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The Role of Sports Medicine in Officer Safety and Wellness. Nancy C. Burke, MS, VATL, ATC Athletic Trainer Fairfax County Police Department, Fairfax Virginia

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the role of sports medicine in officer safety and wellness

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
Learning Goals
  • 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
Overview of the FCPD
  • 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
Pre-Athletic Trainer Program/Policies in the FCPD
  • 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 “IDEA”

The meeting

Project plan developed

Funding

Space

Equipment

Stakeholders

Risk Management

Occupational Health Center

Fire Department

Sheriff’s Office

the pilot
The Pilot

Mission Statement:

Maintain and improve general overall wellness; provide for care and prevention of injury and illness

Housed at CJA

  • Recruit class as the control group
  • Prior tracking of dismissals due to injuries
  • Ability to closely monitor
  • Diverse group from Academy member agencies

Initial Start Up at the CJA

  • Trust – fear of reporting injuries (dismissal etc…)
  • Rapport building
  • Word of mouth
  • Tracking successes
  • Wellness Advisory group meetings
imbedding the program
Imbedding the Program

Position description – created as limited term exempt

  • 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
what is a certified athletic trainer
What is a Certified Athletic Trainer?

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. 

slide10
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.

slide11

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.

slide12
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
Differences: Athletic Trainer / Physical Therapist

Athletic TrainerPhysical Therapist

Rehabilitates injuries of a mostly Rehabilitates injuries and illness orthopedic nature in the active ofmany different patient

population populations

Responsible for the prevention of Work with orthopedic patients, as well as and immediate care of injury patients with unique medical conditions and/or illness

Traditional setting is on-site at the Traditional setting is a clinic. time of injury. Provides immediate Clinical treatments only.

treatment and continues care.

Provides care following physician Provides care following physician

guidelines guidelines

Physical performance test specific to

Law enforcement.

practice domains
Practice Domains
  • Prevention
  • Clinical Evaluation and Diagnosis
  • Immediate Care
  • Treatment, Rehabilitation and Reconditioning
  • Organization and Administration
  • Professional Responsibility
where do athletic trainer s practice
Where Do Athletic Trainer’s Practice?

Secondary Schools Corporate Health Programs

Performing Arts Sports Medicine Practices

Physician Clinics Physical Therapy Clinics

Military Colleges and Universities

Law Enforcement Industrial Health Care

Professional Sports

slide17

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

slide18

Athletic ModelLaw Enforcement ModelTeam Physician Worker’s Compensation Panel Physician / Personal PhysicianCoach SupervisorAthletic Trainer Athletic Trainer

Sports Medicine Team

sports medicine principles
Sports Medicine Principles
  • Prevention / Education
  • Fitness / Wellness
  • Early Intervention / Immediate Care
  • Biomechanics / Ergonomics
  • On-Site Rehabilitation
  • Functional or Work – Specific Training
slide20

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
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
Benefits of the Sports Medicine Model in Law Enforcement Settings
  • Improved Employee Morale
  • Increased Productivity
  • Decreased Incident and Severity of Injury
  • Decrease in Worker’s Compensation Costs
  • Quality of Care
principles of sports medicine care
Principles of Sports Medicine Care
  • Team approach inclusive of physicians, athletic trainer, patient, supervisor;
  • Early intervention
  • Expectation of recovery
  • Function- oriented treatment
medical care costs
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.

general program overview
General Program Overview

Sports Medicine Occupational Model of Care

Allivato, J “The Sports Medicine Model of Care for your Occupational Athlete”, 2003

slide26
“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”)

  • Care for Injured Officers
mission statement
Mission Statement

Mission Statement:

Maintain and improve general overall wellness; provide for care and prevention of injury and illness

goals of the athletic trainer
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
Medical Supervisor

Licensed Physician

Required by NATA Board of Certification and state Board of Medicine

what can the athletic trainer do
What can the Athletic Trainer Do?
  • Provide primary injury evaluation and immediate care;
  • Make referrals to the appropriate worker’s compensation physician, private physician or healthcare provider;
  • Expedite many physician visits;
slide32
Develop a medical care plan with the physician and/or healthcare provider;
  • Administer the medical care plan;
  • Monitor the progress of the officer;
  • Administer physical performance tests to advise physicians on duty status.
therapy provided by the athletic trainer
Therapy Provided by the Athletic Trainer

Therapy may be provided for both work and non-work related conditions.

  • Immediate evaluation and general medical care
  • Cryo-therapy
  • Thermo-therapy
  • Ultrasound
  • Electrical Stimulation
  • Cold Laser and Photo-therapy
  • Prescriptive Exercise Program
  • Recommendations for appropriate braces
  • And much more.
athletic trainer schedule
Athletic Trainer Schedule
  • 40-hour work week
  • Flex schedule to meet workload demands
  • 24/7 access by County cell phone (rolled into Incident Support Services)
slide35

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.

slide36

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.

slide37

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.

slide38

The Athletic Trainer CANNOTsign 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.

slide39

Work Injury Scenario Comparison

SPRAINED ANKLE – 2nd Degree

Pre-ATPost AT

Urgent Care AT clinical diagnosis

Orthopedist – 5 days Orthopedist 1-2 days

Therapy - 7 to 10 days Therapy-Immediate

Lost time Before Treatment:

5 – 7 days 0

Return to Full Duty Status:

4 – 5 weeks 2 – 3 weeks

slide40

Ruptured Achilles/Fractured Foot

Pre-AT Post AT

Urgent Care AT Clinical Diagnosis

Specialist 2-4 days Specialist - same day

Surgery 8-10 days Surgery 3-5 days

Therapy Begun 2 weeks Therapy Begun 4 days 

Recovery to Full Duty

9 months 6 months

Fully capable of performing duties

slide42

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.

slide43

Rehabilitation

  • Rehabilitation occurs in two fashions:
  • 1. The Athletic Trainer works in conjunction with a
  • physical therapist to provide daily care;
  • The Athletic Trainer provides all the rehabilitative care on a daily basis;
  • The treating physician is kept apprised of the employee’s progress.
wellness clinic
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

safe shield
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.

slide52
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.
slide54
In 2002, SACOP produced a survey to determine the types of injuries officers sustain, the severity and frequency of those injuries.

FCPD Trends

Top 12 Body Parts Injured FY 03 – FY 09

slide55

Top 10 Injury Types

FY 03 – FY 09

treatments
Treatments

Work Non-Work Total

FY 06 344 311 655

FY 07 1,320 1,188 2,508

FY 08 3,596 2,974 6,570

FY 09 2,689 3,821 6,512

556 489 00 in savings therapy costs
$556,489.00 inSavings -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$126,278.00$216,513.00

These costs are not billed to the agency

nor the employee.

recognized savings
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%

slide59
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%

slide60
“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
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

slide62
96% are satisfied with the Athletic Trainer

95% are satisfied with Treatment

94.5% are satisfied with the Clinic

Survey Results:

patient comments
Patient Comments
  • “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.”
slide64
Employee comments on the survey demonstrated they view the Athletic Trainer as an “employee” and a great recruitment tool for potential recruits.
slide65
“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”;
  • “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
Activities

The Athletic Trainer is an educational resource for a variety of law enforcement related concerns.

slide67

Health

Bulletins

slide69

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.

additional activities
Additional Activities
  • 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;
slide72
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.
slide73
The Athletic Trainer provides quick access to a healthcare professional for care and prevention of injury and illness.
slide74

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
Future Goals
  • 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
Surviving the Economic Crisis
  • Tracking cost savings and successes
  • Defended program/position reductions
review discussions
Review & Discussions
  • Concept
  • Planning for pilot
  • Imbedding the Athletic Trainer program
  • Tracking program costs & successes
  • Future goals
resources
Resources

Organizations:

National Athletic Trainers’ Association

www.nata.org

Public Safety Athletic Trainers’ Society

www.publicsafetyats.com

slide79
Individuals:

Major Edwin C. Roessler Jr., Director

Fairfax County Criminal Justice Academy

703-449-7272

edwin.roessler@fairfaxcounty.gov

Nancy Burke, ATC, Athletic Trainer

Fairfax County Police Department

703-449-7241

nancy.burke@fairfaxcounty.gov

slide80
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

slide81
“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

slide82
Pamphlets / Brochures

“Athletic Trainers Get Results with Occupational Athletes”

“Unique Health Care Providers”

“Athletic Trainers – not personal trainers”