Study: 34% of high schools in the U.S. do not have access to athletic trainer services

Despite ongoing tragedies in sports as well as research from a host of sources – including the American Academy of Pediatrics – which state schools with athletic trainers (ATs) have lower injury rates, a study released today showed that 34% of public and private high schools, have no access to athletic trainers in the United States. Furthermore, the study indicates that lack of appropriate sports medicine care is even greater for private schools (45% with no AT access) where parents are traditionally paying for what they perceive as a better and safer experience.

The study, Athletic Trainer Services in the Secondary School Setting: The Athletic Training and Locations Services Project (ATLAS), was conducted by the Korey Stringer Institute and published in the Journal of Athletic Training, the National Athletic Trainers' Association's (NATA) scientific publication. To date, this is the most comprehensive study to capture the level of athletic trainer services as it included every U.S. public and private high school with an athletics program.

Notable statistics

Of the 20,272 secondary schools identified, 66% schools (13,473) had "access" to athletic trainer services, defined as receiving services in any form by a licensed or certified AT, while 34% (6,799) had no access.

• Of those schools with access to AT services, 53% (7,119) received full-time (FT) services, the gold standard of care, while 47% (6,354) received part-time (PT) services.
• Public schools (16,076) had 37% FT, 32% PT and 31% with no AT services, whereas private schools (4,196) received 27% FT, 28% PT and 45% with no AT services.

Despite an increase in the number of legal cases, court-ordered overhauling of health and safety policies and awarding of large settlements, school districts, school education boards, state legislators and state athletic associations continue to take a reactive, rather than proactive, approach to addressing safety concerns."

Robert Huggins, PhD, LAT, ATC., lead author

"Providing appropriate care for student athletes comes down to priorities. The safety of student athletes must be the top priority for schools with athletic programs, not just in rhetoric, but in allocation of resources to put the appropriate personnel in place," said NATA President Tory Lindley, MA, ATC. "Schools need to see athletic trainers are an essential requirement to having an athletics program – similar to how they see the coach. While coaches oversee play on the field, athletic trainers are responsible for injury prevention and addressing the physical and mental effects of playing the game. Athletic trainers should not be a luxury but rather a necessity for all programs."

Athletic trainers are the only allied health care practitioners specifically trained in injury prevention for the physically active. ATs also provide on-site emergency and non-emergency care, coordinate appropriate follow-up, conduct rehabilitation and return individuals to safe participation in sport.⁴ They are educated on matters such as orthopedic injury prevention and management, concussion, heat illness, exertional sickling (sickle cell), eating disorders, cardiac arrest, diabetic episodes, early onset osteoarthritis, overuse injuries, substance abuse, disease transmission, weight management, dental and oral injuries and weather-related safety issues, such as lightning and heat, as part of their scope of practice.⁵ Additionally, athletic trainers must graduate from an accredited baccalaureate or master's program. Seventy percent of ATs have a master's degree and all certified athletic trainers conduct continued education to maintain their board certification. The study also mentions various barriers and challenges to hiring athletic trainers, including budget constraints, school size, lack of awareness of the athletic trainer's role and remote location of the school that was released in a previous study.⁵ Many secondary schools that do not provide athletic training services rely on non-medical personnel, such as coaches, to assess and discern medical conditions.

Data for this research was collected from September 2015 to April 2018 by phone or email communication with school administrators or ATs as well as through online surveys of secondary school ATs.