Injuries, Liability Spur Demand for Athletic Trainers

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In January, Spencer Frost broke his leg playing basketball for his high school team in Waterford, Wis.

"I felt it pop and snap," the 17-year-old Waterford Union High School athlete recalled recently. "I was in enough pain that I rolled around on the floor for a while."

It was an away game, and no medical personnel were on hand. So his coach was responsible for evaluating the injury. Although Mr. Frost asked to go to a hospital and to call his mother, he says the coach wrapped his leg up, helped him onto the bus, and let him off at his own school, where his mother picked him up.

Seven pins, a metal plate, and a month's absence from school later, Mr. Frost and his family have begun the process of filing a $10 million lawsuit claiming negligence.

Such incidents of serious sports injuries and legal battles as a result of them are becoming increasingly common, say experts on school sports, many of whom are advising districts to protect both athletes from injury and schools from liability by hiring certified athletic trainers.

"An athletic trainer is trained to provide prevention in areas of education, in areas of diet, preseason physicals, and in areas of environment when it may be too hot to practice," said Tad Blackburn, an executive officer with the American Physical Therapy Association in La Crosse, Wis. "But also the trainer is there to do triage," he said, "and to refer the athlete to a physician if necessary."

Michelle Klein, the executive director of the National Youth Sports Safety Foundation Inc. in Washington, agrees. High school athletic programs, she argues, especially those with football and other contact sports, should have an athletic trainer--even though school officials often dispute the need for one.

"The controversy arises because people say safety needs to be put first, but others say kids won't be able to play sports if an athletic trainer is needed, since it costs the school too much," she said. "We feel that safety needs to be the number-one priority."

'Safety Is Paramount'

According to the National Safe Kids Campaign, 3 million children experience sports- or recreation-related injuries each year. Twenty percent of young people participating in school sports and other athletic activities are injured, and one-fourth of those injuries are considered serious, the Washington-based advocacy group says.

No national statistics exist for the number of certified trainers employed by schools, but experts say the number is growing.

Dr. Judy Young, the executive director of the National Association for Sport and Physical Education, based in Reston, Va., says higher levels of performance and competition at the high school level have increased demand for the trainers. ''Safety is paramount," she said. "You can't have 14- to 18-year-olds sacrificing their bodies for a game."

Many school administrators who have hired athletic trainers agree, saying the cost is more than justified because of the increase in student safety.

"The athletic trainer is the most important position in the program," said Bob Fisher, the athletic director at Rockland High School in Rockland, Mass. "It has to be budgeted into the school. If it's important to the school, it should be supported. It would be the last position I would cut."

Mr. Fisher said the trainer at his school works a minimum of three hours a day, for about $18,000 a year.

The trainer, he said, takes the responsibility away from coaches, who aren't trained to deal with injuries. "Now they can coach the sport and not worry about the peripheral stuff, " Mr. Fisher said.

Another important benefit is that "the athletes gain peace of mind and a satisfaction that they are going to a person who has knowledge of sports injuries," he added. "It's like going to a math teacher for math help instead of the history teacher for math help."

Wisconsin's Waterford Union High has a certified trainer, but he only attends home games, said Mr. Frost, the injured basketball player. Mr. Frost believes that if the trainer had been there when he broke his leg, he would have received better care.

The coach "didn't treat me anywhere close to how he should have," asserted Mr. Frost, who filed an administrative claim, called a "notice of injury" in May. The claim names as possible defendants Waterford Union High School; Wilmount High School, where the injury occurred; the state education department; and the Wisconsin Interscholastic Athletic Association.

Doctors told Mr. Frost and his family that he had broken his fibia, dislocated his ankle, and had minor frostbite on his leg from the ice placed directly on the skin. The claim filed seeks $10 million in damages.

Mr. Frost's coach did not return several calls in recent weeks seeking comment, but Waterford Union's principal, Larry Berg, said the coach followed school policy and had done nothing wrong in treating Mr. Frost's injury.

He declined further comment on the case, and officials with the 900-student Waterford Union High School District also declined to discuss the case.

Contracting for Services

All four high schools in the Parkway school system in Chesterfield, Mo., have had athletic trainers for more than a decade, said Mike Gohn, the athletic director for the 21,000-student district. He recalls a specific incident last year in which the investment paid off.

"We had a district baseball tournament where a certified athletic trainer was on duty," Mr. Gohn said. A base runner sliding into home plate collided with the catcher, leaving the runner with a broken neck. "Having someone there made all the difference," Mr. Gohn said. "I can't put a price tag on that feeling of comfort."

While many districts hire trainers themselves, others contract with local hospitals for such services. HealthSouth Braintree Hospital in Braintree, Mass., has contracts with 16 area schools to provide athletic trainers. The cost for a school runs from $10,500 to $25,700 a year, said Jeri Anderson, the hospital's supervisor of athletic-training services.

She said the number of such contracts has grown in the past 10 years as schools have realized that the trainers substantially reduce their risk of liability.

A.J. Ricciuti, the program director for the department of physical medicine and rehabilitation at Middlesex Hospital in Hartford, Conn., has five schools on contract for athletic-training services.

"Schools want quality people who deal with athletic injuries on a regular basis, rather than have the coaches treating kids," Mr. Ricciuti said.

Model Program

Other experts stress that the use of trainers is not the only answer to a school's sports-safety problems. Often, the idea isn't realistic for rural schools with only a few dozen students, said Dr. Steven Rice, a pediatrician and sports-medicine specialist at the Jersey Shore Sports Medicine Center in Neptune, N.J.

In the 1970s and '80s, he conducted a 17-year study of 20 high schools in Washington state to gauge different ways of protecting student athletes. "Including a trainer is the best way, but it is not the only thing," Dr. Rice said. "You need to look at quality of coaches, conditions of field and courts, condition of equipment, and overall safety issues."

He has developed a model program for the U.S. Department of Education that describes six elements for a good athletic-health-care program:

  • Assess the quality of staff training, fields, equipment, training room, and record-keeping services;
  • Educate everyone involved with sports programs, including coaches, athletic directors, and students;
  • Create procedures, protocols, and standards for care of athletes;
  • Create a central training room where all care will take place;
  • Keep records of injuries; and
  • Evaluate those efforts to see what needs to be worked on.

"Everyone wants athletes to play better and to win," Dr. Rice said. "Here's a way using the health-care side to do that."

Greater Awareness

Jon Almquist, the training specialist for the Fairfax County, Va., schools, developed a system to track sports-related injuries.
--Benjamin Tice Smith

Jon Almquist, the training specialist for the Fairfax County, Va., public schools, says that all 23 high schools in the suburban Washington district have certified trainers on staff.

"Our main concern is the overall, proper, on-site, immediate care of injuries," said Mr. Almquist, who also chairs a secondary schools committee for the National Athletic Trainers Association.

Under Mr. Almquist, the 156,000-student Fairfax district has devised a tracking system that provides information on everything from the severity of injuries to the number of ice packs a trainer gives out. "I think we are more aware of the potential for catastrophe," he said, and parents appreciate the attention to safety.

Mr. Almquist understands that not all schools can afford athletic trainers and suggests that sports program try to work with local clinics or hospitals to establish at least the beginnings of such services.

Dr. Young, of the National Association for Sport and Physical Education, notes that the cost factor is an issue not only in rural areas, but in cities as well.

"City schools need to support 25 athletic trainers to have one in every school," she said, "unlike the four or three needed in modest communities and towns."

Vol. 18, Issue 40, Pages 1, 11

Published in Print: June 16, 1999, as Injuries, Liability Spur Demand for Athletic Trainers
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