Risk Management Concerns in PPE

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Risk Management Concerns in PPE

• Brian Anderson, ATC
• Big Sky Sports Medicine Meeting 2006

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Topics for Consideration

• What determines the Standard of Care?
• What is the Standard of Care?
• President vs. Student-Athlete
• What is everybody else doing regarding PPEs?
• What is risk management?

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Risk Management

• Loss of Revenue
• Prevention of Costly Injuries and Conditions
• Prevention Methods and Analysis
• Minimizing Litigation
• Loss of Time
• PPE Risk Management Front End Prevention

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Risk Management Topics of Interest

• Concussion Protocols
• Emergency Preparedness and Catastrophic Injuries
• Medication Administration
• Team Physician Issues
• Appropriate Medical Coverage
• Eating Disorders
• Spectator Coverage
• Environmental Policies
• Facility
• Documentation / Chart Review

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Preparticipation Examination Considerations

• Disclaimer This is offers no legal opinion and
  any considerations of implementation need to be
  discussed and approved by university team
  physicians and general counsel.

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Questions to Consider

• When?
• How Often?
• Annual, Every Other Year, Entrance, Recruiting,
  Exist
• Who?
• SA Family Physician, Team Physician (Ortho. /
  Internist)
• Purpose
• Screening vs. Treating
• Walk-ons, Cheerleads, Practice Squad
• What if additional test are warranted?
• Time, Cost

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What are the Possibilities

• Hematology Labs
• Metabolic
• HIV / AIDS
• Sickle Cell
• Anemia
• Hepatis
• UA
• EKG
• Echo
• Stress Test
• Drug Test
• Diagnostics
• Physiological Testing
• DNA Testing

• Medical Hx
• Vitals
• Ht. / Wt.
• Vision
• Orthopaedic
• General Medical
• Neuropsychological Screening
• Posturography Assessment
• Baseline Symptomalogy
• fMRI
• Eating Disorder / Nutritional Profile
• Dental
• Special Populations Asthma

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FAU Screening Process

• Medical Hx
• Vitals
• Ht. / Wt.
• Vision
• Orthopaedic
• General Medical
• Neuropsychological Screening
• Posturography Assessment
• Baseline Symptomalogy
• fMRI - Brain
• Eating Disorder / Nutritional Profile
• Dental
• Special Populations Asthma

• Hematology Labs
• Metabolic
• HIV / AIDS
• Sickle Cell
• Anemia
• Hepatis
• UA
• EKG
• Echo
• Stress Test
• Drug Test
• Diagnostics
• Physiological Testing
• DNA Testing

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What determines the Standard of Care?

• National Governing Bodies
• Medical Society Position Statements
• Case Law
• Public Perception

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National Governing Bodies

• Local
• State
• Florida EKG Bill
• USOC
• NCAA
• Sports Medicine Handbook
• Rules and Regulations
• Pre-season and Off-season Conditioning (Football)
• Professional Sports
• High School Federations / Associations

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Medical Guidelines Pertaining to PPE

• NCAA Sports Medicine Handbook
• 3rd Ed. PPE Monograph
• 36th Bethesda Guidelines
• AHA Guidelines

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NCAA Sports Medicine Handbook

• Recommendations
• When do recommendations and guidelines become
  Standards of Care?
• Requirements
• Prior to Football Activities

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3rd Ed. PPE Monograph

• Multiple Association Task Force
• Routine Screening of EKG and Echocardiogram (EIA)
• Frequency
• Qualifications of Examiners

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Goals and Objectives

• PRIMARY OBJECTIVES
• Screen for conditions that may be
  life-threatening or disabling
• Screen for conditions that may predispose to
  injury or illness
• Meet administration requirements
• SECONDARY OBJECTIVES
• Determine general health
• Serve as an entry point to the healthcare system
  for adolescents
• Provide opportunity to initiate discussion on
  health-related topics

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36th Bethesda Conference

• Routine Screening Debate
• EKG
• Echocardiogram
• Italian Studies

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Causes of Sudden Death in 387 Young Athletes
Maron (2003)

• HCM 26.4
• Commotio Cordis 19.9
• Coronary Artery Anomalies 13.7
• Myocarditis 5.2
• Rupture Aortic Aneurysm (Marfan) 3.1
• Arrhythmogenic RV Cardiomyopathy 2.8
• Tunneled Coronary Artery 2.8
• Aortic Valve Stenosis 2.6
• Atherosclerotic Coronary Artery Disease 2.6
• Dilated Cardiomyopathy 2.3

• Myxomatous Mitral Valve Degeneration 2.3
• Asthma 2.1
• Heat Stroke 1.6
• Drug Abuse 1.0
• Other Cardiovascular 1.0
• Long QT Syndrome 0.8
• Cardiac Sarcoidosis 0.8
• Trauma causing structural cardiac injury 0.8
• Ruptured Cerebral Artery 0.8

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American Heart Association

• Family Hx
• Premature sudden cardiac death
• Heart disease in surviving relatives less than 50
  yoa
• Personal Hx
• Heart Murmur
• Systemic Hypertension
• Fatigue
• Syncope / near-syncope
• Excessive / unexplained exertional dyspnea
• Exertional Chest Pain

• Physical Examination
• Heart Murmur (Supine / Standing)
• Femoral arterial pulses
• Stigmata of Marfan Syndrome
• Brachial blood pressure measurement (sitting)
• What to do if Cardiac work-up is warranted??
• Time
• Cost

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Case Law

• Right to Participate
• Americans with Disabilities Act of 1990
• Rehabilitation Act of 1973
• Knapp v. Northwestern
• University Disqualification of Student-Athlete
• Informed Consent
• Defense Considerations
• Disqualification vs. Wrongful Death

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Public Perception

• Teen's death raises cardiac screening issue
  Thursday, August 04, 2005 - Bangor Daily News
• Heart specialists call for cardiovascular
  screening for all young competitive athletes
• League has no criteria for exams --By Roscoe
  Nance, USA TODAY

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University Committee / Review Team

• Team Physician
• Health Services Director
• Head Athletic Trainer
• Athletic Department Administrator
• Risk Management
• General Counsel

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Questions / Comments

• www.csmfoundation.org
• banderson_at_csmfoundation.org