New Study Finds That Student Athletes at More Than Half of All High Schools in California Are at Greater Risk of Injury Due to Lack of Appropriate Care or Unqualifed Personnel Overseeing Their Health and Safety

Despite Second-Highest Number of Student Athletes in the United States California Is the Only State that Does Not Regulate the Athletic Training Profession


Newswise — DALLAS, TX – A study published today in the Journal of Athletic Training, the National Athletic Trainers’ Association’s (NATA) peer-reviewed scientific publication, finds that more than 47 percent of schools in California do not have an athletic trainer (AT), a health care professional who provides preventative services, emergency care, clinical assessment, therapeutic intervention and rehabilitation of injuries and medical conditions, considered to be the gold standard of care according to the sports medicine community. Moreover, 7 percent of schools report that the person filling the role of athletic trainer is an unqualified health personnel (UHP), without Board of Certification Inc. (BOC) certification or with an unknown BOC certification status. 

Currently, in the state of California, any person can represent themselves as an AT and practice in that role as the state does not require certification from the BOC, the nonprofit credentialing organization that establishes the standards of practice and continuing education requirements for ATs. Additionally, the BOC provides oversight mechanisms for investigating, revoking or maintaining credentials, which is vital for the protection of the public.1 California is the only state in the to not regulate athletic training. 

Key Stats

  • More than half (54.6%) of California schools reported that they either did not employ an AT (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7%).
  • Fewer than half of all California high schools use the services of a BOC-qualified athletic trainer (AT).
  • Only 13% of schools reported employing a full-time, year-round AT.
  • ATs in California are more likely to be employed at large public schools with fewer students eligible for the free and reduced-price lunch program.
  • Schools that employed ATs were more likely to be public (50.6%) and less likely to be charter (8.9%). 

“Currently in California, anyone, even if they have zero medical experience, can call themselves an athletic trainer. This should be a major concern to parents,” said NATA President, Tory Lindley, MA, ATC. “Imagine your son or daughter colliding head first with another player while playing basketball or lacrosse. The unexpected blow lands them flat on their back, unable to move. It could be spinal; it could be a concussion or just a hard hit that knocked the wind out of them. Now, imagine there is no qualified medical professional on-site. One wrong decision could leave your child paralyzed forever. That is how serious this is. There is no room in organized sports for this level of risk. Our athletes deserve better.” 

“California has the second-largest number of participants in high school athletics in the nation, so it is especially troubling that over half of the schools do not employ an athletic trainer or choose to employ someone unqualified,” said Eric Post, PhD, ATC, lead author of the study and an assistant professor in the School of Exercise and Nutritional Sciences at San Diego State University. 

Research shows that access to ATs at the secondary school level results in reduced injury rates and improved recognition and management of various sport-related injuries, such as acute musculoskeletal injuries (sprains, strains, breaks, etc.), chronic injuries and concussions. In addition, secondary schools with ATs are more likely to have emergency action plans, heat-illness policies and automated external defibrillators, all of which greatly reduce the risk of catastrophic injury and death among student athletes.

To become a certified athletic trainer, one must graduate with a bachelor’s or master’s degree from an accredited professional athletic training education program and pass a comprehensive test administered by the BOC. Once certified, they must meet ongoing education requirements in order to remain certified. Athletic trainers must also work in collaboration with a physician and within their state practice act.2 

In February, Assemblyman Rob Bonta (D-Alameda) introduced AB-1592 which would prohibit a person from practicing as an athletic trainer or using certain title or terms without being licensed by the California Board of Athletic Training. Under the proposed legislation, all athletic trainers would be required to graduate from an accredited educational program and be BOC certified before registering in the state. The new regulations would more align California’s athletic training professionals with those in the other 49 states and the District of Columbia. It would also allow ATs to travel with and treat athletes and workers out of state without exposure to legal and financial consequences, thus greatly reducing potential barriers to providing health care. 

Additionally, the recently signed into law Assembly Bill 1: California Youth Football Act requires that a licensed medical professional is present during games. Without licensure for athletic trainers, they will not be able to provide care at youth football games, despite having concussion expertise. A study has shown that 94% of concussions in high schools nationally are assessed by an athletic trainer.3 Additionally, ATs provide an unparalleled continuum of care across prevention, assessment and emergency care and rehabilitation, allowing for a safer and more seamless return to play for student athletes.

For more information about athletic trainers, visit nata.org. For more information about licensure for California athletic trainers, visit https://ca-at.org/licensure/

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment, and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 45,000 members of the athletic training profession. For more information, visit www.nata.org.

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1 “BOC.” BOC, https://www.bocatc.org/.

2 “BOC.” BOC, https://www.bocatc.org/.

3 Assessment and management of sport-related concussions in United States high schools. Meehan WP 3rd, d'Hemecourt P, Collins CL, Comstock RD. Am J Sports Med. 2011 Nov;39(11):2304-10. doi: 10.1177/0363546511423503. Epub 2011 Oct 3.

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