Amid a training wreck

Bay area athletic trainers, where available, tend to be spread thin in terms of time and budget with only a few sports programs benefitting from their attention.

Published May 8, 2007

Sharvettye Frazier was shocked upon first glance at Blake High's athletic training room.

Fifty pounds of roach droppings and eggs covered the once-white walls. Old practice jerseys, a checkerboard and boxes covered the floor.

"It was like nobody had used the room for five years, " Frazier said.

Frazier's theory of neglect rang true. Blake was one of nearly two dozen Hillsborough County schools that operated without a certified athletic trainer, a medically accredited professional proficient in preventing and treating sports injuries.

The Florida Legislature has helped, funding a $3-million program last year through USF's Sports Medicine and Athletic Related Trauma Institute that will place up to 10 athletic trainers, like Frazier, in Hillsborough schools by the fall. But an examination of bay area schools showed the presence of athletic trainers ranges from spotty to nonexistent.

"If you don't have one, it's like playing with fire, " said Dave Bintz, Calvary Christian athletic director and basketball coach. "We just got one this year, and we'll never go without one again."

School districts cite budget crunches for why, in some cases, volunteer chiropractors or coaches can be the first line of defense for treating concussions, cardiac arrest or catastrophic spinal injuries.

The Florida High School Athletic Association doesn't require member schools to employ athletic trainers - just 42 percent of the nation's public high schools have access to one. But to Sen. Dennis Jones R-Seminole, a chiropractor in his 27th year in lawmaking, "it's a priority to me."

With athletic trainer contracts in Pinellas and Pasco counties up for renewal next month, a Times investigation reveals there is room for improvement across the bay area:

- Roughly half of the 26 Hillsborough public schools boast "safety coordinators" who don't meet the state certifications for athletic trainers; they're available primarily for football, county athletic director Lanness Robinson said. One school, King, has no athletic trainer, while a handful of others have volunteers part-time (Tuesdays, Thursdays for a few hours and football Fridays).

- For the six schools on the west side of Pasco County, roughly 10 percent of the nonfootball sporting events are covered by a certified athletic trainer. On the east side, football games are the only guarantees. Ambulances stationed at football games are "on call, " meaning they are gone at the next 911 call.

- Pinellas County Schools have paid more than $250, 000 annually to three hospitals to fund athletic trainers at their public schools for an average of 20 hours per week; a peek at an in-house report, however, shows holes, with schools like Osceola going without a trainer for nearly half the 2005 football season.

- School district administrators in Hernando and Citrus counties said they have no specific policies on athletic trainers.

Minutes matter

Matthew Miulli, 17, had just completed a mile run during a preseason baseball practice at Alonso in 2005 when he sat on the bleachers, saying he could not go any farther.

Then he collapsed.

Miulli's coach and paramedics tried to revive the junior, but it took nearly 30 minutes for an ambulance to arrive. Miulli, who had a pre-existing heart condition, died hours later.

"All I could do was watch the clock to see how much time was going by, " his mother, Kathy Miulli, told the board of commissioners months later, pleading to increase the county's ambulance fleet.

"I watched him 30 minutes on the ground fighting for his life."

Miulli's family sued the Hillsborough County school board and FHSAA for negligence due, in part, to not having an athletic trainer or defibrillator on site; the case is open and FHSAA officials declined comment.

Miulli's death served as an impetus for USF and Hillsborough County receiving the state grant, according to Eric Coris, a SMART founder and member of the FHSAA's Sports and Medicine Advisory Committee.

"Sometimes that initial response is the decider between life and death, " Coris said. "Minutes can make a difference."

The No. 1 cause of death among athletes is cardiac disease. Traumatic head and neck injury is second, and heat illness ranks third, according to NATA.

State law requires each high school to have an Automated External Defibrillator, a portable electronic device that diagnoses and treats potentially life-threatening cardiac problems.

But with athletic trainers a luxury for most schools, it puts coaches in what Northeast cross country and track coach Larry Rudisill calls "a sticky situation." Rudisill, who also has coached football, said he has had players "break legs, fracture arms and pass out, " but feels lucky he has yet to face a life-threatening situation.

"What's the legal ramifications if a coach does something that's not textbook?" Rudisill said. "Everyone, at times, panics. You're trying to do the best you can. Some people make mistakes all the time. Do you do more harm than good?"

'Playing the odds'

The Pasco High parking lot is emptying one March afternoon, but its athletic fields are buzzing.

A tennis match is underway. On the other side of campus, baseball practice begins just as track practice wraps up.

J.R. Titsworth, the school's athletic trainer, pulls up in his pickup around 5 p.m. It is the ninth hour of his typical 12- to 13-hour workday, which starts as Pasco's special education teacher, continues at a nearby nursing home and ends teaching a weightlifting class - or covering an event.

Most trainers in the North Suncoast counties are volunteers from local orthopedic/physical therapy clinics. There's Joel Kennedy from Ewing & Thomas Inc. in New Port Richey, who spends 10-15 hours a week between Gulf and Mitchell, most of which in the fall come on football Fridays (4-11 p.m.).

"It's more of a 'call me if you need me' deal, " Kennedy said.

Kennedy said between west county schools - Hudson, Ridgewood, Gulf and Mitchell - and Land O'Lakes about "10 percent" of nonfootball events are covered by athletic trainers; for practices, the numbers are "less than 10 percent."

Even in Pinellas, where each public school boasts an athletic trainer for an average of 20 hours per week, the nonfootball sports are shortchanged.

According to an in-house report obtained by the Times, athletic trainers at eight north county schools logged a combined 10.5 hours with boys and girls cross country teams from August-November 2006; the hours were less for swimming (four) and more for boys soccer (92). But for football, they combined for nearly 2, 700 hours.

Coris said most would be surprised at the sport with the most injuries nationwide - women's cross country.

"All the officers and EMTs like to watch football, but I've yet to see one at a soccer game, a track meet or even cross country, where there's a good chance of heat exhaustion, " said William Eble, father of Pasco runner and soccer player Leeann Eble.

Eble should know. Leeann collapsed in the woods at a cross country meet last season. With no trainer on site, it took 15 minutes to get help. In a soccer game at Nature Coast, Leeann fractured her fibula, but tried to talk her coach into playing.

"You're playing the odds, " Kennedy said of covering primarily football. "Unless you get 100-percent coverage, you're never where you want to be. The potential problem coming up is that with Pasco growing, you're going to be spread more thin."

Focused on training 'ground troops'

Equally as thin are the budgets at school districts, which makes the idea of mandating each school to place an athletic trainer at every event optimistic, but "unrealistic, " said Denarvise Thornton, liaison for the FHSAA's sports medicine advisory committee.

No state has such a mandate, with the closest being Hawaii; it has a statewide public school system operated by the State Department of Education, which budgets money specifically for athletic trainers that can't be used for anything else.

That doesn't mean Coris isn't shooting high. The USF assistant professor hopes the SMART grant, recurring each year for the next five, soon will become a state-wide model.

For now, he is focused on training the "ground troops." In the past two years, SMART has cycled more than 400 coaches in the Tampa Bay area through a four-hour training course called PREPARE; the program includes emergency preparedness, emergency recognition, heat and cold-related illness, medical conditions in athletes (asthma, diabetes, seizures) and major trauma management.

Pasco and Pinellas county administrators are considering their current plans - Pasco the volunteer agreement with local physical therapy firms, and Pinellas County athletic director Nick Grasso said his membership has been "overwhelmingly satisfied" with their commitment to St. Anthony's, Morton Plant Mease and All Florida Orthopaedic Associates.

"It's a shame that a tragedy has to occur before things can change, " Pasco track coach Michael Penix said.

"What are we waiting for?"

Times staff writer Tim Grant contributed to this report. Joe Smith can be reached at joesmith@sptimes.com or at (727) 893-8129.

What is an athletic trainer?

Certified athletic trainers hold a bachelor's or master's degree with a major in athletic training and are focused on injury prevention, treatment and rehabilitation. Seventy percent hold a master's degree or higher. They are required to pursue continued education to retain their certification.

By the numbers

42 Percent of nation's high schools that have access to certified athletic trainer

12 "Safety coordinators" at Hillsborough County schools who do not meet state certifications for athletic trainers.

10 Percent of nonfootball events in West Pasco that are covered by athletic trainers

500,000 Doctor visits high school athletes account for

$40-billion Cost for pediatric sports injuries per year.