by Mark Powell MS ATC CSCS
Wherever you have sports, the possibility of injury exists. Whether it’s an ankle sprain, a shoulder or arm injury or something more serious, like a concussion, an injury will most likely occur. For sports in the collegiate and professional levels, having an available athletic trainer available is the norm. But not so much at the high school level. Only about 40% of high schools in the U.S. have an athletic trainer. Funding is usually the reason why. But schools need to take into account other costs associated with an injury that could have been limited due to the addition of an Athletic Trainer (AT). Over time, schools could benefit by cost reduction from medical expenses, lowered injury rates and liabilities in the case of more severe injuries.
The importance of a certified athletic trainer at the high school level makes sense. Without one, coaches, officials, players and parents are left to help assess the impact of a player’s injury. Although coaches and parents might have some level of knowledge in evaluating a player’s injury, they are in no way as qualified as the athletic trainer to make the critical decisions required to minimize the impact of an injury.
Here is how the National Athletic Trainers Association (NATA) answers the question, “Who are athletic trainers”.1
“Athletic trainers (ATs) are highly qualified, multi-skilled health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. Athletic trainers work under the direction of a physician as prescribed by state licensure statutes.”
Athletic trainers are sometimes confused with personal trainers. There is, however, a large difference in the education, skill set, job duties and patients of an athletic trainer and a personal trainer. The athletic training academic curriculum and clinical training follow the medical model. Athletic trainers must graduate from an accredited baccalaureate or master’s program, and 70% of ATs have a master’s degree.
High schools need to begin to realize that injuries, such as concussions, can have more serious and long-term effects if they are not diagnosed and treated early. Returning a player to the field of play while still having symptoms of a concussion is a recipe for a more serious brain injury.
Although many schools participate in the remove-from-play concussion protocols, without an athletic trainer, it is a valid to ask how closely the rules are being followed, and by who? Coaches and even parents have a vested interest in getting a player, especially the most talented ones, back on the field for the purpose of helping the team win. Not to mention the possible implications of not playing in front of college scouts who may be watching with a scholarship offer in jeopardy.
But with a certified athletic trainer ready, it would be them and only them who makes sure the protocol is followed correctly. They are not only trained to assess an athlete’s symptoms, but they are also trained to evaluate progress and determine when it is safe to allow the player to return to action.
Here is an amazing statistic regarding injuries in high schools with and without an athletic trainer. 2 Re-injury rates in high schools with athletic trainers have been shown in studies to be just 3 percent, while at high schools without athletic trainers they go up to about 60 percent.
That statistic alone should give high schools a reason to look into funding for an athletic trainer at their school. If school administrators have a real concern about the safety of their student-athletes, they should take a closer look at what it will take to employ a true AT. Athletic Directors might also look at schools that use an AT and question them as to how they are able to provide the funding necessary to add the athletic trainer.
In fact, the presence of an AT has a dramatic increase in assuring that a concussion will be correctly evaluated, which is extremely critical in not only avoiding a lengthier recovery but also the risk of permanent brain damage.3
A research paper  presented in October 2012 at the American Academy of Pediatrics National Conference and Exhibition in New Orleans, LA found that eight times more concussions were diagnosed in girls’ high school soccer and 4.5 times more in girls’ basketball in high schools with ATs than those without ATs. 4
“This data shows the valuable role that [ATs] can play in preventing, diagnosing and managing concussions and other injuries,” said Cynthia LaBella, MD, FAAP, the author of the paper presented at the AAP conference, told Science Daily. “Athletic trainers have a skill set that is very valuable, especially now when there is such a focus on concussions and related treatment and care. Concussed athletes are more likely to be identified in schools with athletic trainers and thus more likely to receive proper treatment.”
So, what are a few of the other primary reasons that athletic trainers are a valuable asset to have for the safety of your school’s athletes? Here are a few of the most important.
Training is the most obvious but also the most important reason to have an Athletic Trainer. Athletic trainers have been specifically trained in sports related injuries. In fact, AT’s know more about sports injuries that most other health care professionals. For the safety of the athletes, and the comfort level of their parents, who would you rather have analyzing the symptoms of an injury than a trained professional
Athletic trainers who work with players on a regular basis get to know the student-athletes well, probably more so than their actual parents. They see them on the field and how they react to collisions and contact and can quickly determine when something doesn’t appear right with the athlete. That gives them an edge over a coach or a parent when an incident occurs and can get them off the field for further evaluation.
Athletes tend to build trust with their athletic trainer. They learn to respect their opinion and believe that the AT is only looking out for their safety and well-being. Because of this trust, athletes may be more likely to report symptoms to the AT rather than keeping it to themselves.
5 Indeed, a 2011 study of concussions in high school sports during the 2008-2009 academic year suggests that expanded access to an AT in one Northern Virginia area school district from 2 part-time ATs to 1 full-time AT and one part-time may have substantially increased the likelihood that a concussion was recognized and treated.
Although schools without athletic trainers most likely have staff trained on concussion protocols as well as how to diagnose sports injuries. The question remains; How committed are they to reinforcing them. Having an athletic trainer who is not only trained but responsible for the “good” of the athletes, provides the necessary reinforcement of these guidelines and protocols. AT’s can provide clear medical information and rational reasons why a player should not be allowed to return to action. With solid medical reasoning, players, coaches and parents alike will have a much better understanding of the decision.
Immediate Medical Support
How many times have you been to a sports event and a player was hurt, possibly seriously, and there didn’t appear to be any appropriate medical assistance immediately available? Probably more times than you’d like. Having an AT available on the spot will at the very least provide someone who is trained and knowledgeable regarding various types of sports injuries and can administer some quick tests or observe some apparent symptoms which could lead to a faster diagnosis of the issue and help with any immediate treatments necessary. 6
Fran Bellinger—a physical education/team sports educator in Hawaii, who also officiates volleyball and basketball games—says school athletic trainers are an invaluable asset.
“The need for an athletic trainer to be on site is extremely important,” says Bellinger, who has officiated for more than 20 years. “If a student-athlete crashes, the athletic trainer is right there—on the spot—taking care of the kid.” Bellinger has seen ATs assess as they triage, apply first aid, and help off the field with proper stabilization.
Hawaii is the only state with an athletic trainer in every high school, and the money that is earmarked for the hiring of an AT cannot be used for any other purpose. In the District of Columbia, every high school has an AT. And states such as Arkansas, North Carolina, and Oklahoma, are considering legislation that would mandate funding for athletic trainers.
Considering what is at risk with the safety of high school athletes, it’s imperative that schools should become much more severe with the issue of high school sports injuries. Principals and athletic directors need to continue to look for creative ways to work the cost of an athletic trainer into the school’s budgets.
As NATA President Jim Thornton recently stated,
“If we can find the money to buy new uniforms and improve facilities, we can afford to have an athletic trainer.”
3 LaBella L. A Comparative Analysis of Injury Rates and Patterns Among Girls’ Soccer and Basketball Players. Paper presented October 22, 2012, at American Academy of Pediatrics (AAP) National Conference and Exhibition, New Orleans, LA; High Schools with Athletic Trainers Have More Diagnosed Concussions, Fewer Overall Injuries. Science Daily http://www.sciencedaily.com/releases/2012/10/121022080649.htm (retrieved February 21, 2013)
5 McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players – Implications for prevention. Clin J of Sport Med 2004;14:13-17.