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From the National Athletic Trainers' Association

NATA Sets Guidelines For Managing Sports Injuries in High School and College Settings

First-of-its-kind document sets 'best practices' protocols for athletic programs


The National Athletic Trainers' Association new inter-association task force (1) recommendations titled "Best Practices for Sports Medicine Management for Secondary Schools and Colleges" (2) is believed to be the first of its kind to focus on specific protocols to ensure effective and efficient sports medicine procedures in these school settings.

While not specifically geared to parents, they can use the document to determine whether their child's school is providing proper sports medicine services to athletes.Doctor showing mother and son x ray

There are more than 7.6 million students participating in organized secondary school athletics in the United States. Last year more than 420,000 student athletes represented their colleges in athletic participation. It is estimated that more than 1.4 million injuries occur annually to secondary school athletes; and approximately 209,000 yearly at the collegiate level across 25 NCAA sports.

As the concerns grow over musculoskeletal injuries, as well as life-threatening conditions and traumatic brain injuries such as concussions which can have adverse long-term health consequences, more secondary schools and colleges are being forced to evaluate the medical services that they are providing to their athletes.

Secondary schools with proper medical teams that include a full-time athletic trainer have seen a lower incidence of injuries, both acute and re-occuring than schools without athletic trainers. These schools also see more diagnosed concussions, demonstrating better identification of athletes with concussion. (3)

The task force's recommendations are designed to provide superintendents of schools, secondary school athletic directors, college/university athletic department administrators, athletic trainers and team/school physicians with important considerations regarding:

  • duties and responsibilities of each athletic health care team member;
  • supervisory relationships and the chain of command within the team;
  • decision-making authority related to approval for participation of student athletes;
  • administrative authority for selection, renewal and dismissal of related medical personnel; and
  • performance appraisal tools for the sports medicine team.

"These guidelines were developed for a variety of reasons. Institutions are hiring athletic trainers for the first time and uncertainties exist regarding the administrative authority and supervision of the athletic trainer. There are also wide variances in the administration of the sports medicine program, the chain of command and the selection and evaluation of the sports medicine team," says task force co-chair Michael Goldenberg, MS, ATC, director of athletics and athletic trainer at the Lawrenceville School in New Jersey and member of the NATA board of directors.

"Putting these practices into play ensures a cohesive, collective effort and athletic health care team approach to sports safety," adds Ron Courson, ATC, PT, NREMT, CSCS, also co-chair of the task force and senior associate athletic director for sports medicine at the University of Georgia. "These best practice recommendations serve as a roadmap for anyone involved in secondary school or collegiate sports."

Consensus Statement Recommendations

To ensure best practices in the secondary school and college/university sports settings, the inter-association task force recommends the following guidelines:

1. Establish an "athlete-centered medicine" approach to care.

  • The physician or athletic trainer is often faced with ethical dilemmas about return to play when an individual's best medical interests conflict with expectations of a coach, parent or others.
  • In almost every circumstance, the legal responsibility for the decision to allow an injured athlete to return to play is ultimately made by the licensed physician. In many cases, that physician may authorize an athletic trainer to determine the rate at which the athlete is exposed to progressively increasing physical demands. The statement includes a set of 10 principles to guide organizations on appropriate policies and procedures.

2. Create specific duties and responsibilities of the athletic trainer and team physician. Anyone involved in the primary care of an athlete and his or her short- and/or long-term health should be involved in the creation of that institution's athletic health care team job descriptions. This should also include and are not limited to:

  • Developing an emergency action plan;
  • Establishing criteria for safe return to practice and play; 
  • Determining which venues require the on-site presence of the athletic trainer and team physician; and
  • Setting guidelines for the fit, function and maintenance of all athletic equipment.

3. Establish supervisory relationships and a chain of command within the sports medicine team. There should be a clear delineation of responsibilities, particularly in cases where the athletic trainer may have responsibilities other than medical care (administrative and academic). Supervisory relationships should also be defined so that potential role conflicts are minimized and medical care is not sacrificed. Regardless of the model utilized, in no case should there be a supervisory relationship where members of the sports medicine team report to a coach due to both perceived and real conflicts of interest. The athletic trainer should report to the team or school physician. 

4.  Determine the decision-making authority relating to approval for participation as well as injury management and return to play.

  • Athletic trainers in the high school setting work in conjunction with team physicians who should be actively involved in the athletic health care programs, across all teams, throughout the year.
  • Students must undergo a comprehensive physical examination before participating in sports to determine pre-existing conditions.
    • When the athletic trainer is able to document evidence of functional levels insufficient to ensure the athlete's safety, the athletic trainer should express his/her concerns both to the treating physician and to the team physician.
    • Whether or not the treating physician agrees, authority for the final decision on the athlete's return to play should remain with the team physician.

5. Create policy and procedure recommendations for the hiring, renewal or dismissal of athletic trainers.

  • If there is an athletic trainer on the high school staff, he or she should have significant responsibility in the hiring process within the school's policies and procedures.
  • Renewal of the athletic trainer's job should be based on fair and comprehensive criteria. The team physician should evaluate athletic training services, and all non-medical duties, such as administrative responsibilities, should be assessed by the athletic director and/or principal designee.

6. Establish performance appraisals for athletic trainers. This helps provide a framework and set of resources that enable administrators to evaluate the performance of the sports medicine staff including program evaluation; individual staff performance; teaching; promotion and remediation plans and athletic training service metrics.

"Each of these steps requires rigorous attention to policy and procedure and a full commitment from the sports medicine staff and institution," adds Courson. "With a dedicated team approach, we can and will reduce injury, prevent catastrophic outcomes and enjoy the academic and athletic benefits that come from sports participation in the high school and college and university settings."

Pro-active parents wanted

While the guidelines are geared towards school superintendents, secondary school athletic directors, college/university athletic department administrators, athletic trainers and team/school physicians, "parents should become informed about a school's policies and protocols," says Goldenberg, "be observant, and ask questions" if they have concerns about whether their child's school is following best practices.

In particular, Goldenberg believes every secondary school should have a full-time athletic trainer on staff. Mere "access" to a part-time AT, argues Goldenberg, is not providing "adequate care" to athletes. While recognizing that many school systems are under severe budgetary constraints, he urges parents to be "pro-active" and to "put pressure on those who control the school's finances" to hire a full-time AT.

Sources: National Athletic Trainers' Association

1. The task force was spearheaded by NATA* and included representatives from the following organizations: American Academy of Pediatrics; American College Health Association*; American Medical Society for Sports Medicine*; American Orthopaedic Society for Sports Medicine*; College Athletic Trainers' Society*; National Association of Collegiate Directors of Athletics*; National Association of Intercollegiate Athletics*; National Collegiate Athletic Association; National Federation of State High School Associations* and National Interscholastic Athletic Administration Association (* endorsed the statement, as of July 12, 2013)

2. Courson R, Goldenberg M, et al. Inter-Association Consensus Statement on Best Practices for Sports Management for Secondary Schools and Colleges (July 16, 2013)

3. LaBella C, et al. "A comparative analysis of injury rates and patterns among girls' soccer and basketball players at schools with and without athletic trainers from 2006/07-2008/09" AAP 2012.