Monday, April 1, 2013

A Prime Example of Why We Need More ATs

Yesterday, in the first half of the Duke vs. Louisville elite eight men's basketball game, Kevin Ware of Louisville attempted to block a long shot in front of his bench and landed awkwardly.  The landing resulted in an open compound fracture of the tibia and fibula (both lower leg bones) and you can see in the video where the tibia was protruding from the leg at the point of the break.  (As coach Pitino said after the game, "It was protruding by about six inches from his leg.") The injury was horrifying and my prayers will meet with yours that this young man will make a full and speedy recovery and I hope that this will not affect his future to too great of a degree.

Warning: This video is considered by some to be graphic.
The highlight of this terrible situation has to be the quick and appropriate response of the Certified Athletic Trainers, physicians and EMTs that were present.  Their quick and practiced response helped to make this young man as comfortable as possible in a quick fashion.  The rapid response played a large part in getting this young to the hospital quickly where he underwent successful surgery that evening and has a bright outlook.  I commend the medical staff for their efforts and we should all be thankful that this high quality service was available yesterday.

The centerpiece of this response team was surprisingly not the physician.  The people that were doing the splinting and such were the teams' Certified Athletic Trainers.  These were the people that were making the decisions on the best splint to use and how best to transfer the patient to the gurney.  These were the people who were practiced in the emergency responses that they designed and executed flawlessly yesterday when is was needed.  These are the people who are at their best when you are at your worst.

Unfortunately, this is not always the case.  According to statistics from the National Athletic Trainers Association, only 42% of high schools in the United States have access to an athletic trainer.  This is an appalling statistic in and of itself.  When you examine it even further, you will find that this means that only 42% of high schools have ANY access to an athletic trainer.  This does not mean that there is a full time athletic trainer available for all events that a high school and covering both games and practices.  No, this statistic includes all the part time athletic trainers at schools that might "drop by" once a week for an hour to examine injuries that have occurred in the last week. This is obviously far from ideal, but is still included in this statistic. 

It has been estimated that only a third of these 42% of schools have a full time athletic trainer. (I am looking for the article to cite it.) If you work that out, only 14% of schools in the United States have full time access to an athletic trainer. That is embarrassing! The other point that isn't covered in these stats is that of those 14%, many of those ATs are working 60-70 hour weeks.  They often report that they are not able to keep up with the demand at the schools they work for because of the numbers of athletes and contests that are scheduled concurrently. They are not able to fully implement rehabilitation protocols, preventative measures, or spend the appropriate amount of time that is needed for each athlete because of time constraints.

I can sympathize with this since that is my current situation.  Often, I have to make decisions on which sport to sit and watch depending on the likelihood of an injury occurring.  One prime example that happens a lot is deciding between a varsity soccer game and a freshman football game.  It is tough to have to decide between them since both have a similar high risk.  Often, when the injury occurs where I am not, this causes tension amongst the parents and school.

Finally, this statistic talks to high school athletics only.  It does not discuss the need for athletic trainers to be available for middle school and youth and even recreational adult events where injuries also occur.  In these instances, when there is no athletic trainer who has the training to respond appropriately, you are often left the best of what's available. Sometimes, that option is far less than what is needed and emergencies become tragedies. This is why athletic trainers are so badly needed.  And don't fool yourself, injuries like this happen across the country at every level of play.

It has been an amazing experience for me to see first hand the number of unqualified people who are always too willing to jump in and try to help in an emergency situation.  In conversations last night on Twitter with fellow athletic trainers, we discussed some of our nightmares where well-intentioned, but unqualified people were way too quick to insert themselves into an emergency situation.  I have been verbally accosted by many people in the past because they didn't appreciate my qualifications.  Having a nurse standing over me as I am trying to work and shouting instructions to the group or the EMT handing me his cellphone that he used to call a local physician for a kid that needed EMS transport were the worst examples parents that didn't understand their limits.  I understand that this is a burden that reinforces my drive to educate the public about what it is that I am qualified to do.  However, some of my colleagues have had instances of lab techs, and other lay persons who had NO business on the field, yet felt the need to do something to help.

The ironic part of Kevin Ware's injury is that it occurred on the last day of March, which is National Athletic Trainers Month.  The injury helped to underscore the need for athletic trainers at every level of play.  The number one excuse for not hiring athletic trainers is, and likely always will be, cost.  The Mom's team article that is link here even reflects that 9% of people think a volunteer health care professional is appropriate for this job.  If you plan on hiring the lab tech or the medical secretary to cover the next football game, I will probably hold my child out.  That is unacceptable.

There is a growing mantra from athletic trainers that helps to underscore this idea that is captured in this article.  It states that "If you cannot afford an athletic trainer, then you can't afford football."  I have agreed with others that this should be taken this one step further to include hockey, lacrosse, and other collision sports into this mantra.  Yesterday's injury only underscored this belief and it should probably include contact sports like baseball, softball, basketball, soccer, and other sports like it.

However you approach it, there is an obvious need to change things in our athletic society today. We need to increase the number of athletic trainers in the United States that can be these first responders to injuries like this. I would implore anyone reading this that agrees and would like to see changes made in their local community to perform their own research and discover for themselves what an athletic trainer can provide for their athletic program(s). Listed below are a few more articles that I found very quickly that help to support this argument and can offer direction to anyone doing their own research.

Also, over the last couple of years, I have been saving links to various articles on my social bookmarking (Delicious) account.  There are hundreds of articles linked here: