New Study Shows 37 Percent of Public Secondary Schools Meet Gold Standard of Care For Their Athletes

Wednesday, March 11, 2015
Dallas, March 11, 2015 – According to a new study, just over one third of every high school in the United States has at least one full-time athletic trainer, the gold standard of care recommended by the National Athletic Trainers’ Association. “Athletic Training Services in Public Secondary Schools: A Benchmark Study,” appears in the February Journal of Athletic Training, NATA’s scientific publication.
The encouraging results show that 70 percent of U.S. public high schools have athletic training (AT) services while 37 percent have full-time athletic trainers. Forty-seven percent of the schools reported providing full practice coverage each afternoon. Thirty percent of the schools did not have AT services. These statistics are an update to a 1994 study which indicated only 35 percent of public high schools used AT services. Overall access to athletic trainers has doubled over the past 20 years1.

“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,” says Jim Thornton, MA, ATC, CES, president of the National Athletic Trainers’ Association. “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 Worldwide2, 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.
According to the study, 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.


Study Background: National and Regional Insights

To determine current AT services in public secondary schools, a cross sectional survey was conducted by the Korey Stringer Institute. Researchers from KSI and the Department of Kinesiology at the University of Connecticut contacted all 14,951 public high schools in the U.S. A total of 8,509 (57 percent) of those schools responded. Schools were included if they had interscholastic athletic programs and comprised at least one of grades nine through twelve. Data was collected by athletic directors and school principals via telephone and email. Data collection took place September 2011-December 2013. The study was funded in part by the National Athletic Trainers’ Association.
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.

Region Percent schools with any
Athletic training service
North 86 percent
South 73 percent
Midwest 66 percent
Southwest 58 percent
Northwest 46 percent
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 CDC3, 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.
1Access means very different things from school to school (football game coverage, practice and game coverage, etc.) and does not necessarily mean full-time access.
2Preventing Sports-Related Injuries. Accessed February 13, 2015. 
3A National Action Plan for Child Injury Prevention: Reducing Sports and Recreation-Related Injuries in Children.  Accessed February 13, 2015. 
About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport
Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 39,000 members of the athletic training profession.