Athletic Trainers Play Important Role in Providing Health Care for Students

Appropriate access to athletic health care and protecting student- athletes during athletic activities should always be a priority. In the secondary school setting, accidents and injuries will occur despite the most diligent efforts to mitigate risk.

Schools can take many actions to enhance the safety of student- athletes, such as creating and practicing appropriate athletic Emergency Action Plans (EAPs), securing enough automated external defibrillators (AEDs) for athletic practice and competition locations, and knowing to “cool first, transport second” in the event of exertional heat illness. However, those are only part of delivering comprehensive athletic health care as an essential service.

Athletic Trainers (ATs) are uniquely educated to provide immediate emergency care and acute injury care, and render informed return-to-play decisions while managing everything in between. This range of abilities separates them from other healthcare providers and comprise a skillset that is protected by most states’ licensure and BOC certification.

As of 2020, only 66 percent of U.S. high schools have access to an AT, and only 35 percent of those are full-time1. There are many advantages of having a full-time AT. Coaches and athletic directors have many responsibilities, and the AT can help alleviate those.

AT responsibilities include but are not limited to emergency action planning, hydration procedures, first aid, documentation, environmental monitoring, and participation medical clearance. Additionally, an AT also utilizes preventative measures such as weight monitoring to track sweat loss, pre-concussion baseline testing, checking urine specific gravity as a measure of hydration, initiating programs such as ACL protection, and tracking injury patterns to identify causative issues.

An AT’s presence in this setting supports the academic culture as well. Because of the presence of an AT, trips to urgent care, the emergency department or even a physician can be avoided because the student may be seen and treated at school. Because the AT evaluates injuries and can render immediate care, manage the acute response, and create and supervise a return-to-play protocol without referral to an outside medical provider, the student will spend more time in school.

ATs come to the same medical diagnosis as a physician 92 percent of the time2. This keeps students in school learning, aids their social-emotional well-being by keeping them engaged with their peers, and decreases time away from participation, and often leads to better long-term outcomes due to consistent re-evaluation and adaptation of rehabilitation responses. These actions prevent parents/guardians from having to take off work, pay co-pay and/ or transportation fees, and unnecessary worrying. In the event referral is warranted, ATs can efficiently manage communication between the student’s parent or guardian and the provider.

The AT can also assist in helping file insurance claims, and ensure the student-athlete is receiving the necessary care and following up as directed. If a student-athlete suffers a concussion, the AT serves as a critical liaison between the staff and the student, initiating the need for accommodations when necessary and ensuring that academic performance takes precedence over athletic participation.

These are just a few of the roles that an AT serves to protect the student-athletes. Often because of the AT, the student-athlete can return to activity quicker and more safely. With an AT on staff, a school can mitigate liability and risk, and support the academic culture at the same time. In most cases, ATs are the only healthcare provider readily available after school hours and are educated to recognize and respond to issues behind those orthopedic in nature, such as mental health crises. ATs build unique relationships with student-athletes and often represent a safe, inclusive haven.

Damar Hamlin’s cardiac event on January 2, 2023, serves to illustrate the true value of an AT. His recovery and progress are ongoing, but he was afforded the opportunity because of IMMEDIATE recognition and IMMEDIATE appropriate response in no small part because of an AT. Had the recognition and response been delayed, Hamlin’s prognosis would have been compromised. Would the response look the same at an athletic event or practice in the secondary school setting? Secondary school student-athletes deserve at least one person specializing in emergency response, properly prepared and equipped, when the worst-case scenario occurs.

Many perceived reasons exist for not hiring a full-time AT. Lack of budget funds usually tops the list. When evaluating the depth and breadth of services provided by an AT, it should be apparent that an AT on staff is worth the investment. The day-to-day influence is difficult to quantify, but an athlete who has suffered a time-loss injury and was cared for by an AT often will share the importance of the care provided by the AT. Also, most parents/ guardians share gratitude that someone on the school staff was dedicated to protecting and advocating for their child as an objective proxy. When the unimaginable occurs, the perceived “reasons” for not having an AT on staff no longer ring true.

Although the number of BOC-certified athletic trainers has remained steady or increased, it is seemingly more difficult to fill open positions at the secondary school level, let alone create new ones. To recruit, hire and retain an athletic trainer, the following considerations should be made: the salary should be, minimally, commensurate with that of teachers in the school system. The entry- level degree for an athletic trainer is now at the master’s level. The AT must also pass a national competency exam, and meet continuing education requirements. The number of work hours, number of days worked, and length of the athletic school year should be factored in when setting the salary.

Another factor to be considered is the athletic trainer must be allowed to make decisions in the best interest of the student without fear of reprisal from a coach or administrator. Evaluations of the athletic trainer must be limited to work habits, not the performance of their skillset.

Once employed, the athletic trainer should be allowed to set boundaries regarding time available and when he or she can be contacted, and communication about schedules and injuries must be thorough and timely, and respect for the ATs need for personal time must exist. Administrators need to understand that ATs are seemingly on an “island” – because they can be the only person with their specialized skillset on campus. This can be isolating and lead to burnout and compassion fatigue.

Administrators who support health and safety policies and procedures, alleviate routine tasks where possible (such as preparing water daily for all events), protect a healthy work/life ratio, and foster a healthy work environment go a long way toward retaining an athletic trainer.

Working in any position in the secondary school setting is rewarding beyond comprehension. It would be difficult to find an athletic director, coach or athletic trainer who didn’t say they received more out of their job than they gave, or that what they do isn’t their “calling.” An athletic trainer is an asset to the athletic and activities team and assists in providing a quality experience.

1Huggins, R., Coleman, K., Filep, E., Yoshihara, A., & Casa, D. (2020, June 17). ATLAS Athletic Training Services 2020 Full Report. Korey Stringer Institute. Retrieved February 10, 2023, from https://ksi.uconn.edu/atlas/atlas-report-2/

2Lombardi NJ, Tucker B, Freedman KB, Austin LS, Eck B, Pepe M, Tjoumakaris FP. Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine. Orthopedics. 2016 Sep 1;39(5):e944- 9. doi: 10.3928/01477447-20160623-10. Epub 2016 Jul 12. PMID: 27398784.