Leave Concussion Management to the Pros – Hire an Athletic Trainer

February 16, 2017

Robin Bowman, M.Ed., ATC

Assistant Director for Injury Prevention & Care

University of Nebraska – Lincoln

Concussions have been a hot topic in sports and recreation for the past few years. It seems like every week there is new research coming out that helps us better understand this injury. While it’s great that the medical community is making strides in understanding the mechanisms by which symptoms of concussions happen and recover, it can be difficult to keep up with the latest advances.

Between the difficulty in keeping up with the best practices in recognition, treatment, and return to activity following concussions and the increase in class action lawsuits against sporting organizations who are perceived as not doing enough to protect athletes from the long-lasting effects of mild traumatic brain injury, recreation professionals can feel overwhelmed.

Wouldn’t it be nice if your department had someone on staff that had extensive training in the prevention, recognition, and treatment of concussions and other injuries? An athletic trainer may be just what your department needs. Athletic trainers are skilled in the prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.

What an athletic trainer can do for your campus recreation department’s concussion plan:

• Educate recreation staff, coaches, and athletes about concussions
• Train sport club safety officers
• Organize and assist with pre-participation physical exams
• Administer baseline neurocognitive testing
• Be aware of club members with preexisting medical conditions and be prepared to respond to medical emergencies appropriately
• Provide athletic healthcare at practices and competitions
• Recognize the signs of concussions and make appropriate decisions about return to play
• Facilitate athletes following up with a physician following a suspected concussion
• Direct the return-to-learn and return-to-play protocols (collaborating with your campus’ office for services for students with disabilities for academic accommodations as needed).
• Ensure the athlete is cleared by a physician once the return-to-play progression is complete

While the first athletic trainers started working in campus recreation in the late 1980’s, it has been a trend that has been slow to take off. Even if you’ve never considered adding athletic trainers to your staff before, now may be a good time to look at your options. As with most things, there is no one-size-fits-all solution to providing athletic training to your participants. Here are a few models to consider:

The Full-Timer

Having a full-time athletic trainer working exclusively with recreational sports is beneficial because it eliminates the risk of competing for limited resources with the varsity athletic department on campus. An athletic trainer working exclusively with recreational sports can cover the highest risk activities in your department.

Some institutions provide athletic trainers specifically for their sport club program, but not for other participants. This model usually looks fairly similar to what is often seen in varsity athletics, where the AT may be involved in pre-participation physical exams, neurocognitive baseline testing, and is present for club practices and competitions throughout the season. Some AT’s will even travel with club teams.

Other institutions have more of a ‘clinic’ model in which the athletic trainer has clinic hours during which athletes can drop in for an injury evaluation or treatment. Some offer rehabilitation services while others offer only emergency care and referral. The services offered will vary from one campus to another based on the available financial, physical, and human resources.

In terms of concussion care, having a full-time athletic trainer means you have a healthcare professional on staff who can perform the initial assessment and assist with the return to play progression. At the University of Nebraska, we have three full-time athletic trainers at Campus Recreation. We partner with our University Health Center (UHC) and the on-campus Center for Brain, Biology, and Behavior (CB3) to offer comprehensive concussion care. The CB3 offers free neurocognitive baseline testing for high risk club participants as part of a grant (and they use the data for their research).

When a club athlete sustains a head injury, they will first be evaluated by one of the Campus Rec athletic trainers. If a concussion is suspected, they will be referred to UHC for a medical diagnosis, and then to the CB3 for post-concussion testing. Once the athlete is symptom free for 24-48 hours at rest, the diagnosing physician will instruct the athlete to complete the return-to-play progression with the athletic trainers. This is a five-step process that gradually increases intensity of activity over the course of at least five days. Before the athlete can return to full participation, they will have been cleared by the athletic trainers, the diagnosing physician, and the neuropsychologist. An athlete can return to play when they are symptom-free at rest and with exertion and their neurocognitive test return to baseline levels.

The only real disadvantage to having a full-time athletic trainer on staff is the cost. For departments struggling to secure resources, they may not be able to find the funding to cover a full-time professional to focus on athletic healthcare. Given the litigious society we live in, though, the cost of an AT pales in comparison to the awards for negligence claims in the judicial system. Some schools will start their AT services by hiring a graduate assistant and then growing year by year until they can have a full-time professional. The National Athletic Trainers’ Association has resources to help you explain the value of an athletic trainer in terms of cost savings to the athletes and institution, if you need help making your case.

Sharing with Other On-Campus Entities

For departments that don’t have the financial resources to secure a full-time athletic trainer, try partnering with another on-campus entity to provide AT services to your highest risk activities. You may be able to share an AT with athletics, the student health center, or on-campus hospital.

Sharing can significantly decrease the cost to the department while still being able to offer the best healthcare to the athletes participating in the riskiest activities. Also, once seeing the value of having an AT on the sidelines, you can gain buy-in from constituencies such as sport club members to help push for an AT dedicated solely to recreational sports.

Per-Diem or Contracted

Lastly, you may be able to hire athletic trainers on an as-needed basis for event coverage. You’re not likely to have their services with neurocognitive baseline testing or organizing pre-participation physicals, but they can provide services for practices and/or competitions. Check with local hospitals, physical therapy clinics, and sports medicine practices to see if they have outreach athletic trainers on staff.

Bottom Line

As we learn more about the harmful and lasting effects of mild traumatic brain injuries such as concussions, our duty of care increases. After a few high-dollar class-action settlements for sufferers of repeat concussions from athletic participation, insurers are increasing their scrutiny of sports and recreation organizations. Are your participants currently being given the best care when it comes to the recognition, treatment, and return-to-play decisions following concussions? Who is responsible for this in your department? If your answer is not “an athletic trainer”, you may be falling short of the best practice, and even if you’re willing to take that risk, insurers may no longer be.