On college campuses across the nation, they are normally the first ones called when something is wrong with a student-athlete.

Be it an injury or illness, athletic trainers often are the first responders when it comes to the health and safety of the 375,000 participants who compete in intercollegiate athletics each year.

Spectators see only glimpses of the work these men and women do. There’s much more to the profession than the few minutes a fan witnesses when someone goes down with an injury on game day.

Hopefully, what the student-athletes see is a person they know will competently treat them if a mishap occurs in practice and off-season conditioning.

For that reason, it is not surprising that student-athletes and coaches understand explicitly the value of the athletic trainer. But it’s not as clear — especially to the athletic trainers themselves — that they are as valued in the Association. Athletic trainers want to have a stronger voice in athletics decision-making, but they sometimes feel that the podium from which they might speak isn’t always provided.

Since their primary purpose is to provide treatment and care for the health and safety of the student-athlete on a daily basis, those in the profession believe they can be a valuable resource in the governance of intercollegiate athletics.

To some extent, that has been facilitated through the emergence of the National Athletic Trainers’ Association (NATA), which began in 1950 and has provided a way for members to organize and send strong messages about pressing issues concerning health and safety. Indeed, the days of a few people sitting around a table bandying ideas are gone.

"The organization has grown because the field of athletic training is so popular," said Julie Max, the head athletic trainer at California State University, Fullerton, and past president of the NATA. "I also think we really are making a difference in the quality of health care we can provide to student-athletes. It’s a profession that has just exploded in the last 10 years simply because of the need that exists."

Today, the NATA represents 30,000 members in the athletic training profession. The organization’s influence on playing rules has been evident, most recently in football. The NATA was adamant about changing the environment of preseason two-a-day practices, encouraging the NCAA to adopt legislation requiring teams to hold single practices only for the first five days of preseason camp, followed by alternate two-a-day and one-a-day practices until the season begins. The new preseason environment also includes a five-day acclimatization period for the student-athlete to ease them into the rigors of preseason workouts, often in hot weather conditions.

In 2005, the NATA played a major role in a new rule on head-down contact in football. No player will be allowed to use his helmet (including the face mask) to butt or ram an opponent in an attempt to punish another player. Coaches and student-athletes now receive video instruction that differentiates legal and illegal contact.

"Those two instances show that progress is being made in terms of how athletic trainers’ opinions are being solicited and how those opinions are influencing decisions," said Chuck Kimmel, current NATA president and head athletic trainer at Austin Peay State University. "The changes in how practices can be conducted are revolutionary in terms of protecting the student-athlete against all the things that can happen at that particular time of year, especially with regard to heat illness."

Athletic trainers have representation on the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, but they wish they were better represented on sports and rules committees.

Some athletic trainers believe in fact that any time rules changes or playing and practice season decisions are made, a qualified medical professional should be in the room to provide input on the health and safety aspect of the issue.

"This can be awfully important to the health care of the student-athlete," said Denny Miller, the director of sports medicine at Purdue University. Miller said that aspect is so important in fact that he advocates the competitive-safeguards committee reporting directly to the NCAA president. "That way," he said, "a senior leader could look at the information and it would be brought from the top down to Divisions I, II and III."

No rest for the weary

Athletic trainers certainly feel qualified to provide input, given their amount of hours in the trenches. In any given week, athletic trainers can easily spend 60, 70 or 80 hours on the job. And the long hours don’t just occur during the championship segment of the team to which an athletic trainer is assigned. More and more, athletic trainers are feeling the crunch from staffing workouts during the nontraditional and summer segments as well.

That not only raises concern for the work-life balance the athletic trainer has to manage, but the year-round demands and expectations on student-athletes also pose concerns about "overuse" injuries and the lack of time for the body to heal. Indeed, the days of student-athletes retreating to their hometowns after the spring semester and returning in the fall have disappeared.

Summertime now consists of wildly varied student-athlete weight-training schedules that can spread an athletic training department thin. Some student-athletes prefer a morning workout, while others opt for afternoon or evening sessions to better fit their schedules. The one constant, though, is that no matter when the session occurs, an athletic trainer should be present as much as possible.

Kimmel said, for example, that if a conditioning workout is scheduled for 6 a.m., he is expected to attend.

"If they are going to roll out there, it is my responsibility to join them," Kimmel said.

On the other hand, Kimmel said, not every assistant coach charged with running early morning drills is there every day. On Monday, it’s one coach conducting the drills, while on Wednesday it’s another coach and Friday still another.

"But the athletic trainer is the one getting up at 6 a.m. every day for a meeting we didn’t call," Kimmel said. "The coaches aren’t scheduling them that way simply to be mean —-they understand that they can share those 6 a.m. workouts."

But it’s up to the athletic trainer to adjust to the different times his or her staff is needed.

"In my case, I share the summer workouts because they hold them at 8 a.m., 2:30 p.m. and 7 p.m.," Kimmel said. "I cover the first two and another assistant covers the last one. But that assistant can come in at 10 in the morning instead of 8."

Finding a way to complete the task is nothing unusual to athletic trainers.

For years, the prevailing feeling has been that athletic trainers aren’t always part of the decision-making process. But it’s easy to see how their input would be valuable.

A stronger voice

For example, the athletic trainer might suggest design elements of a new facility the university is considering to ensure that an adequate athletic training room will be available for the student-athletes.

The athletic trainer also should be consulted when an institution bids to host a conference championship or an NCAAchampionship competition, since the athletic training staff ultimately will be responsible for staffing the event.

"The burden typically falls on athletic trainers to just get things done," said Michael Krauss, the outgoing chair of the competitive-safeguards committee. "The mentality has always been to do whatever it takes, no matter how many more hours are required — you are just going to have to get it done. That has been the attitude for a long time."

Many athletic trainers believe they should be part of the discussion when an institution is considering an increase in sports sponsorship, too. Some just want the opportunity to inform their athletics directors on the impact such growth would have on their staff.

Ron Courson, the director of sports medicine at the University of Georgia, has a staff of 10 full-time employees and nine graduate assistants. But he knows from experience that his situation is not the norm at most NCAA schools.

"I started at a Division III school, and we had the same number of sports and the same number of athletes, but we only had three certified athletic trainers," Courson said. "Institutions need to take that into consideration when they are thinking about adding sports. They should ask the question, ‘Do we have the personnel to adequately cover those sports?’ "

Increasing revenue and image

One topic being discussed among athletic trainers is third-party (insurance company) reimbursement of costs for health-care services in a collegiate athletic training room.

Through the first 100 years of the NCAA, injury treatment of student-athletes has been provided free of charge. Some people believe that approach is outdated.

Brian Anderson, president of the Collegiate Sports Medicine Foundation, is a proponent of third-party reimbursement. He views the athletic training room as any other health-care facility. If a private citizen sprains an ankle or has surgery and goes to an outpatient clinic for therapy, those services are billed to that person’s insurance. Anderson said that is a revenue opportunity for an athletics department, just as it is for the clinic in that scenario.

He believes the athletics department could then apply the revenues toward increased athletic training staff, better salaries or state-of-the-art equipment.

"Athletic trainers consistently are forced to ask for those kinds of enhancements," Anderson said. "Sometimes that makes sports medicine look like a black hole because it is basically just cash in. I see the third-party reimbursement as an opportunity to enhance student-athlete services at essentially no additional cost to athletics departments."

But Anderson said there isn’t much momentum from within the athletic training constituency to change its philosophy.

"Many people feel that since this service has always been provided for free, we should continue in that vein," he said. "I agree with that to an extent, but for an institution to bring in additional revenue that can enhance student-athlete services seems like a good trade-off to me."

Anderson said a typical misconception of the idea is that insurance rates would increase for the student-athlete or his or her family.

"If the parents are school teachers who work for the state, for example, those rates aren’t going to be affected, because they are washed out over the thousands of people on that plan," he said. "If the parents are small-business owners, there is a better chance of increasing rates. But if they are coming from a state-funded insurance program, it is not going to have any impact on rates."

Others support the third-party reimbursement idea because it might help athletic trainers be more recognized as the medical professionals.

"People define what we do by who we work on," said Sue Stanley-Green, director of the athletic training program at Florida Southern College. "They say that if somebody tears an anterior cruciate ligament, they need to be an athlete, they need to have a coach, they need to have a locker room. Well, we can’t work on somebody who tears an ACL falling down the steps. There’s that distinguishing population issue that I think is very unfortunate."

NATA influence

With all the issues surrounding the profession, it is easy to see how an athletic trainer might feel overwhelmed.

But the NATA believes it is well positioned to give athletic trainers a stronger voice — both on the fields and courts as well as in the decision-making rooms.

Through marketing, education and the sheer necessity of providing qualified medical coverage to student-athletes, NATA members say they will play an integral role in intercollegiate athletics.

"I see huge potential for growth," said Florida State University Associate Director of Sports Medicine Robin Gibson. "I see that we still have to keep growing as a profession and working with insurance to get third-party billing, which will bring some money to athletics departments and help offset the cost of all this medical treatment. I see our role as educators becoming even more developed and more important, which should encourage even more growth in the profession."

Athletic trainers don’t enter their jobs thinking they’ll be working eight-hour days. Health and safety issues aren’t wrapped that neatly. For most, the goal is simply to have the opportunity to provide the coverage that student-athletes deserve.

"I don’t mind the 80-hour weeks, but everyone would like to have enough help to provide good health care," Miller said.

So when the inevitable call is made for assistance from an athletic trainer, someone will be there to answer it.