‘It’s worth every penny’: A lack of athletic trainers has area athletic directors rethinking their value to student-athlete safety

  • Kearsarge athletic trainer Molly McDougal wraps the wrist of girls’ lacrosse senior Val Soule. McDougal has worked in this position at the school for more than eight years. Courtesy

  • Athletic trainer Kristal Terpstra prepares an ice pack during a Concord High tennis match at Memorial Field. GEOFF FORESTER / Monitor staff

  • Athletic trainer Kristal Terpstra prepares her cart as the Concord teams gets ready to play at Memorial field in Concord on Thursday, May 4, 2023. GEOFF FORESTER—Monitor staff

  • Athletic trainer Kristal Terpstra prepares her cart as the Concord tennis team gets ready to play at Memorial field in Concord on Thursday, May 4, 2023. GEOFF FORESTER—Monitor staff

Monitor staff
Published: 5/6/2023 2:40:31 PM

Concord High School athletic trainer Kristal Terpstra didn’t even know what an athletic trainer was when she was in high school.

As a student at Lynnville-Sully, a school of under 200 students in rural Iowa, about 50 miles east of Des Moines, she played basketball, ran track and even dabbled in volleyball and softball. But anytime she’d suffer an injury, no one was trained to help her.

“I found out there actually were athletic trainers and that that was a job, and I was like, ‘I want to do that,’” said Terpstra, who started as a full-time athletic trainer at Concord earlier this year.

The scenarios she encountered were in no way unique.

On April 17 in a rainy mist at Houston Field in Hopkinton, the Hawks’ boys lacrosse team took on Kearsarge. In the third quarter, Cougars’ teammates Matt Berns and Broady Roberts collided helmet to helmet; Berns left the game with a concussion and did not return.

But Hopkinton didn’t have an athletic trainer present. In fact, the school has been unable to hire one. And they’re not alone.

Among 15 area schools, at least five (Hopkinton, Concord Christian, Franklin, Pittsfield, Hillsboro-Deering) do not currently list having an athletic trainer, according to the New Hampshire Interscholastic Athletic Association.

Concord only recently brought Terpstra on board after shuffling through part-time trainers for a while; John Stark just hired a full-time trainer after not having one throughout the fall season; the Hawks haven’t had an athletic trainer all school year.

Hopkinton athletic director Dan Meserve said the district had a trainer who worked with athletes last year, but he’s since moved elsewhere. Because the school district sets its budget a year in advance (the 2023-24 budget is already set), they only allocated funding for a part-time contract, expecting the previous trainer to stay on the job.

It’s partly a product of demand outstripping supply: Every school wants someone on site at athletic events, but some, like Hopkinton, don’t have full-time positions. Instead, they rely on contracting with outside organizations that in turn, can’t always provide coverage.

Area schools and the NHIAA emphasize student-athlete safety as a top priority. To reinforce that, schools like Concord, John Stark and Kearsarge have decided to make the athletic trainer a full-time district position. Others haven’t yet gone that route.

For those who have full-time trainers on staff, the benefits speak for themselves.

“All coaches get CPR and first aid training, but athletic trainers have extensive training and extensive hours and clinical hours,” said Kearsarge athletic director Scott Fitzgerald, who’s had Molly McDougal on staff full-time as an athletic trainer for over eight years. “To have someone there who can lead our team through that, you can’t put a price tag on it. As a parent, to have that level of support for our sons and our daughters here, to know that we have someone looking over them is huge.”

‘Someone they knowand trust’

The work of an athletic trainer is a demanding one: crazy hours, multiple games to pay attention to at once and, most importantly, the need to be ready at a moment’s notice for an emergency.

Their duties stretch far beyond just watching events.

If an athlete is injured, they’re first on the scene; if an athlete needs to rehab an injury, they’re coordinating their training; and, for students, having a full-time trainer at the school provides a sense of relief that there’s someone there to help them out.

“When they get hurt, that’s a scary thing,” Fitzgerald said. “(But) all of a sudden, someone they know and trust is there while they’re going through something pretty scary.”

Among the scariest circumstances athletic trainers deal with: concussions, especially in high-contact sports like football, hockey, soccer and lacrosse.

Ask any concussion expert, and they’ll emphasize that first and foremost, athletes who display concussion symptoms need to be removed from competition immediately, like was the case in the Hopkinton-Kearsarge game. The result of a second injury would be far more detrimental. But without an athletic trainer present to make that call, the decision becomes left up to coaches and even referees.

All NHIAA coaches must take the National Federation of State High School Association’s concussion course and have first aid and CPR certification, but having that expert on site only makes for safer and smoother operations.

“The onus of that (decision) is put on people who have no business being the person who makes decisions about it such as the official,” said Dr. Kristine Karlson, director of Dartmouth Health’s Sports Concussion Program and head team physician for Dartmouth College. “Their job is to officiate the contest, not to pay attention to the person who is sort of not behaving right and who has already gone to the sideline.”

Coaches aren’t in the best position to make that decision, either.

“The coach’s motivation is to win the game, and if this is their best player, they’re going to say, ‘You got your bell rung. Get back out there,’” Karlson said. “There’s the role for the athletic trainer, to say, ‘That person’s not behaving correctly. I need to pull them and declare them ineligible for the remainder of the contest.’”

While having that concussion training and first aid certification for coaches is surely valuable – it can never hurt to have too many people trained on how to deal with medical situations at sporting events – having that athletic trainer present removes most likelihoods for something to go wrong.

“A concussion course is two hours whereas I have a master’s, so I did spend seven years having everything thrown at me over and over, and in many different situations and many different iterations,” Terpstra said. “I always like to bring this up, but (Buffalo Bills safety) Damar Hamlin, that’s a very good example. His situation, when I saw it, I knew exactly what had happened. … We can immediately see and just react within seconds instead of minutes.”

Whether it’s head injuries or the rare case of cardiac arrest like what Hamlin suffered in an NFL game in early January, that ability for quick response makes a huge difference.

“We had a cardiac arrest at Kearsarge at one point, and coaches and myself did CPR on a student for 15 minutes and finally got the kid back before the ambulance even arrived,” said McDougal, the Cougars’ athletic trainer. “You think about a school that doesn’t even have an athletic trainer on site, the numbers and the statistics of that kid’s survival drop drastically, and while those situations don’t happen all the time, it’s one of the big reasons why athletic trainers are so important in schools.

“I hope that schools that have open positions or are looking to try and create a position take things like that into consideration and think about the health and safety of their kids.”

‘A much higherlevel of service’

Rodney Brown joined John Stark as athletic director last July after a three-year stint in the same role at Mascoma Valley. The struggles of finding an athletic trainer followed him from Canaan to Weare.

“When I first started (at Mascoma Valley), we had an existing contract with Dartmouth, and (they) actually got back to us, and were like, ‘We just can’t fill our contracts’ because they had a shortage of people in their program.”

This past fall season with no athletic trainer employed at the school, Brown relied heavily on the presence of Weare and Henniker EMS at events, especially football. In the meantime, he called all over looking for support.

“I looked everywhere from southern New Hampshire, northern New Hampshire and even some companies out of Massachusetts to see if they’d do it at a per-diem rate,” he said. “Definitely got the same response back about the fact that they can’t get enough people in the position to fill the things that people are reaching out about.”

The problem transcends school size. From smaller schools like Hopkinton and John Stark up to larger ones like Concord, programs that try the contracting route find it increasingly untenable.

Concord athletic director Steve Mello relied on about five different trainers to provide coverage during the 2022 fall season. The physical therapy company he’d worked with, like so many others, just didn’t have anyone to help them out.

“(They) all told us the same thing: Love to take you on, but we don’t have enough trainers to cover our current obligations,” Mello said. “At some point, we got together and we decided that we needed to create a position here and not contract out anymore.”

That led to the hiring of Terpstra.

“Now that we have somebody here, it allows for a much higher level of service,” Mello said. “There’s some familiarity that Kristal has. If you have tennis elbow dating back to the beginning of March, she knows this, and you can see her for treatment and so forth.

“It’s the difference between having your own doctor and going to a different one every time. They’re all qualified, and all those folks we had were really great, but the familiarity piece adds to a level of comfort and care for our students to have familiarity.”

Why, all of a sudden, are area schools that contracted with outside organizations having such difficulty finding athletic trainers? Two reasons stand out: pay and degree requirements – and they’re interconnected.

In May 2015, the National Athletic Trainers Association announced its decision to elevate the degree level requirement to a master’s degree, requiring additional education to become certified. While the organization cited “the best interests of the profession in mind to ensure a vital place for ATs in the evolving health care arena,” the decision has seemingly had negative ramifications across New Hampshire.

The University of New Hampshire announced that it will cease to offer its Bachelor of Science Athletic Training major after Spring 2023; Plymouth State has a “3+2” program that combines the bachelor’s and master’s degrees into one sequence. This combination of fewer programs and the additional time required to spend in school serves as a disincentive to pursue the profession.

“Some of these jobs are offering $40,000 as a starting pay, but you can get that working at Panera or McDonald’s as well,” McDougal said. “It’s hard to justify getting some of these degrees to be making that kind of money.”

‘It’s unfortunatewe have to do that’

Even for schools that have an athletic trainer, they can only be in so many places at once. Take Concord, for example. On any given day, there could be a basketball game in the Concord High gymnasium and a hockey game at Everett Arena; or in the spring, a softball game at Rollins Park and lacrosse at Memorial Field.

Having that awareness and training from coaches helps keep operations a bit safer.

The NHIAA handbook states that every high school in New Hampshire must have a licensed medical professional at practices and games. They list athletic trainer, board certified sports physical therapist, emergency medical technician, nurse, nurse practitioner, physician and physician assistant as acceptable personnel.

If a school doesn’t have a qualified individual, the NHIAA says that there must be “systems developed to call medical personnel to the site of the athletic event.”

Without an athletic trainer on staff, Hopkinton currently operates under that latter protocol.

Meserve, the Hawks AD, said if it’s warranted, their first step is to call 911. If it’s not a clear emergency, they make sure to hold the athlete out of the remainder of the game. He also reminds visiting coaches that they don’t have an athletic trainer, so they know to be prepared in case something happens.

The open communication across schools serves as a safeguard – though a far-from-ideal one – to ensure that student-athletes receive the medical attention they need.

“All of them will text or call me anytime, and they’ll let me know (about injuries),” said McDougal of the Kearsarge coaches. “It’s unfortunate we have to do that, where we know we’re sending kids somewhere that doesn’t have (an athletic trainer). We always just lean towards asking the coaches to be more cautious.”

‘Worth every penny’

While each school district deals with its own budget and decides locally how much they invest in athletic training, the model Concord, Kearsarge and John Stark have followed to make it a full-time district employee position looks to be the most sustainable long-term solution for everyone: the athletic trainers, the athletic directors and the student-athletes they’re tasked with keeping safe.

From the athletic trainer’s perspective, having that full-time job and financial security trumps the lower wages and lack of reliability of contracting.

“People need to pay the bills,” said Karlson, the Dartmouth physician. “They need to have a job that gets them benefits, they need to be employed, and so it’s hard to find athletic trainers who are willing to be part-timers and then the few that are willing to be part-timers like that, all the demand is at the same time of day.”

And more than anything, it provides peace of mind to all involved. Athletic directors don’t have to scramble to find someone to cover an event, and parents don’t have to worry about their kids not receiving medical attention should an injury occur.

“My personal opinion, and I’m certainly not an expert: I think it’s highly valuable for schools to prioritize a full-time athletic trainer and also prioritize a compensation package that reflects their experience, their training and the significance they bring to the team,” Fitzgerald said. “I think it’s worth every penny that a district would invest in that position and then some.

“And then some.”


ERIC RYNSTON-LOBEL is a sports reporter for the Monitor. He graduated from Northwestern University in June 2022 with a degree in journalism and spent his last two years as sports director for the campus radio station, WNUR, leading coverage for nine different sports. A New York native, he's a diehard Yankees and Giants fan much to the displeasure of most of the newsroom.

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