Almost everyone agrees that putting a certified athletic trainer in every high school in North Carolina is a good idea. But that hasn't helped pay for the positions.
Many school systems are cutting budgets and proposed legislation to provide more than $21 million to place trainers at 390 high schools hasn't gotten traction.
The need for the trainers is apparent. At least four high school football players and one assistant coach have died around the country this season, according to the Associated Press, and the season is just getting started.
About 40 percent of the N.C. High School Athletic Association's 390 member schools have certified athletic trainers, according to Jim Scribers, the president of the N.C. Athletic Trainers Association. Wake County, which uses teacher-trainers, has a certified athletic trainer in each of its 20 schools and there are no plans to make changes.
But in other parts of the state, the funding for the certified trainers has been hard to find.
A two-year-old partnership between Charlotte-Mecklenburg Schools and the Carolinas HealthCare System may be providing a diagram of a way to get the trainers into every high school in the state without public funding. It is a model that is attracting national attention.
Carolinas HealthCare, which is affiliated with 33 hospitals and has a network of 600 health care facilities in North Carolina and South Carolina, is providing certified athletic trainers at eight CMS high schools this year and will add trainers at four other CMS school each year until each of the system's 19 high schools has a certified athletic trainer who is a HealthCare employee.
The trainers are hired and paid by Carolinas HealthCare and are not school employees. Each trainer is assigned to one school and is at the school from 10 a.m. until the final athletic practice or game is completed.
The Charlotte-Mecklenburg system has a certified athletic trainer in each of its 19 high schools this fall, but had them in only 11 of 18 high schools in 2008 when students in Greenville, Winston-Salem and Chapel Hill died while playing high school football.
Having certified athletic trainers in all of its schools has been the goal of the N.C. High School Athletic Association school since October 2008, when its Sports Medicine Committee met in emergency session following the deaths, two from brain injuries.
Kevin Guskiewicz, the Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC Chapel Hill, told the committee that schools should consider not fielding teams in football, boys and girls lacrosse, boys and girls soccer and wrestling until a school system had enough money to hire a certified trainer. The NCHSAA board of directors considered the committee's recommendations, but did not move toward requiring its member schools to have a certified trainer.
"The consensus was the NCHSAA couldn't mandate without providing funding," said Rick Strunk, an associate commissioner.
Without state money, many local systems have struggled to fund the positions.
Trainers and supplies
Mecklenburg schools provide a room and supplies and HealthCare supplies the trainer. Carolinas HealthCare also offers yearly free preseason screenings for each of the approximate 10,000 high school athletes in CMS. The exams can include echocardiograms and electrocardiograms if the preliminary screening indicates a need for further testing.
"This may be a blueprint of sorts for other systems to get certified athletic trainers into every high school," said Que Tucker, the deputy commissioner of the state association. "Health care systems and hospitals have a great opportunity to have a huge impact on the state."
Spencer Elliott, who directs the program for HealthCare, said there have been inquiries from across the country about the program's specifics. "There really haven't been any problems," he said.
A pilot program began in 2009 when HealthCare provided a certified athletic trainer for Matthews Weddington in Union County. Former CMS athletic director Vicki Hamilton and HealthCare worked out an agreement last year that placed trainers at Phillip O'Berry, East Mecklenburg, South Mecklenburg and Waddell. This fall, Myers Park, Harding, Vance and West Mecklenburg were added to the mix along with Garinger, which is getting a trainer after Waddell was closed.
The plan is for HealthCare to add four more schools each year until all of the CMS schools have HealthCare trainers. The current trainers who are not HealthCare employees will have the opportunity to stay at their schools as assistant trainers.
HealthCare also is providing trainers in the Fort Mill, S.C., community, in Lincoln County and in Cabarrus County, where five of 20 certified athletic trainers are from HealthCare..
"To us, this is about having a presence in our community," Elliott said. "This is being a part of the fabric of our communities."
"This could be the way to get the trainers," said Josh Canipe, a certified athletic trainer who left New Hanover County Schools to become HealthCare's trainer at Myers Park High in Charlotte. "In this economic climate where state-funded jobs are dwindling, reaching out to large organizations in order to provide the services that are needed."
The similar model has been tried in other parts of the country and is be using at some schools in Forsyth County and in some western North Carolina counties.
Brian Robinson, the trainer at Glenbrook South High near Chicago and the chairman of the National Athletic Trainers Association's secondary school committee, said the model has not always worked well.
"It works in a few places, but it is rather common for it to not be extremely successful," Robinson said. "If the hospital enters the program with the expectation of the partnership generating profits, it usually doesn't work.
"The health care provider would have to have a great deal of long-term commitment."
Robinson said programs such as the one in CMS may be a good way to get certified trainers into schools initially, but that some systems that began with health care provided trainers and moved toward funding the trainers. "School systems generally have funds for priorities," he said. "If the health and safety of the students is a priority, the funds can usually be found."
Spencer said HealthCare is in its program for the long haul. "This is being a part of our community," he said.
Nationally, there are three basic models for getting certified trainers into schools, including having health care providers supply trainers either on a full-time or part-time basis. Franklin County, for example, is getting certified athletic trainers at Franklinton, Bunn and Louisburg high schools from Galland Orthopedic and Sports Medicine. The trainers go to football practices and games.
New Hanover County, on the other hand, uses full-time trainers. While he was in New Hanover, Canipe didn't teach classes, except to other staff members and coaches.
Wake County Schools uses teacher-trainers. The trainers teach classes each day in addition to being trainers.
"Our trainers teach some of our most popular classes," said Bobby Guthrie, Wake County system athletic director. "There would be a loss for us if our trainers were not in the classroom."
Instead of certified athletic trainers - who are medical professionals - the majority of NCHSAA schools use first responders, who are trained in first aid and cardiopulmonary resuscitation.
Partnerships between schools and health systems throughout the state may be changing that percentage though.
"Using this model is certainly better than using a first responder or not having a trainer at all," said UNC's Guskiewicz .
"But similar programs have been tried in other parts of the country and eventually the hospital looks for a return on its financial investment. In my opinion, the best way is to have a full-time athletic trainer who is a staff member at the school and who sees the students on a daily basis. This model may be a good way to get more athletic trainers into more schools."