Administrators of high school and youth sports are responsible for the safety and welfare of all participants in their charge. They also carry some degree of liability for participants when serious injuries or illnesses occur. These cases appear frequently in the media, yet the rate and type of meaningful changes to eliminate them is astonishingly and unacceptably slow.
The Connecticut Legislature will consider a bill this year that would require coaches to be educated on how to prevent, recognize and manage heat prostration — including heat stroke, which is a medical emergency.
The late Korey Stringer died of heat stroke during Minnesota Vikings training camp in 2001. This is just one example of a sport participation medical catastrophe. A 20-year gap between a fatality and action to prevent future deaths is unacceptable. Additional examples are readily available in multiple sports medicine and legal journals.
Most states have only guidelines or policies as to how sports healthcare services should be provided for amateur athletes, and by whom. But typically, healthcare services aren't required.
Approximately 65 percent of United States high schools do not employ licensed athletic trainers — either on staff or from a third-party provider. Who provides on-site healthcare for the athletes at the remaining schools? Why this is still a question in 2021 is difficult to understand. Advances in healthcare in recent decades have been beyond amazing. However, initiation and implementation of healthcare for all athletes in high schools is woefully absent.
Parents must ask themselves how sports injuries and illnesses are managed for their kids, if they're managed at all.
A 20-year gap between a fatality and action to prevent future deaths is unacceptable.
Coach-directed healthcare cannot succeed. Coaches that provide or even influence care are clearly in a conflict-of-interest situation and thereby should recuse themselves. Doing so is best not only for the athlete, but the coach, as coaches with no medical credentials who involve themselves in athlete healthcare expose themselves to significant legal liability. Therefore, the medical case management chain of command can never include a coach. Athlete healthcare must be remanded to healthcare professionals — licensed athletic trainers.
The assumption that coaches are qualified and experienced in any aspect of sports medicine is erroneous. Alternative solutions are available. Here are some suggestions:
• State health departments, state high school athletic associations, the National Athletic Trainers' Association and possibly other agencies should collaboratively and assertively research all aspects of amateur sports healthcare and provide corrective recommendations for evidence-based reforms.
• State legislators and high school athletic associations should require all high schools to employ a licensed athletic trainer. If participation numbers exceed resources, additional resources must meet demand.
• All high schools should be required to evaluate and upgrade their athlete healthcare programs and correct every existing shortcoming, including hiring licensed professionals to provide on-site care.
Athlete healthcare must supersede all other outcomes of participation. Creating a new model that reflects this immutable goal begs aggressive attention. Problems are opportunities. Solutions are available. We are currently choosing to not use them.
Bob Broxterman is a licensed athletic trainer with decades of experience spanning the high school, collegiate and professional levels.
This article appears in the June 2021 issue of Athletic Business with the title "A licensed athletic trainer’s take on coach-directed medical care." Athletic Business is a free magazine for professionals in the athletic, fitness and recreation industry. Click here to subscribe.
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