Student Medical Conditions

Erik raised an interesting point in the Less Strict Dojos thread that I'd like to expand out to a thread on its own.

Erik Haselhofer wrote: Jun, I've raised this point before but it's the dojo which needs to take ownership on this issue. Every student should be asked a number of basic questions before they start training or at the bare minimum "are there any health concerns we need to be aware of"? If there are then the instructing staff, all of it, needs to be made aware of it. Of course, that would also mean the staff would have to get together and have meetings, and that instructors would have to reach minimal competence on certain health issues such as First Aid, CPR, and basic health risks. Really it should go a lot deeper than that but too many dojos just let you walk in, sign up (maybe throw a waiver your way) and let you get on the mat. While a wise student would go out of their way to make their problems known, if they know which they may not, the fact is that a "professional" organization would have policies in place to address this. Frankly, I doubt 10%, I feel generous today, of the dojos in the United States could meet a professional standard on this issue.

How much information about someone's medical information is taken when someone new signs up at your dojo?

Is it just one line of your waiver? Do you conduct any kind of personal interview to get more information?

Do all instructors (regardless of whether they're the student's "main" instructor) receive information on every student's medical information?

Do all of your instructors undergo "formal" training in things like first aid and CPR?

Lastly, do you feel that increasing the awareness of students' medical conditions and the teachers' medical abilities is a good idea?

-- Jun

How much information about someone's medical information is taken when someone new signs up at your dojo?

I don't know...haven't seen the waiver at the main school since I started at a branch dojo. I sure will check it out though.

Is it just one line of your waiver? Do you conduct any kind of personal interview to get more information?

I'll ask about this too...as far as I know, a senior student or instructor talks to the new folks. Some new students seem inclined for something more formal, some not so much, they pay their money and want to train.

Do all instructors (regardless of whether they're the student's "main" instructor) receive information on every student's medical information?

Not sure...will have to check.

Do all of your instructors undergo "formal" training in things like first aid and CPR?

YES.

Lastly, do you feel that increasing the awareness of students' medical conditions and the teachers' medical abilities is a good idea?

I think I take a certain amount of caution on the part of the student and a certain amount of awareness and caring on the part of the instructor for granted...and its not good to take things for granted!! If nothing else, this has made me think.

Ron

Jun, thanks for starting this thread.

Jun Akiyama wrote: Lastly, do you feel that increasing the awareness of students' medical conditions and the teachers' medical abilities is a good idea?

I just realized that I should add something here. When I got on the bandwagon about all of this a few years back it was prior to new privacy legislation regarding medical records. I have no idea if this sort of thing applies to something like an aikido dojo. It may not because we aren't medical providers but nonetheless if anyone knows the answer I'd love to hear it.

Honestly, I hope we get Janet, or anyone else with a medical background on this.

Does Hombu do all of that?

Erik,

Regarding the new HIPAA regulations, it's my understanding a dojo is not a medical provider (unless let's say a dojo also provides acupunture or massage therapy on the premises). HIPAA relates to revealing medical records to parties outside of the doctor/ patient relationship, and it sets up a way for other parties to request the records. This will come up in legal matters such as personal injury cases when one of the parties wants to see the records of the other party and the Patient isn't directly invovled. This shouldn't come up with a sensei asking a student about their medical conditions.

HIPPA was not specifically designed from what I can tell to cover something such as a dojo (medical practitioners). However, I don't think I would test the water. First and foremost, a patient's medical records are private and should not be disclosed to anyone without their permission. Any keeper of the records could be in trouble for violating private information. The instructor if not the owner or person screening should be made aware of relevant, need to know conditions that could affect training. Where it gets sticky of course is the issue of HIV/AIDS. We definitely have people on the mats in the world with this condition and if blood is spilled this becomes a transmission risk. A blood pathogen policy needs to be in place to cover this.

I think that a blood pathogen policy would be a very sensible idea, the issue of HIV and training in contact MA is something I've thought about a few times. To me it would be the sensible thing not to train at all if i was aware that I was HIV positive, blood gets spilled frequently and often at close qaurters. I dont think it would be fair to ones training partners to get on a mat with this possible health hazard. Please dont think im a nazi or homophobic or anything, i just think that its common sense.

I have said this before and will continue to say it: People overreact with regard of HIV/AIDS. Just a commonsense solution is already enough to prevent (the already very unlikely) transmission in a dojo.
No training with uncovered wounds. Blood should be cleaned immediately from the mats. These rules are just common courtesy and should be part of the normal dojo rules regardless of the risk of blood born pathogens.
Another thing that people always forget is that there are far more contagious diseases than HIV/AIDS around (and for a much longer period of time as well) but nobody ever made a big issue about those.

Perhaps people do over react about HIV, there are many more contagious diseases/infections yes, but they arent all incurable and dont all result in eventual death as HIV/AIDS does, which is in my opinion as to why people would prefer to keep away from possible risk of infection. As long as people dont train with open wounds and are considerate with others then it should be ok, but some people arent always considerate towards others safety, basically, if someones pissing blood all over then I stay out of the way, when I bleed I get off the mat and tidy it up myself. Common sense.

I agree with Erik on the HIV issue...hepatitus is just as much a worry as HIV...but you don't here a whole lot of panic about that. Basic dojo cleanliness should handle most of these issues.

Ron

Q How much information about someone's medical information is taken when someone new signs up at your dojo?

A. Both our beginners' form and membership form has a questionnaire about allergies, medical problems etc.

Q. Is it just one line of your waiver? Do you conduct any kind of personal interview to get more information?

A. No interview unless anything on the form suggests a potential problem with specific areas of practice.

Q. Do all instructors (regardless of whether they're the student's "main" instructor) receive information on every student's medical information?

A. No, information only readily available in their "home" dojo

Q. Do all of your instructors undergo "formal" training in things like first aid and CPR?
A. Suggested (and training is freely available) but not mandatory

Q. Lastly, do you feel that increasing the awareness of students' medical conditions and the teachers' medical abilities is a good idea?

A. Tricky one, certainly we try to keep track of which instructors have what level of medical ability. However, student's medical conditions comes into the grey area of personal information so guarded on this one.

On the related hijack, agree, if good practice regarding wounds/blood/secretion of choice is maintained, I can't see a problem.

Jun Akiyama wrote: Erik raised an interesting point in the Less Strict Dojos thread that I'd like to expand out to a thread on its own. How much information about someone's medical information is taken when someone new signs up at your dojo? FL: "Please note any and all medical conditions which may affect your ability to train." Is it just one line of your waiver? Do you conduct any kind of personal interview to get more information? FL: Yes, but there is a follow-up personal interview. Do all instructors (regardless of whether they're the student's "main" instructor) receive information on every student's medical information? FL: Not applicable. Do all of your instructors undergo "formal" training in things like first aid and CPR? FL: Yes. Lastly, do you feel that increasing the awareness of students' medical conditions and the teachers' medical abilities is a good idea? FL: Yes. Additionally, an HIV and blood-borne pathogen protocol for all injuries resulting in bleeding, or conditions which cause open cuts/wounds/sores etcetera including clean-up procedures is in place, requiring both an overall signature and initials on each clause. -- Jun

Beyond the above, any departure from the mat requires instructor's permission, for the safety reasons outlined by Ron above.

Students with cardiovascular difficulties are encouraged to work off the count at a pace which allows them to work continuously, while building cv capacity over time. I would rather have students learn to work continuously through a full hour than work fast, get tired, take a break, work fast again.

Particularly as it relates to partner practice, this seems like a key habit for effective learning. Which I think is as much the point of the practice as the waza themselves.

Hope this helps,

Fred Little

Hi. Great thread.
I agree with those who say that the patient privacy act pertains to medical records of health care providers and insurers, not to an individual handwriting his or her personal health history. However, if a dojo wished to be careful, medical info could be maintained in a separate card file in a drawer and looked at only if a dojo situation warranted (as opposed to on a card where one also tracks one's attendance). Heck--how many dojo reg card even include emergency contact info?
I agree with Eric that the lack of information and training is not good. I'll admit to being as guilty as anybody about perpetuating it: while I did do a brief first aid class at my previous dojo (I'm no longer certified as an instructor, so cannot offer the full first aid or cpr courses) I've not even offered to do so where I train now. I do make sure that the first aid kit is up to date and that my written protocols are posted.
I do believe that there should be a small health history, kept separately in a file for limited access but readily available if needed, for each new member ("any limitations" is NOT a health history) and that instructors should have some cpr and first aid training.

Contributing to the hijack, sorry:

There are diseases out there that can kill you, which do not require a direct transmission of blood or other bodily fluid. HIV is a surprisingly difficult disease to catch, compared to, say, a cold. Compared to pinkeye, it's amazingly difficult to catch -- the bacteria that causes pinkeye can be left on a surface (like a keyboard or a doorknob) and survive for *days* until you come along, touch, rub your eye, and catch the disease yourself.

In all cases where a person is injured enough to shed blood, the procedure both pre-HIV and post-HIV has been to mop up with a solution of bleach and water, allow to dry thoroughly, and then everything is fine. The person cleaning should ideally be wearing impermeable gloves, ie latex or silicon. The person bleeding should get themselves cleaned up and patched up.

Note that all of this is common-sense, and in most cases, with most people, it's overkill.

Moving back to the topic -- every instructor should have basic First Aid/CPR training. Every dojo should have a phone to call emergency personnel (the last one I was in didn't). Every dojo should have a fully-stocked first aid kit which is refreshed annually. Heck, for that matter, every dojo should have a fire extinguisher -- not because sensei will be igniting things with her ferocious ki, but because most dojos have electricity, and stranger things have happened.

In other words, I pretty much agree with the consensus on this thread.
Heather

Heather Bungard Janney wrote: Every dojo should have a fully-stocked first aid kit which is refreshed annually.

Two particularly egregious examples come to mind. The first one is a school whose first aid kit consisted of 50 rubber gloves, roughly 10 bandages (some actually not opened) and a partial role of tape. The second one, where I had my FUBAR experience, the first aid kit consisted of blue ice bags which were covered with ice cream that had leaked on them. I couldn't even find a bandage which is probably just as well.

By the way, in my experience most people do have first aid kits. I just seem to find the dumps for some reason.

I've just finished a Medical First Responder course at the local college. One of the senior members of the dojo I teach at is also an MFR with a local fire dept. We are currently looking into updating our schools first aid kit to deal with some more intense stuff.

Things I want included:

• Cervical spine immobilization collar
• splints of various sizes/moldable splints
• Backboard
• Oxygen tank
• ring cutter
• oral and nasal airways

We have a first aid kit with the basic stuff to handle bumps, bruises, minor cuts and scrapes. But now that I've had some minimal training in dealing with the bigger stuff I see the potential for injury everywhere

I would rather we spend the money on the equipment and never ever need it than need it once and not have it.

Bronson