It is a question I have heard often enough: “Doesn’t the state require a school to have an athletic trainer?”

On both sides of the Indiana-Illinois state line, the answer is no. Neither state's high school athletic association nor its laws require coverage of a sports event by an athletic trainer or a physician.

The District of Columbia is different. There, the public school system’s administrators do not worry about local law. They have been funding full-time athletic trainers for their high schools for over 20 years.

“Athletic Trainers (ATs) are highly educated, multi-skilled allied health care professionals, uniquely qualified to care for and treat physically active individuals and their injuries,” reads the D.C. Interscholastic Athletic Association website. “ATs specialize in prevention, emergency care/assessment, clinical diagnosis, treatment and rehabilitation of injuries and medical conditions. Athletic Trainers must meet the qualifications set by the Board of Certification, Inc., and adhere to state licensing boards. Once certified, ATs must meet ongoing continuing education requirements in order to remain certified.”

Hawaii does our nation’s capital one better with the state legislature funding two athletic trainers at nearly every one of the public high schools in the state. That is 74 athletic trainers at a price tag of $4.28 million per year.

How the Aloha State arrived at such a policy is worth reviewing. Earlier this month, investigative journalist Amanda Waldroupe told the story in a post on the Washington-based InvestigateWest website.

According to Waldroupe, athletic trainers at the high school level were scarce in Hawaii, with none in the public schools, as recently as 1991.

The state’s high school athletic directors and coaches decided change was needed. Simultaneously, the University of Hawaii-Manoa was studying athletic trainer coverage and injury rates in the state, finding that the few private schools with athletic trainers had significantly lower injury rates than the schools without.

By 1993, the state legislature had been convinced to fund a two-year pilot study, placing 10 athletic trainers in 10 public high schools while also watching for benefits — if any. One of the private school veteran athletic trainers compiled data from the 10 public schools and it was compelling.

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“It showed a significant drop in the rate of injury,” wrote Waldroupe, “as well as better health care outcomes and treatment available to student athletes with access to (athletic) trainers.”

The legislators were sold. Next, they funded a single athletic trainer for all 43 public high schools. By 2000, they had upped their commitment by funding two athletic trainers at every school except the nine smallest, which were left with one. As a result, a high school athletic trainer attends every practice and every home game in every sport in Hawaii.

The commitment to athletic training services happened to coincide with the rising concern over concussions among youth athletes. In 2010, the Hawaii Department of Education, the University of Hawaii, the Hawaii Department of Health, the Hawaii High School Athletic Association and the Hawaii Athletic Trainers’ Association combined to form the Hawaii Concussion Awareness and Management Program.

H-CAMP, wrote Waldroupe, “oversees the annual education on concussions for coaches, school administrations, educators, student athletes and their parents.”

In H-CAMP’s first year of existence, 446 concussions were recorded statewide. By the 2013-14 school year, thanks to better awareness, the number had risen to 1,370. The most recent data, according to Waldroupe, is from the 2015-16 school year, when the number had fallen to 1,092.

Multiple studies, including one published in the November 2018 issue of the Journal of Athletic Training, have demonstrated that the greater the availability of an athletic trainer at a school, the higher the rates of concussion and the better the management of those concussions.

While athletic trainers catch more concussions, having them on staff at a high school actually lowers the overall injury rate among such schools, according to a study published by the American Academy of Pediatrics in 2012, thus confirming what was found years earlier in Hawaii. The athletic trainers, it is thought, catch injuries earlier, preventing them from becoming more serious. Thereafter, regardless of the severity of the injury, the athletic trainer then assures recovery is complete prior to return-to-play, which greatly reduces the likelihood of re-injury.

Still not convinced? A study out of Lurie Children’s Hospital in Chicago, and published in Injury Epidemiology last year, duplicated the findings regarding higher concussion rates but lower overall injury rates at schools with athletic trainers in comparison to those without.

I have written in the past that it will take political will to make universal athletic training coverage a reality. That will has been demonstrated in the District of Columbia and Hawaii. It does not matter if that will is found at the local, state or national level. Regardless of where it is found, though, it is bound to pay dividends for both government and private health care insurers but most importantly, for the athletes.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.