Transcript Sports Medicine’s Successful Integration into Law

The Role of Sports Medicine in
Officer Safety and Wellness
Nancy C. Burke, MS, VATL, ATC
Athletic Trainer
Fairfax County Police Department,
Fairfax Virginia
Major Edwin C. Roessler Jr., Director
Fairfax County Criminal Justice Academy
Fairfax County Police Department
IACP Annual Conference
Denver, CO
October 5, 2009
Learning Goals
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Understand what an Athletic Trainer is
Explore how the idea was put into action at
the Fairfax County Criminal Justice Academy
Discuss how the program was incorporated
with business flows
Learn about successes & challenges
Explore future strategic goals
PLEASE ask questions often!
Overview of the FCPD
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County is 399 square miles
Population in excess of 1 million
Department comprised of over 1,700
sworn and civilian personnel
Serves an urban diverse community
Recruit and in-service training is
conducted at the Fairfax County Criminal
Justice Academy
Pre-Athletic Trainer
Program/Policies in the FCPD
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General Order 331
First report of injury by supervisor
Authorized Physician Panel list
Risk Management’s “old” philosophy
Old system = Little to no “advocate”
The “IDEA”
The meeting
Project plan developed
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Funding
Space
Equipment
Stakeholders
Risk Management
Occupational Health Center
Fire Department
Sheriff’s Office
The Pilot
Mission Statement:
Maintain and improve general overall wellness;
provide for care and prevention of injury and illness
Housed at CJA
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Recruit class as the control group
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Prior tracking of dismissals due to injuries
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Ability to closely monitor
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Diverse group from Academy member agencies
Initial Start Up at the CJA
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Trust – fear of reporting injuries (dismissal etc…)
Rapport building
Word of mouth
Tracking successes
Wellness Advisory group meetings
Imbedding the Program
Position description – created as limited term exempt
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Not merit position
Must take break in 11 month
Placement in the organizational chart
Housed at the Academy
Reports in chain of command (Academy)
Direct report to Risk Management and OHC
Joined with Academy Wellness Program
Networks with Incident Support Services
Advisor to specialized training efforts (i.e. SWAT school)
Contributor to Department’s Training Bulletin
Network with other local academies
HIPAA applies
Line item on Department’s budget
Background Information
What is a Certified Athletic Trainer?
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Athletic Trainers are medical professionals who
are experts in injury prevention, assessment,
treatment and rehabilitation of injuries and
illnesses that occur to athletes and the
physically active.
Athletic trainers deliver rehabilitation services
under a physician’s guidelines.
Athletic Trainers are NOT personal trainers.
An Athletic Trainer meets the qualifications set by a
state licensure and/or the Board of Certification, Inc.
and practices athletic training under the direction of a
physician.
A personal trainer prescribes, monitors and changes an
individual’s specific exercise program in a fitness or
sports setting.
Athletic Training is an allied healthcare profession
recognized by the American Medical Association (AMA).
Other allied healthcare professions include, but are not
limited to: audiologists, nurses, cardiovascular
technologist, medical technologist, EMT-paramedic,
dentist, physical therapist, physician’s assistant,
physician, psychologist.
Athletic Trainers are regulated and licensed health care
workers.
Athletic Trainers know and practice health care at the
highest professional, ethical and quality standards in
order to protect the public.
Athletic Trainers specialize in patient education to
prevent injury and re-injury and reduce rehabilitative
and other health care costs.
Differences:
Athletic Trainer / Physical Therapist
Athletic Trainer
Rehabilitates injuries of a mostly
orthopedic nature in the active
population
Physical Therapist
Rehabilitates injuries and illness
of many different patient
populations
Responsible for the prevention of
well as and immediate care of injury
Work with orthopedic patients, as
patients with unique medical
conditions and/or illness
Traditional setting is on-site at the
time of injury. Provides immediate
treatment and continues care.
Traditional setting is a clinic.
Clinical treatments only.
Provides care following physician
guidelines
Provides care following physician
guidelines
Physical performance test specific to
Law enforcement.
Practice Domains
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Prevention
Clinical Evaluation and Diagnosis
Immediate Care
Treatment, Rehabilitation and Reconditioning
Organization and Administration
Professional Responsibility
Where Do Athletic
Trainer’s Practice?
Secondary Schools
Performing Arts
Physician Clinics
Military
Law Enforcement
Professional Sports
Corporate Health Programs
Sports Medicine Practices
Physical Therapy Clinics
Colleges and Universities
Industrial Health Care
Sports Medicine and
Occupational Health
Sports Medicine
Sports Medicine is the practice of treating
individuals who have been injured in physical
activity. Began as a specialty working with
sport specific athletes and has branched out into
the general active person.
Sports Medicine Team
Athletic Model
Team Physician
Law Enforcement Model
Worker’s Compensation
Panel Physician / Personal
Physician
Coach
Supervisor
Athletic Trainer
Athletic Trainer
Sports Medicine Principles
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Prevention / Education
Fitness / Wellness
Early Intervention / Immediate Care
Biomechanics / Ergonomics
On-Site Rehabilitation
Functional or Work – Specific Training
Early Intervention is KEY !
Injured workers treated within the first 24 hours
were more likely to be out of work a week or
less, more satisfied with their medical care,
physician and employer, and less likely to
contact an attorney.
(Zigenfus, G, Physical Therapy)
Fewer physician visits, decreased lost time days.
Early intervention can give the opportunity to set
an expectation of recovery.
Athletes
Athlete - A person possessing the natural or acquired
traits, such as strength, agility, and endurance, that are
necessary for physical exercise or sports, especially
those performed in competitive contests.
Tactical Athlete - any public safety officer
who engages in high risk operations. Such
operations require high levels of strength,
speed, power, and agility. This includes
aerobic and anaerobic fitness.
Benefits of the
Sports Medicine Model in Law
Enforcement Settings
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Improved Employee Morale
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Increased Productivity
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Decreased Incident and Severity of Injury
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Decrease in Worker’s Compensation Costs
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Quality of Care
Principles of Sports
Medicine Care
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Team approach inclusive of physicians,
athletic trainer, patient, supervisor;
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Early intervention
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Expectation of recovery
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Function- oriented treatment
Medical Care Costs
Medical care costs are a combination of:
* Actual medical services delivered;
* Estimated 80% of the cost from lost
work time, indemnity, wage
replacement, administrative costs.
Sports Medicine
Occupational Model of Care
General Program
Overview
Allivato, J “The Sports Medicine
Model of Care for your Occupational
Athlete”, 2003
Care for Injured Officers
“The time is long overdue to provide
‘first class’ treatment and support”.
“Officers not back on duty within 90 days
of an injury (light duty or full duty) have
only a 20% chance of returning to duty.”
(Mathis and Schreuder, “Worker’s Compensation Costs”)
Fairfax County Police Department
Injury Care and Prevention
Program
Mission Statement
Mission Statement:
Maintain and improve general overall
wellness; provide for care and prevention
of injury and illness
Goals of the Athletic Trainer
Prompt access to physicians
Enhance the delivery of medical care
Rehabilitation
Liaison to Third Party Administrators and
Employee
Dedicated educational resource center
Medical Supervisor
Licensed Physician
Required by NATA Board of Certification and
state Board of Medicine
What can the Athletic
Trainer Do?
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Provide primary injury evaluation and
immediate care;
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Make referrals to the appropriate worker’s
compensation physician, private physician
or healthcare provider;
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Expedite many physician visits;
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Develop a medical care plan with the physician
and/or healthcare provider;
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Administer the medical care plan;
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Monitor the progress of the officer;
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Administer physical performance tests to advise
physicians on duty status.
Therapy Provided by the
Athletic Trainer
Therapy may be provided for both work and nonwork related conditions.
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Immediate evaluation and general medical care
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Cryo-therapy
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Thermo-therapy
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Ultrasound
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Electrical Stimulation
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Cold Laser and Photo-therapy
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Prescriptive Exercise Program
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Recommendations for appropriate braces
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And much more.
Athletic Trainer Schedule
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40-hour work week
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Flex schedule to meet workload demands
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24/7 access by County cell phone (rolled
into Incident Support Services)
Whether there is a need to see the physician or
not, the Athletic Trainer can begin rehabilitation
ASAP.
Multiple studies support early rehabilitation
and/or
treatment resulting in faster healing.
Clinic Appointments
Rehabilitation may be completed every day.
Scheduled appointments are made; OR
walk-ins freely accepted.
Walk-in appointments allow for shift changes,
delays at court, weather adjustments, etc.
The Athletic Trainer follows the physician’s
guidelines for rehabilitation and treatment; is
compliant with HIPAA regulations.
Patient progress notification to the treating
physician is made on a timely basis through
email, telephone calls and fax reports.
The Athletic Trainer CANNOT sign the
Medical Status Form to return an officer to
full duty.
The Athletic Trainer keeps the physician
informed of the employee’s progress for the
Medical Status Form.
Work Injury Scenario Comparison
SPRAINED ANKLE – 2nd Degree
Pre-AT
Urgent Care
Orthopedist – 5 days
Therapy - 7 to 10 days
Lost time Before Treatment:
5 – 7 days
Return to Full Duty Status:
4 – 5 weeks
Post AT
AT clinical diagnosis
Orthopedist 1-2 days
Therapy-Immediate
0
2 – 3 weeks
Ruptured Achilles/Fractured Foot
Pre-AT
Urgent Care
Specialist 2-4 days
Surgery 8-10 days
Therapy Begun 2 weeks
Recovery to Full Duty
9 months
Post AT
AT Clinical Diagnosis
Specialist - same day
Surgery 3-5 days
Therapy Begun 4 days
6 months
Fully capable of
performing duties
In athletic training, we offer much
quicker access and entry into the
healthcare system.
Physician Status
Worker’s Compensation Panel physicians
have agreed to see FCPD employees within
24 – 48 hours of the event.
Physicians have agreed to have rehabilitation
done by the Athletic Trainer.
Rehabilitation
Rehabilitation occurs in two fashions:
1. The Athletic Trainer works in conjunction with a
physical therapist to provide daily care;
2. The Athletic Trainer provides all the rehabilitative
care on a daily basis;
The treating physician is kept apprised of the
employee’s progress.
Program Development
Wellness Clinic
Established at the Fairfax County Criminal
Justice Academy
Fully equipped with rehabilitation and
therapy equipment and materials
Assessment and treatment for FCPD
employees and Academy recruits
Weight and Conditioning
Facility
SAFE SHIELD
The Safe Shield Project primary goal is to
accept no less than zero officers injured or
killed while protecting the safety of citizens.
Begun as a long-term project to look at
current and “cutting-edge” technology of
personal protective systems for police
officers.
In 2002, the Southern Association Chiefs Of
Police (SACOP) produced a survey to
determine the types of injuries officers
sustain, the severity and frequency of those
injuries.
SACOP Survey Results
FCPD Trends
FINGER/HAND
In 2002, SACOP produced aKNEE
survey to
BACK
determine the types of injuries
officers
CARDIO/LUNG/HEART
ANKLE
sustain, the severity and frequency
of
SHOULDER
those injuries.
ARM
HEAD
LEG
WRIST
FOOT
ELBOW
EYE
Top 12 Body Parts Injured FY 03 – FY 09
SPRAIN/STRAIN/DISLO
CATION
CONTUSIONS - OR
BRUISE
CUT/LACERATION
HYPERTENSION
FRACTURES/DISLOCA
TIONS
ABRASION
BITE/STING
PUNCTURE
HEART ATT/DISORDER
ALLERGIC REACTION
Top 10
Injury Types
FY 03 – FY 09
Treatments
FY
FY
FY
FY
06
07
08
09
Work
344
1,320
3,596
2,689
Non-Work
311
1,188
2,974
3,821
Total
655
2,508
6,570
6,512
$556,489.00 in
Savings -Therapy Costs
Work
Non-Work
Total
FY 06 $17,824.00
$15,355.00
$33,179.00
FY 07 $47,809.00
$43,935.00
$91,744.00
FY 08 $115,450.00 $99,603.00
$215,053.00
FY 09 $90,100.00
$216,513.00
$126,278.00
These costs are not billed to the agency
nor the employee.
Recognized Savings
ACADEMY
Comparing 3 years pre-Athletic Trainer and 3
years post-Athletic Trainer
Reduced By
Overall Medical Costs:
49.5%
Musculoskeletal Medical Costs: 86.3%
Recognized Savings
DEPARTMENT
Comparing 3 years pre-Athletic Trainer
and 3 years post-Athletic Trainer
Reduced by
Overall Medical Costs
22.05 %
Musculoskeletal Costs
21.2%
“We have seen since the inception of the Athletic Trainer
program, a number of police officers who have been injured and
likely out for a long period of time - weren’t - due to the
commitment of the Department’s athletic trainer. This has truly
been a “success story” as well as a key element to aggressively
managing injury prevention - key elements of a workers’
compensation case and providing successful outcomes!
The high standard for care and treatment is deserving of the
Department’s police officers. Bringing together a new and
innovative way to provide immediate care and response,
while reducing costs involved with potential significant
injuries is a WIN/WIN; and a golden opportunity for all of
us, as a stakeholders in this process - Ms. Teri Flynn, Risk Manager,
Fairfax County, VA
Satisfaction Survey
Male and female Department employees of
varying race, rank, shift and assignment
who had been evaluated and/or treated by
the Athletic Trainer were surveyed.
403 requests sent out
207 returned for a 51.4% return rate
Survey Results:
96% are satisfied with the Athletic Trainer
95% are satisfied with Treatment
94.5% are satisfied with the Clinic
Patient Comments
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“I received more information on my type of injury
from the trainer than I did from my primary care
physician”;
“She quickly assessed my soft tissue injury and
provided treatment that both relieved the pain and
expedited the healing process. I am positive that
her knowledge and skills helped me return to work
more promptly and in the best condition possible. I
would definitely use her services again and
encourage my co-workers do the same.”
Employee comments on the survey
demonstrated they view the Athletic
Trainer as an “employee” and a great
recruitment tool for potential recruits.
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“During a recent injury, the athletic trainer
contacted me and coordinated treatment, resulting
in a very short turnaround to receiving required
surgery and therapy. This went far in reducing my
worries/fears about my career and possible
disability”;
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“The athletic trainer has demonstrated the unique
skill of relating to police officers needs and
concerns in such a manner that we do not feel
threatened to share and give her complete and
honest answers regarding status of injuries.”
Activities
The Athletic Trainer is an educational
resource for a variety of law enforcement
related concerns.
Health
Bulletins
Newsletter
Strengthening Programs Designed Specifically
for Law Enforcement
Grip Strength Exercises and Materials
Dumbbell/Band Exercises. Repeat 12 times per set, 3 sets
daily.
Forearm Curls.
With palm up, weight in hand, bend wrist up. Return slowly.
Duty Belt Information
Additional Activities
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Specialty Unit Advisor
Safety Officer Program
Presentations to FCPD staff on stress management and fitness
activities;
Assisted in the development of the FCPD Family Leave
Manual;
Assist with finding pediatricians, family practice physicians and
other medical specialists for new employees;
Case management for all employees on restricted duty;
Advise on prevention of heat stress and other environmental
training issues;
Advise on shoes, shoe inserts, ergonomics related to car
seats and computer work stations;
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Health education resource for: nutrition,
high blood pressure, Lyme disease, sleep
apnea, return to fitness after childbirth or
other extraordinary life event, diabetes, etc.;
MRSA education;
Onsite blood pressure checks;
Work with the wellness, defensive tactics
and physical training staffs to determine
trends in recruit/employee injury in training
and how to work toward injury free training.
The Athletic Trainer provides quick access to a
healthcare professional for care and
prevention of injury and illness.
Outcomes of the Entry of Sports
Medicine into Public Safety
•Graduate students taking on research topics for public safety
regarding injury, illness and other health related concerns;
•Current and applicable sports medicine strategies, training,
information is more frequently being offered and received by
tactical athletes;
•Sports medicine physicians recognized as better versed to treat
tactical athletes;
•Development of the Public Safety Athletic Trainers Society for
two-way information regarding athletic trainers and public safety
opportunities, as well as future grant opportunities furthering
study in public safety healthcare issues.
Future Goals
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Merit position(s)
Expand services – Fire and Rescue,
Sheriff’s Office, Public Works
Increase technology
Partnerships with County Public Safety
Market successes
Surviving the Economic Crisis
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Tracking cost savings and successes
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Defended program/position reductions
Review & Discussions
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Concept
Planning for pilot
Imbedding the Athletic Trainer
program
Tracking program costs & successes
Future goals
Resources
Organizations:
National Athletic Trainers’ Association
www.nata.org
Public Safety Athletic Trainers’ Society
www.publicsafetyats.com
Individuals:
Major Edwin C. Roessler Jr., Director
Fairfax County Criminal Justice Academy
703-449-7272
[email protected]
Nancy Burke, ATC, Athletic Trainer
Fairfax County Police Department
703-449-7241
[email protected]
Articles
“The Facts about Athletic Trainers” (NATA)
“Athletic Training Education Overview” (NATA)
“Athletic trainers: Providing healthcare for athletes of all kinds” ,
C. Brett Lockard Occupational Outlook Quarterly, Spring
2005
“Athletic Trainers – Workplace Remedies”, Tyler, K, HR
Magazine, Dec. 2008
“The Sports Medicine Model of Care for Your
Occupational Athlete”, Alliva, J, July 2003,
www.primacentral.org
“Certified Athletic Trainers: On-site training for
‘industrial athletes’ helps employers control
losses”, Monteiro, M, MS, ATC, CSCS
Pamphlets / Brochures
“Athletic Trainers Get Results with Occupational
Athletes”
“Unique Health Care Providers”
“Athletic Trainers – not personal trainers”
THANK YOU ! !