Safety and Risk Management

Question 1

Professional Liability
Responsibilities, Limitations, and Legal Implications for
Emergencies
Exercise Testing Protocols for Non-Licensed Professionals
Personal Trainer Liability Insurance
Negligence in Training Environments

Answer 1

• It’s common practice for employers in the fitness industry to require trainers to be certified in CPR (cardiopulmonary resuscitation), AED (automated external defibrillator), and first aid to work at their facilities. Trainers who have these certifications must work strictly within the limitations of the certifications during emergency procedures. However, it may be within the responsibility of non-certified employees to alert emergency personnel and stay with the victim to keep her comfortable. An individual with the proper certification can then take on the responsibility of performing emergency procedures.
• In most rehabilitative or clinical testing laboratories, only exercise physiologists conduct testing procedures, and they do so under the supervision of a physician in case medical emergencies occur during the stress test.
• Prior to agreeing to the terms of service, the trainer should receive guidance from the employer or physician on the limitations and regulations he is required to follow in the exercise testing setting. Any concerns about the duties should be discussed with the employer and supervising physician.
• When it comes to building a personal training business, purchasing adequate liability insurance coverage is an absolute necessity and it should be acquired before the trainer begins operating her business.
  1. Personal trainer insurance provides liability coverage for the various services that the trainer provides to clients, including her training methods, health screening procedures, fitness equipment, exercise testing protocols,, and other risks.
  2. The trainer should discuss the insurance coverage and any limitations with the insurance company to ensure she has adequate coverage that fits the needs of her business.
  3. Some training facilities provide insurance for personal trainers with employment. Be sure to ask the employer whether liability insurance is the responsibility of the trainer or the employer. Trainers must NOT begin work without this type of insurance coverage.
  4. In additional to the personal trainer insurance, other risk management methods are available to help prevent potential litigation:
  4.1. Clientele must sign the necessary forms prior to joining a fitness center or starting a fitness program. Paperwork such as liability waivers (責任豁免), informed consent to exercise, and the assumed or inherent risks of starting a fitness program, all mitigate the risks to the trainer. These signed forms help reduce the possibility that a lawsuit will arise, simply because of the general risks inherent in exercising.
  4.2. Trainers should ensure client safety by following industry standards for items such as safe program implementation, proper emergency procedures, upkeep of exercise equipment, and proper credentialing (資格憑證) for all trainers. Overly aggressive training programs can pose risks of injury that can open up avenues for lawsuits. These risks can be minimized with properly designed programs that are tailored to each client.
• Negligence is a common reason for lawsuits, and can occur in the areas of fitness program design, fitness assessment, medical background, supervision of exercise techniques, cleanliness of facilities, equipment usage, and more. Therefore, it’s essential for the trainer to follow appropriate risk-management strategies to prevent unnecessary lawsuits.

Question 2

Risk Management
Safety Policies and Procedures
Safety Precautions in the Training Facility
Safe Training Practice
Equipment Setup and Maintenance
Components of an Emergency Action Plan

Answer 2

• Safety Policies and Procedures
  1. Implementing and documenting safety policies and procedures can help eliminate the risks associated with emergency situations.
  2. Signage should be posted to indicate where safety and emergency devices (e.g. first aid kits, fire extinguishers, fire exit plans, automated external defibrillators, etc.) are located in the facility.
  3. Any discrepancies found in emergency action plans and procedures could be grounds for a lawsuit against a facility for negligence and failure to prepare for emergency situations. Maintaining safety policies and procedures significantly helps in eliminating risks associated with emergencies.
  4. The safety policies and procedures should also include injury prevention strategies. Also, to further manage risk, it may be advisable to assign supervisory roles, including training program oversight, to spot potential risks like rapid progression. It’s up to each trainer to ensure his/her program is created safety, in order to reduce the risk of injuries related to poor program design.
• Safety Precautions in the Training Facility
  1. Risk management techniques also apply to the training facility. Operating a safe fitness center involves proper floorplan layout, cleaning schedules, and training surfaces. All equipment should be properly spaced so that the moving parts will not collide with other objects or block walking paths or emergency exits.
  2. Floors that get slick when wet can increase the risk of slip-and-fall injuries. Therefore, a rubber mat is better suited to fitness centers than hardwood, linoleum, or other smooth surfaces. However, different types of flooring may be needed for different types of exercise (e.g. hardwood flooring is preferred for fitness studios that hold dance-based aerobics). The type of exercise should be considered thoroughly before installing flooring.
• Safe Training Practices
  1. Risk can also be managed through safe training environments, monitored exercise levels, and proper equipment setup. It’s up to the fitness staff to care for and monitor the integrity of the equipment.
  2. For outdoor training programs, environmental factors must be carefully considered (e.g. rain/snow/ice/extreme temperatures).
  3. Monitoring the intensity of exercise is another method of risk management for the certified trainer. The trainer can help prevent dangerous situations by tracking the intensity of exercise based on the client’s fitness level.
  4. Fitness classes can present complications in monitoring the intensity and managing risk. A description of each class and its intensity level should be indicated on the fitness class schedules. Exercise classes should include modifications to exercises and clients should be encouraged to exercise at their own pace to avoid overtraining or injury.
• Equipment Setup and Maintenance
  1. The proper setup of equipment can help minimize risk. To prevent injury, trainers should encourage clients to utilize the equipment the way it was designed, without modifications or shortcuts, and should ensure proper safety mechanisms are applied (e.g. clips are required for barbells to hold the weight, safety rails on squat racks are required).
  2. Regular maintenance should be performed on equipment and catalogued for appropriate risk management.
  3. If malfunctioning equipment requires a professional equipment mechanic to come out for service, this equipment should be marked with an Out of Order sign to prevent further damage to the equipment and injury to clientele.
• Components of an Emergency Action Plan
  1. The key components of an emergency action plan are outlined by the United States Department of Labor (OSHA).
  2. Emergency procedures should be documented in hard copy and should be easily accessible to all employees.
  3. The guidelines of the US Department of Labor are the minimum regulations. Having a well-designed emergency action plans is essential to the overall safety and risk management of a fitness center.

Question 3

Medical Clearance (醫療許可)
Medical Clearance for Exercise
Reputable (信譽良好的) Resources

Answer 3

• Medical Clearance for Exercise
  1. Ensuring clients are medically cleared for exercise is a high priority for the trainer, since this clearance can reduce the risk of a cardiovascular event during exercise and potentially prevent lawsuits resulting from negligence or liability.
  2. Identifying possible risks in new clientele can be done in various ways. The trainer should require all clients to fill out a medical history and PAR-Q. This way, the trainer will be aware of any health conditions of the client that may be exacerbated by exercise.
  3. A list of risk factors can be applied to a client’s medical history to identify whether the client requires a physician’s clearance prior to starting a new fitness program. The risk factors include:
  3.1. age (the age risk varies by gender)
  3.2. family history of cardiovascular diseases
  3.3. smoking
  3.4. sedentary lifestyle
  3.5. obesity and/or diabetes or pre-diabetes
  3.6. high blood pressure
  3.7. high blood glucose
  4. Based on client’s various health risk factors, they can be categorized as low risk, intermediate risk, or high risk.
  4.1. Low-risk individuals will have <2 of these factors present.
  4.2. Intermediate-risk may have 2 factors, but they must be under a physician’s care or asymptomatic.
  4.3. High-risk clients will have evident and documented cardiovascular risk factors. Trainer should explain to clients in the high-risk category that a medical clearance from their physicians is required prior to participating in an exercise program.
  5. In general, the higher the risk, the more supervision will be required. High-risk clients with known cardiovascular diseases may require a medically administered stress test to see if they are ready for physical activity or an individualized fitness program. After these clients receive a physician’s clearance to work with a knowledgeable trainer, they may ease into a new exercise program. It’s critically important that the trainer have the appropriate expertise for these clients’ special needs.
  6. A medical clearance form should provide space for the physician to detail the client’s contraindications for exercise. The form should also indicate what precautions the trainer should take during exercise sessions.
  7. Speaking with the physician does not replace the trainer’s need for written medical clearance, and signed client paperwork should always be required for legal purposes.
  8. In addition to completing a medical history and PAR-Q form, the client must complete and sign the appropriate informed consent and liability waiver forms.
  9. Prior to beginning an exercise program the client must fill out and sign the following:
  9.1. medical history (and obtain medical clearance if necessary)
  9.2. PAR-Q
  9.3. informed consent for exercise and fitness testing
  9.4. liability waiver to begin the exercise program
• Reputable Resources:
  1. National research organizations (e.g. American Heart Association) offer guidelines on cardiovascular health.
  2. Certifiying fitness organizations such as NASM, ACE, and ACSM, which develop their guidelines through peer-reviewed research are also credible resources for info on fitness.
  3. It’s important that trainers obtain certification through one of these organizations, not only to bolster their knowledge but also to provide evidence of expertise if clients research the trainer’s background and qualifications.

Question 4

Overtraining and Abnormal Responses to Exercise

Answer 4

• Overtraining — means that the human body has not had adequate rest to develop the necessary adaptations to exercise prior to the next round of training.
• Overtraining affects the human body both physically and psychologically. Trainers should understand and be able to recognize the signs and symptoms of overtraining in order to prevent musculoskeletal injuries. They should also learn proper treatment and recovery methods.
• Following is a list of the signs and symptoms of overtraining:
  1. sluggishness (遲緩) or generalized fatigue (全身疲勞)
  2. poor sleep
  3. loss of confidence
  4. increased anger or anxiety
  5. decrease in physical performance
  6. chronic muscle soreness or joint pain
  7. increase in resting heart rate
  8. change in blood pressure
  9. change in mood
  10. change in appetite
  11. depression
  12. excessive thirst
  Though this list is not exhaustive (全面的/詳盡的), these signs are evident that a client may be trying to fit too much into his workouts with inadequate rest and recovery. Not all clients will succumb to the same signs and symptoms, and it’s up to the trainer to keep accurate training records to prevent the onset of this syndrome.
• The trainer should approach overtraining cautiously and require that the client rest for up to 24 hours before overloading the same muscle groups. The athlete can still perform exercise to maintain fitness but should reduce the intensity of the workouts. Psychologically, the overtrained client may require a scheduled break from training, a change of exercise methods or, in severe cases, a complete cessation of exercise.
• The trainer must determine whether the client is experiencing overtraining and musculoskeletal injury, or rather acute muscle soreness and delayed onset muscle soreness (DOMS).
  1. DOMS is different from overtraining because the soreness will eventually subside without any chronic effect on the musculoskeletal system. Joint pain and soreness that does not go away could be a sign of overtraining, and should be taken seriously by both the client and trainer.
  2. Acute muscle soreness and DOMS are common in the muscles and tendons around the joints, but excessive joint pain refers to pain in the joint itself. Training programs should not cause this type of pain. If it occurs, the trainer should take precautions in future exercise programming to avoid overtraining.
  3. DOMS is actually caused by micro-tears in the fibers of the muscles and can even occur in well-trained athletes.
• Other Abnormal Responses to Exercise:
  1. Excessive breathlessness (過度呼吸困難) that does not subside following a cessation of exercise or after minimal effort is one warning sign.
  2. Other warning signs include dizziness, abnormal heart rate, or any signs of heart attack or stroke.
  3. Warning signs of a stroke: FAST (face/arm/speech/time).

Question 5

Injuries and Medical Emergencies
Initial Management (初始管理) and First-Aid Techniques
Obtaining Basic Life Support (BLS 基礎生命維持) and First-
Aid Training
Client Health History and Emergency Contacts

Answer 5

• Initial Management and First-Aid Techniques
  1. Trainers must approach medical emergencies with caution and only within the scope of practice in which they are trained.
  2. Although treating injuries is not within the trainer’s scope, trainers should be able to recognize the symptoms of various injuries and medical emergencies so they can respond appropriately to open wounds, musculoskeletal injuries, cardiovascular and pulmonary events, and metabolic disorders.
  2.1. Open wounds: the trainer should wash an open wound with clean water and apply a sterile dressing (吳俊夫廖) such as gauze or bandages. Injuries to limbs should be elevated above heart level.
  2.2. Musculoskeletal injuries: different types of injury require different first-aid procedures. For contusions (挫傷), sprains (扭傷), and strains (拉傷), it’s common practice to follow the RICE protocol (Rest, Ice, Compression, and Elevation of the injury) within the first day to the first week of the injury to reduce symptoms. If the trainer suspects a bone fracture (骨折) has occurred, he should apply ice to the site and transport the injured person to an emergency department for medical treatment immediately. Bone fractures can be classified as simple, compound, open, closed, or comminuted (粉碎的).
  2.3. Cardiovascular and pulmonary events: cardiovascular events such as heart attack and stroke are often life threatening and must be considered emergencies. Trainers must immediately call 911. Clients who fall unconscious due to suspected cardiovascular events may require CPR.
  2.4. Chest pain: can have many different causes and should be approached with extra caution. Heart attacks are often accompanied by chest pain with pressure, radiation of pain down the neck/arms/shoulders/face, profuse sweating, feeling lightheaded, and shortness of breath. Any chest pain accompanied by these symptoms should elicit immediate medical attention. Additional medical emergencies involving chest pain include aortic dissection (主動脈剝離), pulmonary embolism (費栓色), and unstable angina (不穩定型心絞痛).
  2.5. Tachycardia (心跳過速): Sustained elevated heart rate following cessation of exercise should be considered a potential cardiovascular event and emergency action may be required.
  2.6. Bradycardia (心跳過緩): a decrease in heart rate below normal levels can be just as serious. A low heart rate means that oxygen-rich blood is not being pumped to the tissue. This could result in sudden fainting. The cause of a low heart rate vary, but one potential cause could be damage to heart tissue, which prevents the proper conduction of electrical activity in the heart.
  2.7. Hypertension: can lead to more serious conditions such as heart attacks and strokes. Clients with known hypertension should have their bp checked prior to and following an exercise session. Over time, consistent exercise can help reduce hypertension.
  2.8. Hypotension: abnormally low blood pressure, can result from a rapid change in body position or from potential heart disease. The symptoms of low bp include fainting, lightheadedness, dizziness, cold sweats, nausea, or blurry vision.
  2.9. Hyperventilation (過度換氣): an increase in breathing rate that occurs at rest could be a sign of a cardiac or pulmonary emergency. Serious conditions that could present hyperventilation include heart attacks, excessive bleeding, panic attacks, COPDs, and pulmonary emboli (肺栓塞). If hyperventilation persists or other symptoms of cardiovascular events present themselves, call 911 immediately.
  2.10. Metabolic conditions:
  2.10.1. Hypoglycemia (低血糖 or low blood sugar levels): can cause clients to experience syncope, or fainting. Patients who experience hypoglycemia are often diabetic and require rapidly available sugar to counteract the effects.
  2.10.1.1. Symptoms that could indicate dangerously low blood sugar include slurred speech, dizziness, confusion (錯亂), sweating, loss of coordination, fatigue, irritability, tachycardia, blurred vision, and even loss of consciousness. 2.10.1.2. If symptoms present prior to loss of consciousness, the trainer should administer readily available sources of glucose, such as hard candies or fruit juices. The client should sit down to avoid injury from falling and must be supervised while another individual obtains the glucose.
  2.10.2. Hyperglycemia (高血糖 or high blood sugar): can result in severe side effects if left unchecked.
  2.10.2.1. Typical symptoms include increased frequency of urination, increased thirst, high blood sugar levels in glucose testing, and increased sugar levels in urine testing.
  2.10.2.2. Severe cases can lead to diabetic comas and are typically preluded by ketoacidosis (童症酸中毒) symptoms such as fruity-smelling breath, cottonmouth, vomiting, or shortness of breath. If a client is presenting these symptoms, call 911.
  2.10.3. Hyperthermia (體溫過高): an abnormally increased body temperature.
  2.10.3.1. The potential for hyperthermia is elevated in extremely hot and humid climates that do not allow the body’s thermoregulation mechanisms, such as sweating, to work properly. The sweat will not evaporate and colling does not occur.
  2.10.3.2. The symptoms of hyperthermia include: mood changes, lack of sweat, rapid pulse, flushed skin (皮膚潮紅), fainting, and loss of consciousness.
  2.10.3.3. The client should lie down and cold compresses (冷敷) should be applied to the major arteries and to the groin and armpits. Fluids should be encouraged if the client can drink, and the client should be removed from the heat and sun immediately.
  2.10.4. Hypothermia (體溫過低): a decrease in body temperature below normal levels, is more of a concern in very cold climates.
  2.10.4.1. Clients involved in outdoor winter sports are more susceptible to hypothermia. However, hypothermia can also be caused by cold rain and temperatures above freezing.
  2.10.4.2. Signs and symptoms include: confusion, drowsiness, loss of coordination, and even frostbite (凍瘡) of the extremities and any exposed skin.
  2.10.4.3. Clients experiencing these symptoms should be removed from the cold, stripped of wet clothing, covered with dry clothing and blankets, and given a warm beverage free of alcohol and caffeine.
• Obtaining BLS (Basic Life Support) and First-Aid Training
  1. Certified trainer must receive training in CPR, AED, and basic first aid. BLS classes provide training in CPR and AED. The BLS certification will prepare the trainer to provide emergency first response.
  2. Several organizations provide these certification courses, including the Americal Heart Association (AHA), the Occupational Safety and Health Administration (OSHA), and the American Red Cross. The certifications typically need to be renewed every two years.
• Client Health History and Emergency Contacts: whether stored physically or electronically, all confidential client info must be protected. Electronic info must be password-protected to prevent violation of privacy.