Note: In several recent radio and online interviews, the hosts have asked me why there seem to be more deaths than ever occurring in high school football. More importantly, they want to know what we can do to decrease these numbers. I thought it would be worthwhile to examine the trend for increasing deaths in the sport, so I plan to discuss it in an upcoming column. For this newspaper column, though, I thought that I would address a straightforward solution to decreasing the deaths – hiring athletic trainers.
Eight high school football players across the country have died this season. These tragedies appear to be part of a trend of rising deaths in the last few years. Now more than ever, every high school in the United States needs to hire a full-time athletic trainer.
Key duties of an athletic trainer
There are so many critical functions an athletic trainer performs for student-athletes. They develop emergency action plans. They monitor field, environment, and weather conditions. ATs can develop and coordinate injury prevention programs. They prepare athletes for practices and games, communicate with physicians about injuries, treat and rehabilitate injured players, and help determine return to play for injured athletes. None of these roles impacts the lives of the athletes more than recognition and initial treatment of life-threatening emergencies.
Initial management of heat stroke
As an example, let’s imagine a 17-year-old football player who suffers exertional heat stroke during a summer practice. Without an athletic trainer present, it could take 5 or 10 minutes or more before a coach notices the player confused. The coach might not recognize the problem, thinking he could have suffered a concussion or some other injury. Not knowing the initial management of heat stroke, he might call EMS.
It likely would take at least 15 minutes for the ambulance to arrive. Add 5 to 10 minutes for the paramedics to assess the player and load him into the ambulance. Factor in another 5 to 15 minutes in travel time to a hospital and 5 to 10 minutes or more for the emergency room doctor to assess the patient and start treatment. That’s 30 to 45 minutes – minimum – before treatments to lower the athlete’s core body temperature begin.
Most cases of exertional heat stroke involve the athlete having a core body temperature between 106° and 110°F. There is 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.
Not only can an athletic trainer recognize an athlete in distress sooner, but he or she can also start treatment immediately, while EMS is on its way. 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.
Douglas J. Casa, PhD, ATC, Chief Operating Officer of the Korey Stringer Institute and Director of Athletic Training Education at the University of Connecticut, told me that heat stroke is 100% survivable if you get the athlete’s core body temperature below 104° within 30 minutes of collapse. He has studied over 2000 cases of heat stroke. No athlete has died when athletic trainers and medical providers succeeded in decreasing his body temperature below 104° within 30 minutes.
Statistics on athletic trainer coverage
Sadly a large percentage of high schools in this country do not have athletic trainers. Currently only 70% 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 who didn’t have athletic trainers to determine some of the challenges with schools hiring them. Some common themes emerged.
Barriers to high schools hiring athletic trainers
Many athletic directors cited difficulties convincing school boards to hire athletic trainers. Budgetary concerns were common. Schools in rural areas often noted difficulties convincing athletic trainers to work there.
Coaches with basic medical training not enough
Many athletic directors denied they needed 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 needs of 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.
Volunteer coverage and EMS not enough
Nurses, chiropractors and physical therapists volunteering 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.
“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,” Dr. Casa pointed out in a press release for NATA. “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.”
In 2005, only 42% of U.S. high schools had athletic training services. 70% coverage is an improvement. Still, one third of high schools have no athletic trainers. We must work to get 100% of high schools to hire them.
Ideas to get athletic trainers into the schools
One approach would be for state legislatures to mandate that schools hire athletic trainers. Currently Hawaii is the only state to require employment of them. 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 call 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.
Should EMS be required at football games?
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.
How can we get more high schools to hire athletic trainers? Please share your thoughts below!
A modified version of this article appears as my sports medicine column in the November 12, 2015 issue of The Post and Courier.
Mazerolle SM, Raso SR, Pagnotta KD, Stearns RL, Casa DJ. Athletic Directors’ Barriers to Hiring Athletic Trainers in High Schools. J Athl Train. 2015 Oct;50(10):1059-68.
New Study Shows 37 Percent of Public Secondary Schools Meet Gold Standard of Care For Their Athletes. NATA.org. Accessed November 10, 2015.
High School Deaths Directly Due to Football Injuries are at Highest Three-Year Level Since Late 80’s. By Jason Lisk. The Big Lead. November 5, 2015.
For a limited time, you can join Sports Medicine University for free! If you’re an athletic trainer, physical therapist, sports medicine physician or surgeon, or if you work in sports medicine in some other way, join us! Or maybe you are studying to work in this profession, or you’re just planning to one day, come and learn from and network with sports medicine professionals from all over the world. Membership is free for life – if you sign up right now! Click here to learn more!