Physician sideline coverage recommended for high school games and practices

The past 25 years have seen a significant increase in student participation in high school athletics. Studies have revealed that 2 million injuries, 500,000 doctor visits and 30,000 hospitalizations occur each year among high school athletes. This has led to strong recommendations from the National Athletic Trainers' Association (NATA), the American Academy of Family Physicians and the American Medical Association for physician sideline coverage at high school games and practices.

In addition to this recommendation, providing proper training to athletic directors and coaches, having a defibrillator on the sidelines, having a concussion protocol in place and teaching proper tackling progressions can all impact the overall health and safety of student athletes.

Researchers at Loyola Medicine recently completed a follow-up study to reassess the state of medical sideline coverage during football games and practices at the 99 Chicago public high schools. The team is led by Nathaniel Jones, MD, sports medicine specialist, who collaborated with Pietro Tonino, MD, Chief of Sports Medicine, who published a similar study in 2003.

Through the use of an online survey, researchers requested information about the personnel available to assess medical problems at home football games and at practices as well as CPR and first aid certification of these Chicago public high school staffers.

Of most concern are concussions, catastrophic events, cervical spine injuries and sudden cardiac events, for which players' outcomes can be impacted by having a physician present. "The impact," Dr. Jones says, "is that immediate and appropriate medical care saves lives. Properly trained medical professionals know when to prioritize a serious injury.

For instance, head injuries should be handled differently and more urgently than an ankle sprain." Dr. Tonino notes that concussions are a significant issue. "If an athlete gets a concussion that is not diagnosed, this may impact his or her performance at school which can have long-term effects," he says.

Sixty-six Chicago public high schools responded to the recent survey, revealing a greater proportion of schools with athletic trainers and ambulances on the sidelines at home football games as compared to responses in 2003. By contrast, a smaller proportion of responding schools had a physician or paramedic on the sidelines.

Additionally, the proportion of head coaches certified in CPR and first aid decreased. "Practices are a big issue," says Dr. Tonino, "just as you can get a concussion in a game, the same thing can happen in practice. Often the coach is the only person there. It's important that the coach has some training and basic knowledge."

With regard to practical implications, Dr. Jones notes that Chicago public high schools share stadiums throughout the city. Ideally, Chicago medical centers would commit attending physicians, fellows and residents in primary care and sports medicine to cover stadiums during football games. "If Chicago's medical centers agreed to share coverage, we could offer comprehensive coverage for Chicago public high school student athletes," says Dr. Jones.

Education is also a key component. To that end, Loyola Medicine offers a sports medicine update conference annually, which shares the latest research in sports medicine, updates on best practices, gender differences in sports injuries, and education on a variety of injuries that can occur on the field. This conference is available to medical professionals, coaches and other school staff.

Sports keep kids out of trouble. We don't want students to stop playing sports, but rather, we want athletes to have access to appropriate medical care during games and practices. We want parents and students to know the risks of contact sports, but also know that sports are important for kids to participate in. It keeps kids healthy, teaches teamwork, and kids learn how their performance effects the whole team.

Nathaniel Jones, MD, sports medicine specialist

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