Professional Practice, Safety, and Interprofessional Collaboration
Boundaries and liability
Know your scope of practice and how it differs by credential, and know the elements of negligence: duty, breach, causation, and damages. Informed consent, confidentiality under HIPAA, accurate documentation, and incident reporting are core. Documentation should capture screening results, session content, abnormal responses, and referrals.
Safety systems
Facility risk management includes an emergency action plan with a rehearsed response, access to an AED, current CPR and first aid certification, equipment maintenance logs, clear pathways, appropriate flooring, and temperature control. Sanitation protocols matter in shared-equipment settings. Emergency drills should be scheduled, not assumed.
Interprofessional collaboration
Know the roles on the team: physician for medical clearance and symptom workup, physical and occupational therapists for rehabilitation and functional mobility, registered dietitian for nutrition therapy, pharmacist for medication interactions, psychologist or social worker for behavioral health, and nursing for ongoing monitoring. Communicate findings concisely and in writing, and confirm that a clearance covers the specific activities you plan.
Traps
Diagnosing a condition or prescribing a diet. Continuing a session when a client reports chest pressure. Failing to document a referral. Assuming a general clearance letter authorizes every exercise mode. Discussing a client's health information in an open gym.
Rule of thumb
When in doubt, refer out. Stop and activate the emergency action plan for chest pain or pressure, syncope, new unilateral weakness or slurred speech, resting dyspnea, blood pressure at or above 180/110 mmHg, glucose below 70 mg/dL or above 250 mg/dL with ketones, or suspected autonomic dysreflexia, which presents as a pounding headache with paroxysmal hypertension and bradycardia in spinal cord injury.
Worked example
A client with spinal cord injury above T6 reports a sudden pounding headache mid-session. Stop exercise, sit him upright, check blood pressure, look for a noxious stimulus such as a tight strap or full bladder, and activate the emergency action plan.