Among the things which increase the anxiety level of parents of children playing contact or collision sports, or any sport for that matter, is the fact that many high school programs don't employ certified athletic trainers (ATs) who have received training in treating sports injuries, including heat illness, spine and neck injuries, sudden cardiac arrest, and in recognizing the often subtle signs or symptoms of a concussion.
Statistics on the percentage of high schools with athletic trainers vary, but less than half have ATs. According to the National Athletic Trainers' Association,1 only 42% of high schools have access to an AT, but more than half (52%) of parents in a recent University of Michigan survey reported that ATs were present for games (38% for practices; where 62% of injuries occur). In some states, the number is much lower (Over three-quarters of Nebraska high schools, for instance, are without ATs).
MomsTeam has long advocated that parents have the right to expect that a certified athletic trainer (AT) is on staff. An AT is so important that he or she should be the next hire after the head coach. According to a 2010 University of Michgan poll, two thirds of parents surveyed support a requirement that high schools have an AT onsite for practices and games.
Safety Summit
The ongoing incidence of youth sports injuries and catastrophic events resulting in death has highlighted a need for immediate and improved injury prevention and treatment at the high school level. Supported by 66 sports and health organizations, including MomsTeam.com, the Youth Sports Safety Alliance, formed by the National Athletic Trainers' Association, recently hosted, and I attended (both as a member of the media and as a longtime youth sports safety advocate), the Third Annual Youth Sports Safety Summit on Capitol Hill. The summit featured presentations by leading experts on preventing and managing catastrophic injuries in sport. Topics included concussions and catastrophic brain injuries, exertional heat stroke, exertional sickling, sudden cardiac arrest, asthma and, the important topic of emergency preparation and planning to ensure that a plan is in place if and when these events occur. The mission of the alliance is to raise awareness among the public, parents, coaches, legislators and media on the unacceptable number of catastrophic injuries occurring among this population.
ATs and concussions
Given the increased media attention in recent years on concussions in sports - from the youth level through the pros, the presence of an AT at games and practices in contact or collision sports is particularly critical because:
- In high schools with at least one AT on staff and concussion assessment involved only one medical professional, nearly nine of ten concussions were assessed by an AT and only 9.7% by a primary care physician.
- The AT 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 may be more comfortable reporting symptoms to an AT, who they see on a regular basis, than to a physician they do not see regularly, or to their coach.
- An AT 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.
- An AT is also in best position to perform daily follow-up examinations that allow the AT and team physician to determine when the athlete is symptom-free and determine when he or she may return to play (a 2011 study2 found that ATs returned athletes to play more quickly than physicians but the differences were not found to be statistically significant.
According to a 2011 study, physicians are on site at the time of only 7.7% of the reported concussions suffered by high school athletes in the 2009-2010 school year, while ATs were on site for at least 70%, and, in where they were present, assessed an athlete for concussion 94.4% of the time.2 Reassuringly, the same study found that ATs and physicians used similar return to play intervals when managing athletes who have sustained sports-related concussions, although, where the return to play decision was made by a physician, they were more likely than ATs to utilize computerized neuropsychological testing (52.5% versus 35.7%) in making that decision.
An AT is thus essential, and we should work towards the goal of having a certified athletic trainer on staff at every high school in this country.
For the most comprehensive and up-to-date concussion information for sports parents, visit MomsTeam's pioneering Youth Sports Concussion Safety Center.
1. Waxenberg R, Satloff E. Athletic trainers fill a necessary niche in secondary schools. National Athletic Trainers' Association: 2009. Available at: http://www.nata.org/NR031209.
2. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).
Revised May 23, 2012
