Deb Taylor acted quickly.
When a Glenelg girls basketball player fell to the floor in pain near Reservoir’s bench, Taylor noticed her writhing in pain and grabbing her shoulder. As a practicing physical therapist, Taylor knew her symptoms likely indicated a dislocated shoulder.
Rapid response was necessary at that moment. On Dec. 13, no athletic trainer was on site. Taylor, Reservoir’s varsity coach, intervened immediately and popped the girl’s shoulder back in herself.
Such scenarios are emblematic of a larger issue in Howard County, which is facing a shortage of athletic trainers who ordinarily would be the first to care for an injured student-athlete at a high school sporting event. Because of budgetary issues in one of Maryland’s most affluent counties, there are just seven athletic trainers to care for the thousands of student-athletes among the county’s 13 public high schools.
“That is not acceptable because in any other scenario, potentially 911 is called,” Taylor said. “The kid had clearly dislocated their shoulder before. It went right back in and she actually went back in the game later. That does put [Glenelg coach] David Ebbe in a little bit of a dicey situation because my understanding was the kid said, ‘I’m OK.’ He’s trusting the kid and there’s no one there to evaluate that scenario.”
Each athletic trainer is assigned to a primary and secondary school. Their weekly schedules vary, organized through conversations with athletics and activities managers. Yet with athletic trainers only at some schools once or twice a week, many games and practices are uncovered, putting coaches in a difficult position.
“I do worry about the liability for coaches as well being put in a situation where they’re being asked to make a qualified decision like that with knowledge they don’t possess,” Taylor said. “So, I’m always grateful when we have a qualified trainer in the building and there’s an awful lot in their skill set that isn’t necessarily in mine.”
A trainer’s role
The Howard County Public School System maintains a contractual agreement with PIVOT Physical Therapy for athletic training services. Athletic trainers are only at schools part time. Before they arrive at the schools, they provide clinic hours at PIVOT. They are available immediately after school, conducting rehabilitation in the athletic training rooms and are also available for initial or follow-up evaluations.
“Whether it’s nutrition or offseason workout programs, athletic trainers are very well-rounded and have a multitude of knowledge on a lot of different levels,” PIVOT manager of athletic training services Christy Kingan said. “So, we can be a resource in a lot of different areas.”
When covering games, athletic trainers are prioritized for contact sports and sports with higher injury incident rates, according to Kingan. With many athletic contests happening simultaneously at a school, especially during the busy spring season, this is an ongoing battle for athletic trainers.
Messages left for other county trainers seeking comment were not returned.
In other nearby counties athletic training resources are better utilized. Howard County’s contractual model is outdated causing several trainers to leave recently, which is creating concern among coaches, parents and athletes. Other school systems including Montgomery County, Baltimore County and Baltimore City have athletic trainers as full-time school system employees.
This offers them more financial stability than the current Howard County contractual structure. It also allows athletic trainers to be on-site at schools all day, assisting student-athletes and coaches in a variety of ways.
Montgomery County has 26 athletic trainers, including one trainer at each of the county’s 25 high schools. Shawn Hendi, a 26th certified athletic trainer, serves as the Health and Safety Coordinator for Systemwide Athletics, overseeing athletic training in Montgomery County.
Baltimore County currently has 12 athletic trainers who are BCPS employees and work at a primary school. They also have a secondary assignment, helping to assist at the county’s schools without an athletic trainer, according to the county athletics office.
Meanwhile, Baltimore City has nine athletic trainers providing service, according to Baltimore City Manager of Athletics and Safety Allison Hammond.
Challenges for coaches
Coaches in many sports are challenged by the athletic training shortage. Typically, football, wrestling tri-meets and boys lacrosse games always have an athletic trainer present. However, many other sports do not have the same luxury.
Outside of the mandated care and prevention, CPR, AED, heat-illness and concussion management courses required under the Maryland Code of Regulations, most coaches lack the medical expertise to properly diagnose an injury and its severity. Therefore, many proceed with caution, often keeping athletes out to limit the risk of re-injury, a scenario Howard boys basketball coach Michael Twardowicz faced several times this winter.
In a Jan. 5 game against Wilde Lake, the Lions’ Jamie Delrossa-Freeman landed awkwardly after a 3-pointer and was unable to put any weight on his ankle. Twardowicz grabbed some ice and had him elevate it but couldn’t do much else without an athletic trainer on site.
“I think any coach would tell you that we’re not doctors or medical providers,” Twardowicz said. “My concern is it’s an atom bomb waiting to go off. A lot of these coaches, including myself and being a coach for 25 years in a variety of sports, all it’s going to take is that one incident and it’s probably going to come back down on the coach because the coach didn’t do A, B or C.”
While he had a general idea of the injury, Twardowicz’s concern focused on whether it worsened, trying to balance coaching and the welfare of one of his players.
“Even though I’m sitting there on the bench, I’m looking down at Jamie to make sure he’s not turning completely white,” he said. “I kept on asking him, ‘Is it feeling any different?’ That is just one aspect that is tearing away from me being 100% focused with my kids not having a trainer.”
Athletic trainers’ value extends far beyond injury evaluation. They are vital in an athlete’s rehabilitation process. In many cases, they can clear an athlete to return to competition without visiting an outside doctor and provide rehabilitation exercises to enhance stability and limit injury risk.
Yet, when trainers are only at a school one day a week, developing relationships with athletes and aiding them in their returns can be challenging. The prolonged process can have athletes, coaches and parents feeling frustrated.
“When kids do have injuries and us not having a trainer on-site, the return to play for these scenarios tends to take a lot longer,” Atholton wrestling coach Sidney Billups said. “At that point, they have to go see a doctor to see how well the progress is going with the student, as opposed to having a trainer in the building that can monitor the recovery process. We don’t have that option now. It’s extremely frustrating.”
Potential solution
In January 2023, then-superintendent Dr. Michael Martirano proposed a potential solution. He included a $618,937 addition in his proposed Fiscal Year 2024 operating budget, which would go toward hiring 13 full-time athletic trainers, one at each high school.
“In light of the current events and the absolute necessity of medical attention when an injury is sustained, it is absolutely vital and critical to have trainers at every high school readily available to provide immediate medical attention during practices and athletic contests,” Martirano said while presenting his initial budget proposal to the board of education.”
On Feb. 6, 2023, Howard County Director of Athletics Jack Davis discussed the issue during a BOE work session. Davis explained that with a full-time model, athletic trainers could provide value in multiple ways, including spearheading the required certification of coaches under COMAR at their respective schools. He also referenced the Buffalo Bills athletic training staff’s life-saving quick action when safety Damar Hamlin went into cardiac arrest on the field against the Bengals on Jan. 2, 2023.
“It’s really coming to a head now because we have other school systems that are following the [full-time] model and they’re moving forward with it,” he said during that meeting. “That puts a lot of pressure on the other local school systems in the area to do the same. We’re at a seminal moment here with athletic trainers. We can either fund them now or be scrambling later on. This is the health and safety of our student-athletes.”
In May after the budget process concluded, full-time athletic trainers ultimately weren’t approved.
HCPSS Director of Communications and Engagement Brian W. Bassett told the Howard County Times: “At the conclusion of the budget process, there wasn’t enough funding available for FY 24 to support this and many other priorities by the board.” Davis also deferred to Bassett’s statement.
The situation is unlikely to change soon, according to the 2025 FY budget. On March 7, the Howard County school board unanimously passed a $1.14 billion budget request for FY 25 that will now be sent to the county executive. If adopted, that budget includes cuts for 132 school-based employees and 92 non-school-based positions. It also lists the value of contracted medical services as $556,900, the same as the prior fiscal year.
Concerns for parents
Christy McCauley and Kara Ruddy have a unique perspective on the situation as practicing physical therapists and moms of high school athletes.
For McCauley, the issue is nothing new. A 1991 Mt. Hebron graduate, McCauley twice tried to get athletic trainers into Howard County, proposing it to the BOE her senior year of high school and freshman year of college. In college at Western Maryland (now McDaniel), McCauley worked as a student athletic trainer for three years.
McCauley is now on the other end of the issue as a parent. She’s seen firsthand the impact injuries can have, coaching all three of her daughters in basketball since kindergarten. Her oldest daughter hit her head on the floor during an eighth-grade travel basketball game and was out of school for seven months while recovering from a concussion.
Another one of McCauley’s daughters, Riley Watson, is a junior basketball and soccer player at Howard. Earlier this basketball season, Watson suffered an ankle injury at Wilde Lake. Without a trainer on hand, McCauley taped it for swelling in the first five minutes, giving the immediate care an athletic trainer would ordinarily provide. Since battling that injury, Watson’s been increasingly focused on her mom’s presence at games, uncertain of whether an athletic trainer will be on hand, especially on the road.
Ruddy, whose daughters attend Long Reach, often brought her medical bag to girls soccer games without an athletic trainer at the school most days. She often arrived at games 45 minutes early to tape student-athletes and intervened if a player suffered an injury.
In one game, a Long Reach player had the wind knocked out of her and struggled to breathe. Without an athletic trainer present, Ruddy nearly called 911 before her breathing improved.
Another player injured her knee in Long Reach’s final game of the season. Ruddy could only offer ice and encouragement not to return. Without the proper authorities, she later resumed play and Ruddy learned that she was later diagnosed with a torn ACL.
Her concern doesn’t end there. What if it were a head injury or worse, without an athletic trainer present?
“These kids are aggressive on the field, they’re all different sizes and ages,” Ruddy said. ‘Head trauma and brain injury are nothing to fool around about. That’s my concern if nobody’s there to assess it, keep them out of the game and then tell them to go get medically cleared.”
Booster club presidents and members from each school conducted a video meeting after the initial budget proposal. Several incidents from throughout the county related to athletic training were discussed, according to Wilde Lake booster club president Tracy Hollida.
Hollida’s oldest daughter, now a sophomore at Penn State, benefited from having a full-time athletic trainer when she was at Wilde Lake. She suffered a dislocated patella in high school and the trainer was vital in her recovery process.
“Every parent that I’ve talked to that has kids in athletics seems pretty concerned,” Hollida said. “I have a couple of friends who are in the medical field and people know it. So, they’ll be at games and people will approach them, ‘Can you look at my kid?’ That’s putting pressure on people. It’s not really for them to step in and do that and it’s putting them at risk, too.”
The shortage becomes even more prevalent now during the spring season. Parents say they want to send a county-wide unified message, focused on protecting the health and safety of their children participating in athletics.
“It just seems backward to me,” McCauley said. “I’m just really sad that our county is so far behind when I’m 50 and I was working on this when I was 18 to get trainers and my kids don’t have that access.”