I’d like to start with a story that speaks to every parent’s worst fear.
“By mid-afternoon on August 1, 2017, the temperature in Stockton, Calif. was at least 105 degrees. Thirteen-year-old Jayden Galbert complained to his mother, Shynelle Jones, about the heat, but didn’t want to skip preseason football practice and hurt his chances of making the freshman football team. Instead, he showed up, pushed himself to participate, and then collapsed on the field. “He started vomiting and he was shaking,” Jones says. “He couldn’t see. He was trying to focus, but he couldn’t.” Jayden was eventually airlifted to UC Davis Medical Center, where he was diagnosed with exertional heat stroke, which in turn led to rhabdomyolysis, a dangerous condition in which muscle breakdown can cause kidney damage. “His entire body was shutting down and I almost lost him,” Jones wrote on Facebook shortly afterwards.” – excerpt from His Entire Body Was Shutting Down.' New State Rankings Show Gaps in High School Athlete Safety (Lewis, 2018)
Jayden spent 5 days in the ICU at UC Davis Hospital. A year later he still sees a therapist to address his PTSD because of the event and walks with a limp because of pain in his legs related to the rhabdomyolysis he suffered. He is not currently playing football. In the end, Jayden survived, but not without physical and emotional scars (Lewis, 2018). What he suffered was potentially preventable with access to an athletic trainer – a health care practitioner specifically trained to prevent, recognize, and treat emergent conditions such as the exertional heat illness Jayden suffered. Based on the story it’s difficult to tell if heat acclimatization guidelines and other practice guidelines were followed but, with an athletic trainer, it’s more likely to be the case.
The Issue – From First to Worst
33 years – In 1986 California proposed AT licensure for the first time and it was ultimately vetoed (Mayer, 2017). At that time, it was considered proactive. Now, it’s taken so long that California is the ONLY state in the union that does not protect the profession of athletic training.
50th place – California’s current rank on the school sports safety rankings (Korey Stringer Institute, 2019). California continues to rank at the bottom of the list, not only because athletic trainers aren’t licensed or even required in high schools, but because schools are not legally required to follow a variety of emergency action plan guidelines intended to mitigate heat illness risk. Schools are also not legally required to screen for a previous history of/risk for several conditions that can result in disability or death if not detected or monitored, including heat illness, concussion, cardiac disease, and sickle cell trait. Schools are legally required to remove athletes from play who are believed to have suffered a concussion, and not return them to play without further evaluation as well as have access to AED as of July 1, 2018. These two laws account for most of the points earned relative to the state ranking.
The question is, without regard to legal necessity, who is the most qualified professional to ensure your school meets the standard of care when it comes to prevention, risk mitigation and implementation of emergency action plans? The answer – athletic trainers. The high schools in California that have committed to employing an athletic trainer exhibit a commitment to the overall health, wellness and safety of their student athletes.
819,625 athletes - The total number of high school athletes (National Federation of State High School Associations, 2018) in California, the second most nationally behind only Texas. These athletes deserve the services and expertise of an athletic trainer to make their sports experience safer. These athletes face two major risks to their sport safety: 1) No full-time athletic training coverage (part-time or none) and/or 2) Coverage by someone who is referring to themselves as an “athletic trainer” but does not meet the educational and credentialing standards to ensure athlete safety.
Risk #1 – Limited or No Access to Athletic Trainer
1,558 schools - The number of high schools in California (Korey String Institute & National Athletic Trainers' Association, 2018).
80% - The number of high schools that do not have at least 1 full-time athletic trainer. Of this group, only 37% of these schools have access to a part-time athletic trainer (Korey String Institute & National Athletic Trainers' Association, 2018). While this may be a step in the right direction, it should be a temporary solution.
43% - The number of high schools that have NO athletic trainer available. Assuming student athletes are distributed evenly across all schools, approximately 353,439 athletes do not have a trained advocate available to protect their health, wellness and safety (Korey String Institute & National Athletic Trainers' Association, 2018).
Risk #2 – Care Provided by an Unqualified Individual Utilizing Title of “Athletic Trainer”
When Miller Boafo, a Redlands High School football player, suffered a hit during a game, his team’s athletic trainer (or AT) diagnosed his response as “flu-like symptoms.” After the ambulance was called because Boafo became unconscious, he was taken to the hospital, subsequently undergoing a five-hour brain surgery for bleeding in the brain that almost went undiagnosed. The Redlands High School athletic trainer is still employed and still not certified. And, as of now, that’s perfectly legal. – excerpt from Rehabilitating Sports Safety: Mandating Certified Athletic Trainers in California High Schools (McAnally, 2018)
16.2% - The number of high school athletic trainers using the title of “athletic trainer” that are not properly educated and credentialed, putting other athletes at risk like Miller Boafo. If a parent (or other member of the community) identifies an unqualified professional there is no recourse - no formal process to report a complaint against an athletic trainer for malpractice. Properly credentialed athletic trainers have no protections either. Without licensure there is no accountability for professionals to maintain a minimum level of education, standard of care, and professionalism (McAnally, 2018).
50% - The percentage of all injuries experienced at the high school level that are experienced by football players. These players are more likely to be African-American, disproportionately exposing this group to dangerous life-threatening injuries without the services of a licensed athletic trainer.
The Value – In Our High Schools and Beyond
January 25, 2017 was an afternoon like any other, until it wasn’t. Javier Venegas, a 20-year-old track athlete at Golden West College (GWC), collapsed on the track and wasn’t breathing. Seeing the incident, GWC’s track coach ran to get GWC’s certified Athletic Trainer Pat Frohn, who was in his office. Jumping into action, Frohn grabbed his emergency pack, containing an AED, and raced to the track with Athletic Training Intern Tori Mulitauaopele and the track coach. As the three arrived on the scene, GWC Assistant Track Coach Hank Cochrane was administering chest compressions on the student and Frohn assessed the student’s condition.
“After checking his vitals, I confirmed Javier wasn’t breathing and didn’t have a pulse,” said Frohn. “At that point I took over chest compressions and instructed Tori to start rescue breathing.” Frohn used the AED as he and Mulitauaopele continued CPR; Frohn delivered the jolt and Venegas’ heart started beating and he began breathing. At this point, the EMT arrived and transported the athlete to the emergency room, where he was put into a medically induced coma.
Today, Venegas is fully recovered from what was determined to be a heart arrhythmia. The cardiologists who treated Venegas and his family credit the athletic trainers with saving his life that day.“Each cardiologist who saw him, at three different hospitals, said Javier was alive today because these individuals took quick action,” said Valerie Venegas, Javier’s mother. “Luckily, the right people were in the right place at the right time; this could have been a very different story.” – Taken from California Athletic Trainers’ Association Lifesavers Recognition (California Athletic Trainers' Association, 2017)
Licensing and hiring athletic trainers to protect the public is a win-win value proposition. Hiring athletic trainers saves lives and emotional distress and even saves money. Not only can athletic trainers provide emotional support directly, but by preventing the tragedy of an unanticipated death, communities are saved from a heart-wrenching, life-altering experience that can take years to recover from (Huggins, 2017). Athletic trainers, with a unique focus on prevention, not only save lives, but can also save time and money making them an economic value as much as a public health and safety value.
5.7 times higher – The recurring injury rate for soccer players without an athletic trainer (McAnally, 2018). The overall injury rate for soccer players in schools without an athletic trainer is 1.73 times higher as compared to schools with an athletic trainer (McAnally, 2018).
8.05 times more – The number of times concussions are reported in schools with an athletic trainer, meaning concussions are less likely to go undiagnosed and untreated (McAnally, 2018).
$8,300 per year - The cost savings for schools that employ athletic trainers, not including cost savings by student athletes and their families for care provided, fewer physician visits and fewer physical therapy visits (McAnally, 2018).
78% decrease in the cost related to musculoskeletal disorder prevention in the workplace for athletic trainers employed by companies with health and safety teams (Middleworth, 2018).
5.5 minutes per patient – The time saved by athletic trainers (ATs) in various physician practice settings; improving clinical efficiency, enhancing patient throughput, and providing high physician and patient satisfaction. For orthopedic patients the time savings is 7 minutes. This means more patients can receive needed health care on any given day (Pecha, 2017).
“To meet the challenges of the next decade, athletic trainers can actively engage in physician practice settings enhancing patient throughput and satisfaction in orthopedic, sports medicine and primary care practices across urban, suburban and rural settings (Noller, 2018).”
$8.6 million – The annual amount the Marine Corps will invest in athletic trainers over the next four years to improve the care of Corp members and the Corps’ ability to identify and track injury trends. This means more Marines will remain deployable. Currently all branches of the military and the military academies employ athletic trainers (Harkins, 2018).
Support and Sign AB 1592
39 million people - The number of Americans that proudly call themselves Californians. It’s time to protect them all by protecting properly educated, trained, and certified athletic trainers. No more imposters for safety’s sake. Let’s engage these highly trained professionals in protecting our citizens at work, our children at school and play, and our servicemembers while protecting our country. Engage athletic trainers in the solutions to move healthcare into the future with a focus on prevention, improved value of care, and patient satisfaction.
According to the California Athletic Trainer’s Association licensing athletic trainers would accomplish the following (California Athletic Trainers' Association, 2019):
Ensure that individuals calling themselves athletic trainers in California high schools have the appropriate education and certification to do so.
Require athletic trainers to collaborate with physicians and update their knowledge and skills on a regular basis.
Protect qualified athletic trainers from legal and financial consequences when traveling with their teams to states that require licensure.
Decrease liability for athletic trainers and their employers (many of which are taxpayer supported institutions) by providing a state sanctioned scope of practice.
Now is time to do the right thing. Athletic trainers provide a critical and unique service to the community that is overdue to be properly recognized and protected. You wouldn’t ask a lifeguard to fight a fire, or a teacher to deal with an illness during the school day, why do we expect coaches and parent volunteers to recognize injuries and illnesses that occur because of sport participation? Let the parents focus on cheering, the coaches on strategizing, the referees on officiating and let the athletic trainers manage the health and wellness of the athletes.
Vote for and request Governor Newsome sign AB 1592.
Photo Credit: San Diego Tribune (2017) - Schools Falling Short in Hiring Athletic Trainers
California Athletic Trainers' Association. (2017). Lifesavers: Paul Frohn & Tori Mulitauaopele. Retrieved from California Athletic Trainers' Association: https://ca-at.org/lifesavers-pat-frohn-and-tori-mulitauaopele/
California Athletic Trainers' Association. (2019). Support AB 1592 in the Assembly. Retrieved from California Athletic Trainers' Association: https://cqrcengage.com/cata/app/write-a-letter?1&engagementId=498480&ep=AAAAC2Flc0NpcGhlcjAxYhO1AUamQ9jSpVmnfYfdYFRDpQ7y5NyQl4BwwFiYvrckjWui-un7jHxy8ZcyLJe0GPWwu9r1uD32CYwBdRnWtIV0lKkYg5mmaB_G5wdG_yQ&lp=0
Harkins, G. (2018, August 17). Athletic Trainers Will Head Out to Marine Units After Years-Long Delay. Retrieved from Military.com: https://www.military.com/daily-news/2018/08/17/athletic-trainers-will-head-out-marine-units-after-years-long-delay.html
Huggins, R. C. (2017). Strategies, Successes, Pitfalls When Working To Hire An Athletic Trainer - 3rd Annual Collaborative Solutions for Safety in Sport National Meeting. Retrieved from National Athletic Trainers' Association: https://www.nata.org/sites/default/files/strategiessuccesspitfalls.pdf
Korey String Institute & National Athletic Trainers' Association. (2018). Athletic Training Services in US Secondary Schools, by State. Retrieved from Athletic Training Services in US Secondary Schools, by State: https://ksi.uconn.edu/wp-content/uploads/sites/1222/2018/09/AT-Services-By-State-Tables.pdf
Korey Stringer Institute. (2019, April 1). 2019 High School S[ports Safety Policy Rankings. Retrieved from Korey Stringer Institute: https://ksi.uconn.edu/high-school-state-policies-2/
Lewis, L. (2018, August 22). His Entire Body Was Shutting Down.' New State Rankings Show Gaps in High School Athlete Safety. Retrieved from Time: http://time.com/5374454/high-school-athlete-safety-rankings/
Mayer, K. (2017). Time For Calif. To Require Licensure Of Athletic Trainers. Retrieved from Crowell & Moring LLP: https://www.crowell.com/files/20170526-Time-For-Calif-To-Require-Licensure-Of-Athletic-Trainers.pdf
McAnally, B. C. (2018). Rehabilitating Sports Safety: Mandating Certified Athletic Trainers in California High Schools. Retrieved from Roosevelt Institute: http://rooseveltinstitute.org/wp-content/uploads/2018/04/Roosevelt_10-Ideas_Healthcare_Rehabilitating-Sports-Safety.pdf
Middleworth, M. (2018). 5 Ways an Athletic Trainer Adds Value to Your Health and Safety Team. Retrieved from Ergo Plus: https://ergo-plus.com/workplace-athletic-trainer-value/
National Federation of State High School Associations. (2018, September). Participation Statistics. Retrieved from NFHS: http://www.nfhs.org/ParticipationStatistics/PDF/2017-18%20High%20School%20Athletics%20Participation%20Survey.pdf
Noller, C. L. (2018, Mar/April). Enhancing Coordinated Care Delivery and the Healthcare Team: The Impact and Future of Athletic Trainers in Ambulatory Practice Settings. The Journal of Medical Practice Management, 33(5), 285-291. Retrieved April 19, 2019, from https://search.proquest.com/openview/4c11e1968454f183c6c6e40425979fd5/1?pq-origsite=gscholar&cbl=32264