The NCAA News - News and Features

The NCAA News -- March 15, 1999

NCAA group raising awareness on medical coverage

BY GARY T. BROWN
STAFF WRITER

While the number of skill-instruction sessions and out-of-season practices is on the way up in several intercollegiate sports, at least one NCAA committee is worried that the emergency medical care available at those activities is on the way down.

The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports is concerned that basic medical coverage, particularly in the event of an emergency, is not keeping pace with the expansion of practice activities, especially in the nontraditional season.

Those concerns were borne out during the committee's review of results from a recent survey to assess current emergency medical care available at competitive activities during both the regular and nontraditional seasons in a variety of sports.

The results proved what the committee feared was occurring since legislation was enacted that increased skill-instruction sessions and out-of-season activities: that emergency care practices during those events were not what they could -- or should -- be in either the regular or nontraditional seasons.

Guidelines regarding appropriate medical coverage for practices and games have existed in the NCAA Sports Medicine Handbook for many years. As part of its 1996 plan to heighten awareness of health and safety issues throughout the Association, the committee re-emphasized those guidelines for all activities associated with a particular sport, including activities that occur in the nontraditional season.

Coverage may be slipping

Former committee member Bernie DePalma, athletic trainer at Cornell University, first alerted the group to concerns that basic medical coverage at those events may be slipping. DePalma and fellow committee member Bryan W. Smith, team physician at the University of North Carolina, Chapel Hill, spearheaded the charge to develop the survey.

"The onset of skill instruction put a great deal of stress on the people who historically have covered practices and competitions -- the athletic trainers," Smith said. "As a committee, we were concerned whether there was the proper coverage at these events. That prompted the survey."

The survey sampled half of the 981 NCAA institutions sponsoring each of 11 different sports (football, men's and women's basketball, men's and women's outdoor track, men's and women's lacrosse, men's and women's cross country, women's gymnastics and wrestling). Sports were selected with consideration of gender and revenue status.

Medical care and supervision -- such as whether schools had an emergency medical plan in place for those events, whether qualified personnel were available for emergency care, and whether athletics personnel (including coaches) were trained in cardiopulmonary resuscitation (CPR) and first aid -- was assessed in six activities associated with each sport: regular-season practices and games, nontraditional-season practices and games, strength and conditioning workouts, and skill-instruction sessions.

The committee used the survey to satisfy two primary concerns: whether schools had emergency care plans in place and whether schools had qualified personnel who would be able to render emergency care at each event.

About 60 percent of schools surveyed responded, and results showed that for most sports, including basketball and football, 10 percent or more of institutions did not have an emergency medical plan for regular-season practices and games. While that was somewhat alarming to committee members, their concern was heightened by the fact that more than one-third of schools sponsoring sports that allow skill instruction or strength and conditioning workouts did not have emergency plans for those activities at all.

In cross country and outdoor track, only 60 percent of institutions provided what the committee felt was adequate coverage. And that coverage was significantly reduced in nontraditional-season practices and games. Less than 50 percent of schools had emergency coverage for skill instruction and strength and conditioning workouts or required their athletics personnel to be trained in CPR and first aid.

"We felt that the coverage, if any, at those venues, wasn't as optimal as it could be," Smith said. "Most schools had qualified personnel at regular-season practices and games, but when it came to some practices, particularly the skill instruction and out-of-season practices, schools weren't devoting the same type of coverage."

Guidelines for improvement

As part of its response to the problem, the committee plans a mailing in April targeting presidents, athletics directors and senior woman administrators and emphasizing the need for emergency medical care at all events.

Among the recommendations included is the need for schools to develop an emergency plan and coverage for all activities. For schools that have existing plans, the message is to extend those plans to the nontraditional sessions.

For some schools, that may require hiring additional athletic trainers. For others, it may involve a commitment to retrain existing staff in emergency care skills. William F. Arnet, general counsel at the University of Missouri, Columbia, and chair of the competitive-safeguards committee, said the recommendations are not meant to mandate either one but to raise awareness that the issue is one that schools can't simply choose to ignore.

"There's a responsibility on the institution's part to watch out for the health and safety of the student-athlete," said Arnet. "With the increase in skill instruction, that may stretch staffs very thin."

But Arnet said that the committee, in order to avoid financial consequences as much as possible, refrained from issuing guidelines that would require an athletic trainer to be available for those sessions. The committee instead felt that schools needed to designate someone -- not necessarily an athletic trainer -- who is trained in CPR, emergency care and first aid who can respond to an urgency if it comes up.

"We're not trying to designate who the person is in terms of their position," Arnet said. "It could be a coach or an assistant coach, or even a student-athlete -- as long as it's someone who at least has some basic training in CPR and first aid. Now that may put some additional economic pressure on the athletics departments because they may have to train some staff in CPR and first aid, but it's certainly not as significant as if the guideline had required an athletic trainer at every event."

Mary Wisniewski, athletic trainer at the University of Chicago and a member of the committee, said that the buy-in from the athletics departments to deploy -- or hire -- additional qualified personnel may not be a certainty.

"We need to ask the administrators to increase resources, and I think we might get some resistance there," she said. "It may take a financial commitment in hiring additional staff. That'll be a tough sell, but ultimately it's the only way schools will be able to accomplish this, particularly in Divisions II and III."

Anticipated reaction

Another committee member, Peter D. Carlon, athletics director at the University of Texas at Arlington, said the answer may be in how the athletics staff operates as a team to accomplish the necessary coverage.

"The whole department needs to feel a sense of ownership of the emergency plan," Carlon said. "That way, if there aren't enough trainers to go around, then a coach feels that he's either trained well enough or that someone on his staff is trained well enough to handle an emergency situation."

Smith said the committee anticipates a mixed reaction from institutions.

He said medical staffs likely will applaud the committee recommendations because they will bring some attention to issues that have not been as well addressed as athletic trainers would have liked in the past.

Smith also said the recommendations are timely from a medical/ legal perspective.

"That's the kind of society we live in now -- that's the reality," he said. "If you're not well prepared and things happen, it puts the school as well as the participants in some legal jeopardy."

And while he does not think institutions will downplay the importance of providing coverage, he said some athletics staffs might see the request as an additional task on an already full agenda.

"For athletics administrators, it will be somewhat eye-opening, to be honest," he said. "That's not necessarily a bad thing, but they already have a lot on their plates and this is just going to be one more issue they have to address.

"But I don't think they should feel they have to shoulder the load themselves. That's for them to work out with their particular sports medicine staffs. Again, most institutions have emergency medical plans in place. We're just asking that they extend these plans."

Different solutions possible

Smith said the issue may be one that athletics departments are used to dealing with in other areas -- either reallocating funds and/or personnel or finding other creative solutions to address a need.

"In this day of tight budgets, there are other ways to skin the cat, so to speak," he said. "It just takes some creativity on the part of athletics departments and sports medicine staffs to come up with a functional way to address these issues."

And though the committee's recommendations are just that, other pressures exist that will prompt athletics departments to take this issue seriously. Guideline 1-A of the Sports Medicine Handbook, which includes the committee's recommendations, is part of the Division

I Athletics Certification Program, as well as part of the Divisions II and III Institutional Self-Study Guides.

And Wisniewski said that the NCAA isn't the only group sounding the alarm. She is a member of a National Athletic Trainers' Association (NATA) task force working to identify what it considers to be minimum standards for coverage at out-of-season practices and workouts. She said that group will announce its findings later this year.

She said it is imperative for both organizations to convince schools of the importance of providing adequate coverage -- and for understanding what adequate coverage really is and how it can be provided.

"The survey results proved that there just isn't the compliance with Guideline 1-A that we were hoping to see," she said. "And while the NCAA isn't in position to require schools to hire more athletic trainers, it is in the position to support the idea that, yes, what some schools consider minimum coverage is not adequate. This is a stand the NCAA needs to support."