More boys and girls are participating in high school sports than ever before, with participation for the 2011-2012 school year setting an all-time high of almost 7.7 million students.
To help middle and high schools and private- and community-based youth sports organizations (YSOs) provide appropriate medical care to secondary-school-aged adolescents in sports, the National Athletic Trainers' Association (NATA) has issued a Summary Statement calling for schools and YSOs to establish, in consultation with administrators, coaches, parents and athletes, athletic health care teams (AHCTs) to approach the issue of athletic injuries in a comprehensive way.
The Summary Statement, published in the August 2008 issue of The Journal of Athletic Training, contains 11 consensus recommendations:
- Develop and implement a comprehensive athletic health care administrative system. Schools and YSO's should establish AHCTs to function in a coordinated and efficient way with coaches and administrators and ensure that appropriate medical care is provided for all participants. The AHCT should include an on-site certified athletic trainer supervised by a team physician who will be ultimately responsible for medical decisions.
- Determine the individual's readiness to participate through the preparticipation physical examination (PPE). A PPE is required for all participants in every scholastic sport (except in Rhode Island) and should be encouraged for all those participating in community-based sports programs as well. The fact that, according to the AMA, the PPE serves as the only routine health maintenance for 80% to 90% of adolescents, highlights the critical importance of an annual PPE, preferably performed by the athlete's primary care physician, school doctor, or team physician and based on the the so-called "five society monograph" and including cardiovascular screening recommended by the American Heart Association. The PPE should be performed 4 to 6 weeks before the start of the sports season to allow optimum time to address any issues that arise during the exam.
- Promote safe and appropriate practice, competition and treatment facilities. Secondary school-aged athletes have a right to play in safe facilities and, if injured, be treated in a clean and appropriate environment dedicated to that purpose. Making sports facilities safe for young athletes is of utmost importance from a risk management standpoint and is an integral component of effective sports management. As the Summary Statement notes, the failure of schools and YSOs to provide safe facilities and maintain their safety through regular inspections of facilities not only increases the risk of injury but unnecessarily exposes them to lawsuits which deplete the organization's financial resources, and fosters a negative image to the public about the organization and about sports in general. The NATA calls for all parties involved with youth sports activities, including coaches, administrators, grounds and facilities staffs, and AHCT members, to be involved in regular and thorough safety inspections. It also encourages athletes to immediately report any unsafe conditions.
- Advise on the selection, fit, function, and maintenance of athletic equipment. Equipment essential to some sports (helmets, shoulder pads for football, sticks for ice and field hockey, lacrosse sticks etc.) can either come from the program or the individual participant. If the athlete (or his parent) supplies the equipment, schools and YSOs need to ensure that it meets all safety standards established by such certifying bodies such as the National Operating Committee on Standards in Athletic Equipment (NOCSAE) and the American Society for Testing and Materials (ASTM). Sports programs need to make sure all athletes have properly fitting equipment and that the equipment is properly maintained, periodically examined during the season by qualified personnel (coach, athletic trainer, equipment manager), and reconditioned on a regular basis.
- Develop and implement a comprehensive emergency action plan (EAP). A comprehensive EAP to ensure that appropriate care is provided in a timely manner. It should be developed with input from the AHCT, administrators, coaches, facilities managers, parents, and members of the local EMS, and reviewed annually. The EAP should include planning for responses to medical emergencies involving athletes, spectators, coaches, and officials; crowd control; and evacuation in the event of severe weather, fire and other natural or man-made disasters. Again, as the NATA notes, the failure of a program, school or YSO, to provide an EAP commensurate with the injury risk of the sport involved could make the program liable for damages in a civil suit.
- Establish protocols regarding adverse environmental conditions. The recent and highly-publicized deaths of athletes, particularly football players, from heat stroke, emphasizes the need for the AHCT to develop and implement protocols related to venue and/or region-specific adverse enivironmental conditions (e.g. dangerous levels of heat and humidity, lightning and other severe weather such as tornadoes, air quality, insects, rodents, reptiles, fire, and possible allergic reaction inducing conditions).
- Provide for on-site recognition, evaluation and immediate treatment of injury and illness with appropriate referrals. Immediate and thorough initial on-site evaluation and treatment can mean the difference between life and death (e.g. heat stroke, neck or cervical spine injury, second impact syndrome). All coaches should be trained in first aid and CPR (including the use of an AED). Protocols should be established, in advance, governing referrals to an emergency room or further evaluation by a physician, limiting participation to protect the initial injury and prevent further harm, and return-to-play decisions. The NATA recommends that an athletic trainer (AT) provide the on-site medical care.
- Facilitate rehabilitation and reconditioning. Just as important as evaluation and treatment immediately after injury is a rehabilitation and reconditioning program (treatment, rehab and therapy) designed to safely return the athlete to play at a preinjury level of function. Schools and YSOs should identify an on-site member of the AHCT to manage postinjury treatment plans.
- Provide for psychosocial consultation and referral. Adolescents are at significant risk of substance abuse, eating disorders, suicidal tendencies, weapon use, violence, and vehicular recklessness. Adolescent athletes, in particular, may be at increased risk of depression associated with injury or athletic "burnout." These issues should be addressed in the PPE, preferably by the athlete's primary care physician. In the athletic setting, an athletic trainer may be in the best position to recognize psychosocial concerns because they are most likely to be consistently available on site. An ATC can also use a new test to help determine when an injured athlete is psychologically ready to return to competition.
- Provide scientifically sound nutritional counseling and education. Sports nutrition is a key factor in an athlete's growth, development and performance. Adolescents have unique nutritional requirements that are further complicated by sport participation. Athletes need guidance to make sound nutritional decisions in an age when fad diets and performance-enhancing products, such as energy drinks and supplements are prevalent and heavily marketed to kids. The NATA recommends that sports organizations establish components of a comprehensive sports nutritional support system, based on current science, which should include (1) a system for reviewing an athlete's nutritional status, (2) policies to ensure the availability of hydration fluids in a clean, non-infectious environment at all sports settings, (3) a plan to encourage the ingestion of appropriate pre-exercise and postexercise food, (4) a system to identify athletes at risk for disordered eating and to treat those who have been identified, and (5) a plan that relies on scientifically supported literature when developing rules that restrict the use of performance-enhancing supplements, drugs, and substances, as well as educational programs to inform coaches, athletes, and parents of their dangers.
- Develop injury and illness prevention strategies. More and should be done to prevent sports injuries and reduce their severity. The NATA recommends that prevention, care and appropriate management of sports injuries and age-specific illnesses be developed using a public health model which (1) determines the existence and size of the problem (injury surveillance); (2) identify what may cause the problem (risk factors); (3) determine strategies and interventions that may prevent the problem; (4) implement prevention strategies, and (5) monitor and evaluate the effectiveness of prevention efforts.
Source: Summary Statement: Appropriate Medical Care for the Secondary School-Aged Athlete, The Journal of Athletic Training (August 2008). For a full copy of the statement, click here.
Updated November 13, 2012