Athletic Trainers in Secondary Schools
September 21, 2015
The Certified Athletic Trainer (AT) is specially trained and educated to handle injuries related to sport and recreation. ATs undergo clinical and didactic tracks in the pursuit of a bachelor’s or master’s degree that allows one to sit for the certification exam through the Board of Certification. For over 60 years, ATs have provided health services to thousands of athlete-patients but over the course of time some of these professionals have chosen to pursue employment outside of what is referred to as the “traditional setting.” While not inherently wrong, the author believes that the student-athletes of thousands of high schools are missing out on a valuable resource. Additionally, this exodus has created a separation amongst the profession that could ultimately destroy the profession. The National Athletic Trainers’ Association is made up of about 35,000 members and it is time that all 35,000 members become united with a goal to provide every athlete with the athletic healthcare he or she so deserves1.
In 2009 the National Athletic Trainers’ Association estimated that approximately 42% of all high schools across the United States had “access” to an AT. That simply is unacceptable to have such a low number of schools providing healthcare for its student-athletes. The causes for this are sure to be many and this author believes the profession should share some of the blame.
The first reason many schools they do not have an AT is because it is not in the budget to afford one. Many states continue to slash education budgets and schools choose to spend money in other places. Each day there are articles in the newspaper about school districts laying off teachers and other employees. Unable to fund education, these school districts realize that athletics are not the priority and therefore believe that the athletic department is a good place to start when it comes to budget cuts. As understandable as that is at first glance, the consequences for that thinking could potentially be millions of dollars if those schools choose to continue high-risk sports such as football, hockey, and wrestling. While the author believes that having full-time athletic trainers who are employees of the high school is the best solution, it is important to find a solution that works for that individual high school. Many high schools have ATs who are contracted through a physical therapy clinic or a sports medicine office or an assortment of other healthcare providers. The schools may pay for this service or the clinic may be provided advertisement space as a trade. It is important that medical services be provided for the student-athletes and these services should be available every single day. ATs are the healthcare provider who has the knowledge, skills, and abilities to provide those services on a daily basis. It simply is what the profession does best. Money should not be the one factor that keeps a student-athlete from obtaining excellent athletic healthcare.
The number of sports at a given school makes it difficult for an AT to provide onsite coverage for each sport every single day, but being available for this variety of sports can be managed through careful scheduling and working as a team within the athletic department and with other ATs. Communication between schools and between ATs can go a long way in providing adequate supervision for a lot of athletes. Rather than two ATs being at a volleyball game while a soccer game goes uncovered, one AT could be covering each event. In most states, this is already taking place in that most schools with an AT do provide services for both teams when it hosts an event. For many sports (excluding varsity football) this is adequate and works well.
The next problem is one that is faced by many healthcare professions and that is the lack of ATs available to work in a given area. Rural America suffers from a lack of general healthcare so it is without question an area that lacks the services of the certified athletic trainer. But those athletes are at just as big of a risk as the athlete in more affluent areas. In fact, an argument could be made that these rural areas need ATs even more due to a lack of healthcare in the provided area. ATs are capable of providing many services to the athlete-patient and making that determination if more advanced care is necessary. This could potentially save the families money and prevent missed school time due to appointments.
The last perceived problem for this author is the number of hours many ATs are expected to work. This is one reason that many ATs have made the decision to pursue other career opportunities after frustration over working long hours. Others believe that athletic training is something that can be done “on the side” therefore ATs are forced to teach or work in a clinic setting during the day and then provide athletic training at night. This creates the long hours that so many ATs dread and this must be changed. For the AT to provide the best care possible, he or she needs to be given the opportunity to be at his or her best each time in the athletic training room. Burn out is present in many athletic trainers due to the neglect that goes along with the number of hours being put in. This fatigue and frustration can lead to costly errors that put the athlete-patient at risk.
Previously I have presented a few reasons why there is a lack of ATs in high schools. I will next present several reasons why it is so important that we continue to work as a profession to get ATs into the school system.
The American Academy of Pediatrics released a study in November 2012 that showed the number of injuries reported is lower at schools with ATs than at schools without2. This goes to show that ATs are good at preventing injury and, probably even more important, preventing re-injury. By providing immediate evaluation and treatment, an athlete is more likely to get back onto the field quicker and safer. Additionally, the study showed that more concussions were diagnosed at schools with ATs compared to schools without an AT. This should come as no surprise to an AT because we should recognize that ATs are the best provider for concussion recognition and management in the sports environment. According to a study out of Virginia, significant increases in concussions were noted over an 11-year period throughout all sports. Football remains the #1 culprit with girls’ soccer coming in at #2. Interestingly enough, it was noted that in sports that both genders participated (except lacrosse), females experienced greater incidences of concussions that male counterparts3. This indicates to me that a need for ATs for both genders is crucial for the student-athlete. This is also a common place where AT services fail as many people believe that only sports like football or hockey would need a trained medical person there to deal with injuries. According to those people, injuries do not occur in other sports and if they do, those injuries are not serious. This could not be further from the truth! Injuries occur in all sports and it is the job of the AT to correctly evaluate the injury and properly rehabilitate the injury before allowing the athlete to return to competition.
Not only has the number of injuries increased in the last several years, but so has the severity of those injuries. According to a study published in 2009, over 1800 athletes have died suddenly or survived cardiac arrest4. Nearly 70% of those reported were during the period of 1994-2006 and it continues to rise. It is established that the survival rate of cardiac arrest is significantly low, however quick use of CPR and an AED in the first few minutes can provide the patient with a chance to survive. This has led to some states mandating the presence of AEDs and trained personnel. ATs often find themselves prepared for many emergencies and cardiac arrest is just one of them. Other emergencies that ATs are prepared for can include broken bones, cervical spine injuries, and internal organ injuries. All of these warrant immediate evaluation and immediate treatment. ATs are capable of providing this knowledge and managing these emergencies. ATs must work as a part of the sports medicine team to provide the best care and in an emergency ATs are likely to be the first onsite to start that management process. Emergency management is one domain that we own on the athletic sideline and we must work to keep it ours5.
Reasons why ATs are lacking in schools and reasons why ATs are so desperately needed have been presented. But where do we go from here? How do we make it work to increase that 42%? This is a question that has been asked and lately on social media, it has been a very popular question. It requires cooperation, it requires effort, and it requires forward thinking. As ATs, we think that there is enough evidence to show that we are a standalone profession that is valuable to our community and to our patients. But if a school has never experienced an AT before, those individuals do not fully understand that yet. And so when we are demanding a significant sum of money we have to be able to show them how WE are worth it to them. This sometimes means taking sacrifices to be in a situation to show those schools and the administrators that an AT is needed at all sporting events.
We must work with local organizations to develop the proper sports medicine team. That encompasses multiple professions, but the AT should be at the forefront on the front lines. We must be prepared to work with physical therapists, physicians, and nurses to do our job to the best of our ability. We can develop those relationships and we can help foster that growth in and out of the school system. While I believe the clinic outreach concept is outdated and broken, it sure beats not having the services at all! So rather than scoffing at the idea of working in that environment, maybe it is time some ATs take on the challenge of helping change it! If we do not, then schools will look elsewhere and there are professions out there who believe that their professionals can do our job.
ATs are not just needed at sports like football, wrestling, and hockey. Every sport should have easy access to an AT. Every athlete deserves to have access to an AT. Whether it is a muscle strain in track or a cervical spine injury in football, we must put injuries above all else and handle them with the importance that each kid deserves.
As Dr. Prentice mentioned in his recent editorial, ATs must re-focus on the foundation of the profession6. That is the “traditional setting.” We must not run from the perceived problem, but instead attack it head-on. Our student-athletes deserve the best care possible and ATs have to step up to the plate to take on the task. Every single one of us ATs are trained to work in the traditional setting from the very start of our education. Put that education to good use and make our student-athletes safer. They are our future. They deserve the best and we must give them the best. We cannot justify taking our best professionals out of that area. Instead we must work to improve the setting and put our very best on the front lines where they belong!
We cannot allow other professions to impede our progress. We must continue to show every day why we are the best at what we do and why schools need us. ATs must find ways to overcome the obstacles and see to it that the injuries encountered are handled professionally and correctly by qualified healthcare providers. We are athletic healthcare providers and we are good at it.
1) About the NATA; National Athletic Trainers’ Association; http://www.nata.org/aboutNATA; accessed March 7, 2013.
2) Lincoln, AE., Caswell, SV., Almquist, JL., Dunn, RE., Norris, JB., & Hinton RY. (2011). Trends in concussion incidence in high school sports. The American Journal of Sports Medicine, 39(5), 958-963.
3) High schools with athletic trainers have more diagnosed concussions, fewer overall injuries; American Academy of Pediatrics; http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/High-Schools-with-Athletic-Trainers-have-More-Diagnosed-Concussions-Fewer-Overall-Injuries.aspx; published October 22, 2012; Accessed February 15, 2013.
4) Arrhythmia/Electrophysiology: Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006; Maron BJ, Doerer JJ, Haas TS, Tierney DM, and Mueller FO. Circulation. 2009;119:1085-1092.
5) Athletic Training Services; National Athletic Trainers’ Association; http://www.nata.org/sites/default/files/GuideToAthleticTrainingServices.pdf; published 2010; Accessed March 16, 2013.
6) William E. Prentice (2013) Focusing the Direction of Our Profession: Athletic Trainers in America’s Health Care System. Journal of Athletic Training: Jan/Feb 2013, Vol. 48, No. 1, pp. 7-8.