Standing Orders Operating Protocol


This Standing Orders Operating Protocol shall define the relationship between the below signed medical director who shall serve to oversee all the below signed athletic trainers providing service for  athletes. Under these Standing Orders, all ATs shall render service or treatment under the direction of, or in collaboration with the overseeing physician, in accordance with their training and the state’s statutes, rules and regulations1. This Protocol is only in effect for the students participating in interscholastic athletics in the District and visiting team student-athletes who sustain injury or illness while competing at District facilities or events. The AT(s) shall follow these Standing Orders and all injury and/or illness procedures and policies established by the District. The AT(s) shall perform all duties within their scope of practice defined by State Education Laws, and applicable Amendments to the Regulations of the Commissioner of Education, pertaining to Athletic Trainers.

Injury/Illness Prevention and Wellness Protection7

The Athletic Trainer implements measures to prevent and/or mitigate injury, illness and long-term disability; and utilizes effective communication and education to promote healthy lifestyle behavior to enhance wellness and minimize the risk of injury and illness. 1

Clinical Evaluation and Diagnosis7

The Athletic Trainer implements systematic, evidence-based examinations and evaluation techniques to formulate valid clinical impressions used to determine an appropriate course of action.1 The examination includes:

    1. History: mechanism of injury;
    2. Inspection/Observation, checking for swelling, discoloration, deformities;
    3. Palpation – point tenderness, deformity;
    4. Special testing;
    5. Range of motion.

Immediate and Emergency Care7

The Athletic Trainer provides care and communication procedures used in acute and/or emergency situations, independent of setting and in accordance with a best practice emergency action plan1.

  1. Rule out head and neck injury:
    1. Apply clinical criteria to make appropriate decisions regarding the need for ambulance transport due to loss of consciousness, severe or worsening concussive symptoms, or suspected neck injury.
    2. Apply clinical criteria to make decisions regarding proper repositioning and transfer techniques during care of a critically injured athlete;
    3. Apply clinical criteria to make appropriate decisions regarding on-field management of a critically injured, equipment-laden athlete;
    4. Athlete must be referred to a license healthcare professional if in a stable condition that does not require transport.
  2. Rule out use of epinephrine auto-injector (EAI) for severe allergic reactions:
    1. Administer EAI in accordance with individual asthma/anaphylaxis management plan;
    2. Administer patient’s fast-acting metered-dose inhaler (MDI) alone or via MDI spacing chamber for acute asthma attacks in accordance with individual asthma management plan;
    3. Administer over-the-counter asthma/anaphylaxis medications as indicated and defined in individual asthma/anaphylaxis management plan(s);
  3. Administer appropriate supplemental oxygen prior to the arrival of EMS.
  4. Rule out use of glucagon injector for severe hypoglycemia:
    1. Assess and monitor glucose levels using a glucose meter;
    2. Administer glucagon injection in accordance with individual hypoglycemia management plan;
    3. Administer appropriate over-the-counter glucose supplements in accordance with individual hypoglycemia management plan(s);
    4. Administer appropriate supplemental oxygen prior to the arrival of EMS.
  5. Rule out sudden cardiac arrest:
    1. Deploy and administer AED and high-quality CPR in accordance with established AED/HQ CPR management protocols;
    2. Provide BLS airway management using OPAs or NPAs when indicated;
    3. Administer appropriate supplemental oxygen prior to the arrival of EMS.
  6. Rule out heat stroke
    1. Administer cold-water immersion (CWI) with use of rectal thermometer when indicated.
  7. Provide emergency first aid as needed as per emergency action plan.

Therapeutic Intervention, Treatment, and Rehabilitation1,7,8

The Athletic Trainer works to recondition participants for optimal performance and function by determining appropriate treatment, rehabilitation and/or reconditioning strategies.  Intervention program objectives include long and short-term goals and protection from additional injury.  Appropriate patient-centered outcomes assessments are utilized to document and communicate efficacy of interventions, recommend termination of the intervention program when appropriate, provide a final assessment and recommend consideration for return to play.

  1. Immediate treatment of an orthopedic injury for all student-athletes:
    1. PRICE (Protection, Rest, Ice, Compression, Elevation);
    2. Record injury or illness assessments;
    3. Referral for medical treatment as appropriate.
  2. Notify parent(s) or guardian(s) of the extent of injury or illness.
  3. Immediate follow-up treatment (within 24-72 hours):
    1. Re-evaluation of injury or illness;
    2. Monitor signs and symptoms, orthopedic screening results, head injury management;
    3. Seek additional medical referral if necessary.
  4. Post injury care:
    1. Treatments including modalities as indicated;
    2. Rehabilitation programs for orthopedic injuries;
      1. Short-term goals: protection, decrease swelling, increase range of motion, return function, etc;
      2. Long-term goals: 90% strength and full pain-free range of motion with functional testing as determined by the school medical director’s designee(s).
    3. Supportive techniques:
      1. Taping, bracing, pad fabrication, etc., as determined by school medical director and/or designee(s).
    4. Functional testing:
      1. Determine the level of activity for return to participation
        1. Out, limited, or full participation as determined by attending physician and/or the school medical director’s designee(s).
      2. Step-wise return to participation program for concussion, if required by a license healthcare professional trained in the evaluation and management of concussions.
    5. Return to participation:
      1. Continue rehabilitation until long-term goals are met as determined by the school medical director’s designee(s);
      2. Full participation for orthopedic injuries if 90% strength and full pain-free ROM with functional testing as determined by the school medical director and/or designee(s);
      3. Concussion: if so designated, completion of a RTP program required by a licensed healthcare provider trained in the evaluation and management of concussions;
      4. Release from licensed medical professional, school medical director, and/or designee(s).

 Organizational and Professional Health and Well‐being7

The Athletic Trainer works within the approved practices and guidelines to function effectively, to cope adequately, to change appropriately, and to grow from within to ensure individual and organizational well‐being.

  1. Establishing EAPs;
  2. Establishing health care teams, referral networks;
  3. Professional education to ensure best practice;
  4. Business development and strategic planning;
  5. Budgeting;
  6. Maintain confidentiality with respect to all HIPPA and FERPA regulations.

Term of standard orders operating protocol

This written standing order operating protocol agreement shall be reviewed annually and expires 1 year from signature date.

Statement of Physician Agreement9

 I, agree to bear the responsibility of directing the health care of all athletes who participate in the  athletics program.  The  athletic trainers will operate under my supervision within the scope of their practice as established by the above defined written operating protocol.  The athletic trainers’ scope of practice is defined by (1) the Board of Certification (BOC) Standards of Practice, (2) BOC Role Delineation, (3) the institutions state rules and regulations, (4) the National Athletic Trainers’ Association (NATA) Code of Ethics, and (5) appropriate NATA Position Statements.  I possess the authority to determine the health status of athletes who participate in the  athletic program and will work with the athletic trainer(s) to ensure that the appropriate quality of care is provided.  I have the authority to and do so approve this written operating standing orders protocol.

Medical Director e-Signature: 
Medical Director State License Number: 
Compliance Date: 
 

 

Statement of Athletic Trainer(s) Agreement

I/We the undersigned athletic trainers agree to fulfill the responsibilities defined in the above standing orders operating protocol in caring for all athletes in the    athletic program.  In carrying out this operating protocol I will do so in accordance with the athletic trainers’ scope of practice as defined by (1) the Board of Certification (BOC) Standards of Practice, (2) BOC Role Delineation, (3) the institutions state rules and regulations, (4) the National Athletic Trainers’ Association (NATA) Code of Ethics, and (5) all appropriate NATA Position Statements.

Head Athletic Trainer e-Signature: 
Head Athletic Trainer State Licence/Certification Number: 
Compliance Date: 
 

 

Assistant Athletic Trainer e-Signature: 
Assistant Athletic Trainer State Licence/Certification Number: 
Compliance Date: 
 

 

Assistant Athletic Trainer e-Signature: 
Assistant Athletic Trainer State Licence/Certification Number: 
Compliaince Date: 
 

 

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