PROFESSIONAL PRACTICE Presence of Athletic Trainers in a Youth Football Organization: A Single Institution’s Experience Jillian E. Urban, PhD; Erica K. Cheramie, LAT, ATC; Mary Kopacki, MS, LAT, ATC; Johna K. Register-Mihalik, PhD, LAT, ATC; Jason P. Mihalik, PhD, CAT(C), ATC; Joel D. Stitzel, PhD; Daryl A. Rosenbaum, MD ABSTRACT serious.3 Incidence rates for con- Training and at least one person The experience presented in this report cussions in players ages 8 to 12 are carrying a Red Cross Card to be could inform other youth football or- similar to those of high school and present at all practices. Pop Warner ganizations about the challenges and college football players.4 However, requires at least one person at each benefits of implementing an athletic the consequences of concussion in practice who is certified in CPR/ trainer at the youth level. The authors younger athletes are of concern. First Aid or has completed the report their experience with having an A previous study suggests that re- National Center for Sports Safety athletic trainer present at practices and covery after a concussion may take PREPARE. Pop Warner requires game days for one youth football organi- longer in younger populations un- that a player safety coach be nomi- zation (ages 6 to 13) with more than 170 dergoing cognitive development.5 nated and trained through the USA players during two consecutive seasons. Additionally, the risk of heat illness Football Heads Up Football Pro- [Athletic Training & Sports Health Care. in youth football players is 10 times gram for each organization. 2017;9(2):53-57.] that of other youth sports.6 Many of the requirements are a Most youth sporting events do step toward improving the health not have medical personnel on the and safety of the athletes; however, here are approximately 3 sidelines. Instead, some coaches this basic medical training provides million participants in youth are often required to undergo ba- a minimum safety standard and is tackle football in the United sic medical training. The training not designed to train the coaching T1 States. Numbers have trended is intended to provide the basics staff to appropriately respond to an downward during the past 5 years, needed to respond appropriately injury. Additionally, several youth possibly due to parental concerns in the event of an injury or emer- football organizations that are about safety.2 The injury risk for gency.1,7 For example, American community-based and do not fall football is 5 to 7 times that of other Youth Football requires coaches to under the jurisdiction and guid- youth contact sports,3 with 13% of take the Centers for Disease Con- ance of the nationally recognized youth football injuries classified as trol Heads Up Online Concussion programs that require, or recom- mend, the safety resources men- From Wake Forest University School of Medicine, Winston-Salem, North Carolina (JEU, EKC, JDS, DAR); tioned above. Department of Biomedical Engineering, Winston-Salem, North Carolina (JEU, JDS); Department of Family and Previous studies have demon- Community Medicine, Winston-Salem, North Carolina (EKC, DAR); Innovative Athletic Training, LLC, Greensboro, North Carolina (MK); University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (JKR-M, JPM); strated the benefits of the presence Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Chapel Hill, North Carolina (JKR-M, JPM); of a medical professional at youth Department of Exercise and Sport Science, Chapel Hill, North Carolina (JKR-M, JPM). Submitted: November 3, 2015; Accepted: October 19, 2016 and high school sporting events. The authors have no financial or proprietary interest in the materials presented herein. These studies have shown that the The authors thank the Matthew Gfeller Foundation, the Childress Institute for Pediatric Trauma at Wake Forest Baptist Medical Center, the Childress Institute’s Christopher Budd Fund for Pediatric Trauma Education, presence of a medical professional and the South Fork Panther Organization for providing support for the athletic trainer, and Karen Klein, MA, ELS, improves the identification of con- GPC, for assistance in manuscript preparation. cussion and may subsequently re- Correspondence: Jillian E. Urban, PhD, Department of Biomedical Engineering, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157. E-mail: [email protected] duce the number of concussions doi:10.3928/19425864-20170109-03 that are not reported or missed.8,9 Athletic Training & Sports Health Care | Vol. 9 No. 2 2017 53 PROFESSIONAL PRACTICE It is standard to have a certified ath- Institute for Pediatric Trauma to position for a 6-month contract letic trainer at all collegiate and pro- expand upon this research and in- to attract a candidate with the fessional levels of football. Howev- clude advanced brain imaging pre- time availability and commitment er, a recent study reported that 70% season, post-concussion (if one throughout the season. It was es- of high schools have some access to should occur), and post-season. A timated that 50% of the position an athletic trainer, but only 37% local youth football organization would be devoted to on-field du- have a full-time athletic trainer and competing under the guidelines of ties and 50% to outreach (occa- there are few youth-level organiza- American Youth Football agreed to sional isolated high school event tions that have access to an athletic participate. The investigation team coverage) and assistance in the trainer.10 believed that the presence of an Sports Medicine Clinic (eg, room- During the 2013 and 2014 foot- athletic trainer at the practices and ing patients, demonstrating home ball seasons, our group worked games was necessary because the exercises, and applying braces). A with a youth football organization study protocol required recogni- position was created through the to hire an athletic trainer for prac- tion of potential concussion inju- Department of Sports Medicine at tices and games. In this article, we ries. This was chosen as a reliable Wake Forest Baptist Health and at report the feasibility and potential alternative to relying on reports of a hospital-defined 6-month salary benefits concerning emergency coaches, parents, or parental volun- of $16,328. The total cost to fund treatment, recognition of injury, teers with health care backgrounds the athletic trainer full-time for the and awareness of the importance of but inconsistent presence. length of the employment during safety procedures by way of an an- In the inaugural season, a posi- football season (with 50% effort ecdotal report of our experience for tion description was distributed to devoted to coverage of the youth the 2013 and 2014 seasons. The ob- the local North Carolina university organization) was $8,187. The jective of this report is to document athletic training programs, North funding for this position was made two seasons of experience with a Carolina Athletic Trainers’ Asso- possible through contributions full-time athletic trainer working ciation Facebook and Twitter pag- from the youth organization, grant with a single youth football orga- es, and to professional references funding, a charitable donation, and nization of more than 170 play- provided by colleagues. There was internal departmental funds. Dur- ers. This report may inform youth initial difficulty in finding inter- ing each of the seasons, a licensed sports leaders and sports safety ested candidates for the position, Sports Medicine physician signed advocates about the challenges and primarily because it would be a off on orders. There was no cost to benefits of having an athletic trainer part-time position given the num- the program for the physician and it in a youth football organization. ber of hours needed during the 3- was a necessary component to hav- or 4-month season (approximately ing an athletic trainer on field. CREATING AND FUNDING THE 18 to 20 hours per week); however, POSITION the position was eventually filled. THE ATHLETIC TRAINER’S A 2011 pilot study was conduct- At a rate of $35/hour, the resulting EXPERIENCE ed by the Virginia Tech–Wake For- cost was $7,500 for the season. This One athletic trainer was hired est School of Biomedical Engineer- cost included athletic trainer cov- for each of the fall football seasons ing evaluating head impact exposure erage, liability insurance coverage, during 2013 and 2014. In this youth in seven 7- to 8-year-old football and supplies because the person organization, players were aged 6 players in Blacksburg, Virginia. was employed by the youth orga- to 13 years old. Five teams, with 20 Athletes wore accelerometers in nization rather than through the to 30 players per team, practiced on their helmets for one season, which hospital. The youth organization separate areas of one football field showed that youth athletes received funded 40% of the position, with and two additional teams prac- head impacts that were similar in substantial financial support from a ticed 2 miles away at a local park. magnitude and frequency to those local charitable foundation. Each team practiced three nights occurring in high school and col- In the following season (2014), per week, with approximately two lege players.11 In 2012, our group our team believed that it was nec- full-contact practices per week. The received a grant from the Childress essary to make this a full-time athletic trainer operated primarily 54 Copyright © SLACK Incorporated PROFESSIONAL PRACTICE TABLE 1 Injuries Assessed by the Certified Athletic Trainer in Two Seasons of Youth Footballa Home Organization Other Teams Injuries 2013 2014 2013 2014 Concussions (out of play) 4 4 6 7 Fractures 2 3 5 1 Neck/spine (required boarding) 3 0 11 4 Medical (EMS activated) 1 0 2 5 Dislocations 2 0 0 0 Contusions 10 0 0 0 Sprains 3 3 2 2 Heat-related illness 0 4 0 0 Totals 25 14 26 19 EMS = emergency medical services aInjuries were only counted if presented to the athletic trainer.