Injury management in high school athletics.

Athletics has become part of our everyday life and plays a significant role in the development of our student-athletes. Still, the question remains: Are we providing the participants with the best medical assistance available?

Generally, the individual responsible for the physical well-being of the athlete is the athletic trainer. The statistical breakdown is surprising: We have one Certified Athletic Trainer (ATC) for every 25 professional and collegiate athletes compared to only one ATC for every 5,500 high school athletes (Stopka, 1988).

Our high school athletes simply are not receiving the quality and quantity of care they need and desire.

Consider the following:

1. We have approximately 24,000 high schools in the United States with 5.6 million student athletes (Stopka, 1988).

2. Nearly one in six of these high school athletes will be injured seriously enough for it be considered a time-loss injury (Stopka, 1988).

3. With only 10-20% of our high schools employing athletic trainers (Powell, 1987), most injuries are being managed by the coaching staffs, especially during practice.

4. This lack of professional medical assistance during practice is especially alarming given that 61.2% of the injuries sustained in high school football in 1995 were practice-related (NATA, 1996).

Is it any wonder that our coaches and school districts have become targets for litigation involving inadequate medical coverage and injury prevention? What is the degree of medical coverage for a typical high school athlete?

The author, while a graduate student at Gonzaga University, conducted a survey of the high schools in Spokane, Washington, a city with 10 public schools, nine of which had enrollments of over 1,000 students in grades 10-12.

Though one has to be careful in generalizing the results of such a study, the findings probably reflect what goes on in similar socio-economic settings across the country.

The survey attempted to determine the status of the professional care being involved, when and how often medical care was provided, who was coordinating the programs, and whether the schools had intention of hiring ATC's in the near future.

SURVEY FINDINGS

The incidence rate and severity of injuries in high school athletics has been well documented in the literature and supports the need for having qualified medical professional available to high school athletes on a daily basis. Athletic Directors at nine of the schools surveyed stated that they have a medical doctor present at their home varsity football games. While this percentage (81.8 %) is good, only four of the schools had access to a medical professional during the week.

This cannot be considered acceptable. A recent NATA survey of 6,529 high school football players predicted 506,452 injuries in high school football that year alone (NATA, 1996).

Collision sports such as football have been shown to have the highest rate of injuries and severity levels. However, other sports such as basketball have also incurred injuries of significant seventy to warrant medical assistance in both practices and games (Whieldon, 1990).

Of the 11 schools in this study, two reported a medical doctor in attendance at basketball games, one at some wrestling meets, and one at tournaments only.

Six schools had a physical therapist, three had an ATC, and one had an EMT regularly attending its home athletic events. one school did not report any medical professional at their home events.

Schools receiving professional medical assistance for home events also reported receiving some assistance at practice sessions ranging from two hours a day to two times a month. None of the schools had a doctor present during practice sessions. That left the evaluation and treatment of athletic injuries in the hands of the coaches. Culpepper (1986) reports that this happens 55 to 80% of the time.

Coaches generally do not have the expertise nor the time to deal with each injury. A major concern is that 57 to 67% of them do not feel adequately prepared or qualified to treat injuries upon graduation from college (Culpepper, 1986).

The survey also revealed that injured athletes are being treated by student athletic trainers, that eight of the schools have a student trainer program, and two other schools are in the process of starting one.

But only two of these programs are being coordinated by a teacher/ATC. When asked if their school had intentions of hiring an ATC in the near future, 36.4% stated "no," while 36.4% expressed some interest.

CONCLUSIONS

The high schools of Spokane have medical professionals available to their athletes, but the assistance being delivered is inconsistent and infrequent. It is not uncommon for the medical professional in attendance to be the parent of an athlete on the team. Unfortunately, as the athlete graduates, the medical coverage is lost. Obviously, this type of volunteerism does not provide reliable, consistent coverage.

Phillip Hossler (1985) has presented a number of options that could be used to acquire the services of an ATC. One recommendation is to make the ATC a part-time employee of the school district and also have part-time employment outside the district. The athletic trainer could arrive at the school near the end of the school day and provide professional medical assistance to the athletes on a daily basis.

Although this option is not the best available at the high school level, it could easily be put into practice using the outreach programs that are already in place and could provide a starting point from which a valuable program could be built.

The high schools and the physical therapy clinics currently providing professional medical services could enter into a mutual agreement that would place

ATCs in the schools on a daily basis. With such an agreement, an ATC would work at a physical therapy clinic in the morning and at a nearby high school in the afternoon.

In addition to providing athletic training to the athletes, the ATC could teach and oversee student trainer programs, keep accurate records and documentation of injuries and their management, and develop better lines of communication between the schools and the medical community.

This type of arrangement would need the cooperation of the school districts and the medical community. The financial impact of such an agreement might be significant. Many physical therapy clinics might be willing to donate a portion of the ATC's time, considering the potential for referrals.

This kind of collaborative effort within a school district could keep costs down to a manageable level. It could actually be a cost-saving proposal, considering the cost of a fulltime faculty member. With more and more negligence cases being brought against high schools, the cost savings becomes even more dramatic.

The bottom line is that too many school districts are lagging in their efforts to provide proper medical coverage for practice sessions and games. Every high school in the United States should have a medical professional for their afternoon activities. The health and physical well-being of high school athletes would be the primary beneficiary.

References

* Culpepper, M.I.: "The availability and Delivery of Health Care to High School Athletes in Alabama," Phys. Sportsmed., 1986.

* Hossler, P.: "To Acquire an Athletic Trainer on the High School Level," Athl. Train. JNATA, 1985.

* Stopka, C. & Kaiser, D.: "Certified Athletic Trainers in Our Secondary Schools, The Need and the Solution," Athl. Train. JNATA, 1988.

* NATA: "National High School Injury Survey 1995," NAIA News, 1996.

* Powell, J.: "636,000 Injuries Annually in High School Football," Athl. Train. JNATA, 1987.

* Prentice, E.P. & Mishler, B.: "A National Survey of Employment Opportunities for Athletic Trainers in the Public Schools," ATHL. Train. JNATA, 1986.

* Whieldon, T.J. & Cerny, F.J.: "Incidence and Severity of High School Athletic Injuries." Athl. Train. JNATA, 1990.