Eight high school football players across the country have died this season, and these tragedies appear to be occurring more frequently. Now more than ever, every high school needs to hire a full-time athletic trainer.
There are so many critical functions an athletic trainer performs for student-athletes. Treating and rehabilitating injured players and helping to determine return to play are only part of their duties. No role impacts the lives of the athletes more than recognition and initial treatment of life-threatening emergencies.
As an example, let’s imagine a 17-year-old football player who suffers heat stroke during a summer practice. Without an athletic trainer present, it could take five or 10 minutes before a coach notices the player confused. The coach might not recognize the cause of his symptoms. Not knowing the initial management of heat stroke, he might call EMS.
It could take at least 15 minutes for the ambulance to arrive. Add more precious minutes for the paramedics to assess the player and load him in an ambulance. Factor in another five to 15 minutes in travel time to a hospital and 10 minutes or more for the emergency room doctor to assess and begin treating the patient. That’s 30 to 45 minutes — minimum — before treatments to lower the athlete’s core body temperature begin.
Most cases of heat stroke involve the athlete having a core body temperature between 106 and 110 degrees. There’s a critical threshold for cellular damage around 105.5. If the athlete stays above that temperature for 60 minutes or more, he will almost certainly die or have long-term medical complications. If his temperature exceeds that level for 30 to 60 minutes, he usually lives but often has lasting complications. If his temperature drops below that level within the first 30 minutes, he survives and returns to a healthy life.
An athletic trainer can recognize an athlete in distress sooner, and he or she can start treatment right away. The athletic trainer can remove the uniform and helmet, take a rectal temperature and place the player in cold-water immersion. When his core body temperature drops to around 102 or 103, the paramedics can transport him.
Dr. Douglas J. Casa, director of Athletic Training Education at the University of Connecticut, told me that heat stroke is 100 percent survivable if you get the athlete’s core body temperature below 104 degrees within 30 minutes of collapse. He has studied over 2,000 cases of heat stroke. No athlete has died when athletic trainers and medical providers succeeded in decreasing his body temperature to below 104 within 30 minutes.
Athletic trainers can save the lives of high school athletes.
Sadly a large percentage of high schools in this country don’t have athletic trainers. Currently 70 percent of public high schools have athletic trainers at games or practices, and one third of the schools have full-time athletic trainers.
In a recent study performed at the University of Connecticut, researchers surveyed 20 high school athletic directors across the country to determine some of the challenges with schools hiring them. Some common themes emerged.
Many athletic directors cited difficulties convincing school boards to hire athletic trainers. Budgetary concerns were common. Schools in rural areas often noted challenges convincing athletic trainers to work there.
Many athletic directors denied a need for a certified athletic trainer, claiming that their coaches had taken basic first aid and CPR and even courses on concussions. While those steps are certainly worthwhile for all coaches, they are inadequate for the athletes. A weekend course or online tutorial doesn’t come close to the knowledge and experience of an athletic trainer who completes at least two years of education and hands-on training. Plus conflicts of interest don’t exist with athletic trainers like they could with a coach trying to determine if a star player should come out of the game.
Nurses, chiropractors and physical therapists offering to cover games is admirable and better than no medical coverage, but they cannot perform most of the duties of an athletic trainer. And having an ambulance and paramedics at sporting events is definitely a good idea, but it can be difficult to guarantee with local EMS often responsible for responding to emergencies throughout the town.
How can we overcome these barriers and have all high schools employ athletic trainers?
One approach would be for state legislatures to mandate that schools hire them. Currently Hawaii is the only state to require employment of athletic trainers. Many medical organizations like the American Medical Association and American Academy of Pediatrics have publicly supported high schools hiring athletic trainers. Some advocates have gone so far as to push for barring schools without athletic trainers from competing in contact and collision sports.
Parents could also push for athletic trainer coverage at their children’s schools. Voicing their concerns and even offering funding ideas might help athletic directors find a way to hire full-time athletic trainers.
Athletic trainers play a huge role in keeping young athletes safe. We must find a way to get them into schools where they can make a real difference.
Dr. David Geier is an orthopaedic surgeon in Charleston. For more information about other sports medicine topics, go to drdavidgeier.com.