Tuesday, November 22, 2011

An open question to ATs covering wrestling

History
Several years ago, the NFHS followed the NCAA, NJCAA, and the NAIA in implementing the weight certification process for high school wrestling. I had the unique opportunity to offer input into how the rule was written for Ohio. Before I ask my question, let me explain what we are doing in Ohio high schools. We are using skin fold calipers and urine dipsticks as required by the Ohio High School Athletic Association. Furthermore, the OHSAA has a required parental consent form for the urinalysis. Also, there is a two tiered system of certified assessors. We maintain both master and general assessors. The difference is that general assessors can only perform an initial assessment. The master assessors can perform the initial assessment, the first appeal assessment, and conduct the class required by the OHSAA for new general assessors.  There is also a second step appeal by using a BodPod air displacement test or an underwater weighing, both of which are performed by labs approved by the OHSAA.

My question to my fellow ATs is regarding the urine dipsticks. When the rule was being written, I conducted a pilot of the weight assessments with the cooperation of most of the schools in our conference. At the time, we used refractometry to do the urinalysis. However, a short time later, a coworker from the hospital's lab asked me how we were able to get CLIA certification to perform the refractometry. I was left staring at her with a very dumb look on my face. She referred me to the CMS site to look at the Clinical Laboratory Improvement Amendment. What I found was discouraging. Refractometry, when used to determine a health plan, required an expensive license to perform. There is a waiver that can be obtained, but it required payment for individual tests. That quickly got equally expensive for the number of wrestlers we were looking to test statewide.

When I recognized this issue and brought it to the attention of the OHSAA, they balked at the idea of using refractometry and decided to use the urine dipsticks instead.  The dipsticks required a very small waiver fee and the OHSAA pays that each year for all the assessors in Ohio.  Therefore, for the last six years, we have been using the dipsticks.

By now, my question should be obvious, what is everybody else doing to stay legal while performing the refractometry assessments?  Any information would be helpful since I now have two refractometers sitting in my desk collecting dust.  One brand new and never used and the other is only used the one day of the pilot test.







The following section is included to prevent other questions about why Ohio did what they did in other parts of the assessment.
The OHSAA also decided to the skin fold calipers instead of the BIA because of the cost and questionable accuracy associated with BIA.  I had no issues with this, but this was also why Ohio decided that there would be a class required before being eligible to perform the assessment.  In doing so, the OHSAA could assure better competency with the skin fold calipers by the assessors.  To further ensure competency and credibility, the OHSAA mandated that the minimum requirements for an assessor was a bachelor's degree in a related health field.  That standard includes MD, DO, DC, PT, ATC, RNs, dieticians, and exercise physiologists.  Needless to say, there were some very unhappy health club employees out there (personal trainers, fitness trainers, etc.) because they were excluded from the rule.  Since I am a master assessor, I fielded more than one angry call about why they were excluded when they wanted to become assessors found they weren't eligible to take the class.

1 comment :

  1. Several questions:

    1. Did anyone with OHSAA contact officials inside the Dept. of Health and Human Services to determine if using refractometers in the manner used was a violation of CLIA?

    2. Is the athletic training considered a Clinical Laboratory and subject to these regulations?

    3. Would using a refractometer to determine hydration status of an athlete a violation of this statement?
    "the assessment of the health of a human being; or procedures to determine, measure or otherwise describe the presence or absence of various substances or organisms in a human body"

    4. Could this simple test using the refractometer be "waived testing"?


    I have considered using the refractometer on athletes during 2 a days who have lost 3-5% of the their body weight in the first 2 days to see if they are indeed hydrated. I have yet to do it, but it would be a lot better way of doing it rather than just going by their weight. Would I be in violation of CLIA if I used the refractometer in such a fashion on 2-3 athletes in a year?

    ReplyDelete

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