November 14, 2017, published in Los Angeles Daily News/LADailyNews.com
Javier Venegas, a 21-year-old distance runner for Golden West College, suddenly collapsed on the track one afternoon in late January.
He wasn’t breathing. He didn’t have a pulse.
Fortunately, Pat Frohn, a certified athletic trainer for Golden West, plus a Long Beach State athletic-training student, Tori Mulitauaopele, were in the Athletic Training Room and were called out to the track. They began CPR. It took two shocks from the automated external defibrillator (AED) to return Javier’s heartbeat.
The EMTs arrived and Venegas was rushed to the emergency room, where he was put into a medically induced coma. He is now recovered from what was determined to be a heart arrhythmia.
“If I wasn’t here, if there was no athletic trainer on staff, if this was any high school in the area?” Frohn said, “Javier would be dead.”
California has more than 800,000 high-schoolers playing sports, yet the state does not require schools to have athletic trainers at practices or games—and very few do. Just 25 percent of public high schools employ a full-time athletic trainer, according to CIF data from 2016-17 (athletic directors from 1,406 schools self-reported—an 88.6 percent rate).
Even more troubling? California is the only state that does not regulate the profession of athletic training. That means that anyone can call themselves an athletic trainer, regardless of whether they are certified; regardless of whether they possess the educational qualifications, clinical experience or medical knowledge to practice.
This puts student-athletes at enormous risk. Among those working as athletic trainers in California high schools, 16.2 percent are not certified, according to CIF data.
“It’s a level of fraud,” said Brian Gallagher, director of sports medicine/certified athletic trainer at Harvard Westlake.
The CATA has been working on this issue for more than three decades. California Assemblymember Matt Dababneh (D-Woodland Hills) has introduced Assembly Bill 1510, which would provide for the licensure and regulation of athletic trainers and establish the Athletic Trainer Licensing Committee within the California Board of Occupational Therapy. It would bar a person from practicing as an athletic trainer or using the title unless the person is licensed by the committee.
The bill is scheduled to be heard next at the California State Assembly and Senate at the beginning of 2018.
We’ve reached a tipping point. Or something worse.
“It’s a crisis,” said Trenton Cornelius, coordinator for L.A. Unified School District’s Interscholastic Athletics Department.
PROPER PROTOCOL ‘MISMANAGED’
Michael Boafo, a Redlands High football player, suffered a hit in a 2015 game against A.B. Miller High in Fontana.
Heather Harvey, a certified athletic trainer for Miller at the game, said the Redlands athletic trainer called her over to help him with calling EMS for Boafo. She sprinted over and felt stunned, alleging that neither the athletic trainer nor other staff were monitoring Boafo’s vitals or checking his pulse as he laid face up on the sideline, unconscious.
“Is he breathing?” Harvey asked. She said she was assured that Boafo was “fine” and was simply experiencing “flu-like symptoms.”
Harvey took over care by assessing his vitals and level of consciousness while activating EMS. It seemed apparent to her and her team physician that this was more than Boafo simply being sick.
While on the sidelines, Harvey said it was mentioned that Boafo had suffered a concussion earlier that season. Harvey was able to effectively monitor Boafo until paramedics arrived.
Later that night, Boafo ultimately underwent a five-hour brain surgery to address a bleed in his brain (the surgery was successful and he was able to make a full recovery). Harvey said Redlands’ athletic trainer did not know proper protocol.
The athletic trainer, still at Redlands, is not certified, according to the online registry of Board of Certification Certified Athletic Trainers.
“That was mismanaged,” Harvey said. “I hate seeing it and unfortunately, I see things like that on a regular basis at this point. Not necessarily the catastrophic injuries, but just knowing the people on the sideline might not be appropriate medical personnel.”
How many parents assume the athletic trainers in charge of their child’s safety are qualified to oversee his or her care?
Some athletic directors might not even be aware if their athletic trainer is certified or not, according to Mike Chisar, chair of the CATA Governmental Affairs Committee. “There’s nothing that mandates (certification) as part of the hiring criteria, the minimum qualifications, then (athletic directors) wouldn’t necessarily be looking for that,” Chisar said.
Sometimes well-meaning parents and volunteers assume the role, as do coaches, who are CPR and First Aid certified and must take a sport-specific concussion course and sudden cardiac arrest training. But these are not healthcare providers.
Imagine if Celtics coach Brad Stevens was tasked with tending to Gordon Hayward’s gruesome ankle injury on NBA opening day.
“You can’t cut someone’s hair in our state if you don’t have a professional license and qualifications,” Dababneh said. “We are much more stringent on someone that cuts your hair then someone that can make a decision about your kid’s health in an athletic competition, whether or not he can go back in the game, whether he needs medical treatment.”
Opposition for the bill mainly comes from the California Physical Therapy Association.
Gov. Jerry Brown vetoed bills in 2014 and 2015 that would have required athletic trainers to be certified, reasoning the bills would require athletic trainers to attend college, which would “impose unnecessary burdens on athletic trainers without sufficient evidence that they are really needed.”
WHAT TRAINERS ARE, AND WHAT THEY AREN’T
To understand why athletic trainers are needed, you have to understand who they are and what they do.
Athletic trainers are healthcare providers who focus on the prevention, treatment and rehabilitation of injuries and illnesses. They are not gym trainers or physical therapists or chiropractors.
“Most of us hold Masters degrees and have spent countless hours in clinical settings honing our craft,” said Kirsten Farrell, certified athletic trainer at Venice High School and 2018 California Teacher of the Year.
The CIF, which supports AB1510, is working to educate principals, superintendents and athletic directors on the importance of having athletic trainers. “We’ve got to make it a priority for our schools,” said Roger Blake, CIF’s Executive Director. “They need to see the human value in this.”
Injuries, concussions, heat stroke, cardiac arrest, can happen at any second and immediate response is critical.
Sierra Canyon faced Buena High in a junior-varsity football game on Aug. 31. Buena did not have an athletic trainer when one of its players went down with a hit. Fortunately Eric Dick, Sierra Canyon’s certified athletic trainer, was on site.
Dick asked the player if he had a headache or felt dizzy or nauseous. The player smiled but wasn’t responding. Dick told the player and his father to not wait, and walked them to their car.
Dick asked the player to read the word “SCAN” on the stereo. He couldn’t formulate the words, mumbling and struggling. Eventually he got the words out, but it took far too long. Dick said they should go to the hospital immediately.
“The continual follow up over that time period, was only about five minutes. In those five minutes, he took such a big change in his behavior,” said Dick, who mentioned the importance of having an athletic trainer to make decisions about when it is safe for an athlete to return to play, as those decisions have long-lasting health consequences.
Dick works at a private school — but what about public schools?
LAUSD is a large district of 150 schools and more than 52,000 athletes and comprises the L.A. City Section. Yet only 13 percent of schools of schools that reported in this Section have athletic trainers.
Some are funded by non-profits, such as the West Coast Sports Medicine Foundation or Team Heal Foundation. Alex Merriman, Dorsey High’s certified athletic trainer, is one of them.
She oversees the Dons’ 23 teams on her own, though she has student athletic-training aides to help out. She works 60 hours on what she calls a “good” week and 70-75 hours on a “bad” week (one that involves more injuries and treatment). As devoted as she is, she cannot make every single game, especially with two to three sports going on during one season.
“You have to be really passionate about what you do in this field,” Merriman said. “There are plenty of days where I want to quit and give up and find another job somewhere else, but I remember all the kids that we care for here. What would they be doing if I wasn’t here?”
CIF data indicates that both public and private suffer from a shortage of athletic trainers. However, some of the lower socioeconomic sections (Oakland, L.A. City, Northern) report only 9 to 13 percent of schools having a certified athletic trainer. More affluent sections (San Diego, Southern, San Francisco) report having the largest percentage of schools having an athletic trainer at 60 to 77 percent.
What will it take for students to be protected?
“I don’t want this to become a reactionary story where, God forbid, another student is injured or hurt badly or their health is compromised,” Dababneh said. “Then everybody says: ‘Well why didn’t we do this already?’”