Athletic Directors Face Several Barriers to Hiring Athletic Trainers and Risk Sports Safety of the Student Athlete

Tuesday, October 27, 2015

DALLAS, October 27, 2015 – As the country continues to address several recent reports of youth sports injuries and catastrophic outcomes, a new study sheds light on the barriers some athletic directors (ADs) face in hiring athletic trainers (ATs), whose job it is to help prevent injuries and manage them should they occur. Nearly two-thirds of high schools lack a full-time athletic trainer and almost 30 percent don’t have any AT services, according to the National Athletic Trainers’ Association (NATA).

Athletic Directors' Barriers to Hiring Athletic Trainers in High Schools will appear in the October issue of the Journal of Athletic Training, NATA’s scientific publication and is now online.

“Three major themes emerged from the data,” said lead author Stephanie Mazerolle, PhD, ATC, assistant professor, director of the Athletic Training Professional Bachelor’s Program, University of Connecticut, and Medical and Science Advisory Board member of the Korey Stringer Institute (KSI). “The athletic directors who participated in the study clearly identified lack of power, budget concerns and non-budget concerns – including rural locations, misconceptions about the role of the athletic trainer and community interference – as major factors limiting their ability to hire athletic trainers in their school settings.”

More than 7 million high school students currently participate in organized sports; 1.4 million high school sport-related injuries occur each year; whereas most athletic injuries are relatively minor, potentially limb-threatening or life-threatening injuries can occur.

“Most deaths that occur in sport are preventable and result from a failure to have proper prevention strategies in place, immediately recognize the condition, and/or implement appropriate care,” added Douglas J. Casa, PhD, ATC, FNATA, chief executive officer of KSI and director of Graduate Athletic Training Education, Department of Kinesiology, at the University of Connecticut. “Prompt management of these injuries is critical to the patient’s positive outcome and should be carried out by trained health care personnel, such as the athletic trainer, to minimize risk.”

As reported in the study, in 2013, the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs urged all high schools to have an AT on staff to take care of emergency situations and provide care for student athletes. Some schools rely on coaches, ADs or bystanders who are not trained in discerning the similar signs and symptoms of potentially fatal conditions.

Study Protocol

To facilitate organizational changes within secondary school athletics, researchers sought to assess the current environment and potential resistance to change. Schools that had previously participated in the
CATCH-ON (Collaboration for Athletic Training Coverage in High Schools, more recently referenced as the “Benchmark Study”), initiated by KSI and NATA, served as the initial recruitment pool.

Of the total 568 schools, the authors selected a random sample of those schools that did not have the medical services of an AT. Twenty full-time public high school ADs (17 men, three women), from four geographic regions of the U.S. (North, South, Midwest and West) participated. Data were collected by telephone interviews using a guided questionnaire.

Study Results

Lack of Power:
Public school ADs perceived they lacked the power to make hiring and budget decisions and that there was little to no chance of persuading schools or departments to allow them to do so, despite prior efforts. Responses included “zero chance” and “no way.” Reasons included priority of teacher hires and the challenge of shifting monies from other departments and budget cuts. The ADs said that a lack of support from supervisors in the school hierarchy existed and they did not believe it could be overcome.

Budget Concerns:
The funds allocated to a specific department or projects within a school can be a leading factor in the services and programs that a school can provide for its student athletes. All but one AD in the study attributed not employing an AT to a lack of funding. Eighteen of 20 discussed budget concerns as a major barrier to hiring. “It was financial, period, financial” said one AD. Another said “we would love to but … this is just not going to happen.” A third said “the school just runs a sports program under what’s called the bare minimum amount of money we can come up with.” Limited resources and budgetary concerns were primary factors in prohibiting hires.

Non-Budget Concerns:
Rural Area/Location: Resources in these areas can be substantially limited and location can be problematic; schools may be several miles from cities. Many rural ADs rely on the local emergency medical system (EMS), physician assistants or traveling physicians in the absence of hiring an AT. “We do have one small school that is about 110 miles away and they have a volunteer athletic trainer. It’s just that I don’t know how we’d get someone to come out here,” said one AD.

Misconceptions About the Role of the Athletic Trainer: Although most ADs understood the role of the AT, others thought the coaches had sufficient knowledge and training to address the medical needs of the athletes without an AT. All 20 participants stated that their coaches received training in first aid, CPR and concussion recognition and were expected to apply this knowledge during practices and games. This misconception extended to the belief that other health care providers, including emergency medical technicians (EMT) or physical therapists, could be appropriate substitutes for ATs.

High school interscholastic leagues often mandate medical personnel only for football games. High schools that do not employ ATs may rely on their coaching staffs or others to act in emergency situations. Seventeen ADs reported that they had football teams and did not employ ATs. One AD said that because there was a hospital nearby, they didn’t have an AT on staff and that the hospital might bring someone by the field from time to time. “If minor injuries occur, you know, we handle that on-site ourselves,” said another. “Well, the hospital obviously has a person … I don’t know if it’s like a pure AT and it is probably more of a physical therapist type,” adds a third.

Community Interference: This category encompassed local schools' resources and, in some cases, medical coverage provided free of charge. Interference was based on the notion that other medical care providers who were community members or local to a school supplied sufficient on-site coverage for games – including volunteer medical coverage from local EMS. Some are teachers, principals or others with EMT training. “We have a local guy (EMT) who will donate his services for us,” commented one AD.

Recommendations Moving Forward

While continued research is needed, the authors hope that identifying these barriers will lead to the development of strategies to overcome them. Recommendations include:

Athletic directors should continue to advocate for the hiring of athletic trainers despite budget concerns and educate parents, school boards and superintendents about the benefits that an athletic trainer can bring to the student athlete’s well-being and medical care.

Encourage state legislatures to pass more structured guidelines for athletic health care that follow the recommendations of NATA and other organizations about appropriate medical care in secondary schools.

Promote states that have model programs as well as the positive effects of community support – especially through the collective voice and power of parents.

Address the misconception that basic first aid/CPR/concussion recognition training for coaches is an acceptable substitution for athletic training services.
Budget creatively: sponsor pilot programs with support and/or grants from local hospitals and clinics; hire graduate assistant athletic trainers to provide care in rural areas or appeal to newly credentialed athletic trainers who are excited about their careers who may be a good fit for those environments.

Consider community outreach programs with clinics, hospitals and universities as a way to fund or acquire athletic trainer services.

“It is our goal that these findings are catalyst for change,” says Mazerolle. “We hope that all high school student athletes will someday have full-time athletic trainers and receive the gold standard of care they deserve.”

Additional Resources:

NATA High School Benchmark Study

Best Practices For Sports Medicine in High School and Colleges (consensus statement)

Preventing Sudden Death in Secondary School Athletics (consensus statement)

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 43,000 members of the athletic training profession.