Focusing on Key Issues of the Board of Athletic Trainers
Central Issues highlights key issues the Oregon Health Licensing Agency (OHLA) is addressing in collaboration with the multiple health and related boards and councils the agency oversees.
In the eighth of a series of Central Issues online publications, OHLA and the Board of Athletic Trainers address the following:
- Concussion Care: What Can an Athletic Trainer Do? With the immediate and future health of athletes at stake, can athletic trainers return athletes to participate in sporting events after determining they have not suffered a concussion?
- Scope Spotlight: Can Athletic Trainers Treat Non-Athletes? If a drummer in a rock band develops tennis elbow, can an athletic trainer treat the drummer? Revisiting an issue that continues to generate questions about the scope of practice of athletic trainers.
- Supervising Students: How Much Is Needed for Safe Practice? From defining the type of student supervision to determining when students are practicing as athletic trainers, an update on efforts to ensure safe practice by students who are performing as athletic trainers.
- Three Questions For: Board Chair Dr. Russ Cagle With more than 30 years of experience in the profession, Cagle expounds on the benefits of regulation, the state of athletic training in Oregon, and other current issues.
Concussion Care: What Can an Athletic Trainer Do?
With the passage of "Max's Law" in the 2009 session of the Oregon State Legislature, growing concern of the risks from sports-related concussions became even more of an issue on the forefront of public awareness.
The law, named after a Waldport high school student athlete who suffered debilitating injuries after playing football before fully recovering from a concussion, is aimed at educating high school coaches about concussion symptoms and requiring medical clearance before athletes may play again after being diagnosed with a concussion.
One of the key aspects of the new law states that school districts must "Ensure no coach allows a member of a school athletic team to participate in any athletic event or training on the same calendar day that the member exhibits signs, symptoms or behaviors consistent with concussion following an observed or suspected blow to the head or body."
“The signs and symptoms of concussions are sometimes subtle, insidious, and multifaceted,” says Board of Athletic Trainers Chair Dr. Russ Cagle. “Signs are observable while symptoms are not. For example, a headache is a symptom. Athletes tend to minimize symptoms, particularly during events.”
In response to the new law and in light of growing awareness that concussions are "traumatic brain injuries," the Board of Athletic Trainers is reviewing the scope of practice of the profession related to concussion management.
The athletic training profession has collaborated with the Centers for Disease Control and Prevention and recognized experts to address the issue, developing treatment protocols and educational materials for parents and coaches.
“We need to remember that athletic head injuries are not limited to football, but are possible in all sports, particularly in women’s soccer,” says Cagle.
Currently, the athletic training scope of practice includes "The recognition, evaluation and immediate care of injuries occurring during athletic events or in the practice for athletic events," and "Determination of the level of functional capacity of an injured athlete in order to establish the extent of an injury."
However, under Oregon Administrative Rule (OAR) 331-120-0030(4), "An athletic trainer must consult with or refer an athlete to a physician when the athletic injury is beyond the athletic trainer's scope of practice or expertise, or in instances where the injury is not responding to treatment."
"Given the current knowledge of the risks related to concussions, athletic trainers should follow the mantra, 'When in doubt, hold them out,'" says Cagle. "We want to use this opportunity to review our current standards, as well as ascertain our legal responsibilities. We’ll be looking at current best practices to protect athletes and how to most effectively collaborate with other health care professionals.”
Cagle says that it is crucial that coaches obtain the training necessary to respond to head injuries and rely on the expertise of athletic trainers and physicians when they are available.
“Athletic trainers in the school setting are closely and actively observing an athlete’s condition,” says Cagle. “Their expertise is a valuable resource.”
Click here for more information on implementation of Max's Law (Senate Bill 348), including a concussion awareness and management guide.
Click here for information on Oregon Department of Education proposed rules implementing Max's Law for which a rule hearing is scheduled for January 6, 2011.
Scope Spotlight: Can Athletic Trainers Treat Non-Athletes?
Under Oregon Revised Statutes 688.701(1), "athlete" is defined as "...any individual participating in fitiness training and conditioning, sports or other competitions, practices or activities requiring physical strength, agility, flexibility, range of motion, speed or stamina, generally conducted in association with an educational institution, or professional or amateur sports activity."
Quite a lengthy definition, but does it encompass an individual who engages in "activities requiring physical strength, agility, flexibility, range of motion, speed or stamina..." who may not be what is commonly thought of as an athlete?
The Board of Athletic Trainers is asking that question due to what appears to be a difference in the scope of practice as promoted by the national certification organization, the Board of Certification for Athletic Trainers, and what is allowed under Oregon law.
In other words, can athletic trainers treat a drummer in a rock band with tennis elbow, an "industrial athlete" such as a construction worker whose job requires physical activity, or a member of a marching band who sprains an ankle during a performance?
In 2005, the board attempted to revise Oregon Administrative Rules (OAR) governing athletic training to better align with the BOC's athletic trainer role delineation defining scope of practice, but the proposed rules exceeded the board's statutory authority.
"We encourage our regulated professions to regularly review their scope and standards of practice," says OHLA Director Randy Everitt. "As time goes by, things change, and we want to keep up with that change to reduce barriers to professional practice while retaining public protection."
At its November 29 meeting, the board asked OHLA to seek legal advice from the Department of Justice on the definition of “athlete” in statute and whether the locations allowed for athletic training would include non-sports settings. We will update you in future editions of Central Issues.
Supervising Students: How Much Is Needed for Safe Practice?
Students working toward an undergraduate or advanced degree in athletic training often receive "on-the-job" or clinical training assisting registered athletic trainers before, during and after sporting events and practices.
The Board of Athletic Trainers is reviewing current standards for regulatory oversight of athletic training students, particularly those who may be performing the duties of an athletic trainer without being registered.
"As there is currently no definition in statute or rule for 'supervision,' we're looking at whether or not we need to be more specific," says board member Jeremy Ainsworth. "Should it be direct, onsite supervision, or a combination of direct and indirect supervision depending on the practice setting?"
The board is also looking into whether BOC-certified graduate students who are performing the functions of an athletic trainer in any setting should be required to be registered.
"What we are finding is that graduate students are acting as de facto athletic trainers," adds Ainsworth. "While they may be qualified, they are not being held to the same standard as those registered with the state."
This question was referred by the board to the Legislation and Rules Committee for further discussion.
Three Questions For: Board Chair Dr. Russ Cagle
Professor Emeritus of the Department of Exercise Science at Willamette University and certified as an athletic trainer since 1972, Dr. Russ Cagle has seen the development of the profession and ensuing regulation, including the establishment of mandatory registration for athletic trainers in 2000.
Central Issues asks Dr. Cagle for his thoughts on the current state of the profession and regulation, including why regulation is necessary.
Why register and regulate athletic trainers? Isn't national certification enough? Certification is important, but what if an unqualified individual is purporting to be an athletic trainer? Who is acting as watchdog? Obviously we, and the public, don't want unqualified people pretending to be athletic trainers. As we can see from the growing concerns over concussions, much is at stake. You need a regulatory entity to ensure there is a process to keep unqualified individuals from practicing and for the continuing oversight of those who are qualified.
We forget that while certification organizations establish national standards of practice and ensure competency, these organizations usually have no investigative or adjudicative authority or capacity.
What do you see as the major issue currently facing the board and the profession? Preventing and responding to concussions has become a major issue, and deservedly so. The growing knowledge and awareness we have of concussions represents the general trend in the health and medical fields of rapid developments in treatments and techniques. It's our responsibility to stay current with those developments.
We have a continuing issue with public perception and misunderstanding about the profession, compounded by other professions with “trainer” in the title, from fitness trainers to personal trainers and the list goes on. Currently, 70 percent of certified athletic trainers hold graduate degrees in their profession and 47 states regulate athletic trainers. We play an increasingly important role in the improvement and protection of the health of athletes.
Where do you see the future of athletic training and regulation of the profession heading? We've seen an increase in addressing everything from the effect of diabetes to preventing, detecting and managing disordered eating in athletes, so we're taking an increasingly holistic approach to wellness in general. I expect the profession will continue its growth and importance in protecting athletes and treating athletic injuries and illness, especially within secondary schools.
By the Numbers: Board of Athletic Trainers
|Registration and Regulatory Statistics
July 2009 to November 2010
|Athletic trainers registered in Oregon (as of 11/2010)
|Age group with most registrants (44.02 percent)
|Registrants by gender (M=Male, F=Female)
|Athletic trainers in Board of Certification public registry
|New registrations issued
|Online registration renewals
|Renewals over the counter or by mail
|Revenue & Expenditures - November 2010
|Ending Cash Balance (Actual)
|Ending Cash Balance (Projected through 6/30/11)
News You Can Use: Board of Athletic Trainers
Visit www.oregon.gov/OHLA/AT to find the latest licensing and regulatory news and resources:
Meet Board of Athletic Trainers Members (biographies)
Board of Athletic Trainers Meetings & Minutes
Board of Athletic Trainers Continuing Education Requirements
Related Web Sites of Interest
OHLA Adopts New Agency-wide Investigative Protocol
Renew Online: It's Speedy, Secure and Saves You a Stamp
Subscribe to Licensing Line, OHLA's e-mail news update
Licensing Line is OHLA's news digest covering licensing and regulatory developments of the agency and regulated professions.
Getting to the Issue: Highlighting Key Issues of OHLA, Professions
Central Issues is a series of online publications focusing on the key issues of the Oregon Health Licensing Agency (OHLA), the volunteer citizen boards and councils OHLA oversees, and developments in OHLA-regulated professions.
Comments, questions and suggestions on the issues we cover are appreciated. Contact OHLA Public Information Officer Kraig Bohot at firstname.lastname@example.org or call 503-373-1939.
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