National Collegiate Athletic Association

The NCAA News - News and Features

April 20, 1998

SPORTS SCIENCES NEWSLETTER

Adequate medical coverage

BY BERNIE DePALMA
Cornell University

Student-athlete health and safety principles were incorporated into the NCAA Constitution at the 1995 NCAA Convention, where the Association acknowledged that each member school is responsible for protecting the health of and providing a safe environment for each of its student-athletes.

The foreword of the NCAA Sports Medicine Handbook addresses responsibility for sports safety by stating:

Student-athletes rightfully assume that those who are responsible for the conduct of sport have taken reasonable precautions to minimize the risk of significant injury. The athletics program, via the athletics administrator, should be responsible for providing a safe environment.

The adoption of the health and safety principles into the Association's Constitution and the handbook reinforces this objective.

The handbook was developed by the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports in 1975 for two reasons: (1) to keep member schools apprised of trends and developments in sports medicine and (2) to assist schools in developing safe and sound intercollegiate athletics programs. The guidelines in the handbook support the Constitution's health and safety principles. The committee recommends that schools use the guidelines as a basis for providing a safe environment for student-athletes.

How much coverage?

As part of its October 1997 series of articles on the NCAA, The Kansas City Star reported that, "the NCAA leaves medical protection almost entirely to the consciences and budgets of each college. Without mandates, many colleges turn medical matters into money issues. They don't pay for coaches to learn CPR and they skimp on athletic trainers."

There is genuine concern among medical personnel that many schools have expanded every facet of their athletics programs but medical support. This imbalance places the student-athlete in a potentially unsafe environment. Athletic trainers have attempted to address this concern for the past two decades. Until athletics administrators realize the importance of safety as a part of their and their school's duty and address these concerns, the athletic trainer must take the lead role.

Some athletic trainers have proposed mandating a student-athlete/athletic trainer ratio. If passed, such legislation would require many changes at most schools; therefore, if athletic trainers want to propose a mandatory ratio, its goal must be clearly defined. In addition, the necessary research must be performed and presented to address the needs of all member schools across division, sport and gender.

Some members of our committee believe that legislating a ratio falls short of meeting the Constitution's health and safety principles. They point out that such legislation would leave these issues unanswered:

  • How one would define high-risk sports and differentiate between sports (i.e., collision/contact versus noncontact) and how many certified athletic trainers are assigned per sport? (Example: A football program with 100 student-athletes versus a track and field program with 100 student-athletes).

  • How injury rates would fit into the equation.

  • How a ratio would work for schools with 12-15 sports programs (200-500 student-athletes) and no collision/contact sports compared to schools with 25-40 programs (800-1,500 student-athletes) and three or more collision/contact sports.

  • How schools that use their athletic-training staff for coverage of non-NCAA sports (i.e., club sports, rugby, etc.) would use a ratio.

  • How nontraditional sports seasons would fit into the equation.

  • How overlapping sports seasons would fit into the equation.

  • How a ratio would provide for a qualified person to be present at every practice (including those in nontraditional seasons), skill-instruction session, and strength and conditioning workout.

    The issue of adequate medical coverage is addressed in handbook guideline 1A. The problem in determining what coverage is adequate is that widely recognized and accepted national standards for athletic training do not exist. The only documented recommendations are the operating principles adopted by the NCAA and the handbook guidelines. When a consensus of medical experts makes such recommendations to a large medical community, those recommendations should be followed by medical personnel, as well as athletics administrators. Until there are rules and regulations based on standards of care, the athletics administrator has a moral and ethical obligation to the student-athlete to follow, uphold and respect the guidelines.

    Other variables that help support these guidelines and the operating principles are the Division I athletics- certification process and the self-study document. The self-study items are issues that schools must be prepared to answer when visited by peer-review teams for certification. The language is presented within the operating principles of the equity, welfare, and sportsmanship component of the self-study instrument. Expert medical judgment, in reference to medical coverage based on standards cannot be decided without considering the only components available, i.e., the handbook guidelines and the NCAA operating principles.

    All athletics administrators and medical personnel should review guideline 1A, specifically the portions on equitable medical care and emergency care.

    Tools available

    The operating principles and self-study instrument are guides to commitment in reference to equity, welfare, and sportsmanship and support the NCAA Constitution, which includes this statement:

    Conducting the intercollegiate athletics program in a manner designed to protect and enhance the physical and educational welfare of student-athletes is a basic principle of the Association. Consistent with the fundamental principle the institution shall:

    Provide evidence that the institution has in place programs that protect the health of and provide a safe environment for each of its student-athletes.

    Although not finalized, the new self-study items currently read:

  • The NCAA Sports Medicine handbook has been developed to assist in the creation of safe and sound intercollegiate athletics programs, including drug education. Describe the process by which handbook guidelines are disseminated within the athletics department, who receives this information, and how these guidelines are implemented within the athletics department, including drug education. Identify the administrator who is responsible for institutional awareness of NCAA Sports Medicine Handbook guidelines.

  • Using the emergency-care section of guideline 1A as a guide, describe your institution's emergency medical plan for practices and games. Provide a written emergency plan for your department and discuss specific coverage for out-of-season practices, strength training and skill sessions.

  • Using the equitable-medical-care section of guideline 1A as a guide, describe institutional policies related to equitable medical care. Discuss rationale for distribution of sports medicine resources.

    The handbook guidelines are tools to help the athletics administration develop its sports medicine administrative policies. Probably more importantly, the guidelines are tools that the athletic trainer needs to protect the health of and provide a safe environment for the student-athlete.

    The legislative option

    The key to legislating adequate medical coverage and the process of proposing legislation is the development of a standard of care and the research involved. Legislation would have to be based on the developed standard, as well as proper medical judgment. Guideline 1A must be a component of this standard and part of the equation in developing legislation. If not, the legislation may not accomplish the goal.

    Once properly developed, specific legislation needs to be drafted on a national level and then presented to the respective divisional NCAA management councils. In Division I, legislation can be sponsored by a conference or other constituent group, an NCAA cabinet or committee, or by the Management Council or the Board of Directors itself. In Divisions II and III, an individual can sponsor legislation.

    The following steps would expedite this process. First, a standard of care needs to be defined. No one is more qualified to do this than a national contingent of athletic trainers. The most effective means for organizing such a group on a national level would be through the National Athletic Trainers Association's College/University Committee because of its expertise and ability to obtain input from the NATA collegiate membership and the team physicians. Terry O'Brien, chair of this NATA committee, has established a task force to study this issue.

    Athletic trainers must analyze every NCAA sport to develop a standard for both in-season and out-of-season practices (including nontraditional), competition, skill- instruction sessions, and strength and conditioning sessions. Recommendations also must have support of the team physicians, the student-athlete advisory committee, and the competitive-safeguards committee.

    Drafted legislation would have to be developed based on a standard of care for each sport, a defined season, and a defined sport activity, in conjunction with and through the NATA committee. Further input would come from the collegiate membership, the team physicians, the student-athlete advisory committee, and the competitive-safeguards committee.

    Garnering support

    After the research is conducted and a standard of care defined, support for a legislative proposal would have to be solicited by the NATA committee by means of a letter describing the research. This letter would be sent to all CEOs, conference commissioners, faculty athletics representatives, athletics directors, senior woman administrators, team physicians, and athletic trainers.

    Through its 10 district representatives, the NATA committee may then have to solicit a conference to sponsor the legislation in Division I, if a conference were not already involved. Since an NCAA committee also can sponsor legislation, another approach would be to solicit the competitive-safeguards committee to be a sponsor. Athletic trainers and team physicians, working as a team, would then elicit support at their schools by discussing with their athletics directors how the legislation would directly affect the health and safety of the student-athletes on a daily basis and how it would support the handbook guidelines.

    The key is to clearly define the goal before the process begins. If the goal is to protect the health of and provide a safe environment for the student-athlete, to the best of your ability, from catastrophic injury in all practices, games, and workouts, and to provide for the medical needs of student-athletes on a daily basis, both in-season and out-of-season, the handbook guidelines and NCAA operating principles, which assist in accomplishing this goal, need to be the main component of any proposed legislation. Conversely, if the goal is simply to provide more athletic trainers, then athletic trainers should consider proposing legislation that involves a ratio based on the number of athletic trainers per student-athlete at a given school.

    Bernie DePalma is a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports and head athletic trainer at Cornell University. He can be reached at 607/255-4237; e-mail: bfd@cornell.edu.