receiving the necessary medical attention, documenting follow-up care is essential to the continuum of treatment. At this point, communication between the parent and coach is vital. As each coach and school has a responsibility to the athlete and parent when an injury occurs, the parent and athlete equally share that responsibility to the coach and school.

As with many injuries, additional office visits, diagnostic tests, prescriptions for medications or physical therapy, referrals to other specialists or daily changes in treatment protocols occur during post injury. It is of vital importance that the parent and athlete provide to the coach written documentation from physician, physical therapist or any other allied health professionals involved with the injury so that the coach is informed of physician's recommendations, guidelines or limitations.

The coach and parent must contact each other throughout this process to ensure that the athlete is not only continuing to receive proper medical attention, but to make certain that the athlete is cleared to participate at a level recommended by the physicians. Written medical clearance to participate is a must.

MEDICAL CONFIDENTIALITY:

Another area that should be of concern to coaches is how to deal with the media in the event of injury, most notably to a visible athlete. Whether at the high school, college or professional level, being an athlete brings on certain responsibilities and puts athletes in the public eye. To be certain that confidentiality is not violated, each athlete should be apprised of his rights and sign a release of medical information form in the event an injury does occur and information is released to the media. This form should be signed annually as part of the medical history questionnaire and kept in the athlete's file.

In addition, it is also the responsibility of the coach or administrator to accurately report and disseminate pertinent information regarding the athlete's injury. The administration and coaches should develop a plan as to who will be the spokesperson for such occurrences and how the information will be distributed. Failure to do so will result in misleading or deceiving the media and can be harmful to the injured athlete.

As this article has stated, these are concerns in the absence of a certified athletic trainer. All of the aforementioned required documentation and communication is essential for the complete recovery process of an injured athlete. Coaches and/or administrators who are not qualified or certified to handle such a cumbersome task. Therefore, not only is it advisable for each school to have a certified athletic trainer on staff, but it is also vitally important that if there is no certified athletic trainer, that the administration and/or coaches clearly define the policies and procedures that are necessary to ensure that the lines of communication are defined to ensure the safety of each and every athlete.

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