I am at a new middle school this year where we have an athletic trainer onsite every day for morning practices. At my prior district, I did it all.
At first, it was kind of nice to have someone else deal with all of the injuries, especially during football season. Now, it just seems like it creates more work for me. The AT ices and wraps every tiny non-existent injury for DAYS!! Plus, she has started sending home kids for vomiting, fevers. My principal put his foot down on that one at least.
To me, this just perpetuates kids to leave class constantly. They want more ice after she leaves, wraps come loose or they even take it off and want me to wrap it. I have a $400 a year budget. If I gave out ace bandages like the trainers do - I figured it would cost me about $2000 year. Sorry, I wrap / splint stabilize something serious until parent can pick up.
It just sort of bothers me that they diagnose things (with no xray, mri, etc). I understand they have a different scope of practice, but......
Do any of you have experience in this area? How do you handle things?
I, too, am an RN who used to be an athletic trainer. When I was an athletic trainer, I never iced my athlete's with a barrier between their skin and the ice. As a matter of fact, I would WRAP that ice to their injured body part with an ace wrap. The maximum time I iced someone was for 20 minutes every couple of hours. So if students are coming to you and hour or two after getting ice with a melted bag- that bag should have been emptied and thrown away after 20 minutes of icing.
I wrapped body parts all the time as an athletic trainer. I rarely wrap as a nurse- only if I am stabilizing an injury for transport by parent for medical evaluation.
I would rewrap a swollen body part that already had an ace wrap on it. I would not rewrap if the body part is not swollen or there is no visible injury.
Specializes in ICU/community health/school nursing.
The first year it may be a little awkward as you're both figuring out each other's scopes. I used to direct kids who received primary treatment from the AT back to the AT - and the ATs appreciated it because a lot of that was a kid trying to get out of class or whatever.
It is within the scope of an AT to take a temperature and follow school policy on when a student cannot be here (no fever, vomiting or diarrhea)...
I, too, am an RN who used to be an athletic trainer. When I was an athletic trainer, I never iced my athlete's with a barrier between their skin and the ice. As a matter of fact, I would WRAP that ice to their injured body part with an ace wrap. The maximum time I iced someone was for 20 minutes every couple of hours. So if students are coming to you and hour or two after getting ice with a melted bag- that bag should have been emptied and thrown away after 20 minutes of icing.
I wrapped body parts all the time as an athletic trainer. I rarely wrap as a nurse- only if I am stabilizing an injury for transport by parent for medical evaluation.
I would rewrap a swollen body part that already had an ace wrap on it. I would not rewrap if the body part is not swollen or there is no visible injury.
Great info / insight!! May I ask why no barrier??
What we're trying to limit (not prevent) is an inflammatory response as well as provide some analgesia for the injury. One reason why AT's don't do ice with a barrier is this practice allows the ice to quickly cool the skin down and by limiting the maximum time the ice is in contact to 20 minutes (and 12 minutes for certain body parts), you avoid causing further injury as the skin is cooled down significantly without becoming frozen.
When you ice with a barrier in place, the cooling ability of the ice bag can vary significantly with the barrier used. If you use a dry barrier, heat transfer is much slower than if you use a wet barrier or no barrier. By using a dry barrier, you can allow the ice to remain applied for far longer and with less intense supervision as you'll never actually cool the skin down significantly enough to cause a cold injury. This is great for those times when your patient is not going to be closely supervised while having that ice applied. To restate something from above, if an ice bag has been applied AT style for more than 20 minutes, it needs to be removed, emptied, and thrown away. If you cannot do close enough supervision where you cannot ensure that an ice bag is removed after 20 minutes, then you need to place a barrier (preferably dry) and go about your usual routine. If you cannot trust your athlete to follow your instructions to remove the ice bag after 20 minutes, that athlete needs to be closely and directly supervised and taught to place a barrier when icing at home.
To touch on another point earlier in this thread, we do know that inflammation is necessary to appropriate repair of an injury. The problem is that inflammatory processes cause too much local tissue swelling. Yes, it's the body's initial attempt to protect an injury as the swelling limits range of motion. Since we can do this externally, the body doesn't need to have that much swelling. So we attempt to limit the swelling and this allows range of motion preservation, By limiting the initial swelling, the body also doesn't have to remove all that extra "stuff" from the area as it repairs the damage...
One other major reason why AT's are able to limit the initial swelling and inflammation is that they're able to attend to, and evaluate, the injury within a couple minutes of the injury occurring, before the swelling gets going. The thing with getting the initial evaluation done that quickly is the AT can figure out what was damaged before the swelling obscures the injury site and limits ROM, which makes physical exam difficult. One reason we don't do much exam of athletic injury (physical exam) is that by the time the patient/athlete reaches the ED, too much time has elapsed and too much swelling has occurred to allow a really good physical exam. So... they look at xrays to screen for fractures and if nothing's broken, it must be a soft-tissue injury, so wrap it, ice with a dry barrier, and refer to PCP or orthopedics in a few DAYS to allow the swelling to subside so a good exam can be done.
What we're trying to limit (not prevent) is an inflammatory response as well as provide some analgesia for the injury. One reason why AT's don't do ice with a barrier is this practice allows the ice to quickly cool the skin down and by limiting the maximum time the ice is in contact to 20 minutes (and 12 minutes for certain body parts), you avoid causing further injury as the skin is cooled down significantly without becoming frozen.
When you ice with a barrier in place, the cooling ability of the ice bag can vary significantly with the barrier used. If you use a dry barrier, heat transfer is much slower than if you use a wet barrier or no barrier. By using a dry barrier, you can allow the ice to remain applied for far longer and with less intense supervision as you'll never actually cool the skin down significantly enough to cause a cold injury. This is great for those times when your patient is not going to be closely supervised while having that ice applied. To restate something from above, if an ice bag has been applied AT style for more than 20 minutes, it needs to be removed, emptied, and thrown away. If you cannot do close enough supervision where you cannot ensure that an ice bag is removed after 20 minutes, then you need to place a barrier (preferably dry) and go about your usual routine. If you cannot trust your athlete to follow your instructions to remove the ice bag after 20 minutes, that athlete needs to be closely and directly supervised and taught to place a barrier when icing at home.
To touch on another point earlier in this thread, we do know that inflammation is necessary to appropriate repair of an injury. The problem is that inflammatory processes cause too much local tissue swelling. Yes, it's the body's initial attempt to protect an injury as the swelling limits range of motion. Since we can do this externally, the body doesn't need to have that much swelling. So we attempt to limit the swelling and this allows range of motion preservation, By limiting the initial swelling, the body also doesn't have to remove all that extra "stuff" from the area as it repairs the damage...
One other major reason why AT's are able to limit the initial swelling and inflammation is that they're able to attend to, and evaluate, the injury within a couple minutes of the injury occurring, before the swelling gets going. The thing with getting the initial evaluation done that quickly is the AT can figure out what was damaged before the swelling obscures the injury site and limits ROM, which makes physical exam difficult. One reason we don't do much exam of athletic injury (physical exam) is that by the time the patient/athlete reaches the ED, too much time has elapsed and too much swelling has occurred to allow a really good physical exam. So... they look at xrays to screen for fractures and if nothing's broken, it must be a soft-tissue injury, so wrap it, ice with a dry barrier, and refer to PCP or orthopedics in a few DAYS to allow the swelling to subside so a good exam can be done.
So you're saying the cellophane wrapped bag of sloshing water isn't therapeutic????
Thanks for your insight. You always offer good info.
So you're saying the cellophane wrapped bag of sloshing water isn't therapeutic????
Thanks for your insight. You always offer good info.
That's pretty much exactly what I'm saying... By the time the cellophane wrapped bag becomes sloshing water, it's ceased to be therapeutic, and probably has caused some injury. This is why a certain group of people are taught to use a dry barrier...
Today, the trainer is out and here comes a kid in the clinic that injured his ankle at the football games 2 days ago being carried by a coach. No swelling, blah, blah. However, if you get carried in the clinic - then you are going to get an x-ray. Coaches send his backpack and some crutches a few minutes later. Sorry, should have given him the crutches before coming to see me.......
EnoughWithTheIce
345 Posts
Great info / insight!! May I ask why no barrier??