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Guidance for Sports Physiotherapists working under COVID-19 Alert Level 2

9th September 2021

Under COVID-19 Alert Level 2 many physiotherapists are working alongside sports teams, players and athletes, whether that be on the field, courtside or within clubrooms. It is important to remember that while many sports return at Alert Level 2, physiotherapists working with these athletes should take the same care and precautions to protect themselves and the public, as they would working in any other environments.

Under Alert Level 2 some tasks may require adaptation to ensure they comply with the Ministry of Health guidance released for community allied health, scientific and technical providers. While much of the Ministry’s guidance refers to face-to-face consultations, any assessment, treatment, strapping or massage of an athlete or player is deemed to be a consultation.

 

Ministry of Health’s guidance for face-to-face consultations during Alert Level 2:

As a reminder under Alert Level 2 the Ministry of Health has stated for community allied health, scientific and technical providers:

‘Clinical reasoning and risk assessment remain the fundamental principles for considering care at Alert Level 2. Telehealth and virtual appointments are still the preferred option and please exercise extra caution when treating vulnerable groups

Clinicians will be able to see patients face to face if the following processes are in place:

When considering travel within and between regions ensure all risks have been taken into account before undertaking to provide care to patients and traveling to receive training.

Group treatment (e.g., exercise classes) can occur so long as physical distancing is in place.’

While physiotherapy services can open for face-to-face consultations under Alert Level 2, protocols must be implemented by physiotherapists providing services to maximise patient and staff safety, including ongoing risk assessment and appropriate infection prevention control procedures.

 

Overarching Requirements for all Physiotherapists at Alert Level 2

Physiotherapists must:

  • be aware that under Alert Level 2, there may be some community transmission of Covid-19. An extremely high level of vigilance is required. Physiotherapists must use a high level of clinical judgement when assessing and treating patients in order to keep themselves and the public safe
  • have knowledge of and understand the most current Health and Safety procedures, and the latest advice from Ministry of Health
  • consider safety for themselves and their patients as well as both whānau and families
  • screen patients for COVID-19 risk factors, signs or symptoms when making the appointment and again on arrival. If they are present, do not continue with the face-to-face consultation
  • carry out a full risk assessment and have a plan in place for the location of the treatment. Risk assessment during Alert Level 2 should be ongoing and continuous
  • have an MoH COVID app/ QR code in place for their premises. This must be used by all those entering the place where physiotherapy services are being provided
  • continue to register ALL people who have been in the clinic/service with current contact details confirmed such as staff members, delivery/pick up personnel and cleaning staff, in case contact tracing is later required.
  • adapt their practise to allow time between appointments to clean equipment and surfaces before seeing another patient. This includes cleaning of high touch points in the car, scooter, motorbike or bike and keys etc taken to get to the appointment(s). Don’t forget to clean your computer screen, keyboard and mouse.
  • carefully assess the risks and benefits of a face-to-face consultation if patients have significant co-morbidities or vulnerabilities. Consider using telehealth services.
  • This guidance from the Ministry of Health, PNZ and the Physiotherapy Board should be adapted by practitioners to suit their own working environment. For sports physiotherapists planning for this is especially important as the environment and setting may change quickly and not all environments are ideally suited for easy infection control.
  • Planning, preparation, and continuous risk assessment are vital components of keeping physiotherapists and the public safe.
  • Clubs, sports teams, athletes and players need to be made aware that while sporting activities are returning, the provision of health services has not returned to business as usual. They may need to work alongside physiotherapists and adapt club practices to ensure physiotherapy services can be delivered safely.
  • Physiotherapists must remain aware that they are often exposing themselves to multiple patients over multiple locations e.g., sports field or courts, clinic, regional travel.

Considerations for sports physiotherapists in addition to the existing COVID-19 Alert level 2 Guidance released by the Physiotherapy Board should include the following:

  • a risk assessment and plan for providing services needs to be in place prior to commencing work with athletes
  • communicate to clubs, sports teams, athletes, and players early about how physiotherapy services may differ from usual
  • approach the club to see if there is a more suitable place to see athletes or players during training, which can be cleaned and controlled as necessary including limiting entry to the treatment area
  • confirm and be comfortable with the tracing and screening systems the club currently has in place
  • physiotherapists still need to screen athletes and players that they have provided services for and keep a separate record of ALL contact details
  • if working with a club with multiple teams training consider limiting this to one or two teams during this period if possible
  • discussions with and professional supervision of less experienced physiotherapists by more experienced physiotherapists may be required or need to increase during this time
  • physical distancing should still be maintained where possible
  • keep the physical contact to the least number of players as necessary during practice and matches
  • use signs to discourage casual ‘walk ins’ by players. They must have been screened before entering the treatment area.
  • try to encourage players to do as much for themselves as possible. If they can get another player who they have already been in contact with, to help them stretch, it may be a better option than having another patient ‘contact’
  • if you feel uncomfortable with the set up the club has provided then discuss it with them. If it feels unsafe, remove yourself from the situation
  • try to control the environment as much as possible. That may mean isolating an area where athletes and players can see you for treatment or come to get strapped, but setting it up in a way that ‘walk ins’ are discouraged
  • discourage athletes and players from attending physio with their teammates
  • ensure you have enough cleaning supplies for training sessions and game day. Have a cleaning plan for the area you are working in, equipment being used on set up and during sessions, post session cleaning and packing up
  • maintain control of your team kit as appropriate and ensure players sanitise hands before taking tape from the team kit
  • while physiotherapists may sometimes be asked to cover for opposing teams this should only be used if there is no other option, and you have the ability to screen, contact trace and minimise interactions
  • visiting teams should be made aware of the above point prior to the match. If you do agree to see them, screen athletes and players that they have provided services for and keep a separate record of ALL contact details
  • familiarise yourself with the current updates on CPR from the New Zealand Resuscitation Council during the COVID-19 situation
  • Encourage good hygiene practices

As preparation for providing services to sports teams you should seek assurance from the team manager/club officials that players have been asked to cease:

  • the use of shared water bottles
  • using shared towels for body fluid clean up
  • spitting