Athletic Trainer Plays Key Role In Concussion Safety
Athletic trainers (ATs) play a key role in the assessment of concussions in high school sports and the critical return to play decision.
ATs are on the front lines in the concussion safety battle. According to a 2011 study, while physicians were present at the time of injury in only 7.7% of cases of reported concussions suffered by high school athletes in the 2009-2010 school year,* ATs were on site for at least 70%. When present, they almost always were involved in assessing an athlete for concussion (94.4%).
There are a number of reasons why an AT is such an invaluable member of the concussion assessment team:
- Athletic trainers have concussion training.
- Since their specialty is sport-related injuries, an athletic trainer, in general, will know as much, if not more, about sports-related concussions than other health care professionals who do not have an interest in sports medicine or concussive brain injury.
- A 2006 survey found that many primary care physicians (e.g. pediatricians, internists, and family practitioners) were either unaware of current management guidelines or found the guidelines too confusing to put into practice, and that only 16% had reliable access to neuropsychological testing within 1 week of injury. Since they were found in a 2011 study to be involved in assessing 6 out of 10 concussions suffered by high school athletes, the authors said “efforts to support them in this regard could have a major influence on management.”
- Athletic trainers know the athletes best. The AT may also be better able to identify subtle signs that an athlete has suffered a concussion because he or she knows the athlete’s usual behavior and demeanor. Because they see athletes on a daily basis, the athletic trainer is also in best position to perform daily follow-up examinations that allow the AT and team physician to determine when the athlete is symptom-free and determine when he or she may return to play.
- Athletic trainers are trusted by athletes:
- Athletes fail to, or are reluctant to self-report symptoms of a concussion, no doubt in part because some parents and coaches, and even the very culture of the contact or collision sport they are playing encourages them to follow a code of silence. As a result, developing the trust of an athlete is a necessary and vital part of the process of assessing and managing a concussion and the return to play decision.
- Because an AT often sees the athlete on a daily basis, athletes may be more comfortable reporting symptoms to them than to a physician they do not see regularly.
- Because athletes trust athletic trainers, they may also be in the best position to educate them about the signs and symptoms of concussion and the dangers of second-impact syndrome (SIS) that can result from not reporting concussion symptoms. Indeed, a 2011 study of concussions in high school sports during the 2008-2009 school year suggests that expanded access to an AT (from 2 part-time ATs to 1 full-time AT and 1 part-time) may substantially increase the likelihood that a concussion is recognized and treated.
- Athletic trainers are just as conservative as doctors in the return to play decisions. The study of concussions in high school sports during the 2009-2010 school year1 found no difference between ATs and physicians in terms of how quickly they allowed athletes to return to play.
One of the most challenging aspects of game and practice coverage is the response to injuries involving the head and cervical spine (neck). Knowledge concerning the clinical presentation and proper emergency care in the event a player suffers a potentially serious or catastrophic head or neck injury is required for athletic trainers and medical personnel.
The AT’s role during games and practices is to prevent injury and provide immediate first-aid care and triage. To be properly prepared:
- Before the season, the athletic training staff should create an emergency medical plan instituting all procedures that must be followed during an emergency. Baseline computerized neuropsychological testing of athletes, particularly in contact sports such as football, hockey, soccer and lacrosse, is recommended.
- The various entities making up the institutional medical team – the secondary support teams, including local emergency medical services, ambulance units, and level 1 trauma centers (including helicopter transport) – should be listed.
- Policies, such as which circumstances requiring immediate removal of an athlete from play and when he or she is allowed return to play, should go through the proper administrative protocols before being instituted [Note: a
- All equipment to be used on a daily basis must be inspected and tested before each season, and in some instances, such equipment must be re-calibrated annually.
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