Because physicians are present at relatively few youth sports practices and games, initial evaluation and management of head and neck injuries is usually performed, at least at the high school level, by a certified athletic trainer (ATC).

The ATC is an invaluable member of the sports medicine team, particularly when an athlete suffers a concussion:

• The ATC often sees the athlete on a daily basis, and thus has the opportunity to establish a trusting relationship. This trust is a vital part of the process of evaluating and managing a concussion.
  
  

• Athletes commonly believe that getting their "bell rung" is a natural part of the sport they are playing, and as a result may not feel the need to report symptoms of a concussion. Athletes who do not report injuries or who underreport symptoms may be placing themselves at potentially life-threatening risk of brain injury, such as Second Impact Syndrome. Athletes may be more comfortable reporting symptoms to an ATC, who they see on a regular basis, than to a physician they do not see regularly.
  
  

• The ATC may also be better able to identify subtle signs that an athlete has suffered a concussion because he or she knows the athlete's usual behavior and demeanor.
  
  

• The ATC is also in best position to perform daily follow-up examinations that allow the ATC and team physician to determine when the athlete is symptom-free and determine when he or she may return to play.

It is important for the ATC to educate the athlete about the signs and symptoms of concussion and the dangers of second-impact syndrome (SIS) that can result from not reporting concussion symptoms.

One of the most challenging aspects of game and practice coverage is the response to injuries involving the head and cervical spine (neck). Knowledge concerning the clinical presentation and proper emergency care in the event a player suffers a potentially serious or catastrophic head or neck injury is required for athletic trainers and medical personnel.

The ATC's role during games and practices is to prevent injury and provide immediate first-aid care and triage. To be properly prepared:

• Before the season, the athletic training staff should create an emergency medical plan instituting all procedures that must be followed during an emergency.
  
  

• The various entities making up the institutional medical team - the secondary support teams, including local emergency medical services, ambulance units, and level 1 trauma centers (including helicopter transport) - should be listed.
  
  

• Policies, such as which concussion grading system and return-to-play guidelines to follow, should go through the proper administrative protocols before being instituted.
  
  

• All equipment to be used on a daily basis must be inspected and tested before each season, and in some instances, such equipment must be recalibrated annually.

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Article updated August 1,2007

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