Educator Toolkit
Athletic Trainers

PRINTER-FRIENDLY VERSION

Lessons from Litigation

Athletic Trainers

Facts of the Case

A 16-year-old male athlete, while participating in a routine football practice session was reportedly involved in a collision with another student athlete.  Documentation by the Athletic Trainer reflects following the collision the coaching staff and the athletic trainer “checked him over” and made the decision to dismiss him from the rest of the practice and allowed him to go home. There is no documentation of what the athlete reported he experienced or what if any symptoms he may have reported. There is also, no documented indication the coaching staff or athletic trainer reviewed his health and injury history, knew or were aware of any evidence the athlete may have suffered a concussion, a mild traumatic brain injury or possibly multiple concussive traumas, as a direct result of the reported collision.

The following day the athlete was held out of practice. Again, there is no documentation to reflect what the athlete reported when he arrived at practice, the reasoning behind the decision to keep him from engaging in practice or, that a baseline assessment was conducted.  

The player was then allowed to resume activities with the team on the second day post the reported collision absent a medical clearance. During warm-ups, the athlete complained of headaches and pain to the back of his head.

He was again, dismissed from practice. The coaching staff and athletic trainer did not document an evaluation or assessment following his complaints during the warm-ups. There is no indication in the records that a baseline concussive assessment was conducted or, that a post-concussive protocol was considered. Based on the lack of documentation it appears they were operating under the belief there had not been evidence of a concussion as a result of the collision three days prior.

Also absent was any indication efforts were made to communicate with a parent or legal guardian when the athlete was again dismissed from practice.

Medical Outcome: The athlete collapsed and expired three days after his attempt to return to practice. The medical examiner ruled the death “the result of head trauma while playing football.”

Suit was filed against the County Board of Education, the coaches and the athletic trainer (all employees of the school).

Allegations

• Failure to initiate concussion protocol
• Failure to contact the parents/legal guardians to advise them of a concussion
• Failure to obtain medical clearance by a licensed physician before allowing the athlete to resume practice activities

Defense

The school district based their defense on the fact that neither the coaching staff or the athletic trainer knew, or were aware, of any evidence the athlete may have suffered a concussion (or possibly multiple concussive traumas), as a direct result of the collision.

Conclusion

The case was settled by the school district before trial for an undisclosed amount.

PRINTER-FRIENDLY VERSION

Lessons from Litigation

Athletic Trainers

Facts of the Case

A certified athletic trainer, employed by a University, was responsible for monitoring player’s injuries during practices and games, conducting assessments of the athletes and, initiating referrals to the team physician when an injury was suspected. Additionally, The ATC was responsible for conducting concussion baseline testing of all student-athletes upon their joining the team, as well as, when an injury occurred.

 A paper baseline concussion assessment was completed on a student athlete who joined the football team in the fall of 2011. The assessment was conducted consistent with University protocols and determination was made that the athlete was not at risk for concussions.

Throughout the athlete’s career at the University it is reported that he sustained injuries on four separate occasions within a six-month period.

The ATC’s actions and documentation were evaluated and found to be consistent with University protocols and procedures for each event with a suspicion of concussion or mild traumatic brain injury. Additionally, for each event, concussive tests performed were consistent with policies and procedures and reflected appropriate and timely referral to a physician each time the assessment revealed any suspicion of a concussion.

Medical Outcome

Two years post his career as an athlete at the University, the young man was diagnosed with permanent brain damage requiring care 24 hours per day, seven days per week.

Allegations

• Failure to use objective post-concussion testing on four occasions within a six-month period
• Failure to provide adequate medical treatment (referrals to the physician by the ATC)
• Failure by the University (and their employees) to protect the athlete from further injury by allowing him to continue to play football post concussive events
• Failure by the University (and their employees) to refer the athlete to a neurologist following confirmation of concussive or mild traumatic brain injury

Defense

Defense counsel received favorable reviews from experts who asserted the ATC properly completed an initial paper based assessment and was in compliance with the University’s policies and procedures for all concussion tests performed and physician referrals when findings indicated suspicion of a concussion. 

Conclusion

Defense Counsel’s case evaluation determined the former athlete would make a favorable impression on a jury and that there was potential for a large jury verdict based on the young man’s medical status.

The case was settled for $1.5M, divided equally between the University and the Athletic Trainer. 

PRINTER-FRIENDLY VERSION

Lessons from Litigation

Athletic Trainers

Facts of the Case

An Athletic Trainer employed by a University also served as the Director of Sports Medicine.  In her role as Director, the ATC was required to develop training programs for the various teams.

The women’s soccer team had an off-season training plan that included Stamina runs of 2 miles in twelve minutes or, two miles in twelve minutes with a six-minute rest and then run a third mile in six minutes or less (2-6-1 test) based on their fitness levels. It also included half-mile repeats under three minutes with a two-minute rest repeated to the athlete’s appropriate body level.

When team practice began for the season, the practices were run by the Athletic Trainer Assistant. The team soccer practice regime included a three total mile run comprised of two miles under twelve minutes with a twenty-minute period for rest and hydration, then a third six-minute mile. Cold water was easily available to the athletes for hydration throughout the practice field and the twenty-minute break for rest and hydration was planned due to increased external temperatures, extending the common ten-minute break for every half hour of heavy exercise.

As a student athlete was completing the third mile of her run, she was observed by the Assistant to slightly stumble before collapsing. The ATC also having observed the student’s collapse immediately dialed 911 and followed closely behind the assistant and the athlete into the nearby training facility. The staff quickly soaked the athlete in iced cold water and placed ice bags in her groin, arm pits, on her head and neck and bags of ice on various surfaces of her body in an effort to lower her core temperature, in the absence of an operable ice tub. While policies and procedures were in place and training had been conducted on emergent response and management of suspected Extreme Heat Exhaustion (EHE) and Exertional Heat Stroke (EHS) the ATC failed to assess and monitor the athlete’s core temperature utilizing a rectal thermometer. The EMS response was approximately 12 minutes at which time they emergently transported the young woman to the hospital, where the Emergency Room Physician confirmed the diagnosis of Extreme Heat Stroke.

Medical Outcome

Following emergent treatment and stabilization the young athlete was admitted to the hospital for treatment of heat stroke.  While hospitalized she remained in a comatose state for twenty-three days, and developed additional complications including systemic damage to her vital organs, as well as cardiac and neurologic compromise. She was eventually discharged with permanent injury to her kidneys and residual effects of a Cerebrovascular Accident (CVA) which caused her the loss of function of one side of her body and compromised her cognitive abilities. She requires on going care 24 hours per day and 7 days per week.

Allegations

• The ATC was negligent in allowing the outdoor practice to continue in an excessive heat (with a reported Heat Index above 102 degrees
• ATC was negligent as a result of her failure to modify the running drills
• Failure to properly cool the athlete in an ice bath after she experienced an extreme heat injury
• Failure to use a rectal thermometer to check the athlete’s core body temperature
• The University’s failure to have available a working ice tub
• The University is accountable for the acts of their employees/agents

Defense

The Athletic Trainer appears to have breached the standard of care when responding to an extreme heat injury or stroke

The University appears to bear responsibility for their employees’ actions as well as for the failure to maintain operable equipment required for an emergent response (ice tub).

Commentary

The University has refused to provide a defense for the Athletic Trainer

Outcome