The ongoing discussion about the future availability of student athletic trainers may be growing into an even more important discussion about the provision of emergency medical care for student-athletes participating in smaller programs.

To be sure, many Division II administrators appear concerned over how they will be affected in 2004 when individuals seeking to become certified athletic trainers no longer will be able to use internship hours as a means of becoming eligible to take the certification examination. Instead, they will be required to qualify by successfully completing a certified curriculum.

Many small programs in intercollegiate athletics currently rely upon student athletic trainers who are accumulating intern hours. Answers for what they are supposed to do in the alternative appear to be in short supply, and the issue was on the minds of participants at a Division II issues forum January 9 in San Diego.

"Sometimes, presidents have so many issues that we don't act when we see the light so much as we do when we feel the heat," said panel member Charles D. Dunn, president of Henderson State University. "This is one of the issues that has great potential to provide great heat."

However, Dunn spoke in the larger sense of meeting the emergency-care needs of student-athletes.

"It's my specific advice to the CEOs, ADs and others in the audience for you to go home and make certain that you have a workable emergency health-care plan in place for your student-athletes," he said.

Presumably, any such plan would have to deal with a shortfall in student training support that will be increasing over the next four years. But that is just one factor to be considered amid many other athlete safety issues.

Emergency-care survey

Randall W. Dick, NCAA senior assistant director of health and safety, told the audience that 10 percent of the institutions responding to a 1998 survey had no emergency medial plan for regular-season practices or games for most sports. Twenty-five percent had no plan for nontraditional season practices and games, while more than one-third had no emergency plans for skill instruction or strength and conditioning workouts. The responses indicated that such plans were less likely to be available in Divisions II and III than in Division I.

The National Athletic Trainers' Association (NATA) claims that its primary purpose is to create a safer environment for athletes. Dennis Miller, former NATA president and athletic trainer at Purdue University, said that improved care was the motivation for eliminating the internship option.

"People ask why," he said. "Basically, it's very simple. You want your medical personnel to be on top of the game."

Miller said that the door is not closed on all student training assistance. Certified programs still will be able to provide clinical experience for their students for programs other than their own (programs in remote locations claim this option has little relevance to them). Also, some discussion has taken place on whether those using an entry-level master's program might be somehow credited with clinical experiences gained as an undergraduate.

In any case, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports will continue to work with NATA to see what options it can identify.

Standards of care

At its next meeting, the competitive-safeguards committee also will be considering a "standards of practice" document developed by a NATA task force to identify minimum standards of care for student-athletes.

Edward Hammond, president of Fort Hays State University, said that since the changes in the certification process likely will mean a smaller pool of certified trainers in the future -- about 60 percent of current trainers came from the internship route -- the NCAA should take care to make certain that its member schools can live with the standards document.

"The single document that I believe is most critical that we do have control over is the medical standards of care," he said. "Whatever we establish as the minimum standards of care is going to be that critical threshold that we have to meet or assume some liability.

"If we reduce the number of trainers available and then we adopt a minimum standards of care document that says they have to be there at a certain ratio, then I think we're putting ourselves in a difficult position."

Dunn also identified another difficult position that could be avoided, noting that resource-strapped programs should think carefully about emergency-care issues before voting to support any legislation that expands playing or practice seasons.

-- David Pickle