Athletic Training and Sports Health Care

Original Research 

Emergency Medical Services Personnel's Perceptions of the Roles and Responsibilities of Athletic Trainers During On-field Injury Management

Eleni Diakogeorgiou, MBA, ATC; John J. Cotter, MAT, ATC; Stephanie H. Clines, MS, ATC; Dana Lynn Jusino, MEd, ATC

Abstract

Purpose:

To understand what emergency medical services (EMS) personnel perceive to be athletic trainers' education and knowledge, which could lead to more efficient education and communication.

Methods:

In this online survey, 115 EMS personnel from 18 states responded to open-ended questions regarding their perceptions of an athletic trainer. Data analysis followed the general inductive approach. Data credibility was established through multiple analyst triangulation and peer review.

Results:

Themes included: (1) protocols are a guiding factor in how EMS personnel handle a situation; (2) EMS personnel possess a lack of knowledge regarding the emergency care domain in athletic trainer education; and (3) previous experiences with athletic trainers guide overall trust level.

Conclusions:

Increasing EMS personnel's knowledge of athletic training may aid in the creation of similar protocols. This may also lead to more athletic trainers and EMS personnel reviewing and practicing prior to seasons beginning, which may increase trust.

[Athletic Training & Sports Health Care. 2017;9(4):154–162.]

Abstract

Purpose:

To understand what emergency medical services (EMS) personnel perceive to be athletic trainers' education and knowledge, which could lead to more efficient education and communication.

Methods:

In this online survey, 115 EMS personnel from 18 states responded to open-ended questions regarding their perceptions of an athletic trainer. Data analysis followed the general inductive approach. Data credibility was established through multiple analyst triangulation and peer review.

Results:

Themes included: (1) protocols are a guiding factor in how EMS personnel handle a situation; (2) EMS personnel possess a lack of knowledge regarding the emergency care domain in athletic trainer education; and (3) previous experiences with athletic trainers guide overall trust level.

Conclusions:

Increasing EMS personnel's knowledge of athletic training may aid in the creation of similar protocols. This may also lead to more athletic trainers and EMS personnel reviewing and practicing prior to seasons beginning, which may increase trust.

[Athletic Training & Sports Health Care. 2017;9(4):154–162.]

Athletic health care has evolved significantly, leading to a need for a comprehensive wellness team to manage athletic-related injuries.1 During competition, athletic trainers are the primary caregivers and first responders when an injury is sustained. If an injured athlete requires transport, athletic trainers work with emergency medical services (EMS) personnel to prepare the athlete.1–4 Despite the required teamwork between athletic trainers and EMS personnel, at times athletic trainers may perceive the athlete's care on the field to be handled inappropriately2 by EMS personnel. This may be due to a variety of factors, including not understanding EMS personnel's protocol for certain situations or a lack of communication between both parties. During a true emergency, miscommunication can endanger the lives of those being cared for.1–4

A lack of understanding regarding the qualifications of an athletic trainer by both the public and other health care professionals has been identified.3,5 Research concerning the perceptions of athletic trainers by EMS personnel is limited to quantitative surveys or specific levels within the EMS system.3,4 Biddington et al.3 sought to identify EMS directors' perceptions of athletic trainers during emergency situations and found that EMS directors were more comfortable with athletic trainers handling emergencies when a preseason meeting had occurred prior to the event.3 These findings are supported by Storch et al.,6 who concluded that the more exposure athletic trainers have with other health care providers, the more comfortable those health care providers are with the abilities of athletic trainers. Mazerolle et al.4 found misunderstandings by EMS personnel regarding athletic trainers' best practices could lead to conflict during an emergency situation. Literature supports a lack of understanding between professions during American football cervical spine injuries and identifies that conflicts do occur,2 and also acknowledges that further research is needed from the perspective of EMS personnel.2,4

The National Athletic Trainers' Association (NATA) Position Statements on Emergency Action Planning in Athletics7 and Management of a Cervical Spine Injured Athlete8 go into great detail on communication and actions of athletic trainers in an emergency. Concentrating on emergency situations, our research aimed to investigate the perceptions of the athletic training profession that EMS personnel possess, specifically regarding prehospital care. Our study focused on interviewing EMS personnel with online open-ended questions, without limits on level of certification (ie, basic or paramedic) for participants. We also wanted to gain a better understanding of what EMS personnel perceived an athletic trainer's qualifications to be. It is our hope that identifying how EMS personnel perceive the athletic training profession will guide better education and communication between the two professions, translating to effective prehospital care on the athletic field.

We pursued three guiding questions: (1) What do EMS personnel perceive as their (EMS') roles on the field during an emergency situation at an athletic event? (2) What is EMS personnel's knowledge of athletic training? and (3) Do EMS personnel trust an athletic trainer during an emergency situation, including management of a cervical spine injury? Figure 1 outlines associated survey questions and emerging themes.

Guiding questions, associated survey questions, and emerging themes.

Figure 1.

Guiding questions, associated survey questions, and emerging themes.

Methods

Research Design

A qualitative methodology was chosen to explore the beliefs of EMS personnel. A structured interview was conducted using an online format with all participants. This method was chosen as the best medium for this study due to the technique's convenience for both the participant and researcher, confidentiality, and cost-effectiveness of the method.9–11 The asynchronous nature provides participants with flexibility to complete the interview at their leisure, which is important when the investigated population is traditionally limited on time. This flexibility also contributes to the ability of the participant to reflect on the questions posed and provide a thoughtful response in comparison to a one-on-one interview where questions require immediate answers.10,11

Participant Selection

Participants met the following inclusion criteria: (1) emergency medical technician (EMT) or emergency medical responder (EMR) certified and (2) currently practicing as an EMS responder. Exclusion criteria included: (1) board of certification–certified athletic trainer (ATC) or (2) enrollment in a Commission on Accreditation of Athletic Training Education accredited athletic training program. Participants were recruited purposefully via direct recruitment by the research team or indirect recruitment facilitated by state, regional, and national EMS response organizations. EMS personnel from 18 states participated.

Participants

A total of 238 questionnaires were opened, whereas 118 were completed. Of those 118 interviews, three sets of responses were excluded due to the ATC credential, resulting in a total of 115 participants and a response rate of 48.3%. Data saturation was reached when the answers of participants were redundant and similar in response. Training levels of participants included EMR (n = 2), EMT-Basic (n = 27), EMT-Advanced (n = 23), EMT-Paramedic (n = 59), and Unknown (n = 4). Years of experience ranged from less than 1 year to more than 20 years. Participant demographics can be seen in Table 1, and Table 2 includes the location of participants by state.

Demographic Information

Table 1:

Demographic Information

Participant Locations

Table 2:

Participant Locations

The demographics section of the interview gave insight into the familiarity with athletic trainers and some common interactions: 58 respondents (50%) had been working in the EMS system for more than 20 years and 37 respondents (32%) had been working in the EMS system for 10 to 20 years, giving us a large sample size with ample experience, which may have allowed for more interactions with athletic trainers. Of the respondents, 62% knew their local high school employed an athletic trainer, whereas 24% did not know, and 75% had covered an athletic event, whereas 7% had never covered an athletic event. A total of 82% of the athletic events covered by EMS personnel also reported having an athletic trainer present.

Data Collection

Data collection occurred over a 5-month period via an online survey using the web-based survey platform SurveyMonkey (Portland, OR). Instructions for participants were located on the interview website. Consent was obtained prior to participation by completing an electronic consent form at the beginning of the questionnaire. The interview was divided into two sections: a demographic questionnaire and open-ended questions regarding the EMS personnel's perceptions of athletic trainers regarding prehospital care. Open-ended questions were derived from previous literature on athletic trainer and EMT perceptions and interaction in the management of emergency athletic situations.2–4

The survey questions were designed in consultation with a qualitative research expert to ensure accuracy of the questions and flow of the survey and to eliminate any potential bias. Survey questions were designed based on three guiding questions: (1) What do EMS personnel perceive as their (EMS') role on the field during an emergency situation at an athletic event?, (2) What is EMS personnel's knowledge of athletic training?, and (3) Do EMS personnel trust an athletic trainer during an emergency situation, including management of a cervical spine injury? A total of 16 questions made up the online survey: 8 open-ended questions, 7 demographic questions, and 1 question regarding informed consent. The survey was then peer reviewed by 15 athletic trainers to ensure content validity. Minor changes were made to correct grammatical errors, order of questions, and clarification issues brought to our attention. Before data collection, the study was piloted twice by the same group of 10 EMS responders to ensure test–retest reliability.

Data Analysis and Credibility

Aspects of grounded theory were used for data analysis to uncover the most dominant themes from data.12,13 Open-ended responses were initially read in their entirety to capture an overall sense of the data. The responses were then read a second time and compared by all researchers in an open forum discussion. Subsequent readings occurred and consisted of marking key phrases assisting in coding with conceptual labels. Finally, codes were grouped into categories, which were used to develop overall themes.

Data credibility was maintained using two strategies: (1) multiple analyst triangulation and (2) peer review. Each researcher independently analyzed the data following the general inductive approach. Once the researchers completed their analysis, the findings were discussed as a group to confirm label assignments and emergent themes. Peer review occurred in two steps. First, as previously mentioned, our interview was developed in conjunction with and reviewed by an expert with extensive qualitative research experience in the athletic training field. Second, once all analyzed data were agreed on by the research team, the findings were presented to an independent researcher with qualitative research experience within athletic training for peer review to validate our coding structure and established themes.

Results

Analysis of the data revealed three overarching themes regarding EMS personnel's perceptions of athletic trainers: (1) EMS protocols determine how EMS personnel respond to and handle situations on the field, (2) EMS personnel possess a lack of knowledge regarding the emergency care domain within athletic training education, and (3) previous experiences with athletic trainers guide overall trust of the profession. Each guiding question had associated survey questions. After data analysis, each guiding question was grouped into a theme.

Theme 1: EMS Protocols Determine How EMS Personnel Respond to and Handle Situations on the Field

Guiding Question 1.What do EMS personnel perceive as their (EMS') role on the field during an emergency situation at an athletic event? Associated survey questions for Guiding Question 1 were: What do you think your roles and responsibilities are on the field in an athletic emergency when an athletic trainer is NOT present? And what do you think your roles and responsibilities are on the field in an athletic emergency when an athletic trainer is present? We also asked what EMS personnel believed the athletic trainer's role to be on the field when EMS is present and not present. These questions were used to gain an understanding of what EMS personnel perceived as their duties on the field with and without an athletic trainer present.

We sought to recognize EMS personnel's personal thoughts to compare training level and perceived training level as it pertains to athletic trainers' duties on the field during an emergency. EMS personnel overwhelmingly stated that once they are called to an emergency they will follow their guiding protocols regardless of other professionals present. Many EMS personnel stated that when they arrive on scene “EMS” is in charge (37 responses, 31.36%). Others responded in terms of “patient care” as their primary concern (28 responses, 23.73%), whereas some stated that what they would do depends on the “injury” (25 responses, 21.19%). One response read: “Once requested we must act accordingly with our protocols. Even if the athletic trainer has a protocol in place, the EMS protocol will override the site's protocol.”

In regard to what the athletic trainer should be doing on the field, when EMS is there respondents answered with key terms including “assist EMS” (34 responses, 28.81%), “work with EMS/provide support” (10 responses, 10.16%), and assist “when needed” (21 responses, 17.80%). Other responses included to provide an “assessment” (17 responses, 14.41%) and “care” (34 responses, 28.81%) for the patient to determine when EMS is necessary. This accounts for 99% of responses in regard to the athletic trainer's role on the field when EMS is present. Six responses included athletic trainers guiding the equipment removal process if needed.

One response regarding this question and the incorporation of equipment removal was: “[athletic trainers should] provide any previous medical history and assist with equipment removal as appropriate. We work together for care and destination of the patient.”

Theme 2: EMS Personnel Possess a Lack of Knowledge Regarding the Emergency Care Domain Within Athletic Training Education

Guiding Question 2.What is EMS personnel's knowledge of athletic training? Many studies3–5 and empirical data suggest that EMS personnel and the general public and other health care professionals lack an understanding of athletic training. We sought to answer and discover EMS personnel's general understanding of the athletic training profession and more specifically their understanding of the athletic trainer's education and training in regard to emergency care. Our associated survey questions regarding this guiding question were as follows: In your own words, what is an athletic trainer? What qualifications do athletic trainers have in regard to emergency response and care? What are the roles and responsibilities of an athletic trainer during an athletic emergency?

We found responses concerning knowledge of athletic training: 50 respondents (43%) accurately described one or more of the domains and 36 respondents (31%) showed a general understanding of the profession. Most responses in these categories included words and phrases such as “care and prevention” (58 responses, 50%), “sports injuries” (27 responses, 23%), “medically trained” (8 responses, 7%), and “trained professionals” (6 responses, 5%). One response (EMT-Paramedic) went as far as saying that athletic trainers serve in an “underappreciated role” in the care of athletes. Thirty-four responses fell into two other categories, including personal trainer/training (17 responses, 15%) and a combination of personal training and athletic training, where they stated “helps athletes” (11 responses, 9%), “conditioning” (6 responses, 5%), “train athletes” (< 1%), “keep athletes fit” (< 1%), and other similar responses.

We discovered a resounding lack of understanding of athletic training in the emergency care domain. Responses included statements regarding athletic trainers having general cardiopulmonary resuscitation certification (41 responses, 35%), “unknown,” “dependent on education and certification,” “unsure,” “minimal,” and “I have no clue,” which accounted for 30 responses. In total, this accounts for 71 respondents (61%). Other responses included where the level of emergency training an athletic trainer possesses is due to the amount of experiences he or she has had with emergency care (5 responses, 4%) and athletic trainers should monitor and care for an athlete until EMS personnel arrive.

Specific responses pertaining to emergency training of athletic trainers included: “I do not know, I would hope that they could recognize a ‘real’ emergency condition and do what is necessary to minimize the situation until qualified EMS personnel arrive on scene,” “Unsure of ‘emergency’ response. I would think extensive knowledge in kinetics,” “This varies by individual. Most programs provide for a basic instruction in emergency response and care but other programs and individuals complete further education in this area,” and “The athletic trainer has very good understanding of the injuries that a patient might have knowing the sport etc. . . . Field stuff training level could be up to a Paramedic level but I have seen some [athletic trainers] that have no emergency training.”

Encouraging responses included: “That of a well-educated first responder. It depends on the injury, musculoskeletal, or sporting equipment based, highly trained. Cardiac, allergic reaction, syncopal episodes, etc and support for EMTs.”

Theme 3: Previous Experiences With Athletic Trainers Guide Overall Trust of the Profession

Guiding Question 3.Do EMS personnel trust an athletic trainer during an emergency situation, including management of a cervical spine injury? We had a variety of associated questions related to this guiding question: Have you had interactions with an athletic trainer? If yes, in what context—please explain. Would you trust an athletic trainer to hold c-spine and facilitate the spine boarding of an athlete? Please explain why or why not.

Overall themes that emerged were the experience or lack of experience with athletic trainers guided the trust level of EMS personnel with regard to the profession and with emergency management on the field. We collected encouraging responses (56 of 113 responses, 50%) in regard to athletic trainer/EMS personnel interactions, but also received troubling information (23 of 113 responses, 20%). A positive response was categorized as any answer stating that EMS personnel would work with the athletic trainer. A negative response was categorized as any answer stating EMS personnel would take charge with little or no assistance from an athletic trainer. Of the responses, 30% (34 of 113 responses) were considered neutral because they did not refer to working with an athletic trainer but rather stated they simply follow state protocols.

When asked “Have you had interactions with an athletic trainer? If yes, in what context—please explain,” some positive responses included:

Several times, most often on the football field and in the field of gymnastics. I have always had positive results. The athletic trainer's I have interacted with have always had the patient's best interest at heart and we had a cooperative effort in patient management.

Yes. In my current setting we provide 9-1-1 services to a small urban community with a State University. We provide EMS standby services to the University at various athletic events. We have developed an integral working relationship with the University's athletic trainer Staff. We have integrated training exercises that are scenario based with High Fidelity Simulation Mannequins that allow us to fine tune the integrated response to an injured athlete. Additionally, we use our SIM lab to look for best practice approaches when an integrated response does not go well.

Troubling responses included:

Yes, in emergency settings on the field or court and it is a constant battle of who's in charge of the patient.

Yes, a few bad interactions have soured what should be a great relationship. I've been on scenes with athletic trainers who have refused to allow us to assess open extremity fractures with bleeding and absent distal pulses, prevented us from treating patients who have suffered traumatic brain injuries/seizing.

More detailed responses included:

YES. High School level and College level. We currently have an athletic trainer working for our local high school. However, this relationship is very strained at this time due to miscommunication regarding roles and responsibilities. We have attempted to meet with the athletic trainer to discuss these issues and our offers have been declined.

Indirectly. Grandson was injured in football practice. All athletic trainer did was call parent and didn't recognize concussion or multiple facial fractures. Left child alone to wait on parent. Never examined pt. Father arrived and took pt to the hospital ER. Was immediately admitted for concussion and facial surgery. P.S. Father was EMT and knew what was wrong while athletic trainer couldn't even examine the boy or recognize his serious condition or stay with him till dad arrived. . . .

Further information related to this guiding question of trust were described by one EMT-Paramedic response, which was detailed and echoed the overall thoughts of the responses:

1. Do no harm, 2. Interact with EMS and not against (ie, have them walk it off or walk to sideline and get help), 3. Have a medical file on the sport participant, 4. Have had pre-incident training/planning with EMS to go over roles/responsibilities, 5. Realize that EMS is bound to written protocols that must be followed and if I don't then I need a very good reason why not, and trying to communicate this over a pt on a scene is not the time to try and figure each other out.

Some EMS personnel reported it is dependent on the injury whether or not EMS personnel take the “lead” or the athletic trainer takes the “lead.” Sixty-six responses included words and phrases such as “assess the needs of the patient” and “assess need for EMS personnel” (21 responses, 20%). Some responses included “injury” (26 responses, 22%) and “arrive” (19 responses, 16%), meaning, the athletic trainer should determine what the injury is, call for EMS personnel when warranted, and give care until EMS personnel arrive. These answers account for 99 participants' answers (87%) and included that athletic trainers should hand over care when EMS personnel arrive, communicate what happened, and assist as needed.

In regard to cervical spine stabilization specifically, many EMS personnel voiced concern that their protocols are changing, which may cause confusion, and many answers echo this similarity:

One of the problems we have had is they do not understand or are up to date on our (EMS emergency protocols/procedures), which constantly change. We are required or have to do things different based on our protocols/medical orders. Older athletic trainer's don't understand that. An example is backboarding. No longer do we backboard every patient like we use to. New protocols have come out in the last year that have us back boarding patients a lot less frequently.

Overall, in this category 69% (77 of 111 responses) of EMS personnel stated that they would allow the athletic trainer to hold a cervical spine injury. Respondents cited a positive response to an athletic trainer holding a cervical spine injury based on working with an athletic trainer prior to an emergency situation or that they simply believed an athletic trainer was capable to hold in-line stabilization. Of the responses, 31% (34 of 111 responses) were negative in regard to allowing an athletic trainer to hold a cervical spine injury. Many respondents cited not practicing with an athletic trainer before an emergency, and their lack of understanding of an athletic trainer's training as being reasons why they did not trust an athletic trainer overall. Others mentioned state protocols would not allow them legally to give an athletic trainer authority to hold the cervical spine injury.

Additionally, when broken down by level of certification, EMT-Paramedics showed the most percentage of positive interaction with athletic trainers at 58%. EMT-Advanced showed 52% of responses had positive interactions with athletic trainers, whereas EMT-Basic showed just 37%. Figure 2 shows the positive, negative, and neutral interactions and perceptions of athletic trainers by EMS personnel.

Theme 3: Emergency medical technicians' (EMT) previous experiences with athletic trainers (ATs). EMT-B = EMT-Basic; EMT-P = EMT-Paramedic

Figure 2.

Theme 3: Emergency medical technicians' (EMT) previous experiences with athletic trainers (ATs). EMT-B = EMT-Basic; EMT-P = EMT-Paramedic

Discussion

Theme 1: EMS Protocols Determine How EMS Personnel Respond to and Handle Situations on the Field

Emergency medical personnel agree that communication is necessary in emergency situations. Similar to findings in a quantitative study done by Hardy et al.,14 when EMS is activated EMS personnel will follow specific protocols that dictate how they respond to an emergency situation.14 Conflict arises because athletic trainer protocols, emergency action plans, and standing orders differ from EMS protocols. Interview responses indicate when EMS personnel arrive onto the field their protocols take precedence and they take the lead.

Conflicts may arise because athletic trainers are also taught that in certain instances (eg, cervical spine stabilization) the athletic trainer is at the head and is “in the lead.”9 It is the responsibility of athletic trainers, no matter how long they have been practicing, to stay up to date on best practices and changing protocols for other health care professionals they may have to deal with. Protocols differ and the two professions need to understand each other and what each are being directed to do—this communication is key in avoiding conflict on the field7–9,15 and ensuring the proper care and management of potentially catastrophic injuries.

Theme 2: EMS Personnel Possess a Lack of Knowledge Regarding the Emergency Care Domain Within Athletic Training Education

It has been noted that many health care professionals do not understand the capabilities, education, and training of an athletic trainer.3 When the health care team lacks an understanding of each other's roles and qualifications, increased miscommunication and a greater potential for low quality care and a mishandling of a patient may occur.1 Athletic training as a profession has been working diligently to educate the public on the roles and responsibilities of the profession. It was encouraging to see EMS personnel were able to accurately describe at least one domain or have a general understanding of the profession (74% of responses). Although encouraging, it was evident that EMS personnel's thoughts of the athletic trainer's role and education in the emergency management of injuries was lacking.

The majority of responses (61%) indicated that athletic trainers' knowledge of cardiopulmonary resuscitation was basic, minimal, or unknown. This was concerning, especially because most participants had contact with athletic trainers (84%, 92 of 110). Athletic trainers need to ensure that they are communicating with their EMS personnel and taking simple steps to introduce themselves and gain an understanding for each other's roles in the emergency action plan for their venues. Based on information gathered, athletic trainers and EMS personnel should collaborate to understand each other's professions. During preseason and the off season, it may behoove both professions to meet and review their emergency action plan, and to also discuss their education and training. Although EMS personnel have various levels of training (EMT-Basic through EMT-Paramedic), entry-level education for athletic trainers has been consistently based on Commission on Accreditation of Athletic Training Education accreditation since 2004. This concept is misunderstood by EMS personnel.

Theme 3: Previous Experiences With Athletic Trainers Guide Overall Trust of the Profession

Some of our findings are similar to Biddington et al.'s4 in regard to EMS personnel trusting athletic trainers in their emergency preparedness and effectiveness at handling an emergency situation based on preseason meetings and practice. Hardy et al.14 conducted an online survey finding statistical significance in the level of trust between athletic trainers and EMS personnel. Both parties (athletic trainers and EMS personnel) in fact lacked trust in each other.14 Hosting preseason meetings and reviewing the emergency action plan may also assist with the third overall theme that individual interactions with athletic trainers dictated the trust level of EMS personnel. Those who practiced with athletic trainers had a greater level of trust and understanding of the profession—responses showed that any experience (good or bad) was a driving force for levels of trust. In their responses, many EMS personnel recommended training together, which was positive.

Words and phrases such as “constant battle” and “never allow an athletic trainer to take the lead” are troubling. Individual interactions can dictate overall perception of the profession. Athletic trainers need to be aware of this and must ensure they always conduct themselves professionally, no matter what the situation. It is the professional responsibility of athletic trainers to maintain their education level and knowledge in all domains, including, and arguably most importantly, in emergency care.

Emergencies are the most important situations dealt with in the context of saving someone's life. Athletic trainers must ensure they practice and are comfortable with managing life-threatening situations if they arise. Additionally, because competencies constantly change and new research is published regarding emergency management, athletic trainers need to be aware of both their field's most current research and other health care professionals' most current research. “Protocols” was a frequent answer and many respondents voiced their concern that EMS protocols are changing15–17 and the general athletic trainer population may not be up to date with these protocol changes. “Backboarding” protocols for EMS personnel have recently changed and they do not backboard as often as previously experienced.15,17 On a positive note, some EMS personnel recognized the athletic trainers' ability and knowledge in equipment removal. Time and again throughout the answers we saw examples of communication and how it could lead to positive results, as many studies have recommended.1–5,7,8,18 Although there may be negative interactions between athletic trainers and EMS personnel, athletic trainers can easily take those negative interactions and make them positive. Positive interactions between the two groups were echoed in various responses and showed that state associations and individual athletic trainers can take the lead in collaborating with EMS personnel.

Our research also showed those EMS personnel with more years of experience and higher levels of certification had a more positive outlook on athletic trainers. This leads us to believe that the more education EMS personnel obtain and the more interaction they have with athletic trainers, the better the perception of the athletic trainer profession. Conversely, some limitations may be that EMS personnel with more than 20 years of experience may not understand the changes that have taken place within athletic trainer education. Furthermore, we did not collect demographic information on the number of athletic trainers they interacted with, how long the athletic trainers they interacted with had been practicing, and at what level those athletic trainers obtained their certification (internship vs joint review committee athletic trainer vs Commission on Accreditation of Athletic Training Education).

Implications for Clinical Practice

Our findings suggest more training, communication, and practice can occur between EMS personnel and athletic trainers. We highly recommend that athletic trainers take the time to meet, discuss, and practice their emergency action plan with their local EMS personnel. Athletic trainers can practice with EMS personnel on the field and run through emergency action plans. If this is not feasible, athletic trainers can meet with EMS personnel at their headquarters or meet and discuss the emergency action plan and other protocols with EMS directors who can disseminate the information. Finally, all athletic trainers need to ensure they introduce themselves to attending EMS personnel at games. Emergency personnel and athletic trainers should combine their skills, communicate, and practice together.1,3,5,7,8,18

Courson et al.1 stated “sharing information, training and skills between the ATC and EMT facilitates the delivery of the highest possible quality emergency health care to the athlete (p. 17).” Athletic trainers have the ability to build comprehensive health care teams.19 It is obvious that communication plays a critical role in how emergency situations are handled.2–4 Proper management of an emergency on the field is highly determined by the amount of practice that has occurred3 and EMS personnel in this study and in others1,3–4,7,8,18 welcome communication and regard it as highly critical.

Athletic trainers need to ensure they are upholding professional standards, staying up to date with new competencies, practicing emergency care, and communicating with various health care providers to build a comprehensive medical team. Although EMS personnel work with the entire population and therefore different health care providers, it is the athletic trainer's responsibility to coordinate with EMS officials before an emergency situation arises to ensure the best possible care for the patient.

References

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  8. Swartz EE, Boden BP, Courson RW, et al. National Athletic Trainers' Association position statement: acute management of the cervical spine-injured athlete. J Athl Train. 2009;44:306–331. doi:10.4085/1062-6050-44.3.306 [CrossRef]
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  15. Barishansky RM, Kamin RA. EMS Provider Scope of Practice Expansion: Spinal Motion Restriction. Hartford, CT: Connecticut Department of Public Health; 2014. http://sponsorhospital.org/wp-content/uploads/2013/07/State-of-CT-Spinal-Motion-Restriction-October-2014.pdf.
  16. Wronski EJ. Spinal Protocol, 1st ed. Troy, NY: State of New York Department of Health; 2008. http://www.health.ny.gov/professionals/ems/spinal/docs/spinal_protocol.pdf.
  17. National Association of EMS Physicians, and American College of Surgeons Committee on Trauma. EMS spinal precautions and the use of the long backboard. Prehospital Emergency Care.2013;17.3:392–393. doi:10.3109/10903127.2013.773115 [CrossRef]
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  19. Wham GS Jr, Saunders R, Mensch J. Key factors for providing appropriate medical care in secondary school athletics: athletic training services and budget. J Athl Train. 2010;45:75–86. doi:10.4085/1062-6050-45.1.75 [CrossRef]

Demographic Information

Level of TrainingTotal Number of RespondentsYears of ExperienceResponded to an Athletic Event With AT Present
EMR21 to 10 = 1; 10 to 20 = 0; > 20 = 1Yes = 0; No = 2
EMT Basic271 to 10 = 7; 10 to 20 = 12; > 20 = 8Yes = 21; No = 6
EMT Advanced231 to 10 = 2; 10 to 20 = 7; > 20 = 14Yes = 19; No = 4
EMT Paramedic591 to 10 = 8; 10 to 20 = 18; > 20 = 33Yes = 54; No = 5
Unknown4< 1 = 1; 1 to 10 = 0; 10 to 20 = 1; > 20 = 2Yes = 2; No = 2
Total115< 1 = 1; 1 to 10 = 19; 10 to 20 = 37; > 20 = 58Yes = 96; No = 19

Participant Locations

StateNumber
Montana29
New York22
Pennsylvania19
Connecticut13
Indiana9
New Hampshire7
Massachusetts4
Idaho2
Maine1
Vermont1
Kentucky1
Rhode Island1
California1
New Jersey1
Colorado1
Iowa1
Canada1
Missouri1
Total115
Authors

From Sacred Heart University, Fairfield, Connecticut (ED, JJC); Old Dominion University, Norfolk, Virginia (SHC); and Select Physical Therapy, Stratford, Connecticut (DLJ).

The authors have no financial or proprietary interest in the materials presented herein.

The authors thank Dr. Sarah Benes for her assistance and expertise in creating the survey questions.

Correspondence: Eleni Diakogeorgiou, MBA, ATC, Sacred Heart University, College of Health Professions, 5151 Park Ave., Fairfield, CT 06825. E-mail: diakogeorgioue@sacredheart.edu

Received: February 11, 2016
Accepted: December 08, 2016
Posted Online: April 28, 2017

10.3928/19425864-20170310-01

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