High school football championship season is here and, in many school districts around the nation, it’s a very big deal. Teams go to great lengths planning what they hope will be winning strategies; in some instances, entire communities come out to support the players. But there’s one crucial element frequently missing from the sidelines of playing fields during even these biggest games of the season: certified athletic trainers.
It’s unclear whether the specialized training of a certified athletic trainer could have changed the outcome for Elijah Gorham, a 17-year-old Baltimore City high school senior wide receiver who suffered a traumatic brain injury during a fall 2021 game while attempting to make a catch. Elijah remained on the sidelines for 45 minutes after his injury, at some point receiving attention from a medic (whose training or experience is unclear). Afterwards, he was transported by ambulance to a nearby hospital and underwent brain surgery. He died about a month later due to “cardiac arrest, multi-system organ failure, accidental trauma, and a traumatic brain injury,” according to a medical examiner’s report.
Elijah is among at least 200 students who have died playing high school sports in the past decade, according to the National Center for Catastrophic Sport Injury Research. It’s impossible to say how many of these deaths could have been prevented by the presence of certified athletic trainers—health-care professionals who are now required to earn master’s degrees and are trained to assess, prevent, and diagnose orthopedic injuries and other sports-related medical emergencies, as well as do behind-the-scenes work like developing action plans for campuses in the event of medical emergencies, according to the National Athletic Trainers’ Association.
What is clear is that there is a severe shortage of certified athletic trainers in the secondary school setting. About one-third of all high schools in the United States with athletics programs have no athletic training services, according to a 2019 report by the trainers’ group that included input from 20,272 public and private high schools with school-sanctioned interscholastic athletics programs. Among the schools that do employ an athletic trainer, that employee is generally the only such person on staff providing this support, which typically translates to a caseload of up to hundreds of student-athletes from different teams who may be practicing or competing simultaneously. Further, only one state, Hawaii, requires public high schools to employ athletic trainers.
But tragic events like the death of Elijah Gorham create awareness of the important role these professionals play, and spur a push for change in school systems.
“There’s a misperception of the role of the athletic trainer as someone who hands out water and tapes up an ankle here and there,” said Christianne M. Eason, president of sport safety and education for the Korey Stringer Institute and a kinesiology professor at the University of Connecticut. “There’s a lack of recognition of the education and skill set of the certified athletic trainer.”
Low pay, high burnout pose recruitment challenges
Certified athletic trainers weren’t recognized as allied health professionals until 1991, said Eason. Since then, training requirements have increased significantly. Aspiring certified athletic trainers now must earn a master’s degree, pass a comprehensive certification exam, meet ongoing continuing education requirements, and work in collaboration with or under the guidance of a physician.
Advocates had hoped that increasing the requirements of the profession would lead to better pay, but that hasn’t necessarily happened. In 2022, the median pay for athletic trainers (including those in educational and private industry settings) was $53,840 per year.
New Jersey has been able to attract more athletic trainers than some states due to better pay. These professionals in New Jersey belong to the same union as the state’s teachers, so they receive higher (teacher rate) salaries and other benefits of educators, according to Eason. Salaries of New Jersey athletic trainers in 2021 were the fifth highest nationwide (behind Hawaii, Massachusetts, Connecticut, and California), with an annual mean wage of $59,270, according to a Forbes survey.
But because most states aren’t seeing salary hikes for athletic trainers, the profession overall is seeing a lot of burnout.
“You might be the only athletic trainer for hundreds of students. It’s a huge administrative load,” said Eason, who points to administrative duties beyond on-field activities, such as developing emergency action plans and ordering medical supplies. Further, athletic trainers tend to operate in relative isolation compared to most school employees, as they usually work later shifts to accommodate after-school practices and sporting events.
Positive change spurred by litigation
The number of school-based athletic trainers varies from district to district and state to state. Baltimore City public schools, where Elijah was enrolled, has 37 high schools. It hired its only certified athletic trainer amid the calls for change that followed his death. As part of a settlement agreement with the Gorham family, the school system promised, among other actions, to hire athletic trainers at every high school that offers interscholastic athletics by the 2024-2025 school year, according to a Washington Post report. To date, the district has hired only one, with plans to have at least a second person hired by January.
Elijah’s death also prompted a new law in Maryland, The Elijah Gorham Act, which requires middle schools and high schools to “develop venue-specific emergency action plans for the operation and use of automatic external defibrillators, heat acclimatization, and coordination of care for other emergent injuries and severe weather for outdoor facilities”—responsibilities best carried out by a certified athletic trainer.
Support for the profession has also come from a landmark NFL concussion settlement in 2015, the year the Education Fund was launched. One of the fund’s initiatives, the innovATe project, provides funding to support athletic trainers in under-resourced secondary school systems across the country. Districts selected to participate receive funding for an athletic trainer’s salary and necessary equipment and supplies. To date, at least nine districts nationwide have participated in the program, from urban districts such as Boston and Baltimore to rural districts in Georgia and West Virginia.
It’s an initiative Eason sees as vital for under-resourced areas. “Athletic trainers might be the only health-care provider these young people have,” she said.