Tag: California Athletic Trainers Association

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California athletic trainers back push for state licensing

Article reposted from  The Press Democrat
Author: LORI A. CARTER

A football player bangs helmets with another during a high school game. One gets up slowly, a little stunned.

Off the field, someone asks him how he is. “I’m fine, just got my bell rung. I can go back in,” he says. He didn’t lose consciousness and doesn’t have a headache. He knows where he is and can see straight.

Should he go back in?

Who determines that, particularly in California, wields a huge influence on that athlete’s future — possibly even his life.

A certified athletic trainer would likely pull him and send him through a weeklong concussion protocol with a step-by-step return-to-play checklist that monitors his symptoms.

But California doesn’t require its athletic trainers to be licensed, which allows just about anyone on the sideline to make that determination.

“Someone could just say they’re an athletic trainer and work and function as an athletic trainer, and there’s no real law against it. That’s dangerous,” said Monica Ohkubo, the head athletic trainer and director of the athletic training program at Santa Rosa Junior College.

California is the only state in the nation that does not require licensure or regulation of such medical professionals, entrusted with the care of hundreds of thousands of high school, college and professional athletes who play in the state every day.

Newly introduced legislation aims to change that.

Assembly Bill 1510, introduced last month by Assemblyman Matt Dababneh (D-Encino), would require licensure and regulation of athletic trainers by an existing occupational therapy oversight board and impose disciplinary action for those who work without proper licensing.

It would also create a scope of practice, codifying what athletic trainers can and can’t do in a medical setting.

Santa Rosa’s Ohkubo and others hail the effort to get California on the same page as other states — both for athletes’ safety and to ensure legal protection for athletic trainers and their employers.

According to the California Athletic Trainers’ Association, which is sponsoring the bill, many school districts do not require any athletic training education or certification, and about 30 percent of those calling themselves athletic trainers in high schools are unqualified for the role.

That poses a significant hidden risk to those seeking medical treatment, the CATA argues. Unqualified employees acting as athletic trainers in high schools run the gamut from coaches and teachers to administrative personnel and other staff.

The legislation has support from the NCAA, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, the National Federation of State High School Associations and more than two dozen other related organizations.

No one has registered any opposition to the bill, although in past versions organizations representing nurses, physical therapists, occupational therapists and teachers have challenged the idea. Their concerns focus on the existence of already qualified practitioners and the proposed scope of practice, which they viewed as too broad, which might overlap with their professions.

Many athletic trainers in California have passed state or national certification exams, but those backing the bill argue that’s not enough.

“Anyone can say they are an athletic trainer by saying they are. It’s that simple,” said Tom Abdenour, former head athletic trainer for the Golden State Warriors and San Diego State University.

With an uncertified or unlicensed trainer, there may be no basic medical training, nor any continuing education on new trends, and therefore a greater risk of something going wrong, Abdenour said.

Parents and athletes have no way to know whether a school’s athletic trainer is qualified, other than questioning their credentials or work history.

“Also, in California, because we have no way to monitor or filter out unqualified people from other states, there may be people didn’t finish their schooling or didn’t pass the certification exam who are passing themselves off as athletic trainers,” he said. “We’re putting the public at risk because we have no way to filter them.”

Someone whose license was revoked in another state could also work in California.

Ohkubo gives other examples that might not be quite as obvious as the head-injury question:

A soccer player injures the anterior cruciate ligament in her knee. She can still play and move with some pain, but it’s not debilitating.

“Now the knee is unstable and they go back in and blow the whole knee out, lose total function,” she said.

Or an untrained trainer “could apply a tape job that makes an injury worse or makes it feel like nothing’s wrong, and the athlete further injures it. The list could go on. Coaches should be able to rely on them. And they can’t,” she said. “It’s a huge health and safety liability and these school districts just don’t know.”

As the danger of concussions has become more recognized, schools and professional teams have placed greater emphasis on prevention and treatment of serious injuries.

At Santa Rosa City Schools, its district athletic director, Russ Peterich, has worked with local physicians Ty Affleck and Robert Nied in a concussion management group, whose members are pushing for athletic trainers at every high school in the state.

But more subtle injuries can be tricky as well, Ohkubo said. Athletic trainers handle issues as far-ranging as skin infections, improper equipment use, lightning and storm safety protocols, asthma attacks, eating disorders, psychological and mental health problems, sprains, breaks, sunburns and more.

But with no state-sanctioned scope of responsibility, there is a legal gray area for trainers, particularly for those who travel with their teams to states that require licenses.

“An increasing number of states, including Utah, Texas, Hawaii and Massachusetts, have made it illegal for an unregulated athletic trainer to travel to their state and work with their teams,” Abdenour said.

As a result, athletic trainers who treat their athletes in those states, as well as their employers, expose themselves to legal and financial consequences.

A legal framework would help protect everyone involved, said Mike Chisar, chair of the CATA’s governmental affairs committee and director of the sports medicine-athletic training program at Diablo Valley College.

“Institutions and employers are concerned,” he said. “They’ve been coming to us more recently, asking, ‘Would you begin licensing? We don’t have any guidelines about how you can work in our facilities. Everyone else has guidelines of what they can and can’t do.’ It puts them on edge.”

Abdenour, the former Warriors trainer, shared a story that he said shows the benefits of regulation.

A young lacrosse player in San Diego was in a collision and went down.

“The athletic trainer got to him. He recognized signs of a spinal injury and immediately went to work. Would the coaches have called 911? Maybe. But the athletic trainer kicked into high gear and made sure everything was done correctly,” he said.

“One wrong move could have been the difference between a paraplegic situation or not. But if we have someone who is making the decisions out of haste or doesn’t recognize some of the subtleties of the situation, it could be a problem.”

The bill is scheduled to be heard in a state Assembly committee meeting on March 21.

You can reach staff writer Lori A. Carter at 707-521-5470 or lori.carter@pressdemocrat.com. On Twitter @loriacarter.

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California Schools falling short in hiring full-time athletic trainers

Article reposted from The San Diego Union Tribune
Author: P.K. Daniel

Last month, a spectator suffered a heart attack while attending a basketball game at Rancho Bernardo High.

Robbie Bowers — the school’s certified athletic trainer, also known as an AT— was working the game. He and his staff put their emergency action plan into effect, utilizing the school’s defibrillator and CPR to save the elderly man’s life.

Unlike at Rancho Bernardo and other high schools in the Poway district, few student-athletes — let alone fans — in the CIF’s San Diego Section enjoy the safety and benefits of a full-time certified athletic trainer.

According to a 2015 story by CBS Sacramento, 80 percent of California high schools don’t employ full-time athletic trainers, whose job is to collaborate with physicians in providing preventive and emergency care, diagnosis, rehabilitation and other medical services.

Additionally, not all trainers are certified. And none are licensed in California.

“In California, anyone can say they are an ‘athletic trainer’ regardless of educational preparedness or skill,” said Tom Abdenour, longtime AT with the Golden State Warriors and former SDSU athletic trainer. “Needless to say, this can put a young student-athlete at risk if the wrong person does the wrong thing at the wrong time.”

California is the only state that does not recognize athletic trainers as licensed health-care practitioners. It doesn’t regulate the industry or define its scope of practice.

The California Athletic Trainers’ Association (CATA) has been campaigning for the passage of legislation since the mid-’80s. The most recent measure in 2015 would have restricted use of the title “athletic trainer” to only those individuals who have fulfilled the requirements for certification by a national body.

The bill had unanimous support in the legislature but was vetoed by Gov. Jerry Brown, who said certification imposes unnecessary burdens on athletic trainers without sufficient evidence that certain levels of education are needed.

As it stands, certification requires a bachelor’s degree with 70 percent of athletic trainers holding a master’s degree. According to Brown, the “burdens” outweigh the risk of having unlicensed trainers.

Mike Chisar is chairman of CATA’s Governmental Affairs Committee. He said the association has provided incidents of harm but pointed out the challenge of documentation since uncertified athletic trainers generally don’t keep medical records.

“You would hate for a kid to die to make (Brown) go, ‘Oh, there’s harm here or there’s the potential for harm by having somebody who’s not trained making (medical) decisions,’” Chisar said.

Alaska recently joined an increasing number of states (including Texas, Hawaii, Utah, Arizona, New York and Massachusetts) that require out-of-state trainers practicing in their state to be licensed, prompting new licensure legislation to be introduced this month in California.

The California Interscholastic Federation, the state’s governing body for high school sports, has safety guidelines on several issues. When it enacted concussion management and return-to-play protocols, it was complying with state law. But mandating full-time athletic trainers at every high school is beyond the CIF’s purview. Personnel and staffing decisions are under the local control of elected school boards.

Certification and licensing issues aside, a lack of funding is often cited as the reason ATs are not required.

“I think it really comes down to resources,” said Bowers, the outgoing secondary schools chairman for CATA. “In the past, I think there was confusion as to what an athletic trainer was/does, but I think through education that perception is becoming more clear and (schools) are desiring an athletic trainer. How to pay for it has become the bigger issue.”

Until this school year, San Diego Unified, the second-largest school district in California, did not have athletic trainers at each of its 16 high schools that have athletic programs. But district backing, including $416,000 in funding, allowed Scott Giusti, director of PE, health and athletics, to contract with UC San Diego to hire part-time certified athletic trainers.

“I cannot stress enough what a great thing this has been for our students and our schools,” Giusti said.

The CIF’s San Diego Section does ensure that athletic trainers are at most postseason competitions.

“At CIF events, we either require or provide trainers,” section Commissioner Jerry Schniepp said.

This year, the San Diego Section started a health and safety advisory committee composed of physicians, athletic trainers and school administrators.

“We are trying to provide for all schools a best-practices guideline on athletic training issues, head injuries, etc.,” Schniepp said.

San Diego schools and districts have dealt with the issue of athletic trainers in different ways. In 2015, CATA conducted a survey in which only 33 of more than 100 San Diego Section schools participated. Ten schools had no athletic trainer, six had an uncertified athletic trainer and 17 schools had at least one certified athletic trainer. Chisar said the employment status ran the gamut from attendance at football games only, to part time to full time. In the San Diego sample, 13 trainers were full time, eight were part time and two were football only.

The Grossmont district allots $10,000 to each of its nine comprehensive high schools as part of the annual athletic trainer budget, allowing each school to hire a part-time trainer.

“We strive to hire certified athletic trainers,” said Brian Wilbur, director of athletics for the Grossmont district. “In many cases, the trainer is also a teacher at the school or holds another classified position.”

Sweetwater Union has placed full-time certified athletic trainers at eight of its 12 high schools, and expects to have all 12 staffed next year. The trainers teach sports medicine and physical therapy classes during the day. Their remaining hours are devoted to athletic training.

Helping to implement the program was Dr. Charles Camarata, who has devoted many years to helping South County high school athletes.

Said Camarata: “The district is on board and sees the value.”

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Football In California: Is Anyone On The Sideline To Provide Emergency Medical Treatment?

Article reposted from Capital Public Radio
Author: Bob Moffitt

A million high school football players will likely watch the Super Bowl this weekend. Many of their parents assume their games are staffed with medical professionals, just like in the pros. But that’s not the case.

During this season’s North Coast Division 5 championship in Martinez, a St. Patrick-St. Vincent defensive player dove for Fort Bragg’s quarterback, but missed. Instead, he collided with the left leg of one of Fort Bragg’s linemen.

“His foot was kind of pointing in one direction and his ankle was slid over to the other direction,” describes Bruce Triplett, Fort Bragg’s principal.

His leg was broken, his ankle was dislocated. The crowd looked around the stadium for an ambulance, but there wasn’t one.

Several people called 911.

“Then we just sat there and waited for an ambulance to show up,” says Triplett.

VIDEO: St. Patricks St. Vincent vs. Fort Bragg

According to the Contra Costa County Fire Protection District, it took about 11 minutes for an ambulance to arrive on the field and another four to load the player.

“It was frustrating when the ambulance did show up, they weren’t code three, they didn’t have lights going,” says Triplett. “They stopped at stop signs and turned on their blinkers.”

Triplett says Fort Bragg parents are used to having an ambulance or fire truck at their home games.

But it’s not a statewide requirement. Each California Interscholastic Federation section has its own rules. Some require schools to have medical staff at games. Some do not.

“We require that a physician, an ambulance, an EMT, a paramedic or a certified athletic trainer be present at all of our football games,” says Gil Lemmon, commissioner of the North Coast Section.

Lemmon says an athletic trainer was on site and put the leg in an air cast.

But there’s no guarantee that a California school’s “athletic trainer” is qualified to provide medical care because the state does not require them to be licensed.

“We know of shipping and receiving clerks and personal trainers and all sorts of people who may have nothing more than CPR and may not even have that,” says Mike Chisar, who is with the California Athletic Trainers Association.

Chisar estimates that only a third of California schools have a trainer with the education and experience required in other states.

The North Coast Section’s Gil Lemmon says schools should pay to hire licensed trainers, but also says ambulances are too costly and mostly unneeded, except in extreme cases.

“Unless there’s attention within, say, three minutes, they actually could expire, lose their life,” says Lemmon. “And those kinds of things you’re not going to be able to do anything about. You offer the best care that you can and we had absolutely great care available at the venue.”

Alex Robertson is an EMT and says Fort Bragg was fortunate to have an assistant coach, who is also an EMT, at the game to tend to the fallen player.

Robertson was in Ventura near the end of the season for a CIF Southern Section game when two players crashed into a 66-year-old official.

“Knocked him about ten feet back,” says Robertson. “By the time he hit the ground, he was unconscious. He had snoring respirations, which means his airway was blocked and so he needed immediate interventions.”

Robertson used a tool called an airway adjunct to help the man start breathing. He says even a licensed trainer would not have had an EMT’s tools or advanced skills required to save the man’s life.

“Minutes count and depending on the response time of the municipality that you’re in, anywhere from seven to 11 minutes, that’s critical and that can determine literally not only the quality of life afterwards, but sometimes life and death,” says Robertson.

He says the CIF fails to recognize that emergency staff on the sidelines can save lives. He also says Southern Section schools had no medical staff at his sons’ games, which is why he started a business to staff games with EMTs.

According to research by the Colorado School for Public Health, there are about 39,900 football injuries nationwide that require surgery.

The CIF, though, says it cannot force schools that host regular-season games to provide advanced medical care and the CIF will not require the sections that host playoff games to provide it either.