Panel hears need for trainers

An expert on injuries recommends that each N.C. high school have a licensed athletic trainer on staff

CHAPEL HILL -- Every high school in North Carolina should have a licensed athletic trainer in order to protect the safety of athletes, a national expert told a key panel of the N.C. High School Athletic Association on Thursday.

The recommendation, if approved, would affect about two-thirds of the state's schools and carries an estimated price tag that could reach $18 million.

By December, the high school association is expected to consider the issue and others related to safety after the deaths of three football players this fall.

On Thursday, the association's Sports Medicine Committee met in an emergency session and listened to a national leader in concussion research -- Dr. Kevin Guskiewicz, who is the chairman of the Department of Exercise and Sports Science at the University of North Carolina.

"This is a public health issue," Guskiewicz said. "We need to say the safety and health of our high school athletes is a priority."

Guskiewicz unveiled a broad plan to the committee, which is made up primarily of physicians and athletic trainers.

Guskiewicz said about half of the NCHSAA's 381 schools have someone who acts as a trainer now, including unlicensed first responders.

But about 65 percent of the schools have no licensed athletic trainers.

Only about 10 percent have full-time licensed athletic trainers who don't also have to teach classes. Ideally, Guskiewicz said, each school would have a full-time licensed athletic trainer who is not required to teach.

Guskiewicz estimated that the cost of having a full-time licensed athletic trainer at every school would total $18 million, assuming an average salary of $40,000. He proposed that the state legislature commit the money.

He said the issue was so important that the alternative would be for high schools to eliminate football, boys and girls lacrosse, boys and girls soccer and wrestling until a system has enough money to hire a full-time trainer.

Those are the sports most prone to producing injuries, he said.

When the state passed legislation in 1997 to license athletic trainers, it did not require schools to hire them. Sen. David Hoyle, a Democrat from Gaston County and the bill's primary sponsor, said the schools had made clear they couldn't afford a mandate to hire licensed athletic trainers.

"If I were to get re-engaged in this, I would make an appropriation with the bill to fund the cost to the schools," Hoyle said recently. "If we're going to require it at the state level, then we ought to require ourselves to pay for it."

Guskiewicz emphasized how difficult concussions, or traumatic brain injuries, are to diagnose.

"The key is to have a person on the scene who is trained to recognize the symptoms and to take the right actions," he said.

Greenville Rose running back Jaquan Waller collapsed during a game Sept. 19 and died the next day from "second impact syndrome," which typically occurs when a young athlete suffers two relatively minor head injuries within a short period. The medical examiner reported that Waller had suffered a concussion in practice two days earlier, although Pitt County school officials said they weren't aware of that.

Rose does not have a licensed athletic trainer.

Also this year, Chapel Hill's Atlas Fraley died after returning home from a preseason football practice. The medical examiner's report has not been released. Winston-Salem Reynolds' Matt Gfeller died from a brain injury.

Both schools have licensed athletic trainers.

Three high school football deaths in one year in one state represent an unusually high total, said Dr. Frederick Mueller, director of UNC's National Center for Catastrophic Sport Injury Research.

At Thursday's meeting, Mueller noted that nine North Carolina high school players had died from injuries directly related to football from 1931 through 2007 and three died from indirect injuries over the same time span.

Direct fatalities result from activities such as tackling and blocking. Indirect fatalities are caused by exertion while participating in football, such as heatstroke, or a complication that was secondary to a non-fatal injury.

Guskiewicz also recommended that athletes undergo baseline testing before a season to give licensed trainers a basis for judging the extent of a brain injury.

Charlie Adams, the NCHSAA's executive director, said he expects the association's board to mandate that no athlete be allowed to return to play until the school has received a written release from a physician -- already part of a licensed trainer's protocol. The policy could take effect by early 2009.

Adams said a task force would be assembled to write the final recommendation on the issue of licensed trainers for the NCHSAA board to consider in December.

Wake County has licensed athletic trainers in 18 of its 19 high schools; Durham County has in six of its seven.