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Houston Athletics Sports Medicine

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DAY TO DAY OPERATIONS

TEAM COVERAGE AND WORKOUTS
Pre-season
In-season
Post-season
Summer season

Weight room work-outs
Conditioning work-outs
Individual work-outs
Practice sessions

The Training Room in the Athletic Alumni Facility will serve as the main training room for all University of Houston student-athletes. The training room will open at 7:00am for all athletes and close when all practices have ended for the day.

Primary coverage of all sports will be handled through the Main Training Room on a daily basis. As designated by the head athletic trainer, a staff trainer will be in direct or indirect responsibility of a specific sports team. Whenever possible, a member of the Sports Medicine Staff will cover as many activities as possible.

All conditioning and practice sessions should and will be directly covered by a staff trainer regardless of season. Therefore it is very important for all coaches involved with scheduling such sessions to communicate fully with the sports medicine staff.

Physician Coverage

  1. Football: our Head Team Physician, Dr. Walter Lowe, MD, will provide medical staff coverage of football for all home and away games. Coverage will be an on-site basis.
  2. Basketball and Soccer: All home games will have on-call or on-site physician coverage.
  3. Volleyball, Baseball, and Softball: All home games will have on-call or on-site physician coverage.
  4. Track and Field: All home meets will have on-call or on-site physician coverage.
  5. Swimming/Diving, Golf, and Tennis: All home meets and matches will have on-call or on-site physician coverage.

General Procedures for Athletic Training Coverage

  1. All Head Coaches must notify the staff athletic trainer with their sport of all requests pertaining to sport needs. This includes practices, competitions, travel requests, etc. prior to season start dates.
  2. The staff athletic trainer in charge of a sport will communicate individual sport requests to the Head Athletic Trainer
  3. All requests for coverage of special games and/or practices must be made by a coach of that sport at least 24 hours in advance with the staff athletic trainer in charge of their sport

Ambulance and EMT Coverage

  1. Ambulance and EMT coverage will be on-site during all events.

Post and Summer Season Coverage

Coverage for the post and summer season conditioning is by request only (exception FB). Post and summer season athletes working out on their own will be covered through normal training room hours.

GAME OPERATIONS
All game operations will be determined by the Head Athletic Trainer and the staff athletic trainer in charge of the event. Needs and expectations will also be discussed in the annual operations meeting prior to the beginning of each sport season.

INJURY REPORTING
Every student athlete is instructed to report any sickness or injury immediately to the athletic training staff. It is important that the athlete make every effort to report their health status no later than 10:00am. The athlete is encouraged to not wait until just prior to practice to report sickness and injuries. If an athlete requires a physician's care, the staff trainer will refer them to our team physician(s) for evaluation and treatment. If an athlete seeks medical treatment on their own, without staff trainer/physician approval, the athletics department cannot assume responsibility for the cost of such treatment. The athletics department cannot be held responsible for any medical bills incurred as a result of non-athletic related injuries as well.

INJURY EVALUATION AND REFERRAL

I. On the field evaluation
  1. Control the environment
  2. Calm the athlete
  3. Efficient evaluation
    1. Eliminate life threatening / emergency
    2. History / Inspection / Palpation / Functional Testing
    3. Make critical removal decisions

Survey the scene
Hazards
Number of victims
Position/posture of victim
Mechanism (cause) of injury

Primary Survey
"Identify life-threatening emergencies"
LOC - Mental status (AVPU) Alert, respond to Verbal, respond to Pain, Unresponsive
A - Airway
B - Breathing
C - Circulation
D - Disability: (PMSC) Pulse, Motor, Sensation, Capillary refill
        Motor and sensation - spine injury
        Distal pulse (circulation) - extremity injury
E - Expose: Head to toe: Head/Neck/Chest/Abdomen/Pelvis/Extremities
        Look And Feel for Deformity, Open wounds, Tenderness, Swelling
        Environmental conditions
F - Facilitate: Critical thinking; identify priority of athletes
        Initiate EAP protocols and transport decisions "if in doubt, transport out"

II. Clinical Evaluation
Ordered sequence of procedures used to assess the nature, site, and severity of an injury.
"Problem solving approach"

Evaluation Map / SOAP Notes

Subjective:History:Chief Complaint
 Onset
 MOI
 Pain
 Provocation / Alleviation
 Predisposing Conditions
Objective:Inspection: Obvious deformity
 Swelling
 Palpation:Point tender - Bony and soft tissue
 Special Testing:AROM
 MMT
 PROM
 Joint stability testing
 Other clinical testing
 Neurological
 Circulatory
Assessment:Differential Diagnosis
Plan:Acute Care - EAP
 PRICE - Treatment goals (Mgt pain/swelling - Increase ROM - Increase NM control)
 Physician referral
 Rehabilitation and RTP

Wound Care - MRSA Policies and Procedures

MRSA or methicillin resistant staphylococcus aureus is a type of infection becoming more prevalent in today's athletic departments. Some key characteristics include but are not limited to:

  • Resistive to antibiotics
  • Identified through microbial testing
  • Found in wounds and nasal passages
  • Signs and symptoms are very similar to those of a normal infection

MRSA can be transmitted via:

  • Skin to skin
  • Fluid (from lungs/nose) to skin
  • Equipment to skin

In order to decrease the risk of occurrence here at the UNIVERSITY OF HOUSTON, athletes should be educated on MRSA annually and encouraged to:

  • Wash hands regularly, thoroughly, and properly
  • Shower immediately after activity
  • Individuals with open wounds should avoid community tubs/whirlpools
  • Properly wash workout clothing and clean equipment after every use
  • Avoid sharing equipment, towels, razors, and clothing
  • Actively seek first aid for ALL skin lesions
  • Inform the sports medicine staff of all lesions that do not heal properly

The sports medicine staff should, in an effort to actively help prevent risk of infection, take the following precautions on a regular basis:

  • Educate ALL athletes, coaches, and related staff members of the dangers of MRSA
  • Maintain a clean training room with daily cleaning routines, specifically for treatment tables and whirlpools
  • Help maintain a clean workout facility and weight room
  • Wash hands after dealing with every athlete
  • Take proper note and keep track of any athlete that reports with a suspicious lesion
  • Enforce the rules above with all athletes
  • Although MRSA infection is rare, with the institution of the above precautions there should be no incidents here at the UNIVERSITY OF HOUSTON. For further information please refer to Centers for Disease Control and Prevention's statement on CA-MRSA on-line at http://www.cdc.gov.ncidod/hip/aresist/ca_mrsa_public.htm and/or The National Athletic Trainer's Association's official statement at http://www.nata.org.

    TREATMENT/MODALITIES/REHABILITATION

    Standard protocol is to put the athlete in the best environment in which to heal.
    Follow PRICE (Protect; Restrict activity; Ice; Compression; Elevation) principal.

    Cryotherapy

    Therapeutic Effects

    1. Minimize accumulation of swelling
    2. Pain reduction
    3. Decrease muscle spasms
    4. Reduce chronic edema

    Contraindications

    1. Cold hypersensitivity/allergy
    2. Area of decreased sensation
    3. Localized circulatory impairment

    Application

    1. Whirlpool (50*-60*F) for 10-15 minutes
    2. Ice massage 10 minutes, instruct athlete to keep ice moving
    3. Ice bag 20 minutes, applied directly to the skin

    Thermotherapy

    Therapeutic Effects

    1. Decrease joint stiffness
    2. Decrease muscle spasm
    3. Increase blood flow
    4. Decrease pain
    5. Increase extensibility of collagen tissues
    6. Decrease effusion (in conjunction with cold)

    Contraindications

    1. Area of decreased sensation
    2. Acute injury
    3. Fully submerged athlete

    Application

    1. Whirlpool (104*-110*F) for 15 minutes
    2. Moist heat pack for 10-15 minutes

    Neuromuscular Electrical Stimulator (NMES) Protocol
    (Interferential/Hivamat/Wellness Pro)

    INDICATIONS

    1. Relaxation of muscle spasm
    2. Prevention or retardation of disuse atrophy
    3. Muscle re-education
    4. Reduce swelling
    5. Pain reduction

    CONTRAINDICATIONS

    1. Cardiac disability of any kind
    2. Pacemaker
    3. Pregnancy
    4. Stimulation over carotid sinus area
    5. Transcerebral stimulation
    6. Unestablished etiology of pain syndromes
    7. Complete or partial sensory loss
    8. Malignancies

    OPERATION

    Refer to the Rich-Mar Theratouch Operation Handbook and Manual located in the training room next to the Rich-Mar Theratouch machine.

    Make sure stimulation is not uncomfortable. Do not stimulate for longer than 30 minutes. Use heat and ice as necessary. Allow 3-4 hours between treatments.

    Ultrasound

    INDICATIONS

    1. Post acute inflammatory conditions
      • bursitis
      • tendinitis
    2. Post acute muscle strains
    3. Joint contractures
    4. Myositis ossificans
    5. Residual swelling

    CONTRAINDICATIONS

    1. Acute injuries
    2. Never use over the following:
      • brain
      • spinal cord
      • eyes
      • heart
      • reproductive organs
      • fracture sites
      • open wounds
      • areas of vascular or sensory deprivation
      • pregnant uterus

    OPERATING PROCEDURE

    Select sound head, frequency (1 MHz or 3 MHz), units of measurement (watts or watts/cm 2), and select duty cycle - continuous or pulsed (100%, 50%, etc.)

    1. Apply gel to the area
    2. Distribute gel with sound head
    3. Set the time (4-7 minutes)
    4. Increase intensity (0.5-1.5 watts/cm2)
    5. Keep sound head moving at all times in a circular or stroking motion
    6. Keep sound head in contact with treatment area
    7. Daily treatments should continue for 10-12 treatments
    8. Instruct athlete to notify you of any pain during treatment
    9. Clean sound head thoroughly when finished
    10. Make sure intensity is turned down after every treatment

    Rehab protocols
    PRE principle

    Three main goals
            Manage inflammatory response - Decrease pain and swelling
            Increase pain free ROM
            Increase Neuromuscular Control

    All rehab and return to play protocols are through doctor prescription.

    DISPENSING MEDICATIONS
    (See Medical Services; Section III, D)

    RECORD KEEPING

    HIPAA and Buckley Amendment Statement: States the protection and rights of the student athlete under HIPAA and the Buckley Amendment. (See physical exam form)

    Vivature (Electronic Medical Records - EMR)
    SOAP Notes/Injury report
    Treatment log/Progress notes
    Rehabilitation protocols and progress notes
    Physician notes/Diagnostic reports
    Dr. Sign-up sheet
    Physician referral
    Authorization forms
    Athlete folders - filing

    REFERRAL SYSTEM/AUTHORIZATION
    In order for the athletic department to assume responsibility for payment of services, the injury must be a reported injury, the injury incurred during a UH sponsored event, and deemed "athletic related". All medical services must be approved by a staff trainer or a team physician. Authorization form and staff signature are required.

    The team physician is the final authority concerning when an athlete should be removed from participation, referred to another doctor, and when they may return to participation.

    CLEANING
    Proper cleaning of a medical facility is a must for proper hygiene and to depress the spread of bacteria and viruses.
            Daily cleaning
            Friday cleaning
            Semester cleaning

    The University of Houston Sports Medicine Department has been proactive in taking the necessary precautions to help prevent the spread of HIV, Hepatitis B and C plus other known viruses and MRSA through contact with surfaces and equipment in the training room.

    • ♦ Appropriate solution will be purchased annually to help prevent those listed above. This solution decision will be reviewed annually to make sure that the most up to date solution is purchased.

    • ♦ Clean treatment tables, taping stations, counters, and rehabilitation equipment daily using spray bottles and wipe clean with towel.

    • ♦ To clean ice tub: Drain tub and clean using spray bottles. Wipe clean using towel. This is to be done weekly.

    An Assistant Athletic Trainer or Graduate Assistants who are assigned for maintenance of training room are responsible to clean up and keep the chemical level and water level steady every week. Also the SwimEx, ice tub and hot tub need to be cleaned and maintained weekly.

    SAFE HANDLING OF WATER AND BEVERAGES

    1. COOLER, LID AND WATER BOTTLE CLEANING
      1. Coolers, lids and water bottles should be cleaned and sanitized at least once every 24 hours.
      2. The 3-sink method should be used when cleaning items. Preferably, each sink should be of sufficient depth for immersion of the cooler.
        1. Sink 1
          1. Sink should be filled with soap and hot water.
          2. All items are to be scrubbed thoroughly with sponges each time the cooler is cleaned.
          3. Pay particular attention to cleaning spigots.
          4. Dump out excess soap and water.
        2. Sink 2
          1. Rinse all items thoroughly in hot water.
        3. Sink 3
          1. All items are sanitized with an approved sanitizer solution - a 10 % bleach solution is acceptable.
          2. The items must be sanitized for a minimum of 2 minutes prior to removal from the solution.
          3. If there is a concern about the possibility of a bleach taste, items may be rinsed after the 2 minutes or rinsed prior to their next use.
      3. In cases where the coolers or items are too large for the sinks, a clean and sanitize in-place procedure can be used. This includes the use of a clean bucket and sponge or washcloth for the detergent cleaning step, followed by rinsing the container at least three times with water and, finally, spraying the inside of the container and spigot with the sanitizer solution.

    2. COOLER STORAGE
      1. After the sanitization step, all items should be air-dried and stored above the floor in a clean place, such as a shelving system.
      2. The drain racks, trays and shelves shall not be made of a corrodible material and shall be kept clean.
      3. Items shall be inverted to allow for water drainage.
      4. The floors of the room where the items are stored should be made of a construction that is easily cleaned and shall be kept clean and in good repair.
      5. It is recommended that the floors should be of sealed concrete or vinyl tile.
      6. The joints between the floor and walls should be rounded or otherwise constructed to provide a tight seal between the walls and floor.
      7. The walls and ceilings should be smooth, washable and dept clean.
      8. Items should be stored at least 6 inches above the floor to allow for proper drainage.
      9. Shelves should be placed at least 1 inch from the wall.

    3. STORAGE, HANDLING AND USE OF ICE
      1. Ice used with beverages should be manufactured from an approved water supply.
      2. Ice should be dispensed or transferred with a scoop, spoon or other sanitary method. When not is use, the scoop or spoon may be stored in the ice with the handle protruding, or on a clean
      3. Ice machines should be cleaned on a regular schedule.

    4. WATER SUPPLY
      1. Water must be from a public distribution system or an approved water supply that is tested to endure conformity with applicable regulations.
      2. Portable hoses should be used to fill coolers. Garden hoses contain materials which may contaminate the water supply.
      3. Hoses should be used exclusively for drinking water dispenser filling and not to fill other equipment or tanks, or to clean other things.
      4. The water hose should not be stored or come in contact with the ground and should not be capable of being submerged into a drain. A hose reel is effective in meeting this recommendation.
      5. The coolers should be filled in an area free from environmental contaminants such as dust and insects.
      6. The cooler should not be placed on the floor while filling.

    BUGETING/INVENTORY/ORDERING OF SUPPLIES

    1. Budgeting Process
      1. Documenting the expenditure for the fiscal year including salary of graduate assistants and student athletic trainers. A copy of invoice and voucher shall be filed and the amount and date of invoice shall be logged into the Microsoft Excel "total expenses".
      2. Evaluating the expenditure for the fiscal year after the spring football practice is over. The needs, quantity, quality of products, technical supports and price of products for the Sports Medicine Department will be discussed during the evaluation process with staff athletic trainers.
      3. Once the decision of the budgeting plan is made for the next fiscal year, the budget form will be provided by the Athletic Director office and the form will be filled out and turned back to AD office by the due date.

    2. Inventory Process
      1. Mass supply shipping is scheduled in the middle of July. Keep the receipts when they are shipped in the training room and counts all supplies and equipments.
      2. Keep the inventory log into the Microsoft Excel "Inventory" each time when the order is made by the assistant athletic trainer who is in charge of inventory. Total inventory and order for all supplies and equipments will be shown on the worksheet.
      3. Student athletic trainers will be assigned to count final inventory at the end of fiscal year. Total amounts and quantities for the fiscal year will be figured out when the athletic trainers finish their inventory.

    3. Order/Purchasing Process
      1. Six basic steps in the purchasing process.
        1. Request for quotation/bidding
        2. Negotiation
        3. Requisition
        4. Purchase order
        5. Receiving
        6. Accounts payable
      2. Mass order bidding process ideally is completed by June. Shipping date is set on the middle of July so enough supplies are stocked in the training room for pre-season practice.
        • communicate the retailer (A-Athletic, Medco, Alert, etc) that the payment date is on September 1st for the mass order.
        • communicate the AD office and the business office for the mass order.
      3. Budget should be checked often with the business office so budgeting status is clear all the time.
      4. At the end of season or fiscal year, prior approval form may be used to request purchase supplies or equipments out of the budget. The form needs to be turned in to the AD office to get approved.
      5. Regular order uses Excel file "ordering format" to request a bid and process the order.

    TRAVELING REQUEST

    Recruiting/individual business travel expenses/itinerary must be requested to University of Houston Athletic Department Business Office prior to travel date. University of Houston Sports Medicine staff will be cooperated with the Business Office to complete travel request form by following these notes below.

    1. Complete travel request form and route for signature prior to leaving on trip or booking airfare.
    2. Airfare - book airfare through travel agency and bill to appropriate UATP account (agency will do this for you). You can also book airfare on your Travel Card.
    3. Hotel - make your own reservation using either your Travel Card or personal credit card.; Upon checkout, obtain hotel folio that shows payment in full and balance due of $0. If in Texas, present Texas State Hotel Tax Certificate to avoid cost of 6% state tax. If using Travel Card, do not allow any incidentals to be charged. If you expect to incur incidental expenses (movie, water, room service) use your personal credit card. Personal expenses on the Travel Card will result in cancellation of card.
    4. Rental Car - if renting from Houston branch, use direct bill account with Enterprise (Athletics sponsor). Avis is an alternate option. Insurance coverage is included in the rental fee so decline all insurance. If you are not able to use either Enterprise or Avis, purchase liability and collision damage waiver insurance only. Decline the Fuel Purchase Option - please refuel car before returning vehicle.
    5. Rental Car Gas - charge to either Travel Card or personal credit card.
    6. For convention travel, include a copy of the convention itinerary.
    7. Mileage - provide point to point addresses in conjunction with Compliance documentation.
    8. Per Diem is &36 per day regardless of city. Never purchase meals on the Travel Card.
    9. Parking - use economy/shuttle parking at airport if possible. At hotels, choose self-park instead of valet option.
    10. KEEP ALL RECEIPTS! If receipt is smaller than a sheet of paper, tape receipt to sheet of paper.
    11. Complete ACS recruiting database as required by Compliance and print out ACS contact sheets.
    12. Complete Travel Expense Summary packet with all above documentation, sign, have supervisor sign, and turn into Business Office for review. FAILURE TO TURN IN RECEIPTS TO THE BUSINESS OFFICE WITHIN 60 DAYS OF THE END OF THE TRIP WILL RESULT IN THE REIMBURSEMENT BEING TAXED.
    13. IF SUING A TRAVEL CARD, FOLLOW DOCUMENTATION PROCESS ON TRAVEL CARD MEMMO.

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