- Includes potential to exposure

- Not limited to health care professionals (anyone who is committed to First Aid and CPR under the OSHA standard)

- Hepatitis A

- Hepatitis B

- HPV

- HIV

- AIDS

- Must receive training on hazards and procedures

- Employers must offer annual training

- Occupational exposures

- Other potentially infectious materials: semen, vaginal secretions, blood, other body fluids with visibile blood

- Wash with soap and water

- report date and time

- report job classification

- report protective equipment being used

- report training for activity

- seek medical care: blood must be tested

- Organisms present

- Extent of the organisms

- Type of exposure

- Health immunization status

Symptoms of Hepatitis

- Loss of appetite

- Nausea

- Jaundice

- Fatigue

- Abdominal pain

- Vomiting

*HBV vaccine is very effective and needs to be offered to allied health care providers and those covered by the OSHA standard

*HCV - unusual to exhibit signs and symptoms. There is no vaccine.

HIV - 100,000 people in the U.S.

AIDS - 300,000 people in the U.S.

*The only way to determine HIV is to be tested

Symptoms:

- Fatigue

- Night sweats

- Weight loss

- Fever

- Gland swelling

- Muscle/joint pain

- Minimizing occupation exposure through engineering controls, work practice controls, personal protective equipment (PPE), and universal precautions

- Biohazard labels

- Needleless IV systems

- Shear cleaning needles

- Eye wash station

- Sharps container: must be closable, leakless, puncture resistant, and labeled with a biohazard label

*Regular repair and inspection of engineering controls is required

- Cautions regarding eating, drinking, and cosmetics

- Sharps controls

- Hand washing controls

- caution with equipment: (wear gloves when washing towels)

10% bleach and the rest water

- Never take chances

- Treat all human blood and bloody fluids as if they contain blood born pathogens: blood from dental work, bloody fluid, unidentifiable body fluid

- Feces

- Nasal secretions

- Spotem

- Sweat

- Tears

- Urine

- Vomit

- Follow engineering controls

- Use personal protective equipment (PPE)

- Follow universal precautions

- Keep up on new developments and procedures

- Follow employer's exposure control plan

- now don't sting, but tell children to blow on the wound while you spray the wound. This activates the proprioceptors

- now come in the form of aerosols

- Neosporing (Polysporin)

- First Aid Cream

- Triple Antibiotic Cream

*Try to use pre-packaged if possible. However, this is more expensive than the tube.

**Use a cotton tip applicator (que tip) to apply the ointment.

***Not all wounds need ointment. If there is no blood or dirt, it is clean and doesn't need ointment

- Tape Adherent = tough skin

- Helps to hold things in place

- Help takes the pain away

- IB Profin

- Aspirin

- Tylenol

- Flexol

- IcyHot

- Bengay

- BioFreeze: one of the better because it somewhat penetrates the skin

- Used in heel lace pads

- Skin lube: reduce friction over the joint

- Petroleum gel: keeps mositure in (dry hands)

- Use sterile gauze to treat a wound

- 2', 3', 4', 6'

- Different sizes for different size wounds

Bandages

(sheer, flexible, plastic)

- All different types and sizes

- Sheer allows air to go through and will stay in place

- Flexible has elastic in it

- Plastic: pretty much useless (they don't work very well)

Athletic Tape = white tape

Elastic Tape = stretchy tape

Pre-wrap = helps to protect skin from tape

- can be used for knee tendinitis

- holds things in place

IB Profin: Try to get pre-packaged

*Check expiration dates frequently

**Always ask if the athlete has taken it before

- Elastic Wraps

- ACE Wraps

- Get small, medium, and large

- Foam

- Felt

- Protect area from further damage if there is a contusion

- Arch support padding

- Blister pads (different sizes)

- Heel pads

- Horsehoes (clean before re-use)

- Scissors

- Tweezers

- Suture scissors

- disposable scaple

- ring cutter

- pen light

*Get a case that hulls your instruments

- Cleaners for tables and countertops

*Must meet OSHA standards

**Must kill HIV and MRSA

- Mouthguard

- Tongue depressers

- Pen/pencil/paper

- Safety pins

- Rubber bands

- Splints

- Throat drops

- Soap and water is the best cleaner

....followed by salene

....then betadine

....Hydrogen peroxide: great for abrasions and get out dirt, but doesn't disinfect

*Don't use alcohol. It only removes a superficial layer of dirt

- Splints

- Stretcher chair

- Spine board

- Cervical collar

- Crutches (different sizes)

- Immobilizer (used on knees)

AT EVENTS

Things to be at the visitor's bench

- Water

- Lots of cups

- Cooler with ice bags

- Biohazard bag

- First Aid supplies

- Kleenex

**it's nice to put water and cups in the locker room

**The same goes on the home team's bench

Legal Aspects of Athletic Training

Liability -  is the state of being legally responsible for the harm one causes another person

- This may be from performing something wrong

- Civil laws

- Negligence torts

- Malfeasance: unlawful or improper act, doing something that is not in scope of practice, and/or practicing without a license

- Misfeasance: improper performance of a lawful act; doing something improperly even though you are allowed to perform the act

- Nonfeasance: failure to act when there is duty to act

- Malpractice: negligent in the line of duty

- Grose negligence: total disregard for the safety of others

- Assault: verbal threat

- Battery: intentional touching

- False imprisonment: imprisonment (kidnapping)

- Definition of Character: slander, libel (accusing of things)

- Fraud: Misrepresentation of yourself

- Invasion of privacy: right to be left alone

- Ordinary negligence: failure to act as a reasonable and prudent person would act under similar circumstances

- Grose negligence: total failure to provide elements that would normally be deemed proper in a given situation (For example, checking to see if there are holes in the playing field or not cleaning up water on a basketball court) Making sure that things are taken care of

- inability to be sued (Game officials have this privilege)

- An ATC employed by public schools or state-funded college/university

- Provides limited protection against legal liability to any person who voluntarily chooses to provide first aid

- stay within scope of practice

- doing things that any normal prudent person would do

- The individual through expressed or implied agreement, assume that some risk or danger will be involved in the particular undertaking. In other words, a person takes his or her own chances.

- If you are injured because of your actions, you have assumed the risk, and the coach is not liable

- If the coach teaches this to you in practice, then the coach is responsible

- Individual fails to perform legal duty

- physician informs a coach that a player cannot play and the coach plays them anyways

- individual commits an act that is not legally his or hers to perform

- A coach fixing a dislocation (not under their scope)

- Guidelines and level of quality of care

- Guidelines: What level of care should you provide?

- assessment of an injury or illness by an allied health care provider

- Athletic trainers make diagnoses

- If a person is unconscious, consent is implied (there is consent to treat)

- identify yourself and ask if you can help

- For minors, parents must give consent to treat unless it is an emergency situation

- Warn the individual of the potential dangers in the sport/activity/test

- supervise constantly and attentively

- properly prepare and condition the individual

- properly instruct the individual in the skills of the sport/activity/test

- Make sure that safe equipment and facilities are used by the individual at all times (For instance, filling in a hole at a shoot)

- Use reasonable care to provide proper medical treatment

- Keep good records (document everything)

- Conduct by the athletic trainer: was it approved by other athletic training professionals

- Was there a duty to act? When is there a duty?

- Causation - Breach of the  duty must be an immediate cause of the injury suffered

- Damage: harm, physical injury, financial loss, mental anguish, invasion of personal rights

Assumption of risks - They the risks

Statute of limitations

Sovereign immunity

Good Sammaritan immunity

- Keep good records

- Be familiar with the health status of your athletes (never give an athlete medicine unless your know they've taken it before)

- Extreme caution in distribution of non-prescription medications

- only use the therapeutic methods your allowed to use in that state

- Don't permit hazards or faulty equipment

- Don't permit any injured participant to play until they are cleared to play by a physician (or the physician gives you the right to clear them)

- Use common sense = do what the reasonably prudent person would do)

- Hyperthermia

- Hypothermia

- Body core temperature rises to dangerous levels

- Normal core body temperature = 98.6

- It can rise to 106 (even 108 degrees)

- Can result in death

- Sweat glands allow water to penetrate to the surface

- Evaporation of water takes heat with it

- When radiant heat and environment temperature are higher than body temperature, loss of heat through evaporation is key

- loss of 1 quart of water per hour for up to 2 hours

- Air must be relatively water free for evaporation to occurs (relative humidity of 65% will impair evaporation and 75% stops evaporation)

- Use a wet bulb globe temperature index which takes into account radiant heat. This determines humidity and dangerous levels.

- Most places use sling pyschcrometers with takes into account air temperature and humidity

(Sling the pyschcrometer around for about 3 minutes and the relative humidity can then be determined by lining up the thermometers)

- Anything above 60% starts to get dangerous

- Heat, sunshine, and humidity must be monitored closely

- web bulb globe temperature index (WBGT) - provides objective measure for determining precautions concerning participation in hot

(WBGT incorporates different thermometer readings)

- Dry bulb (standard mercury temperature)

- Wet bulb (thermometer with wet gauze that is swung around in air)

- Black bulb (black casing that measures radiant heat)

- Formula yields WBGT index

Vertilation is provided by whirling thermometer (sling psychrometer) or suction fan (aspiration pyschcrometer)

- New models utilize digital sensors

- Heat rash (prickly heat)

- Hot red, dry skin

- Treat by taking to cool location, fluids

- Heat syncope (heat collapse)

- Rapid fatigue and overexposure, standing in heat for a long period of time

- Caused by peripheral vasodilation or pooling of blood in extremities resulting in dizziness and fainting

- Treat by placing athlete in cool environment, consuming fluids and laying down

- Need about 2.5 liters of fluid a day to reduce the risk of this occuring with minimal activity. If you are very active, this should be doubled. (You can tell if you are dehydrated by looking at your pea)

- Partial muscle spasms (calf, abdominal) due to excessive water loss and electrolyte imbalance

- Occurs in individuals in good shape that overexert themselves

- Prevent by consuming extra fluids and maintaining electrolyte balance

- Treat with fluid ingestion, light stretching

- Put ice around places that retain heat (armpits) to try to cool them down

- Lots of fluids if they are conscious (not someone is unconscious. They will choke) Water is the best and can be supplemented with Gatorade and Powerade. But these contain high sugar which is not a good thing when you are dehydrated.

- Result in inadequate fluid replacement

- Will exhibit signs of profuse sweating, plae skin, mildly elevated temperature, dizziness, hyperventilation, and rapid pulse

- May develop heat cramps or become faint dizzy

- Core temperature will be 102 degrees

- Performance may decrease

- Imeediate treatment includes fluid ingestion (intravenous replacement) place in cool environment

- Serious life-threatening condition, sweating, mechanisms slow down

- Characterized by sudden onset - sudden collapse, LOC, flushed hot dry skin, shallow breathing, strong rapid pulse, and core temperature of greater than 106 degrees (They lose consciousness)

- Temperature must be lowered within 45 minutes or they will not survive (Some places use ice baths. However, this could potentially send them into shock) A cold shower may also be used

- This is a medical emergency (drastic measures must be taken to cool athlete)

- Once a person has a heat illness, they are more likely to sustain another if they are not careful

- They may have seizures or stop breathing

- Common sense and precaution (consume fluids and stay cool)

- Fluid and electrolyte replacement: body requires 2.5L of water daily when engaged in minimal activity, 1-2% decrease in body weight due to dehydration results in thirst, if thirst is ignored dehydration results in vomitting, nausea, fainting and increases the risk for heat illness, prevent through hydration don't ignore thirst, generally only 50% of fluid is ever replaced and should therefore be replaced before, during, and after exercise. Athletes should have unlimited access to water. Electrolyte drinks (optimal CHO lvel is 14g per 8 ounces of water)More CHO results in slower absorption. Higher glucose levels delay gastric emptying. High levels of sodium retain fluid and cause hyperthermia. Effective for both short term and endurance activities

- Con't stay out in the heat for a long time

- replace fluids: for every pound of fluid you lose, replace with a pint of water

- Any 1-2% drop in body weight results in thirst (3-5% loss in body weight needs to be replaced by the next practice or there wil be dehydration

- Electrolyte drinks high in carbohydrates (14g or higher) don't help, but are good for muscle recovery. They don't pertain to heat problems. We are more worried about the fluid. Stay away from drinks that have high glucose levels.

- Most effective method of avoiding heat stress

- Involves becoming accustomed to heat and exercising in heat

- Early pre-season training and graded intensity changes are reccommended with progressive exposure over a 7-10 day period

- 80% of acclimation can be achieved during first 5-6 days with 2 hour morning and afternoon practice sessions

- You must graudally become more climatized to the hot environment

- The athlete needs to be worked into the heat

- Adjust practice to accomodate this

Identify Susceptible Individuals

- Anyone who has had a heat illness

- Anyone with large muscle mass

- Anyone who is overweight

- Women are more likely because they store heat more readily: women are physiologically more efficient with regard to body temperature and regulation but susceptible

- older adults and children

- those with poor fitness

- People with any kind of chronic illness

**If there are people that fit into these categories, you need to pay specific attention to them

- cotton that breathes

- leave shirts on even if they are soaking wet

- light and non-tight fitting

- base on temperature and humidity

- dress for the weather and temperature

- Light colors, breathable material

- Keep track of pre and post practice weights for first two weeks

- If increase in temperature and humidity occurs during the season, weights should again be recorded

- A loss of 3-5% body weight includes extreme dehydration and must be replaced before the next practice

- Weigh them in before and after practice. Any weight loss is loss in fluid. This loss must be replaced by the next practice.

- Heat stroke is always preventable.

- Dry and wet bulb readings should be taken on the practice/playing venue prior to practice to monitor heat index

- Modify practice according to severity of environmental conditions

- Avoid soft-drinks and caffeine (is a diaretic)

- Eat food that are light, not heavy

- Penty of fluids and fruits and vegetables (esp bananas)

- Fluids: water, electrolyte drinks, juices

- Temperature in conjunction with wind chill and dampness or wetness can increase chances of hypothermia (decrease in body core temperature)

- Heat loss through head so make sure it is covered. 65% of body heat is lost through radiation (head and neck 50%), 20% through evaporation, 2/3 through skin, 1/3 through respiration

- Problems arise when heat loss exceeds heat production via metabolism (results in impairment of neuromuscular function which can also be impaired by shivering)

- Drop in core temperature below 85-90 degrees. Shivering will stop and death may be imminent. Sivering = body trying to produce energy to keep you warm

- Death is imminent when temperature falls below 77-85 degrees

- Wear several layers of clothing

- To re-warm your hands, place them in a place that heat is staying in

Waterproof and windproof fabrics that allow passage of heat and sweat and allow movement

- Layers and adjusting them are key to maintaining body temperature (during period of activity)

- Inadequate clothing = improper warm-up and chill factor can lead to injury, frostbite, chiblains, and/or minor respiratory problems

- Be aware of hydration levels as well to enhance blood volume and heat maintenance

- Localized cooling can result in tissue damage: formation of ice crystals between cells, destroys cells, disrupts blood flow, clotting may occur

- Frost nip: involves ear, nose, chin, fingers, and toes; occurs with high wind and/or severe cold; skin appears firm with cold painless areas that may peel and blister (24-72 hours); treat with firm pressure, blowing warm air on hands in armpits if fingers involved; do not rub

Frostbite: chilblains result from prolonged exposure causing redness and swelling, tingling pain in toes and fingers; due to poor peripheral circulation; supericial frostbite involves only skin and subcutaneous tissue; appears pale, hard, cold, and waxy; may blister and be painful for several weeks; deep frostbite indicates frozen skin requiring hospitilization; rapid re-warming is necessary (100-110F); tissue will become blotchy red, swollen, painful and may become gangrenous