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The Basics

What teams need for an adequate athletic training program
by: Valerie Hunt
National Athletic Trainers\' Association
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It's been called the sick tank, the warm-up room - and in at least one case, the wildlife sanctuary. It's where players go to prepare for battle and where they return to let their game faces down as they confront the pain of injury.

It's not a simple place.

The athletic training room, even in its most basic form, is a microcosm unto itself. Building one entails careful attention to the structural requirements, which are more detailed than finding four walls and a ceiling. Building a sports medicine program to fill that room is even more complicated.

Many coaches, however, find themselves with the responsibility of creating and maintaining just such a room. But, where do they start? What to do?

A coach can start with the six basic components of an athletic training room: personnel, education, structural facility, equipment, supplies and procedures.

Personnel

Qualified professionals are the most important part of any athletic training room, said Myrtle Beach High School's Jim Berry, MEd, ATC, SCAT.

"You need at least one certified athletic trainer (ATC), and preferably more than one, depending on the size of the school and the athletics program," said Berry, director of sports medicine and head athletic trainer. "However, we know not all schools have that. In the absence of an ATC, you need a team physician who can at least be available on Friday nights for football games. They can also do referrals if your players need specialized care."

While most athletics departments already have named a team physician, it's important to cultivate a good working relationship with that doctor before an emergency occurs, said Brian Robinson, ATC, of Glenbrook South High School in Illinois.

"You don't want to get in the heat of the moment and then find out your team physician has wildly different viewpoints than you do," Robinson said. "If you're a coach, you've got so many other things going on already that you need to be on the same page with that doctor before anything happens."

It's also crucial to make sure people who volunteer to assist on thesidelines and in practice are qualified to render that assistance, Berry added.

"Probably the best rule of thumb is you don't want to use Johnny the janitor as your athletic trainer just because he knows how to tape an ankle," Berry said. "Coaches need to be sure that anyone they're going to allow to provide medical attention to their athletes is adequately trained and acting within legal bounds."

Adequate training for coaches themselves also is key, said Don Bagnall, ATC, of the Hopkins School in Connecticut.

"At the very least, every coach at every level - high school, college and professional - should be certified in first aid and CPR," Bagnall said. "It's a good idea for coaches to take a sports medicine clinic or sports first aid program as well. The American Red Cross has one, and the National Federation (of State High School Associations) can suggest several also."

Education

In the absence of allied health providers to care for athletes, coaches must pick up the slack. To prepare and keep up with those duties, ongoing education is key.

Again, CPR and first aid certification must be obtained and refreshed everyyear. In addition, contracting with a local sports medicine clinic or nearby certified athletic trainer can be helpful, said Joe Iezzi, ATC, of Downingtown Senior High School in Pennsylvania.

"We do that a lot," Iezzi said. "Some schools in our area don't have certified athletic trainers on staff, so we'll go present a good in-service program to the coaching staff to familiarize them with some of the basic first aid and prevention tips they'll need to care for their athletes. This also is a chance to get them started thinking about other things like emergency plans, pre-participation physicals, and things like that."

In addition, Bagnall said, proper education should help coaches know what they can handle and what needs more attention.

"They have to know what they can take care of and what needs advanced care," he said. "That can be a fine line, and properly educated coaches have an easier time making the call."

Coaches should make sure they are educated in providing first aid or first responder care. Beyond that, the care should be provided by an allied health care professional such as the ATC.

Structural Facility

After a school has designated health care personnel or educated the coaches for the basics of first aid, a room should be set aside for athletic training - and the bigger, the better.

"I started in a closet," Robinson said. "A lot of schools will just make whatever leftover closet or storage space they've got available into the athletic training room. Obviously that's not ideal, but if that's what you've got, you can work with it."

Berry said a 300 square foot room is what he recommends as a bare minimum for schools just starting out.

"That's even on the small side," Berry said. "I prefer they set aside a room with 1,000 square feet."

Other physical considerations include:

* Location: A good athletic training room will have access to the outside of the building as well as to other rooms in the building.

In addition, Berry said, it's important to make sure males and females have equal access to the room. "We had a school in our district that built a great new athletic training room, but the only way to get to it was to go through the men's locker room," he said. "Obviously, that won't work, especially with Title IX compliance."

The athletic training room also should be close to the playing facilities.

Ventilation: "In most parts of the country, you really need airconditioning," Berry said. "In every part of the country, the room has to be well-ventilated at least."

Lighting: Bright fluorescent lighting is the best, Bagnall said, because being able to differentiate between bruises and tricks of light and shadow is important.

Electricity: An athletic training room must have working electricity, preferably with 30A outlets four feet off the ground and placed every couple feet around the room, Iezzi said. In addition, outlets used for whirlpools and hydrocollators should be grounded accordingly, using ground fault interrupter circuits.

Plumbing: At least one water faucet and one sink is necessary, due to OSHA regulations and to the nature of athletic training, Robinson said. "You need to be able to wash your hands before and after treating an athlete, so you need a sink and faucet," he said. "You'll also need to be able to wash cuts and abrasions and fill and clean coolers and ice chests. Really, two sinks is better."

Flooring: Non-slip, washable flooring is best, such as non-slip tile or concrete. Industrial carpet is harder to clean and maintain but can be used as well. In addition, areas with whirlpools should have drains in the floor.

Security: The athletic training room must have a lock on the door, with keys given only to necessary personnel. "You don't want unauthorized people messing around with medical supplies and equipment," Iezzi said. The athletic training room should be accessible to students and staff only when the ATC or designated personnel are present.

Telephone lines: The athletic training room should have a telephone line that can be used without the main switchboard of the school. "If you've got a night game and the doctor has to call you at the athletic training room, you don't want him being dumped into a voice mail system or otherwise unable to reach you directly," Iezzi said. "And you've got to be able to call out for the same reason."

Storage: Ample storage helps schools manage the budget better simply because the cost of supplies drops with volume. A storage room or cabinets that can be locked are essential.

Equipment

The basic equipment for an athletic training room is fairly simple, Bagnall said.

"You need an ice machine, coolers, ice chests, taping tables, treatment tables and probably at least two whirlpools," he said.

Berry said if funding is an issue, an ice machine can be replaced with a freezer to stockpile ice, and whirlpools - at least initially - can be supplanted by buckets with hot and cold water. A desk, a filing cabinet, a computer and either cellular telephones or two-way radios complete the essentials, he said.

"You need the cell phones or radios so that coaches out on the practice field can communicate immediately with the athletic training room," Berry said. "That's absolutely a must. If you've got an emergency situation, you must be able to call 911 or call someone with access to 911 immediately."

In addition, an athletic training room needs a set of scales to weigh athletes for hydration monitoring, Iezzi said. Other re-usable equipment that should be stocked are crutches, a spinal backboard and a knee immobilizer. Depending on the program, exercise machines for basic rehabilitation also could be included.

Supplies

Staff members who are new to sports medicine may have a difficult time deciding which supplies to order and in what quantity. To avoid the pitfalls of ordering the wrong material or falling short halfway through the year, coaches should contact a certified athletic trainer who can help them prepare an order.

Coaches without access to an ATC can order ready-made supply kits, which come stocked with tape, pre-wrap, antibacterial ointment, bandages, scissors and other essentials.

"A lot of supply companies, especially the big ones, have different programs," Bagnall said. "They have ready-made orders and they'll help you with a ballpark figure to fill the needs of your specific program. It at least gives you a starting point, something to work with."

Overall, the consumable supplies needed in an athletic training room are athletic tape, which comes in three sizes; pre-wrap; gauze pads; bandages; protective padding or foam; first aid and wound care products such as hydrogen peroxide and antibacterial ointment; and scissors or other tape cutters, Berry said.

In addition, each athletic training room needs antibacterial hand soap, disposable towels and cleaning supplies to maintain and sterilize treatment tables, taping tables and the room.

Coaches charged with stocking an athletic training room can find help by contacting a local certified athletic trainer or by contacting one of the companies that provide supply kits, such as Cramer Products, Micro Bio-Medics, Creative Custom Products, Mueller Sports Medicine, Moore Medical Corp., SportsMedic and others.

Procedures

A vital but often overlooked part of the athletic training room is the policy manual, Berry said.

"All of the coaches and administrators need to know what happens when an athlete goes down or there's any emergency," he said. "Who's going to call 911? Who's going to tend the athlete? Who's going to tend the crowd? Who's going to keep the chain of command informed?

"You need to figure out the responsibilities of all involved, and then write it down and give everyone a copy," Berry said. "It's important to go through it every season."

The policy book also should include a map of all the athletics facilities, marking entrance and exit routes as well as land-line telephone locations. In addition, the names and all contact numbers (office phones, cell phones, pagers, etc.) of coaches, team physicians and other related personnel should be posted in every book. Ambulance service and hospital locations and telephone numbers are helpful as well.

Iezzi said student records should be carefully maintained, with the procedure included in the policy book.

"Coaches need to be able to produce a signed medical consent form for every athlete at any time," Iezzi said. "You never know when or where you're going to need to be able to treat a player, so those forms must accompany the coach if an athletic trainer is not present.

"You also need to decide beforehand when a player can return to competition after an injury and whether a doctor's note is required," he said.

Robinson said coaches also must consider things such as lightning policies, hot- or cold-weather policies and other situations.

"The bottom line is, you really need a certified athletic trainer because the coach usually does not have the time, the education or the skills necessary to cover all the medical bases," he said. "Medical care is not supposed to be the coach's job. But the fact is coaches are sometimes asked to do double-duty. They, like any other staff, have a duty to put the safety and welfare of the athlete above everything else. That's the first priority, the utmost importance."

To obtain a more detailed blueprint of an athletic training room and program, including budget considerations, medical care options and other information, request a Position Proposal Guide from the National Athletic Trainers' Association by calling (800) 879-6282, ext. 119, or visiting the website at www.nata.org.






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