Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries.

CONTEXT: Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. The use of emergency medical services (EMS) in settings with different access to athletic training services remains unknown. OBJECTIVE: To compare the incidence of EMS activations for patients with sport-related injuries among zip codes with various levels of access to athletic training services. DESIGN: Descriptive epidemiology study. SETTING: Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. PATIENTS OR OTHER PARTICIPANTS: Zip codes where 911 EMS activations for sport-related injuries among individuals 13 to 18 years old occurred. MAIN OUTCOME MEASURE(S): Incidence of EMS activations, athletic training service level (no ATs employed [NONE], less than full-time employment [PARTIAL], all ATs employed full time [FULL]), and athletic training employment model (independent contractor [IC], medical or university facility [MUF], school district [SD], mixed employment models [MIX]) for each zip code. RESULTS: The EMS activations were 2.8 ± 3.6 per zip code (range = 1-81, N = 4923). Among zip codes in which at least 1 AT was employed (n = 2228), 3.73% (n = 83) were IC, 38.20% (n = 851) were MUF, 27.24% (n = 607) were SD, and 30.83% (n = 687) were MIX. Compared with SD, MUF had a 10.8% lower incidence of EMS activations (incidence rate ratio [IRR] = 0.892; 95% CI = 0.817, 0.974; P = .010). The IC (IRR = 0.920; 95% CI = 0.758, 1.118; P = .403) and MIX (IRR = 0.996; 95% CI = 0.909, 1.091; P = .932) employment models were not different from the SD model. Service level was calculated for 3834 zip codes, with 19.5% (n = 746) NONE, 46.2% (n = 1771) PARTIAL, and 34.4% (n = 1317) FULL. Compared with NONE, FULL (IRR = 1.416; 95% CI = 1.308, 1.532; P < .001) and PARTIAL (IRR = 1.368; 95% CI = 1.268, 1.476; P < .001) had higher incidences of EMS activations. CONCLUSIONS: Local access to athletic training services was associated with an increased use of EMS for sport-related injuries among secondary school-aged individuals, possibly indicating improved identification and triage of sport-related emergencies in the area. The difference in EMS use among employment models may reflect different policies and procedures for sport-related emergencies.

Practices and Perceptions of Family-Centered Care: A Cross-Sectional Survey of Secondary School Athletic Trainers.

Family-centered care (FCC) includes collaboration between families and healthcare providers, the creation of flexible policies, and the family taking an active role in the delivery of care. Secondary school athletic trainers provide care for underage patients in school-based health systems, making them responsible for maintaining communication with parents, guardians, and/or caregivers. This cross-sectional survey investigated the extent to which athletic trainers (n = 205) include aspects of FCC in their daily secondary school clinical practice (current practices = CP) and whether they believe that aspect of care is necessary for FCC to be provided in athletic training (perceived necessary = PN) in their everyday practice using the Family-Centered Care Questionnaire-Revised tool. The total mean score for the CP scale (mean = 26.83 ± 4.36) was significantly lower (p ≤ 0.01) than the PN scale (mean = 35.33 ± 4.17). All FCC subscales compared between CP and PN were significantly different (p ≤ 0.01), with each being of higher importance than CP in athletic training. Data analysis revealed four themes related to enhancing FCC in secondary schools: limited education and resources, staffing and space concerns, non-technical skills, and social determinants of health. Attention should be placed on developing resources and interventions for secondary school athletic trainers to collaboratively work with children and their support systems.

Injuries and Referral Patterns During Basic Combat Training: An Examination of Data From the Certified Athletic Trainer-Forward Program.

INTRODUCTION: Injuries sustained during basic combat training (BCT) result in large economic costs to the U.S. Army. The inclusion of athletic trainers (ATs) in other military branches has reduced Troop Medical Clinic (TMC) referrals. However, the inclusion of ATs during BCT has yet to be studied. The purpose of this study was to describe the frequency and nature of sick call visits during BCT and determine how the presence of an AT affects referrals to the TMC. MATERIALS AND METHODS: A prospective cohort study was conducted at the Fort Jackson Army Training Center for one calendar year. Soldiers in BCT, aged 18-42, who reported to sick call were included. Independent variables collected included: Soldier demographics (sex and age), visit reason, and provider impression. Training battalions were placed in three conditions: control (CON), full-time medic (FTM), and part-time athletic trainer (PAT). The dependent variable was disposition (referred or returned to duty [RTD]). Frequencies and proportions were calculated. Logistic regression compared conditions while considering the other independent variables. Return on investment was calculated. RESULTS: Fourteen thousand three hundred and four visits were documented. Most soldiers were female (n = 7,650; 53.5%) and under 20 years old (n = 5,328; 37.2%). Visits were most commonly due to physical injury (n = 7,926; 55.4%), injuries affecting the knee (n = 2,264; 15.8%) and chronic/overuse conditions (n = 2,031; 14.2%). By condition, the FTM and PAT conditions resulted in 1.303 (95%CI: 1.187, 1.430; P < .001) and 1.219 (95%CI: 1.103, 1.348; P < .001), or 30.3% and 21.9% higher, odds of being RTD compared to the CON condition, respectively. Return on investment was $23,363,596 overall and $2,423,306 for musculoskeletal-related cases. CONCLUSIONS: Injuries were common in BCT, particularly in females. Soldiers in both the PAT and FTM conditions were more likely to be RTD compared to those in the CON condition. Athletic trainers (ATs) are effective at reducing potentially unnecessary referrals, demonstrating their value as healthcare providers in the BCT environment. Understanding variables associated with recruit disposition may aid medics and ATs in the development of triage protocols and further reduction of potentially unnecessary soldier referrals. The Certified Athletic Trainer-Forward Program resulted in significant return on investment, further supporting the inclusion of ATs in BCT.

The Association Between Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries.

CONTEXT: Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. Utilization of emergency medical services (EMS) with different access to athletic training services remains unknown. OBJECTIVE: Compare the incidence of EMS activations for sport-related injuries between zip-codes with varying access to athletic training services. DESIGN: Descriptive epidemiology study. SETTING: Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. PATIENTS OR OTHER PARTICIPANTS: Zip-codes where 9-1-1 EMS activations for sport-related injuries among individuals 13-18 years old occurred. MAIN OUTCOME MEASURE(S): Incidence of EMS activations, athletic training service level (NONE, PART, FULL), athletic training employment model (independent contractor, IC; medical or university facility, MUF; school district, SD; mixed employment models, MIX) for each zip-code. RESULTS: There were 2.8±3.5 EMS activations per zip-code (range 1-81, n=4,923). Among zip-codes where at least 1 AT was employed (n=2,228), 3.73% (n=83) were IC, 30.83% (n=687) were MIX, 27.24% (n=607) were SD, and 38.20% (n=851) were MUF. Compared to SD, MUF had a 10.8% lower incidence of EMS activations (95%CI: 0.817, 0.974, p=0.010). IC (IRR: 0.920, 95%CI: 0.758, 1.118, p=0.403) and MIX (IRR: 0.996, 95% CI: 0.909, 1.091, p=0.932) were not significantly different from SD. Service level was calculated for 3,834 zip-codes, with 19.5% (n=746) NONE, 46.2% (n=1,771) PART, and 34.4% (n=1,317) FULL. Compared to NONE, FULL (IRR: 1.416, 95%CI: 1.308, 1.532, p<0.001) and PART (IRR: 1.368, 95%CI: 1.268, 1.476, p<0.001) had higher incidences of EMS activations. CONCLUSIONS: Local access to athletic training services is associated with an increased utilization of EMS for sport-related injuries among secondary school aged individuals, potentially indicative of improved identification and triage of sport-related emergencies the area. The difference in EMS utilization between employment models may represent the presence of different policies and procedures for sport-related emergencies.

Epidemiology of Emergency Medical Services Activations for Sport-Related Injuries in the United States.

Background Literature examining emergency medical services (EMS) activations for sport-related injuries is limited to the pediatric, high school, and collegiate student-athlete populations, excluding older individuals and recreational athletes. The purpose of this study was to examine EMS activations for sport-related injuries using the National EMS Information System Database from 2017-2018. Methods Data were obtained using the National EMS Information System Database from 2017-2018. EMS activations were limited to 9-1-1 responses for individuals aged 3-99 who sustained a sports-related injury. Independent variables included patient age group: pediatric (<18 years old) vs. adult (≥18 years old). Dependent variables were patient age, gender, and chief complaint anatomic location. Frequencies and proportions were calculated for each variable. Injury proportion ratios (IPRs) with 95% confidence intervals were calculated to compare chief complaint anatomic location by age group. Results There were 71,322 sport-related injuries. Patients were 36.6±22.9 years and most (58.1%, n=41,132) were male. Adults had higher proportions of injuries affecting the abdomen (IPR: 2.05, 95%CI: 1.83, 2.31), chest (IPR: 1.90, 95%CI: 1.75, 2.05), general/global (IPR: 1.54, 95%CI: 1.50, 1.58), and genitalia (IPR: 2.40, 95%CI: 1.39, 4.15), and lower proportions of injuries affecting the back (IPR: 0.55, 95%CI: 0.50, 0.60), lower extremity (IPR: 0.63, 95%CI: 0.60, 0.65), upper extremity (IPR: 0.50, 95%CI: 0.47, 0.53), head (IPR: 0.73, 95%CI: 0.70, 0.77), and neck (IPR: 0.18, 95%CI: 0.16, 0.20) compared to pediatric patients. Conclusion Injuries sustained differed between adult and pediatric patients, indicating sport-related emergencies may change across the lifespan. General/global chief complaints likely indicate sport-related injuries affecting multiple anatomic locations and organ systems. Stakeholders planning large or high-risk athletic events should consider arranging standby or dedicated advanced life support units for their events.

Environmental Conditions and Seasonal Variables in American Youth Football Leagues.

Our study describes youth football (YFB) environmental conditions and the associated heat index (HI) risk category. An observational research design was utilized. Independent variables included month, time, event, and geographic location. Main outcome variables were frequency of events, average HI, and corresponding risk categorization. The HI was recorded with the day and time for each YFB event across 2 YFB seasons. Nearly half (49.8%) of events were in a high HI risk category and 20.0% should have been cancelled. The hottest HI values were recorded in July and August (83.2 ± 9.4°F to 87.2 ± 10.9°F; 24.0% of YFB events). The 7 to 10 am time frame was cooler (67.7 ± 14.5°F; 6.3% of YFB events) than other time frames ( P < .001). Hotter HI values were recorded in practices versus games (75.9 ± 14.1°F vs 70.6 ± 14.6°F; t = -6.426, P < .001). Starting the YFB season in September and holding weekend events in the early morning hours can decrease exposure to environmental heat stress.

The Role of Personality in Job Satisfaction Among Collegiate Athletic Trainers.

CONTEXT: The degree to which an individual likes his or her job is known as job satisfaction. A person with higher job satisfaction is less likely to depart from a profession than a person with lower job satisfaction. Researchers studying job satisfaction among other allied health professionals suggest a personality component could explain why the reasons for departure can be so individual. SETTING: Collegiate institutions. OBJECTIVE: To determine the relationship between job satisfaction and personality among collegiate athletic trainers (ATs). PATIENTS OR OTHER PARTICIPANTS: A total of 202 ATs (68 [33.7%] men and 134 [66.3%] women), were recruited using the National Athletic Trainers' Association e-mail database. We excluded any AT from this study who worked outside of the collegiate setting. The response rate was 20.2%. INTERVENTION(S): Data were collected using a Web-based survey instrument consisting of 3 sections: (1) demographics, (2) job satisfaction survey, and (3) Big Five Personality Inventory. MAIN OUTCOME MEASURE(S): Independent t tests were run to determine sex differences, and correlations were run to evaluate relationships between demographics and job satisfaction and between job satisfaction and personality. RESULTS: Women reported higher levels of neuroticism than men. Extroversion and conscientiousness showed a weak positive relationship with job satisfaction. A moderate positive relationship was found between agreeableness and job satisfaction. A moderate negative relationship was noted between neuroticism and job satisfaction. CONCLUSIONS: Based on our findings, head ATs or other organizational leaders may consider using personality assessments during interview processes, or athletic training program directors may be able to better guide students interested in athletic training based on knowledge of their personalities.

Diagnostic problem solving in male collegiate athletic trainers.

CONTEXT: Knowledge and experience may be important factors for understanding expertise based upon a clinician's ability to select and execute an appropriate response as a clinician during injury evaluation. OBJECTIVE: To describe how collegiate male certified athletic trainers represent injury-evaluation domain knowledge during a situational interview using a think-aloud protocol. DESIGN: Qualitative. SETTING: National Collegiate Athletic Association Division I and II colleges in National Athletic Trainers' Association District 3. PATIENTS OR OTHER PARTICIPANTS: A total of 20 male certified athletic trainers (n = 10 with less than 2 years of experience in the college setting and n = 10 with at least 10 years of experience in the college setting) participated in the study. DATA COLLECTION AND ANALYSIS: We collected data using a situational interview and questionnaire. Data were transcribed, reduced to meaningful units, and analyzed using verbal analysis procedures. Member checks, triangulation of data, field journaling, and peer-debriefing techniques were used to ensure trustworthiness of the data. Knowledge concepts were enumerated to describe differences between experts and novices. RESULTS: Compared with novices, experts had more knowledge concepts of patient history and predictions and fewer concepts of situation appraisal. CONCLUSIONS: Expertise in athletic training shares traits with other areas in health care. Athletic training education and professional development may benefit from our understanding which cognitive processes differentiate expert practice. Future investigators should attempt to describe other settings and study diagnostic problem solving in a natural environment.

Clinical integration and how it affects student retention in undergraduate athletic training programs.

CONTEXT: A better understanding of why students leave an undergraduate athletic training education program (ATEP), as well as why they persist, is critical in determining the future membership of our profession. OBJECTIVE: To better understand how clinical experiences affect student retention in undergraduate ATEPs. DESIGN: Survey-based research using a quantitative and qualitative mixed-methods approach. SETTING: Three-year undergraduate ATEPs across District 4 of the National Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: Seventy-one persistent students and 23 students who left the ATEP prematurely. DATA COLLECTION AND ANALYSIS: Data were collected using a modified version of the Athletic Training Education Program Student Retention Questionnaire. Multivariate analysis of variance was performed on the quantitative data, followed by a univariate analysis of variance on any significant findings. The qualitative data were analyzed through inductive content analysis. RESULTS: A difference was identified between the persister and dropout groups (Pillai trace = 0.42, F(1,92) = 12.95, P = .01). The follow-up analysis of variance revealed that the persister and dropout groups differed on the anticipatory factors (F(1,92) = 4.29, P = .04), clinical integration (F(1,92) = 6.99, P = .01), and motivation (F(1,92) = 43.12, P = .01) scales. Several themes emerged in the qualitative data, including networks of support, authentic experiential learning, role identity, time commitment, and major or career change. CONCLUSIONS: A perceived difference exists in how athletic training students are integrated into their clinical experiences between those students who leave an ATEP and those who stay. Educators may improve retention by emphasizing authentic experiential learning opportunities rather than hours worked, by allowing students to take on more responsibility, and by facilitating networks of support within clinical education experiences.

Retention and attrition factors for female certified athletic trainers in the National Collegiate Athletic Association Division I Football Bowl Subdivision setting.

CONTEXT: Organizational effectiveness and the continuity of patient care can be affected by certain levels of attrition. However, little is known about the retention and attrition of female certified athletic trainers (ATs) in certain settings. OBJECTIVE: To gain insight and understanding into the factors and circumstances affecting female ATs' decisions to persist in or leave the National Collegiate Athletic Association Division I Football Bowl Subdivision (NCAA D-I FBS) setting. DESIGN: Qualitative study. SETTING: The 12 NCAA D-I FBS institutions within the Southeastern Conference. PATIENTS OR OTHER PARTICIPANTS: A total of 23 women who were current full-time ATs (n = 12) or former full-time ATs (n = 11) at Southeastern Conference institutions participated. DATA COLLECTION AND ANALYSIS: Data were collected via in-depth, semistructured interviews, transcribed verbatim, and analyzed via a grounded theory approach. Peer review and member checking methods were performed to establish trustworthiness. RESULTS: The decision to persist involved 4 main factors: (1) increased autonomy, (2) increased social support, (3) enjoyment of job/fitting the NCAA D-I mold, and (4) kinship responsibility. Two subfactors of persistence, the NCAA D-I atmosphere and positive athlete dynamics, emerged under the main factor of enjoyment of job/fitting the NCAA D-I mold. The decision to leave included 3 main factors: (1) life balance issues, (2) role conflict and role overload, and (3) kinship responsibility. Two subfactors of leaving, supervisory/coach conflict and decreased autonomy, emerged under the main factor of role conflict and role overload. CONCLUSIONS: A female AT's decision to persist in or leave the NCAA D-I FBS setting can involve several factors. In order to retain capable ATs long term in the NCAA D-I setting, an individual's attributes and obligations, the setting's cultural issues, and an organization's social support paradigm should be considered.

Student retention in athletic training education programs.

CONTEXT: The success of any academic program, including athletic training, depends upon attracting and keeping quality students. The nature of persistent students versus students who prematurely leave the athletic training major is not known. Understanding the profiles of athletic training students who persist or leave is important. OBJECTIVE: To (1) explore the relationships among the following variables: anticipatory factors, academic integration, clinical integration, social integration, and motivation; (2) determine which of the aforementioned variables discriminate between senior athletic training students and major changers; and (3) identify which variable is the strongest predictor of persistence in athletic training education programs. DESIGN: Descriptive study using a qualitative and quantitative mixed-methods approach. SETTING: Thirteen athletic training education programs located in District 3 of the National Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: Ninety-four senior-level athletic training students and 31 college students who changed majors from athletic training to another degree option. DATA COLLECTION: Data were collected with the Athletic Training Education Program Student Retention Questionnaire (ATEPSRQ). ANALYSIS: Data from the ATEPSRQ were analyzed via Pearson correlations, multivariate analysis of variance, univariate analysis of variance, and a stepwise discriminant analysis. Open-ended questions were transcribed and analyzed using open, axial, and selective coding procedures. Member checks and peer debriefing techniques ensured trustworthiness of the study. RESULTS: Pearson correlations identified moderate relationships among motivation and clinical integration (r = 0.515, P < .01) and motivation and academic integration (r = 0.509, P < .01). Univariate analyses of variance showed that academic integration (F(1,122) = 8.483, P < .004), clinical integration (F(1,119) = 30.214, P < .001), and motivation (F(1,121) = 68.887, P < .001) discriminated between seniors and major changers. Discriminant analysis indicated that motivation was the strongest predictor of persistence in athletic training education, accounting for 37.2% of the variance between groups. The theoretic model accurately classified 95.7% of the seniors and 53.8% of the major changers. A common theme emerging from the qualitative data was the presence of a strong peer-support group that surrounded many of the senior-level students. CONCLUSIONS: Understanding student retention in athletic training is important for our profession. Results from this study suggest 3 key factors associated with student persistence in athletic training education programs: (1) student motivation, (2) clinical and academic integration, and (3) the presence of a peer-support system. Educators and program directors must create comprehensive recruitment and retention strategies that address factors influencing students' decisions to stay in the athletic training profession.

Pedagogic Strategies Perceived to Enhance Student Learning in Athletic Training Education.

OBJECTIVE: To investigate students' and instructors' educational experiences in Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education programs and specifically to determine to what extent pedagogic strategies were reflected in students' perceptions of their learning experiences, instructors' perceptions of their teaching, and athletic training course syllabi. DESIGN AND SETTING: Students and instructors currently enrolled in or teaching in 5 university athletic training programs accredited by CAAHEP provided in-depth interviews pertaining to students' educational experiences. Students' educational experiences in CAAHEP-accredited athletic training programs were also examined through current athletic training education course syllabi. SUBJECTS: Twenty-one students (9 males, 12 females) and 12 instructors (7 males, 5 females) were interviewed to examine their perceptions of teaching and learning experiences within their program. MEASUREMENTS: Students' and instructors' perceptions of their educational experiences in CAAHEP-accredited athletic training education programs were analyzed qualitatively using the data-analysis software program NUD*IST. Data from all 3 sources (students' interviews, instructors' interviews, course syllabi) were coded into categories within the NUD*IST program and then triangulated to ensure the authenticity of the findings. RESULTS: Based on the analysis of students' and instructors' interviews and course syllabi, 3 pedagogic strategies were identified that appeared to facilitate athletic training education in CAAHEP-accredited programs: use of scenarios and case studies, authentic experiences, and a positive educational environment. CONCLUSIONS: Students and instructors in CAAHEP-accredited athletic training education programs recognize and value specific pedagogic theories of teaching and learning and achievement motivation in students' educational experiences. Specific educational themes identified across athletic training instructors, students, and programs are outlined. All athletic training educators should take an interest in understanding what students and instructors in CAAHEP-accredited athletic training programs view as helpful pedagogic practices within their educational experiences.