Thursday, December 29, 2005

Matters of Coverage

Head athletic trainers (AT) and athletic directors (AD) at universities and high schools face several challenges when it comes to ensuring the safety of their athletes. Facility safety, emergency care responses, and pre-participation physicals are all examples of administrative responsibilities that can impact player safety.

One additional administrative challenge that is especially interesting from a legal standpoint is the issue of appropriate medical coverage. In other words, if you're the AD at Arizona State University, how do you decide how many ATs you must employ in order to reach an appropriate level of medical coverage across all practices and events? If you're the head AT, how do you decide to make coverage assignments for your group of AT employees? How you decide how many ATs to assign to Fall football, swimming, soccer, etc.?

What about the high school? In most cases, high schools employ only 1 (if any) full-time ATs who are then responsible for the medical care of all student athletes. At many large high schools, several hundred student athletes might be active simultaneously, many of whom might be practicing or playing at remote sites. How do you decide what event you should physically attend and how do you stay in touch with the others?

The goal in both settings is to make informed decisions about medical staff placement based on knowledge of 1) the intensity of the sport (e.g., collision vs. contact vs. non-contact), 2) the injury rates in the sport, and 3) the likelihood of catastrophic injury (e.g., severe head / neck injury) in the sport. This is why, in most cases, the lone high school AT will always cover football while ensuring other sports can be in contact with him by cell phone or walkie-talkie. On the other hand, because universities tend to have a little more money, each major sport will usually receive the coverage at least one AT. Sports like football will be covered by a small army of medical staff for the reasons I identified above, and because of the large numbers of players on a typical university football team.

You can imagine, however, that if high school Sally, a freshman girls basketball player is injured, and medical response to her injury is delayed because the lone AT must run, or golf-cart, or even drive from one facility to another, and if that delay contributes to increased morbidity or mortality of the injury, Sally (or her parents) are going to wonder why the AT of AD didn't take steps to ensure a more immediate response for their daughter? Yes, there is an expectation that coaches can serve as first responders and provide at least basic 1st aid & CPR, but many athletic injuries or illnesses can overwhelm those responses very quickly.

To provide some formal structure and decision making tools for these situations, the National Athletic Trainers' Association (NATA) created relevant guidelines and recommendations in the form of two documents: Recommendations and Guidelines for Appropriate Medical Coverage of Intercollegiate Athletics and a Consensus Statement on Appropriate Medical Care for the Secondary School-Age Athlete.

I'd recommend you take a look at these. First, notice that we're dealing with recommendations, guidelines, and a consensus statement. The NATA was not looking to create policy (nor could they), but certainly these documents could be used to establish a standard of care. Second, appropriate medical coverage is defined much more broadly than the 3 guiding principles for coverage I mentioned earlier. Third, you'll notice some striking differences between the two documents. The first takes an almost formulaic approach to the issue. The second is more brief and seeks to establish the characteristics of appropriate medical coverage and who is capable of providing such coverage.

To my knowledge, neither has been used in formal legal action.
A matter of time, I suppose.

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