The Role of Sports Medicine in Officer Safety and Wellness

1. 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

2. 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!

3. 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

4. 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”

5. The “IDEA” The meeting Project plan developed Funding Space Equipment Stakeholders Risk Management Occupational Health Center Fire Department Sheriff’s Office

6. 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

7. 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

8. Background Information

9. 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. 

10. 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.

11. 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.

12. 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.

13. 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.

14. Practice Domains • Prevention • Clinical Evaluation and Diagnosis • Immediate Care • Treatment, Rehabilitation and Reconditioning • Organization and Administration • Professional Responsibility

15. 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

16. Sports Medicine and Occupational Health

17. 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

18. Athletic ModelLaw Enforcement ModelTeam Physician Worker’s Compensation Panel Physician / Personal PhysicianCoach SupervisorAthletic Trainer Athletic Trainer Sports Medicine Team

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

20. 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.

21. 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.

22. 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

23. Principles of Sports Medicine Care • Team approach inclusive of physicians, athletic trainer, patient, supervisor; • Early intervention • Expectation of recovery • Function- oriented treatment

24. 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.

25. General Program Overview Sports Medicine Occupational Model of Care Allivato, J “The Sports Medicine Model of Care for your Occupational Athlete”, 2003

26. “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

27. Fairfax County Police Department Injury Care and Prevention Program

28. Mission Statement Mission Statement: Maintain and improve general overall wellness; provide for care and prevention of injury and illness

29. 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

30. Medical Supervisor Licensed Physician Required by NATA Board of Certification and state Board of Medicine

31. 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;

32. 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.

33. 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.

34. 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)

35. 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.

36. 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.

37. 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.

38. 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.

39. 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

40. 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

41. In athletic training, we offer much quicker access and entry into the healthcare system.

42. 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.

43. 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.

44. Program Development

45. 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

49. Weight and Conditioning Facility