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Health care in high school athletics in West Virginia.

INTRODUCTION
The purpose of this study was to determine the level of implementation of emergency preparedness procedures and administrative procedures to provide appropriate medical coverage to high school athletics in the predominantly rural US state of West Virginia. Particular attention was given to determine the extent to which the schools provided the recommendations for best practice in the National Athletic Trainers Association consensus statement outlining appropriate medical coverage for high school athletics.


METHODS
A listing of all public schools participating in the state high school athletic association with at least one team participating in interscholastic competition was obtained from the state Department of Education office. An electronic survey was sent to the principal at each high school with instructions that an administrator or sports medicine professional complete the survey. A total of 62 respondents completed the survey (49.6% response rate). Most respondents were principals (92%), followed by athletic administrators (8%). The majority of schools reported a rural zip code at the school level based on the Rural Urban Community Area Codes. Measures assessed the school demographics, including size and rurality. Additional measures assessed the development and implementation of a comprehensive athletic healthcare administrative system, and the development and implementation of a comprehensive emergency action plan.


RESULTS
The majority of respondents reported that there was a consent form on file for student athletes (91%) and comprehensive insurance was required for participation (80%). A third of the respondents (33%) reported that all members of the coaching staff were certified in first aid and cardiac pulmonary resuscitation (CPR) and 31% reported 'never' when asked if all coaches were required to be certified in CPR and first aid. When asked if there was a written emergency action plan (EAP) that outlines procedures to follow in emergency situations during athletic participation, 36% responded 'never' and 38% responded 'always'. When asked about specific limitations for health care to athletes the three main themes identified in qualitative analysis were lack of funding, lack of certified medical personnel, and the inability to locate certified medical personnel in a rural area.


CONCLUSIONS
This study confirmed expected barriers to health care for high school athletes in West Virginia, specifically the lack of funding and resources available to rural schools. In order to prevent a life threatening emergency or possibly sudden cardiac death, preparing and planning for emergencies should be an essential part of high school athletic programs. Rural areas face significant challenges in regards to funding and qualified personnel. Requiring first aid and CPR certification for coaches and requiring an EAP are two steps that could improve the health care provided to athletes. These are inexpensive and achievable steps that could be taken to improve the safety for athletes at high schools in both rural and non-rural areas.