Sport Club Athletic Trainers: Part 2

July 18, 2011

We Can No Longer Afford Not to Afford Them!

Tom Roberts
Director Recreation and Wellness
University of Richmond

“I have coached college rugby for eight years now, and I have a long list of things that we would love to have to make our club better, and more competitive, but to be honest, athletic trainers at home and away matches is the single most important thing the University could provide our club. After all, the welfare of the students should come first before everything else”. (Carl Schmitt, President of the Virginia Rugby Union and University of Richmond Rugby Coach)

High schools have made the safety of athletes a priority. Passing legislation and mandating better concussion training and medical services, public high schools now require full-time certified athletic trainers at high risk sporting events. The NCAA has provided a set of guidelines that have become recognized as the standard of care. These guidelines ensure that athletic trainers are available at almost all NCAA athletic team practices and competitions. So why are there not athletic trainers at university sport club practices and competitions? Ask most sport club administrators, coaches, and athletes and the answer you’re likely to get is “we cannot afford to pay for athletic trainers”. Well it’s time we recognize we can no longer afford not to afford them! The risk is too great for our sport club athletes and the legal responsibility and protection of our universities, especially for contact and high risk sports.

The next questions often asked: what have our national governing bodies done to attempt to pass legislation and mandates, like the high schools, to provide better protection for our sport club athletes? What have our professional organizations done to adopt and endorse the NATA guidelines, or similar guidelines, like the NCAA has done to demonstrate the safety of our athletes is a high priority? After all, a primary responsibility of national governing bodies (NGB) is to make strategic decisions for the benefit of their sports and to provide standards of competition and safety guidelines. Unfortunately, despite their responsibility to provide safety standards, in a review of various national governing body bylaws and guidelines, it appears very few have made safety of the athletes a priority.

The NGBs of three of the most physical high risk contact sports have not gone far enough to implement formal steps to mandate and require athletic trainers at sport club competitions. Apparently most NGBs are leaving it up to the regional and local organizations to determine the level of medical care with a vast level of variance. The American College Hockey Association (ACHA) requires the hosts for regional and national tournaments are responsible for having certified athletic trainers present at each tournament game, but has no requirements for practice and competition. The Blue Ridge Hockey Association, a regional affiliate, takes it a step further and requires athletic trainers at all competitions. USA Rugby does not provide a firm mandate beyond stating that programs should aspire to provide medical coverage at all major events. According to Mid Atlantic Rugby Football Union (MARFU) President, Kris Kabza, “Neither the MARFU nor USA Rugby mandates the presence of medical personnel at individual college matches or practice. While I cannot speak for USA Rugby and what they require at their tournaments, I can tell you that MARFU requires medical personnel to be present at MARFU tournaments”. The Virginia Rugby Union (VRU) also requires medical coverage at tournaments: “The host club shall provide medical services, including the presence of an EMT, Sports Medicine Trainer, doctor, or ambulance and a medical kit.” US Lacrosse and the most competitive association at the club level, the Men’s Collegiate Lacrosse Association (MCLA), do not appear to have any specific requirements in their bylaws or operating guidelines that references medical coverage requirements for competitions and practices.

The National Intramural Recreational Sports Association (NIRSA), an organization for recreational professionals responsible for the administration of sport clubs, has been slow to adopt any guidelines or mandates for institutions to consider in developing sports medicine policies appropriate for the administration of sport club programs. Our national governing bodies and professional organizations are hesitant to impose mandates requiring athletic trainers because they are concerned that many clubs and institutions cannot afford the cost. They recognize the complexity of sport clubs and their various levels of competition and financial support from institution to institution and that imposed mandates may have an adverse impact and prohibit some clubs from participation.

What more can our national governing bodies and professional organizations do to protect our sport club athletes and demonstrate that their safety is a high priority? Perhaps the real question that needs to be asked is, what have we done to lobby and justify the need for the presence of athletic trainers at sport club practices and competitions? What have administrators, coaches, athletes, and parents done at their respective institutions to improve and elevate the level of medical care and coverage for our sport club athletes? Sport clubs compete in many of the same sports as high school and NCAA programs. Sport club practices and competitions are often just as rigorous and physical. The university’s liability and assumption of risk are just as great and perhaps even more prevalent. In many ways the standard of care has already been set for taking whatever steps are necessary to justify and provide vital medical coverage and services for our sport club athletes.

Until our national organizations and national governing bodies can successfully bring us to a level of medical coverage in compliance with the NATA guidelines and in alignment with the NCAA programs we will need to rely on our individual institutions to strive to make student safety a priority and provide the highest level of medical coverage. A search for best practices has identified the following institutions as leaders in the field:

• Boston University — One of the first to hire full time athletic trainers specifically for sport club athletes. In 1996 Boston University started with one full time athletic trainer and continues to expand and improve the services for sport clubs. There is currently a designated Athletic Training Services office staffed by two full time athletic trainers and two graduate assistant athletic trainers that are available for club practices and competitions. All 34 club sports at Boston University have access to the athletic trainers during open office hours and all sport club athletes have full access to four team physicians.
• Loyola University Maryland – In 2007 Loyola University Maryland contracted with a local hospital to provide a part-time 30 hours per week athletic trainer and a training room designated specifically for sport clubs. Eric Eckenrode, Assistant Director of Recreational Sports at Loyola University Maryland, discusses the impact on the program: “Since the inception of our athletic training program, I have heard nothing but positive feedback. Our club athletes and coaches are appreciative to have an experienced professional working exclusively with their teams, a privilege that many other schools unfortunately do not have. This program has had a tremendous impact on our students’ well-being and we are grateful for the opportunity to keep them healthy and safe. Whether its injury prevention, recognition, management, or rehabilitation, we know that we’re providing a service to our students that is world class.”
• Sacred Heart University – In 2008 Sacred Heart University established a specific club sports division of athletic training that provides rehabilitation, injury prevention, emergency care and education. Athletic trainers are available for high risk sports and the trainer room is available during week days for several hours a day for sport club athletes. Robert Huggins, Head Athletic Trainer of Club Sports at Sacred Heart University stresses the importance of athletic trainers, “athletic trainers are absolutely essential to any college or university that provides club sports to its students. We are healthcare providers specifically trained in the prevention, recognition, evaluation, and management of sports related injuries. Athletic trainers decrease the liability that an institution has and provide an invaluable service to the student athletes.”

Boston, Loyola, and Sacred Heart are examples of universities that have committed the resources to make the safety of their students a priority. In addition there are many other institutions that should be praised and recognized for their efforts and progress to provide some level of medical service to their sport club programs.

The following information may be helpful for those that do not currently have athletic trainers, but may be considering hiring athletic trainers. Athletic trainers are recognized by the American Medical Association as allied health professionals that work under the direction of a licensed physician, and in cooperation with other health care providers. They specialize in the prevention, diagnosis, assessment, treatment, and rehabilitation of muscle and bone injuries and illnesses. A bachelor’s degree from an accredited college or university is required for almost all jobs as an athletic trainer and is part of the requirement for becoming certified by the Board of Certification (BOC). They are required to continue taking medical-related courses and adhere to standards of practice to retain their certification.

Priority should be given to scheduling athletic trainers at team practices and competitions, which are often on evenings and weekends, and as we all know these schedules can change on short notice due to weather and unforeseen circumstances. The ideal situation includes a full-time athletic trainer responsible for hiring and scheduling part-time athletic trainers to cover games and practices that the full-time staff is unable to attend. Resourceful administrators can work cooperatively with the varsity athletic training room and local high schools and hospitals to find part-time athletic trainers. Whenever possible, and when training room facilities are available, having athletic trainers available for athletes to drop by for consultation and treatment is a tremendous service and benefit. Eric Eckenrode, Assistant Director at Recreational Sports at Loyola University Maryland has found the availability of athletic trainers to be a positive impact on the recruitment of students, “Throughout the year, I give presentations to prospective students and parents about the Department of Recreational Sports. I make sure to include our athletic training program when speaking, which always seems to impress the parents. Most ask if the training program is shared use with athletics, but when I tell them it’s solely for club sport athletes, they are astounded. I think that knowing there is a qualified, professional athletic trainer accessible to their sons or daughters at any time are very comforting to them. If their child is an athlete, I think this becomes a key factor when their son or daughter is deciding on which school to attend.”

The roles and responsibilities for athletic trainers will vary depending on the institution. As the first healthcare provider on the scene when injuries occur, athletic trainers must be able to recognize, evaluate, and assess injuries and provide immediate care. This commonly includes applying tape and bandages and protective or injury-preventive devices such as braces. Athletic trainers also have responsibilities for the prevention of injuries by providing instruction and advice on the proper use of equipment, exercises to improve balance and strength, and effective exercise and therapy programs. They need to have good social and communication skills to manage difficult and potentially disruptive situations when disagreements arise with athletes, coaches, or parents regarding removing a player from the game or suggested treatment. Some athletic trainers may have administrative responsibilities that include attending regular meetings with administrators and physicians, coordinating schedules, budgets, purchasing, and development and enforcement of policies and procedures.
The administration of sport clubs requires a proactive approach to risk management in order to provide a safe environment for the participants and reduce the likelihood of injury and litigation. The risk is too great for our sport club athletes and the legal responsibility and protection of our universities. Universities can no longer afford not to afford sport club athletic trainers, especially for contact and high risk sports. It’s paramount that recreational sports administrators take whatever steps are necessary to justify and provide vital medical coverage and services for our sport club athletes. A summary of recommendations to take a proactive approach to risk management includes:

• Ask Institution to Hire Athletic Trainers to be available at all sport club practices and competitions. At a minimum, have athletic trainers available and present at home competitions for all high risk sports.
• Ask Professional Organizations to establish recommendations for appropriate medical coverage to assist institutions in providing the best possible health care for all intercollegiate student-athletes.
• Ask Governing Bodies to consider mandates and requirements for the presence of athletic trainers at all competitions and tournaments.
• Don’t Wait until something happens and it’s too late. The risk is too great for our sport club athletes and the legal responsibility and protection of our universities.

In a recent opinion article in the college newspaper Sarie Hill, captain of the women’s rugby club at Kenyon College, references the Oberlin incident (see Part 1 of this article) and pleads to the administration and Board of Trustees to be proactive rather than reactive in providing medical trainers. “The issue of providing trainers for the rugby team faces the administration once every few years and every time, it is blown off. Once again, this is the case. Responsibility for rugby-related injuries lies on the shoulders of several people. As one of the captains of the women’s rugby team, I know that responsibility partly lies with me, because captains are the ones who teach the rules and conduct of safe play. I am not a medical professional, however, and rugby is a rough sport in which people will inevitably get hurt. We are not qualified to diagnose the difference between a severe concussion and a fractured skull – give us somebody who is.” Sarie Hill and the members of the rugby club at Kenyon College have fulfilled their responsibility to be proactive and have made a formal plea to the administration and Board of Trustees for athletic trainers. What have you done?

Sources Part 2
ACHA Staff. American Collegiate Hockey Association 2006-2007 Manual. Publication. West Bloomfield, 2006. Web. 18 Mar. 2010. http://www.brhockey.com/images/images/1/0/acha_manual_2006-72.pdf

“Athletic Trainers- Occupational Outlook Handbook, 2010-11 Edition.” U.S. Bureau of Labor Statistics. 17 Dec. 2009. Web. 18 Mar. 2010. http://www.bls.gov/oco/ocos294.htm#earnings

Blue Ridge Hockey Conference- Bylaws. Rep. 2010. 1 Oct. 2008. Web. 18 Mar. 2010 http://www.brhockey.com/images/images/1/0/bylaws.pdf

Chapman, David, ed. VIRGINIA RUGBY UNION HANDBOOK 2010. Rep. Web. 18 Mar. 2010. http://www.rugby.org/handbook/2010_vru_handbook_word_6x9.pdf

Doherty, Jack, and John Harrington. 2008-10 NCAA MEN’S AND WOMEN’S ICE HOCKEY RULES AND INTERPRETATIONS. Rep. Indianapolis, 2008. NCAA, Aug. 2008. Web. 18 Mar. 2010. https://www.ncaapublications.com//productdownloads/2008-10_MW_IceHockeyRules7ff9e6ab-7d20-441b-b768-522bfb15c487.pdf

Hill, Sarie. “Rugby Needs Athletic Trainers.” Kenyon Collegian 12 Nov. 2009. Web. 18 Mar. 2010. http://media.www.kenyoncollegian.com/media/storage/paper821/news/2009/11/12/Opinion/Rugby.Needs.Athletic.Trainers-3834800.shtml

Men’s Collegiate Lacrosse Association (MCLA) – 1 League, 10 Conferences, 213 Teams. Web. 18 Mar. 2010. http://mcla.us/

Mid-Atlantic Rugby Football Union. Web. 18 Mar. 2010. http://www.marfu.org

Popke, Michael. “Hit Hard. Heightened Awareness of Concussions Is Changing the Culture of Prep Sports.” Athletic Business Dec. 2009. Web. 18 Mar. 2010. http://www.athleticbusiness.com/articles/article.aspx?articleid=2850&zoneid=33

Tong, Anna. “Group Sounds Alarm on Youth Sports Injuries in California The Sacramento Bee 13 Jan. 2010: 4A. Web. 18 Mar. 2010.
http://www.sacbee.com/2010/01/13/2457793/group-sounds-alarm-on-youth-sports.html

USA Rugby. Web. 18 Mar. 2010. http://www.usarugby.org/
Zimmerman, Don, and Charles Winters. NCAA Lacrosse 2009 and 2010 Rules and Interpertations. Rep. Indianapolis, 2008. NCAA, Nov. 2008. Web. 18 Mar. 2010. https://www.ncaapublications.com//productdownloads/Mens_Lacrosse_Rules5e9d8fea-8ef6-4a9d-a2c9-530b631edf2e.pdf