24 Del. Admin. Code § 2600-15.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 2600-15.0 - Advanced Training Requirements

Certain techniques used in physical therapy and athletic training require advanced training to assure the licensee meets accepted standards of care.

15.1 Emergency administration of asthma and anaphylaxes medications: The licensee must be certified in first aid by the American Red Cross, American Heart Association, National Safety Council or other agency approved by the Board and posted on the Division of Professional Regulation's website. Proof of such certification shall be provided by the licensee to the Board or a member of the public on demand.

15.2 Emergency administration of glucagon: The licensee must complete the online course covering the emergency administration of glucagon provided by the American Diabetes Association, or other agency approved by the Board and posted on the Division of Professional Regulation's website. Proof of such course completion shall be provided by the licensee to the Board or a member of the public on demand.

15.3.1 Definitions

15.3.1.1 "Approved supervisor" shall mean a licensed physical therapist with Sports Physical Therapy Specialist ("SCS") certification by the American Board of Physical Therapy Specialties ("ABPTS"), a licensed athletic trainer, or a board certified sports medicine physician.

15.3.1.2 "Collision sports" shall mean sports such as football, soccer, wrestling, ice hockey, men's lacrosse or rugby.

15.3.1.3 "Direct supervision" shall mean that the approved supervisor is physically present and has the ability to intervene in all care or coverage.

15.3.1.4 "Indirect supervision" shall mean that the approved supervisor is available by telecommunication.

15.3.1.5 "On-the-field care" shall mean physical therapy or athletic training care provided outside the clinical setting, at an athletic venue, to athletic injuries.

15.3.2 Physical therapy or athletic training care may be provided outside the clinical setting at an athletic venue to athletic injuries only where:

1) as set forth in subsection 15.3.2.1, the licensee is either a physical therapist with SCS certification or an athletic trainer;

2) subject to the requirements of subsection 15.3.2.2, the licensee is pursuing SCS certification through a residency program; or

3) subject to the requirements of subsection 15.3.2.3, the licensee is pursuing SCS certification through supervised hours.

15.3.2.1 Certification. The licensee has received certification as an SCS by the ABPTS or has received certification as an Athletic Trainer by the Board of Certification for the Athletic Trainer; or

15.3.2.2 Residency program: The licensee is a licensed physical therapist enrolled in an approved, accredited APTA SCS residency ("SCSR"); and

15.3.2.2.1 Maintains CPR and first aid certification at the minimal level of Basic Life Support for Healthcare Providers by the American Red Cross, American Heart Association, National Safety Council or other agency approved by the Board and posted on the Division of Professional Regulation's website; and

15.3.2.2.2 Is directly supervised by an approved supervisor when providing on-the-field care for at least the first 100 hours, at least half of which shall be performed while covering collision sports, and until all residency competencies for on-the-field care have been satisfied. Such competencies shall include, but are not limited to:

*	Administer acute emergency care

*	Make recommendations concerning return to play

*	Apply external bandages, dressings, and supports

*	Provide health status information and recommendations to coaches, parents, and physicians

*	Recommend activity limitations based on environmental conditions

*	Recommend modifications to playing environments

*	Select, fit and maintain athletic equipment; and

15.3.2.2.3 After the 100 hours have been completed, is indirectly supervised until the results of the next offered SCS examination are obtained; or

15.3.2.3 Supervised hours: The licensee is a licensed physical therapist obtaining experience hours under direct supervision by an approved supervisor at all times when on-the-field care is provided; and

15.3.2.3.1 Maintains CPR and first aid certification at the minimal level of Basic Life Support for Healthcare Providers by the American Red Cross, American Heart Association, National Safety Council or other agency approved by the Board and posted on the Division of Professional Regulation's website; and

15.3.2.3.2 Completes SCS certification within a four-year period, with the hours documented, including the confirmation signature of the primary supervisor.

15.3.3 All licensees providing care pursuant to subsection 15.3 shall provide proof of certification or documentation of training to the Board or public on demand.

15.4 Dry Needling

15.4.1 Dry needling is "an intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying muscular tissue, connective tissues and myofascial trigger points for the management of neuromusculoskeletal pain and movement impairments; is based upon Western medical concepts; and requires a physical therapy examination and diagnosis." 24 Del.C. § 2602(6). Dry needling is within the scope of practice for a Physical Therapist. 24 Del.C. § 2602(10)(a). It is not in the scope of practice for Athletic Trainers, Physical Therapy Assistants or Physical Therapy Aides.

15.4.2 Requirements for Physical Therapists to perform dry needling:

15.4.2.1 Dry needling may be performed by a licensed Physical Therapist who meets the requirements of subsection 15.4.

15.4.2.2 The Physical Therapist shall have no less than 2 years of active clinical experience in the treatment of patients as a licensed Physical Therapist and shall hold a current license in good standing.

15.4.2.3 The Physical Therapist shall have current CPR certification by the American Red Cross, American Heart Association, National Safety Council or other agency approved by the Board and posted on the Division of Professional Regulation's website.

15.4.2.4 Dry needling shall be performed directly by the Physical Therapist and shall not be delegated.

15.4.2.5 Dry needling shall be performed in a manner that is consistent with generally accepted standards of practice, including clean needle techniques and the bloodborne pathogen standards of the Occupational Safety and Health Administration ("OSHA").

15.4.2.6 Dry needling is an advanced procedure that requires specialized training. A Physical Therapist shall not perform dry needling in Delaware unless he or she has and maintains documented proof of completing a Board-approved training program on dry needling.

15.4.2.6.1 The program shall be a minimum of 54 hours, which shall be completed within no more than two years;

15.4.2.6.2 The Physical Therapist shall successfully complete the minimum passing criteria for the dry needling program; and

15.4.2.6.3 The Physical Therapist shall only utilize the specific techniques for which he or she has demonstrated competency.

15.4.3 Physical Therapists who are performing dry needling at the time of enactment of this regulation, and who have completed 25 hours of dry needling education, may continue to practice dry needling, upon submission of proof of experience and education to the Board. Such Physical Therapists shall complete the required 54 hours of education within two years after enactment of this regulation.

15.4.4 Board approved dry needling training program: A dry needling training program shall include the following to be eligible for Board approval:

15.4.4.1 A dry needling training program shall require each trainee to demonstrate successful psychomotor and cognitive performance through practical and written examination.

15.4.4.2 A dry needling program shall be attended in person by the Physical Therapist, shall not be attended online or through any other means of distance learning and shall not be a self-study program.

15.4.4.3 The program curriculum shall include the following:

15.4.4.3.1 History and current literature review of dry needling and evidence based practice;

15.4.4.3.2 Pertinent anatomy and physiology;

15.4.4.3.3 Choice and operation of supplies and equipment;

15.4.4.3.4 Knowledge of technique including indications/contraindications and precautions for use;

15.4.4.3.5 Proper technique of tissue penetration;

15.4.4.3.6 Knowledge of hazards and complications;

15.4.4.3.7 Safe practice guidelines and generally accepted standards of practice including clean needle techniques and OSHA's bloodborne pathogen standards;

15.4.4.3.8 Post intervention care, including an adverse response or emergency;

15.4.4.3.9 Documentation of successful completion of psychomotor and cognitive performance through practical and written examination; and

15.4.4.3.10 Supervised training.

15.4.4.3.11 The dry needling program, including the required supervised training, shall be taught by a Physical Therapist who meets the qualifications of subsection 15.4.

15.4.5 Scope of Practice

15.4.5.1 A Physical Therapist may not perform dry needling on a patient until completion of at least 25 hours of education in a Board approved dry needling program.

15.4.5.2 A Physical Therapist may not perform dry needling on high risk areas until completion of at least 54 hours of education in a Board approved dry needling program. As used in this regulation, high risk areas are the anterior cervical region, abdominal region, and the region directly over the ribs, unless the pincher technique is performed.

15.4.6 Examination and Informed Consent

15.4.6.1 Examination: A Physical Therapist shall only perform dry needling following an examination and diagnosis for the purpose of treating specific anatomic entities selected according to physical signs.

15.4.6.2 Informed consent: At the first visit, a Physical Therapist performing dry needling shall obtain written informed consent from the patient before the Physical Therapist performs dry needling on the patient. The patient shall receive a copy of the informed consent, and the Physical Therapist shall retain a copy in the patient's record. The informed consent shall include, at a minimum, the following:

15.4.6.2.1 The patient's signature;

15.4.6.2.2 The risks and benefits of dry needling;

15.4.6.2.3 The Physical Therapist's level of education regarding supervised hours of training in dry needling; and

15.4.6.2.4 A clearly and conspicuously written statement that the patient is not receiving acupuncture, including the following language: "Dry needling is a technique used in physical therapy practice to treat myofascial, muscular, and connective tissues for the management of neuromuscular pain and movement dysfunction. Dry needling technique should not be confused with an acupuncture treatment performed by a licensed acupuncturist."

15.4.7 Referral required: A physician referral specific for dry needling is required. If the initial referral is received orally, it must be followed up with a written referral.

15.4.8 Procedure notes: A Physical Therapist who performs dry needling shall maintain documentation in the patient's chart or record for each dry needling session. The note shall include the treatment received, the response to treatment and any adverse response.

15.4.9 Documentation of training: The Physical Therapist bears the burden of proof of sufficient education and training to ensure competence with the treatment or intervention. If requested by the Board or a member of the public, the Physical Therapist practicing dry needling shall provide documentation of completion of the training required by this regulation. Failure to provide written documentation to the Board of meeting the training requirements shall be deemed prima facie evidence that the Physical Therapist is not competent and shall not be permitted to perform dry needling.

24 Del. Admin. Code § 2600-15.0

18 DE Reg. 469 (12/1/2014)
18 DE Reg. 899 (5/1/2015)
20 DE Reg. 913 (5/1/2017) (Final)