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Do High School Athletes Really Need Athletic Trainers? Part I: Emergencies

Some ask if there is hard evidence documenting the value of athletic trainers in high schools. Do they save lives, shorten injury time, prevent small problems from becoming big ones or help in other ways?

Now a group of studies provides parents, coaches and school administrators with information to help answer these questions. The research suggests that athletic trainers improve the recognition, treatment and outcomes of important health problems.

“A growing body of research is providing empirical evidence for the impact of the athletic trainer on the health and safety of high school athletes,” says Lauren A. Pierpont, Ph.D., A.T.C., of the University of Colorado and colleagues in a 2018 study.

In this article, we look at the evidence assessing the impact of athletic trainers on emergency preparedness and survival after sudden cardiac arrest. In Part II, we look at athletic trainers’ role in recognizing and caring for concussions and other injuries that cause athletes to take time away from sports.

Highly endorsed, but underused

Athletic trainers are tasked with creating emergency medical action plans, and recognizing, treating, rehabilitating and preventing injuries. They provide a safe space where athletes can talk candidly about injuries, and they relieve coaches of medical duties.

“Athletic trainers are the entry point to the healthcare system,” notes Jennifer Carrol, P.A.-C., A.T.C., of the University of Washington, and president of the Washington State Athletic Trainers’ Association. “They are trained for the evaluation and management of injuries and for emergency care. That’s their job.”

The American Academy of Pediatrics(AAP), American Medical AssociationNational Athletic Trainers’ Association and others endorse athletic trainers as key members of the sports medicine team. “Skilled athletic trainers should be available on the sidelines, as evidence shows they can reduce the number of injuries for players,” the AAP stated in 2015.

Despite this, only about one-third of high schools in the U.S. employ full-time athletic trainers for their students; approximately one-third employ athletic trainers part-time, and another one-third hire none, according to 2018 data from the Korey Stringer Institute.

Surviving sudden cardiac arrest

Every two or three days in the U.S., a young athlete dies as the result of sudden cardiac arrest. It is the number one cause of sudden death in exercising young athletes. (For more, see our article, Sudden Cardiac Arrest: Know the Danger.) In most cases, the arrest occurs with no warning. In the midst of play or practice, the athlete suddenly collapses; if appropriate action is not taken within minutes, the athlete will die or be left with serious brain damage.

Research has shown that automated external defibrillators (AEDs) significantly increase the chance that an athlete will survive sudden cardiac arrest. Two studies suggest athletic trainers are key to their success. 

In a 2019 study that examined 132 cases of exercise-related sudden cardiac arrest over two years, survival was nearly twofold greater if an AED was available or an athletic trainer was on site. The average age of the athletes was 16. Findings of the study, conducted at the University of Washington, included:

  • Overall survival after sudden cardiac arrest in young athletes was 48%
  • If an athletic trainer was on site, survival increased to 83%
  • If an AED was nearby, survival rose to 89%

“Exercise-related sudden cardiac arrest is almost always a survivable event when you have prompt recognition by witnesses, proper resuscitation and an AED close by,” said the lead author, Jonathan Drezner, M.D., in a statement.

“Forty-eight percent is far better than the overall survival rate for sudden cardiac arrest in the U.S. But this data tells me that a lot of young athletes we should be saving are dying.”

Emergency preparedness

Compared to high schools without athletic trainers, high schools with athletic trainers are more likely to adopt best practices for emergency preparedness, according to a 2017 study in Oregon. Among the best practices endorsed by national organizations are the creation of an emergency action plan for all athletic venues, the availability of lifesaving AEDs at all venues and personnel trained in cardiopulmonary resuscitation and AED use.

Researchers invited all school athletic directors in Oregon to complete a survey; 108 responded.

  • All schools with an athletic trainer had at least one AED on campus
  • Schools with athletic trainers were twice as likely to have an emergency action plan
  • But athletic trainers were not a cure-all; nearly half of schools with athletic trainers did not have emergency action plans for every one of their athletic venues.

“Participation in high school sports involves an inherent risk of catastrophic injury. Although such events are rare, institutions must be prepared to respond,” the authors wrote.

“Although [athletic trainer] services were available at just half the schools, their presence was associated with increased adoption of best practice recommendations, including venue-specific [emergency action plans] and AED availability,” they added.

“Athletic trainers are ideally suited to guide the development and implementation of emergency policies and procedures; schools should use the athletic trainer as a resource, and athletic trainers must in turn promote the use of best practices.”