There's good news and bad news about athletic trainers.

The bad news is that three out of ten U.S. high schools do not currently have any access to ATs, relying instead on coaches and administrators to determine proper medical treatment when injuries and emergencies arise during practice or competition.

The flip side is that 70 percent of U.S. public high schools do have access to athletic training (AT) services, with 37 percent having a full-time athletic trainer on staff, and 47% providing full practice coverage each afternoon. As a result, 86% of all high school athletes have access to AT services.

Survey responses collected by researchers at the Korey Stringer at the University of Connecticut from 8,509 of the 14,951 public secondary schools in the U.S. showed that overall access to athletic trainers has doubled over the past 20 years from 1994, when a study which indicated only 35 percent of public high schools used AT services.

"While this significant increase is promising, the quality of care in secondary schools will continue to improve as the number of schools with athletic trainers - particularly full-time - increases," said Jim Thornton, MA, ATC, CES, president of the National Athletic Trainers' Association, about the study, which appeared in NATA's scientific journal, The Journal of Athletic Training.

"Athletic trainers provide the highest level of medical care for their student athletes by offering a continuum of care, which comprises prevention, diagnosis, treatment and rehabilitation of injuries."

Athletic trainers worked most often at games and competitions than at practices, placing athletes at a substantial risk of injury during a large portion of sport participation, the authors note in their report. According to Safe Kids Worldwide, 62 percent of organized sports-related injuries occur during practices. Schools that employ at least one full-time AT, the gold standard model, are better prepared to protect their student athletes during this particularly high-risk part of athletic participation. During practices, athletes may perform drills or exercise longer than during games, leaving them without appropriate medical coverage on a regular basis.

Secondary schools without AT services rely on coaches and administrators, such as athletic directors, to determine proper medical treatment when injuries and emergencies arise during a practice or competition. This poses considerable risks for the athlete, school and school district. Most coaches do not have the proper medical education to treat injuries or recognize the common causes of life-threatening medical conditions, which may put the lives of athletes in jeopardy. Moreover, if coaches do recognize a medical emergency is present, they are not trained to treat potentially life-threatening conditions, nor should it be their responsibility to do so.

"Ultimately, these findings provide athletic trainers the data we need to ask state officials, state high school athletic associations and school administrators to hire full-time athletic trainers to protect student athletes," lead author Riana Pryor, MS, ATC, said.

"It is vital for schools to have appropriate sports medicine care during games and practices to ensure sports safety of high school student athletes," says co-author, Douglas J. Casa, PhD, ATC, FACSM, chief operating officer of the Korey Stringer Institute (KSI) and director of Athletic Training Education, Department of Kinesiology at the University of Connecticut. "While many schools need to enhance coverage for appropriate care and some schools still need to begin having ATs on staff, the momentum shows strong movement forward. This trend can and will have lifesaving consequences."

In 2013, an inter-association task force for preventing sudden death in secondary school athletics programs released best practices recommendations that stressed the importance of appropriate on-site medical care at the high school level and specifically recognized the value of athletic trainers in that role. The document was endorsed by 14 health care and sports organizations.

A National Federation of State High School Associations survey indicates that more than 7 million students participate in organized secondary school athletics in the United States each year. Approximately 1.4 million injuries occur annually to secondary school athletes taking into account both practices and games.

Approximately 10 secondary school football players died each year from 1990-2010 in games and practices, according to the benchmark study. Of these deaths, 85 percent involved illnesses related to head, heart and environmental heat. According to researchers, these catastrophic outcomes could be prevented by having the appropriate medical professional such as the AT onsite who can provide care within minutes of the onset of symptoms.

Access to athletic trainers is most prevalent in the eastern part of the country, with the northeast region having the highest percentage and northwest region having the smallest percentage of schools with AT access.

Pryor said the results offer a baseline look at the current state of medical services in secondary schools. "I hope that athletic personnel and school administrators can now see how their region, state and school compare to others, with the hope that they will also want to improve upon their medical services," said Pryor, director of research at the Korey Stringer Institute. "The more athletic trainers we have in our high schools, the safer sports practices and games become."

According to the CDC, many sports-related injuries are predictable and preventable. Athletic trainers prevent, diagnose, treat and rehabilitate injuries and illnesses and can help stave off chronic or potentially fatal situations. They specifically implement prevention strategies including coaching education, pre-participation exams, emergency action plans and heat acclimatization policies and possess the knowledge and training to treat conditions ranging from minor to life-threatening injuries and conditions.

"While the percentage of secondary schools with AT services has increased dramatically in the past 20 years, school districts should begin or continue to hire athletic trainers to improve coverage for appropriate care," concludes Casa. "The decisions made in the first 10 minutes after an incident will often be the difference between life and death - hence, the necessity of appropriate on-site health care services."

"We encourage schools, parents, coaches, health care professionals and others to advocate for increased youth sports safety protocols and to develop and adopt best practices for the safety of their student athletes," adds NATA's Thornton.

Sources:

National Athletic Trainers' Association press release

Pryor RR, Casa DJ, et al. Athletic Training Services in Public Secondary Schools: A Benchmark Study. J Athl Tr. 2015;50(2):156-162.

Posted December 9, 2015