Key factors for providing appropriate medical care in secondary school athletics: athletic training services and budget

Athletic Trainer and Emergency Medical Technician or Paramedic Opinions of Each Other's Understanding of Essential Emergent Football Injury Situation Tasks

OBJECTIVE

Improving the role understanding between essential emergency healthcare providers may improve teamwork and efficacy. This study asked licensed athletic trainers (ATs) and emergency medical technicians (EMTs) or paramedics for their opinions of the others' understanding of essential tasks in an emergent football injury situation. The hypothesis was that groups would have differing opinions.

METHODS

An electronic survey was emailed to 160 licensed EMTs or paramedics and 45 licensed ATs. All participants were full-time employees with ≥1 year experience at their current position. In addition to demographic questions (age, sex, experience), respondents completed 11, 5-point Likert-scale type questions (end range: "strongly agree" or "strongly disagree") regarding their opinion of the other profession's understanding of essential tasks in an emergent football injury situation. Participants also answered questions about the amount of control of the injury situation they assumed upon scene arrival and how frequently they partnered with the other profession when covering a game. An α level of P ≤ 0.05 was selected to indicate statistical significance.

RESULTS

Thirty-four EMTs or paramedics (21% return) and 12 ATs (26.7% return) responded. Group demographics did not differ with the exception of the EMT or paramedic group having more men (P = 0.006). Emergency medical technicians/paramedics perceived that ATs better understood facemask removal timing (P = 0.002), facemask removal technique (P = 0.04), and extremity splinting (P = 0.02). Athletic trainers perceived that EMTs/paramedics better understood proper airway management (P < 0.001) and cardiopulmonary resuscitation (P < 0.001). EMT/paramedics more strongly perceived control of the injury situation upon scene arrival than ATs (P = 0.005). As AT experience increased, they more strongly agreed that they frequently partnered with EMTs/paramedics (r = 0.84, P < 0.001); however, an insignificant relationship was observed for EMTs/paramedics.

CONCLUSIONS

Opinions differed about the other profession's understanding of essential tasks. More experienced ATs partnered more strongly with EMTs/paramedics. Both professional groups would benefit from collaborative workshops or seminars to improve the teamwork needed to optimize an emergent football injury situation. The development and implementation of practices such as these may also improve teamwork and patient-center healthcare at mass participant sporting events such as marathons, triathlons, and road cycling events.

Medical Supervision of Illinois Public and Private High School Athletics

BACKGROUND

High-school sports participation in the United States has increased over the years with a corresponding increase in the number of injuries. Leading medical and sports organizations nationwide advocate for an increase in proper medical supervision of athletes.

OBJECTIVES

To analyze athletic medical coverage in Illinois high schools and compare differences between public and private Illinois high school.

METHODS

A survey addressing various components of sports medical coverage was distributed in 2018 to all 810 Illinois High School Association (IHSA) high schools to be completed electronically.

RESULTS

The response rate was 50% (407/810 schools). Of the responding schools, 14% were private high schools and 86% public high schools. An orthopedic surgeon, family doctor, pediatrician, or another type of physician were present on sidelines in 9.2% of private high schools and 8.5% of public high schools. Athletic trainers (ATs) were present on sidelines in 91% of private high schools and in 79% of public high schools. There was 68% of private high schools reporting coaches trained in CPR versus 85% in public high schools. Both private and public high schools had high rates of having written emergency action plans (89% vs 91%), AED on site (100% vs 99%), written concussion management protocols (96% vs 97%).

CONCLUSION

Our study found similar rates of high school medical coverage as compared to national studies, with some significant differences found between private and public high schools. Most Illinois high schools had high rates of having written EAPs, concussion management protocols and AEDs on site. Overall, an increase of medical supervision and emergency preparedness is needed, which should come in the form of increasing AT and physician presence alongside community and school engagement for improved implementation of coverage.

Secondary School Socioeconomic Status and Athletic Training Practice Characteristics

CONTEXT

Socioeconomic status (SES) is a significant predictor of morbidity and mortality across health outcomes. Limited information exists on how school SES impacts athletic training practice when a certified athletic trainer (AT) is present at secondary schools.

OBJECTIVE

To describe contact frequencies and service rates provided by ATs for injuries among secondary school student athletes and how these differ by school SES.

DESIGN

Cross-sectional study Setting: Athletic training room (ATR) visit days and AT services were collected from 77 secondary schools. Schools were separated into three school SES groups: affluent (n=31), average (n=29), and disadvantaged (n=17).

PATIENTS OR OTHER PARTICIPANTS

Secondary school student-athletes participating in 12 boys' and 11 girls' sports who visited the ATR during the 2014-2015 through 2018-2019 academic years and received athletic or non-athletic injury care.

MAIN OUTCOME MEASURES

Contact frequencies expressed as ATR visit days per injury, AT services per injury, and AT services per ATR visit day. Rates for service type utilized were expressed as the total count over reported athlete-exposures.

RESULTS

ATs documented 1,191 services. Affluent and average SES school communities provided greater contact frequencies for injury related care compared to disadvantaged school communities, particularly by AT services/injury (7.10±13.08 versus average: 9.30±11.60 and affluent: 9.40±12.20; p=0.020). Affluent school communities provided greater rates of services in five of the eleven service groups reported. No significant differences were observed among school SES groups in therapeutic exercises.

CONCLUSIONS

Our findings reflect that AT practice characteristics may differ by school SES, but these differences do not appear to result in less medical care. Given the complexity and widespread effects of SES, future investigations should utilize a complex method to determine SES as well as aim to identify how SES may impact secondary school student athletes outside of AT practice characteristics.

Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers.

OBJECTIVE

To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries.

DESIGN

Descriptive study.

SETTING

Ninety-five athletic training facilities across 24 states.

PATIENTS OR OTHER PARTICIPANTS

A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1).

MAIN OUTCOME MEASURE(S)

Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care.

RESULTS

A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit.

CONCLUSIONS

Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.

Athletic training employment in secondary schools by geographic setting and school size within the United States

CONTEXT

The Athletic Training Locations and Services (ATLAS) Annual Report suggests there are differences in athletic trainer (AT) employment status on the basis of geographic locale. However, the influence of geographic locale and the school size on AT employment is undetermined.

OBJECTIVE

To describe if differences exist in the odds of having AT services by locale for public and private schools, and by student enrollment for public schools.

DESIGN

Cross-sectional study.

SETTING

Public and private secondary schools with athletics programs.

PATIENTS OR OTHER PARTICIPANTS

Data from 20,078 US public and private secondary schools were obtained.

MAIN OUTCOME MEASURES(S)

Data were collected by the ATLAS Project. AT employment status, locales (City, Suburban, Town, and Rural) for public and private schools, and school size category (large, moderate, medium, and small) only for public schools were obtained. AT employment status was examined for each category with odds ratios. A prediction model was produced by Logistic Regression Analysis.

RESULTS

Of the 19,918 public and private schools with AT employment status and locale, Suburban schools had the highest access to AT services (80.1%) with an increased odds compared with Rural schools (OR = 3.55 [3.28 to 3.850]). Of 15,850 public schools with AT employment status and student enrollment, large schools had the highest rate of having AT services (92.1%) with nearly 18.5 times greater odds (OR = 18.480 [16.197 to 21.083]) versus small schools. The logistic model determined that an odds of having access to AT increases by 2.883 times as the school size goes up by one category.

CONCLUSIONS

Nationally, Suburban schools and large public schools have the largest access to AT services compared to schools that are in more remote areas and with less student enrollment. These findings elucidate the geographic locales and student enrollment levels where AT services are most prevalent.

Access to Athletic Trainer Services in California Secondary Schools

CONTEXT

California is currently the only state that does not regulate who can and cannot call themselves athletic trainers (ATs). Therefore, previous national or state-specific investigations may not have provided an accurate representation of AT availability at the secondary school level in California. Similarly, it is unknown whether the factors that influence AT availability in California, such as socioeconomic status, are similar to or different from those identified in previous studies.

OBJECTIVE

To describe the availability of ATs certified by the Board of Certification in California secondary schools and to examine potential factors influencing access to AT services in California secondary schools.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Representatives of 1270 California high schools.

MAIN OUTCOME MEASURE(S)

Officials from member schools completed the 2017-2018 California Interscholastic Federation Participation Census. Respondents provided information regarding school type, student and student-athlete enrollment, whether the school had ATs on staff, and whether the ATs were certified by the Board of Certification. The socioeconomic status of public and charter schools was determined using the percentage of students eligible for free or reduced-price lunch.

RESULTS

More than half (54.6%) of schools reported that they either did not employ ATs (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7.0%). Nearly 30% of student-athletes in California participated in athletics at a school that did not employ ATs (n = 191 626, 28.9%) and 8% of student-athletes participated at a school that employed UHP in the role of AT (n = 54 361, 8.2%). Schools that reported employing ATs had a lower proportion of students eligible for free or reduced-price lunch than schools that did not employ ATs and schools that employed UHP (both P values < .001).

CONCLUSIONS

With ongoing legislative efforts to obtain regulation of ATs in California, secondary school administrators are encouraged to hire ATs with the proper certification to enhance the patient care provided to student-athletes and improve health outcomes.

Implementation Science: Lessons Learned From Evaluating Practice Recommendations for the Care of Patients With Spine Injuries

Health care providers are encouraged to provide care according to practice recommendations because these suggestions should improve patient care and promote optimal patient outcomes. The goals of these practice recommendations are to improve patient care and promote optimal patient outcomes. However, without integration into clinical practice, the value of practice recommendations in supporting patient care is lost. Unfortunately, little is known about the success of integrating practice recommendations into clinical practice, and targeted efforts to promote integration are likely needed. Implementation research is a broad area of study that focuses on how guidelines, programs, or interventions are put into practice and delivered. The Translating Research Into Injury Prevention Practice (TRIPP) framework consists of 6 stages that support implementation science, and the framework has been used to assist in integrating injury-prevention programs into patient care. The structure of the TRIPP framework makes it applicable to other programs that would benefit from implementation science, including practice recommendations. Stages 5 and 6 of the TRIPP framework emphasize the need to explore the implementation context and factors related to uptake of a program by end users. This commentary highlights our efforts to use methods for implementation research to evaluate stage 5 of the TRIPP framework as it relates to acute care for patients with suspected spine injuries and provides 6 lessons learned that may assist in future efforts to better implement practice recommendations in patient care. Targeted efforts to assist clinicians in implementing practice recommendations may promote their use and ultimately enhance the care provided for patients with a variety of health conditions. An essential component of any implementation effort is understanding end users via stages 5 and 6 of the TRIPP framework, and this understanding may maximize knowledge translation and encourage practice change and advancement.

School and Community Socioeconomic Status and Access to Athletic Trainer Services in Wisconsin Secondary Schools

CONTEXT

Secondary schools have made significant progress in providing athletic trainer (AT) coverage to their student-athletes, but the levels of access at schools with ATs may vary widely. Socioeconomic disparities in medical coverage and access have been noted in other health care fields, but such disparities in the level of access to AT services have not been thoroughly examined.

OBJECTIVE

To determine if (1) access to AT services or (2) the level of access (AT hours per week and athletes per AT hour) differed based on the socioeconomic characteristics of secondary schools.

DESIGN

Cross-sectional study.

SETTING

Mailed and e-mailed surveys.

PATIENTS OR OTHER PARTICIPANTS

High school athletic directors and ATs from 402 Wisconsin high schools.

MAIN OUTCOME MEASURE(S)

Respondents provided information as to whether their school used the services of an AT and the number of hours per week that their school had an AT on-site. The number of athletes per AT hour was calculated by dividing the total number of athletes at the school by the number of hours of AT coverage per week. The socioeconomic status of each school was determined using the percentage of students with free or reduced-cost lunch and the county median household income (MHI).

RESULTS

Schools without an AT on-site were in lower MHI counties ( P < .001) and had more students eligible for a free or reduced-cost lunch ( P < .001). Lower levels of AT access (fewer hours of AT access per week and more athletes per AT hour) were observed at schools in the lowest third of the county MHI and with the highest third of students eligible for a free or reduced-cost lunch ( P < .001).

CONCLUSIONS

Socioeconomic disparities were present in access to AT services. New models are needed to focus on providing a high level of AT access for all student-athletes, regardless of socioeconomic status.

Epidemiologic comparisons of soccer-related injuries presenting to emergency departments and reported within high school and collegiate settings

BACKGROUND

Few studies compare sports injury patterns in different settings. This study described the epidemiology of soccer injuries presenting to emergency departments (EDs) and compared injuries presenting to EDs to injuries presenting to collegiate and high school athletic trainers (ATs).

METHODS

Soccer-related injuries (product code 1267) in the National Electronic Injury Surveillance System (NEISS) that were sustained by individuals at least two years of age in 2004-2013 were included. High School Reporting Information Online (HS RIO) data for high school soccer injuries during the 2005/06-2013/14 academic years were compared to NEISS data for those aged 14-17 years in 2005-2013. National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) data for collegiate soccer injuries during the 2009/10-2013/14 academic years were compared to NEISS data for those aged 18-22 years in 2009-2013. All datasets included weights to calculate national estimates. Injury proportion ratios (IPRs) with 95% confidence intervals (CIs) compared nationally estimated injury distributions between the HS RIO/NCAA-ISP and NEISS data subsets.

RESULTS

During the study period, 63,258 soccer-related injuries were captured by NEISS, which translates to an estimated 2,039,250 injuries seen at US EDs nationwide. Commonly injured body parts included the head/face (19.1%), ankle (17.6%), hand/wrist (15.3%), and knee (12.2%). Common diagnoses included sprains/strains (34.0%), fractures (22.2%), and contusions (17.7%). Compared to their respective age ranges in NEISS, sprains/strains comprised a larger proportion of injuries in HS RIO (48.3% vs. 33.7%; IPR = 1.38; 95% CI: 1.33, 1.42) and NCAA-ISP (51.3% vs. 37.0%; IPR = 1.39; 95% CI: 1.31, 1.46). In contrast, fractures comprised a smaller proportion of injuries in HS RIO than in NEISS (7.5% vs. 18.6%; IPR = 0.43; 95% CI: 0.39, 0.47) and NCAA-ISP (2.8% vs. 15.7%; IPR = 0.18; 95% CI: 0.14, 0.22).

CONCLUSIONS

ATs more commonly reported injuries that are easily diagnosed and treated (e.g., sprains/strains); EDs more commonly reported injuries with longer recovery times and rehabilitation (e.g., fractures). Although ED surveillance data can identify the most severe sports-related injuries, high school and college sports surveillance may better describe the breadth of sports-related injuries. Our findings may provide further support for school-based sports medicine professionals, but further research is needed to comprehensively examine the potential economic and health-related benefits.

Athletic Trainers' Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

  For the practice characteristics of the services athletic trainers (ATs) provide to be identified, all ATs must complete high-quality patient care documentation. However, little is known about ATs' perceptions of patient care documentation or the potential barriers they may encounter while trying to ensure high-quality documentation.

OBJECTIVE

  To explore ATs' perceptions of and barriers to patient care documentation via the Clinical Outcomes Research Education for Athletic Trainers (CORE-AT) electronic medical record system in the secondary school setting.

DESIGN

  Qualitative study.

SETTING

  Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

  We interviewed 10 ATs (4 men, 6 women; age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) who were members of the Athletic Training Practice-Based Research Network (AT-PBRN) and employed in the secondary school setting.

DATA COLLECTION AND ANALYSIS

  We conducted an individual interview with each participant. After transcription of the interviews, the data were analyzed into common themes and categories following the consensual qualitative research tradition. Data triangulation occurred through member checking and multiple researchers to ensure accuracy during data analysis.

RESULTS

  Participants revealed several perceptions of patient care documentation, consisting of quality, expectations and accountability, priority, incentive, and culture of the secondary school setting. In addition, we identified barriers to quality patient care documentation: lack of time, lack of accountability for documenting patient care, inadequate facility resources, and lack of personnel. Participants discussed the volume of patients as a unique challenge in the secondary school setting.

CONCLUSIONS

  Whereas ATs perceived patient care documentation as important, several practical barriers may inhibit their ability to complete high-quality documentation of the services they provide. Effective strategies to improve the quality of patient care documentation among ATs are needed to ensure that their value, particularly in the secondary school setting, is accurately characterized.

Athletic Training Services During Daily Patient Encounters: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

Athletic training services such as taping, wrapping, and stretching are common during routine care but rarely captured in traditional patient documentation. These clinical data are vital when determining appropriate medical coverage and demonstrating the value and worth of athletic trainers (ATs).

OBJECTIVE

To analyze clinical data from daily encounter forms within the Athletic Training Practice-Based Research Network (AT-PBRN).

DESIGN

Descriptive study.

SETTING

Secondary school athletic training clinics.

PATIENTS OR OTHER PARTICIPANTS

Adolescent patients (n = 4888; age = 16.3 ± 1.4 years) seeking care from ATs.

MAIN OUTCOME MEASURE(S)

We used Web-based electronic medical records from December 1, 2009, to July 1, 2015, to obtain patient characteristics via deidentified data. Descriptive data regarding practice characteristics from patient encounter forms were analyzed and reported as percentages and frequencies.

RESULTS

A total of 36 245 patient encounters (mean = 7.5 ± 11.6 encounters per patient) were recorded. Football, basketball, soccer, track, and volleyball accounted for 85.1% of all encounters. Most encounters were for preventive services (48.8%, n = 22 329), followed by care for a current injury (37.2%, n = 17 027) and care for a new injury (13.9%, n = 6368). Of the preventive encounters, taping (52.7%) was the most common service provided, followed by ice- or hot-pack application (25.4%) and treatment (9.6%). Taping (28.7%) was also the most common service for current injuries, followed by treatment (26.7%) and ice- or hot-pack application (26.2%).

CONCLUSIONS

Our findings highlight the unique role of ATs as health care providers who provide substantial preventive services to their patients. Further, these results represent one of the first attempts to describe athletic training services related to nontime-loss injuries, emphasizing the significant role that ATs play in the health care of secondary school athletes. These findings should help clinicians and administrators make more informed decisions regarding appropriate medical coverage.

Athletic Directors' Barriers to Hiring Athletic Trainers in High Schools

CONTEXT

In its best-practices recommendation, the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs urged all high schools to have a certified athletic trainer (AT) on staff. Despite the recommendation, many high schools lack the medical services of an AT.

OBJECTIVE

To examine the barriers that athletic directors (ADs) face in hiring ATs in public high schools and in providing medical coverage for their student-athletes.

DESIGN

Qualitative study.

SETTING

Semistructured telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty full-time public high school ADs (17 men, 3 women) from various geographical regions of the United States (6 North, 4 South, 4 Midwest, 6 West) participated. Data saturation guided the total number of participants.

DATA COLLECTION AND ANALYSIS

We completed telephone interviews guided by a semistructured questionnaire with all participants. Interviews were recorded and transcribed verbatim. Multiple-analyst triangulation and peer review were included as steps to establish data credibility. We analyzed the data using the principles of the general inductive approach.

RESULTS

We identified 3 themes. Lack of power represented the inability of an AD to hire an AT, which was perceived to be a responsibility of the superintendent and school board. Budget concerns pertained to the funding allocated to specific resources within a school, which often did not include an AT. Nonbudget concerns represented rural locations without clinics or hospitals nearby; misconceptions about the role of an AT, which led to the belief that first-aid-trained coaches are appropriate medical providers; and community support from local clinics, hospitals, and volunteers.

CONCLUSIONS

Many ADs would prefer to employ ATs in their schools; however, they perceive that they are bound by the hiring and budgeting decisions of superintendents and school boards. Public school systems are experiencing the consequences of national budget cuts and often do not have the freedom to hire ATs when other school staff are being laid off.

Epidemiologic comparison of injured high school basketball athletes reporting to emergency departments and the athletic training setting

CONTEXT

Basketball is a popular US high school sport with more than 1 million participants annually.

OBJECTIVE

To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005-2011 seasons.

DESIGN

Descriptive epidemiology study.

SETTING

Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database.

MAIN OUTCOME MEASURE(S)

Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison.

PATIENTS OR OTHER PARTICIPANTS

Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball.

RESULTS

Nationally, an estimated 1,514,957 (95% confidence interval = 1,337,441, 1,692,474) athletes with basketball-related injuries reported to the emergency department and 1,064,551 (95% confidence interval = 1,055,482, 1,073,620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values < .0001). Comparisons of body site and diagnosis combinations revealed additional differences. For example, athletes with lower leg fractures more often presented to the emergency department (IPR = 6.53), whereas those with hand fractures more frequently presented to the athletic training setting (IPR = 1.18; all P values < .0001).

CONCLUSIONS

Patterns of injury differed among high school basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department.

The national sports safety in secondary schools benchmark (N4SB) study: defining athletic training practice characteristics

CONTEXT

Increased rates of sport participation and sport-related injury have led to greater emphasis on and attention to medical care of student-athletes in the secondary school setting. Access to athletic training services is seen as a critical factor for delivering adequate injury prevention and medical care to student-athletes. However, few data are available regarding practice characteristics of athletic trainers (ATs) in this setting.

OBJECTIVE

To characterize the practices of secondary school athletic trainers (ATs).

DESIGN

Descriptive study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 17 558 ATs with current National Athletic Trainers' Association membership were identified for survey distribution. Of these, 4232 ATs indicated that they practiced in the secondary school setting, and 4045 completed some part of the survey.

MAIN OUTCOME MEASURE(S)

A Web-based survey was used to obtain demographic information about ATs and their secondary schools and characteristics of athletic training practice. Descriptive data regarding the athletic trainer's personal characteristics, secondary school characteristics, and practice patterns are reported as percentages and frequencies.

RESULTS

Most respondents were in the early stages of their careers and relatively new to the secondary school practice setting. Nearly two-thirds (62.4%; n = 2522) of respondents had 10 or fewer years of experience as secondary school ATs, 52% (n = 2132) had been certified for 10 or fewer years, and 53.4% (n = 2164) had 10 or fewer years of experience in any practice setting. The majority of respondents (85%) worked in public schools with enrollment of 1000 to 1999 (35.5%) and with football (95.5%). More than half of respondents were employed directly by their school. Most respondents (50.6%) reported an athletic training budget of less than $4000. The majority of ATs performed evaluations (87.5%) on-site all of the time, with a smaller percentage providing treatments (73.3%) or rehabilitation (47.4%) services all of the time.

CONCLUSIONS

This is the first study to describe secondary school athletic training that reflects national practice trends. To improve the quality of athletic training care and to support and improve current working conditions, the profession must examine how its members practice on a day-to-day basis.

Evidence-based medicine and the recognition and treatment of exertional heat stroke, part II: a perspective from the clinical athletic trainer

CONTEXT

Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented.

OBJECTIVE

To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS.

DESIGN

Qualitative study.

SETTING

In-person focus groups consisting of 3 to 6 collegiate or high school ATs.

PATIENTS OR OTHER PARTICIPANTS

A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study.

DATA COLLECTION AND ANALYSIS

Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data.

RESULTS

Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting.

CONCLUSIONS

Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings.