Risk Assessment Checklist: Sports Medicine and Athletic Training

The head athletic trainer in consultation with the director of sports medicine should be responsible for completing the following risk assessment before September 1 of each academic year. Indicate yes or no next to each statement. For each no response, provide a complete explanation of the deficiency and recommendations for correction at the end of the report. If the recommendation is a policy solution, attach a copy of the current policy with proposed revisions.

Distribution of Drugs and Supplements
____1.     Nonmedical employees, including coaches, are strictly prohibited, under all circumstances, from dispensing or recommending for the improvement of health or performance, any drug, medication, vitamin, nutritional or ergogenic aid, or other ingestible solid or liquid supplement purported to improve health or performance to any student-athlete.
____2.     A policy exists specifying that the distribution of any drug, medication, vitamin, nutritional or ergogenic aid, or other ingestible solid or liquid supplement purported to improve health or performance to any student-athlete by nonmedical personnel is grounds for immediate termination of employment.
____3.     A policy exists prohibiting nonmedical employees from distributing to any student-athlete any prescription or over-the-counter medicines, including aspirins, cold medicines, and so on.
____4.     Athletic department policy specifically encourages coaches to promote the intake of water, Gatorade, or other fluid replenishments provided by the athletic training staff and prohibits coaches from withholding or limiting fluid intake during any practice session.
____5.     A policy exists specifying that only credentialed athletic trainers are authorized to distribute prescription drugs under the direction and supervision of a prescribing physician according to specific department procedures.
____6.     A policy exists specifying that only a credentialed athletic trainer is authorized to distribute over-the-counter drugs under specified circumstances according to specific department procedures. 
____7.     A policy exists specifying that only a credentialed athletic trainer or a student trainer under his or her direct supervision is authorized to distribute iron, calcium, and vitamin supplements according to recommended daily allowances (RDA) or in therapeutic dosages when documented and recommended by a physician.
____8.     A policy exists that specifies that prescription and nonprescription drugs used by the athletic training staff are required to be stored under lock and key in a location under the direct supervision of the athletic trainer.

Disordered Eating
____9.    Does an athletic department policy exist that prohibits the weighing of student-athletes in non-weight-controlled sports, with the exception of weigh-ins related to hot conditions and loss of fluids?
____10.    Does part of the required athletic department preparticipation medical screening questionnaire specifically address nutrition and eating disorder screening questions?
____11.    Is a training session conducted at the beginning of the school year for coaches and athletic trainers on the identification, referral, and treatment of athletes with eating disorders?
____12.    Has an eating disorder treatment team been designated that has the head athletic trainer serving as athletic department liaison to the team?
____13.    Does a comprehensive athletic department policy exist on the identification and treatment of eating disorders, including the right to restrict participation of medically unstable athletes?
____14.    Has a senior staff administrator been designated to work with the athletic training staff and external medical and psychological service providers regarding athletes with eating disorders and the enforcement of policy guidelines for eating disorders?

Medical Screening
____15.     Does a policy exists that requires a preparticipation initial medical evaluation that includes a comprehensive health history, immunization history as defined by current Centers for Disease Control and Prevention (CDC) guidelines, and a relevant physical exam that emphasizes the cardiovascular, neurologic, and musculoskeletal evaluation?
____16.     After the initial entry medical evaluation, does the athletic department require an updated history of the student-athlete's medical condition that is administered by an institutional medical staff member (e.g., sports medicine staff, team physician) to determine whether additional examinations (e.g., physical, cardiovascular, neurological) are required?
____17.     Does the athletic department have a policy requiring preparticipation screening for the CDC recommended immunizations—MMR, hepatitis B, diphtheria, tetanus, and meningitis?
____18.     Are follow-up examinations required for student-athletes who have sustained a significant injury or illness during the sports season to re-establish medical clearance before resuming participation in their respective sports?
____19.     Does the institution screen for sickle cell trait?
____20.     Do all athletic staff members understand that the medical records it keeps are subject to federal and state law? Has the institution’s legal counsel been consulted, and has counsel rendered an opinion regarding the confidentiality and content of student-athletes’ medical records?
____21.     Does the athletic department have clear written guidelines about the creation, maintenance, and release of medical records and the information that they contain, and are all personnel who have access to student-athletes’ medical records familiar with such guidelines and informed of their role in maintaining the student-athlete’s right to privacy?
____22.     Does an athletic department policy exist requiring that each student-athlete annually sign a permission form that authorizes the release of medical information to others, specifying all persons authorized to receive such information, and the type of medical information that may be released?

Physical Activity in Extreme Conditions of Heat or Cold
____23.    Does the athletic training staff produce team hydration protocols for each sport each season that (1) consider the uniqueness of each sport, (2) are approved by the team physician, and (3) are transmitted to all coaches and the athletic training staff?
____24.    Does the athletic training staff conduct a thorough, physician-supervised, preparticipation medical screening before the season starts to identify student-athletes predisposed to heat illness based on risk factors and those who have a history of exertional heat illness?
____25.    Are individual hydration protocols designed for student-athletes who have a history of heat illness submitted to the team physician for approval, communicated to the appropriate coaches and training staff, and explained at meetings with affected student-athletes?
____26.    Does the athletic department educate student-athletes about the effects of dehydration and the factors for risk by seasonally conducted health and awareness sessions implemented by coaches and training staff?
____27.    Does the athletic training staff provide informational postings at practice facilities and training rooms to maintain awareness of the importance of adequate hydration?
____28.    In conditions of extreme heat, are coaches instructing athletes to wear clothing at practice and competition that is lighter in color or fabric, regardless of school colors?
____29.    Does the athletic department transmit recommendations to all coaches from national medical and athletic training associations regarding the identification of symptoms and procedures to lessen the risk and prevent the likelihood that heat-related illness will occur among its student-athletes?
____30.    Do certified athletic trainers and other health care providers attending practices or events have the authority to evaluate and examine any student-athlete who displays signs or symptoms of heat- or-cold related illness and restrict the student-athlete from participating if symptoms are present?
____31.    Do coaches and the athletic training staff work together to ensure that practice workloads are adapting student-athletes to exercise in the heat (acclimatization) gradually over 10 to 14 days?
____32.    Does the athletic training staff supervise a practice of weighing high-risk student-athletes and, in high-risk conditions, weighing all student-athletes before and after practice to estimate the amount of body fluid lost during practice and to ensure a return to prepractice weight before the next practice?
____33.    Are all of the following supplies available to the certified athletic training staff to use on the field, in the locker room, and at various other stations to meet heat-related concerns?

  • Supply of cool water or sports drinks or both
  • Ice for active cooling (ice bags, tub cooling) and to keep beverages and student-athletes cool during exercise
  • Rectal thermometer to assess body-core temperature
  • Telephone or two-way radio to communicate with medical personnel and to summon emergency medical transportation if necessary
  • Tub, wading pool, kiddy pool, or whirlpool to cool the trunk and extremities by immersion cooling  therapy

____34.    Does the athletic training staff conduct a thorough, physician-supervised, preparticipation medical screening before the season starts to identify student-athletes predisposed to cold-related illness based on risk factors and those who have a history of cold-related illness?
____35.    Does the athletic training staff educate student-athletes and coaches concerning the prevention, recognition, and treatment of heat-related and cold-related injury and the risks associated with activity in high heat, high humidity, or extremely cold environments?
____36.    Does the athletic training staff follow event and practice policies that ensure proper management of student-athletes participating in cold, windy, and wet conditions, including the use of wind-chill guidelines that consider the effect of wind speed on the influence of air temperature?
____37.    Does the athletic training staff work with coaches to ensure that student-athletes wear proper clothing when participating in cold, windy, and wet conditions (i.e., an internal layer that allows evaporation of sweat with minimal absorption, a middle layer that provides insulation, and a removable external layer that is wind and water resistant and allows for evaporation of moisture)?
____38.    In intense cold, are student-athletes instructed to rewarm as needed during and after activity using external heaters, a warm indoor environment, or additional clothing?
____39.    In intense cold, does the athletic training staff provide all of the following supplies on the field, in the locker room, or at convenient aid stations?

  • Supply of water or sports drinks for rehydration as well as warm fluids for possible rewarming
  • Insulated containers for fluids that may freeze during events in subfreezing temperatures or procedures assuring intermittent replacement
  • Heat packs, blankets, additional clothing, and external heaters, if feasible, for active rewarming
  • Flexible rectal low-reading thermometer probe (capable of measuring temperatures below 95.6 degrees Fahrenheit [35.6 degrees Celsius]) to assess core body temperature
  • Telephone or two-way radio to communicate with additional medical personnel and to summon emergency medical transportation
  • Tub, wading pool, or whirlpool for immersion warming treatments (including a thermometer and additional warm water to maintain required temperatures)

Control of Blood-Borne Pathogens and Infectious Diseases
____40.     Is an annual training session conducted at the beginning of the school year to review standard precautions and all policies related to blood-borne pathogens and infectious diseases with the coaching staff, athletic trainers, team managers, event management and facilities staff, and other appropriate support staff?
____41.     Has a specific employee been designated to conduct training on standard precautions for blood-borne pathogens and infectious diseases and to review all policies with coaches or support staff who have been hired after the annual training has completed?
____42.     If wrestling is a sport within the athletic program, has a specific employee been designated to educate wrestling coaches on NCAA guidelines regarding skin infections in wrestling?
____43.     Has an employee been designated as responsible for ensuring that all supplies and equipment are available to coaches for the proper care of contaminated environmental surfaces according to OHSA standard precautions?
____44.     Has a specific employee has been designated to ensure that a first aid kit has been distributed to all coaches and they have been instructed on how to control an athlete’s bleeding wound?
____45.     Is athletic department policy in full alignment and compliance with OSHA standards for blood-borne pathogens and NCAA Sports Medicine Handbook guidelines?
____46.     Does athletic department policy prohibit mandatory HIV testing or participation restrictions of individuals with HIV?

Training Room Staff and Operations
____47.     Is the head athletic trainer NATA certified and a licensed athletic trainer in the state where the institution is located?
____48.     Is the athletic training program responsible for maintaining complete documentation of student-athlete health care screening, medical history, the treatment of injuries (including symptoms, responses, and progress), physician diagnosis, and consultation with specialists?
____49.     Does an athletic department policy exist regarding the student-athlete’s right to privacy and protection of confidential information unless obligated or allowed by law to disclose such information?
____50.     Are athletic trainers responsible for consultation with appropriate licensed medical practitioners in the design of treatment strategies?
____51.     Are athletic trainers mandated by policy to seek clarification of any instructions or treatment regimens that they have reason to believe are inaccurate or contraindicated?
____52.     Do athletic department policies permit student-athletes to use the services of any physician at his or her expense and without the approval of the team physician?
____53.     Have consulting physicians been appointed by the athletic department team physician in the areas of orthopedics, gynecology, dentistry, internal medicine, allergies and immunology, dermatology, cardiology, ophthalmology, and other specialty areas as determined by the health care needs of student-athletes?
____54.     Does athletic department policy require that the employment or association on a paid or voluntary basis of allied health care professionals (chiropractors, massage therapists, nutritionists, and do on) be approved by the team physician and head athletic trainer according to established procedures?
____55.     Does athletic department policy require that coaches and athletic trainers ensure that allied health care personnel provide their services in professional settings (training room, locker room, and so on) as opposed to home, dormitory, or hotel rooms?
____56.    Does athletic department policy require that the work of allied health professional personnel be under the direct supervision of a full-time member of the coaching or athletic training staff?
____57.     Does athletic department policy require that allied health care professionals document all treatments rendered?
____58.     Does athletic department policy hold the head athletic trainer responsible for maintaining a state-of-the-art athletic training room that contains all required modalities for treatment, has sufficient consumable supplies to meet the needs of the athletic training staff, and is operated with a standard of care and cleanliness that diminishes the possibility of contamination by blood-borne pathogens or infectious diseases?
____59.     Does athletic department policy require that all prescription and nonprescription drugs and supplements be kept in locked cabinets and that distribution and use procedures adequately control or supervise access?
____60.    Does an athletic department policy exist that establishes standards of dress for treatments and conduct of student-athletes in the training room, and are the athletic training staff and coaches charged with enforcing such standards to ensure the health and safety of training-room occupants?

Do not reprint without permission.  Use with attribution.  Lopiano, D. and Zotos, C. (2013) Athletic Director's Desk Reference.  Human Kinetics: Champaign, IL.