Variation in State Policies on Sideline Medical Coverage of High School Athletic Events

Certified athletic trainers (ATs) are the primary source of sideline coverage for high school athletic events, providing an essential role in student-athlete health. However, there is a paucity of literature evaluating the existence of state requirements regarding the presence of ATs and mandatory sideline medical coverage of high school athletic events.

It was hypothesized that there is significant variation among state policies on sideline medical coverage and AT requirements for high school athletic events.

Cross-sectional study.

A 17-question survey was emailed to the executive directors (or analogous position) of the state high school athletic associations for all 50 states and the District of Columbia. The survey was conducted to assess current state regulations regarding the provision of sideline medical coverage for high school athletic events and the employment of ATs in the United States from 2023 to 2024. We also sought to determine if any state based its requirement for sideline medical coverage on the perceived risk of injury. "Risk-independent" referred to a sideline medical coverage mandate irrespective of the perceived risk of injury, whereas "risk dependent" referred to coverage that was provided for those sports with a higher perceived relative risk of injury. We used descriptive statistics and compared states using odds ratios (ORs) and Fisher exact test.

Of the 51 high school athletic associations, 48 responded to the survey. Of the 48 responders, 11 (23%) had sideline coverage mandates: 3 states (6%) had risk-independent sideline coverage mandates, while 8 states (17%) had risk-dependent sideline coverage mandates. Of the 48 responding associations, 37 (77%) had no sideline coverage mandate. No state required the presence of an AT at high school athletic events. On average, states with more high schools were 95% less likely to have mandated sideline coverage than those with fewer high schools (OR, 0.05; 95% CI, 0.00094-0.54; P = .003). Overall, 92% of high schools in the United States are in states without a formal requirement for sideline medical coverage.

This study highlights the widespread absence of state policies mandating sideline medical coverage or the presence of an AT for high school athletic events, which may contribute to disparities in the care and safety of student-athletes. These findings underscore the need for statewide policies to improve access to trained health care professionals, such as ATs, at sporting events, especially for high-risk sports such as football.