Minimizing the inherent risk of participating in interscholastic athletics has been a focus of the NFHS for many years. The education of coaches, players and parents about those risks has proven to be successful through various efforts, such as new sports rules and a free concussion course on www.NFHSLearn.com, among others.
Another aspect of risk minimization is increasing access to appropriate doctors and trainers in an efficient and cost-effective manner. According to a recent study by the Journal of Athletic Training, 70 percent of public secondary schools had access to athletic training services at games or practices, but only 37 percent had full-time services.
Across the country, the growing use of telemedicine to evaluate and treat injured athletes or those suspected of a concussion is providing athletes with access to appropriate health-care professionals, which may not have been feasible or cost-effective before.
The NFHS is currently involved with a pilot telemedicine program in Mississippi. Working with the Mississippi High School Activities Association (MHSAA) and the University of Mississippi Medical Center (UMMC), this program is allowing up to 11 schools to bring concussion testing to football sidelines this fall.
“We’re exploring new ways to help our schools that don’t have full-time trainers get access to medical personnel during games,” MHSAA Executive Director Don Hinton said.
In order to participate in the program, each school must complete consent forms for its athletes and have staff members trained on how to collect baseline information on athletes suspected of having a concussion. Thus far, six schools have completed the required steps and have “gone live.”
UMMC’s Elizabeth Joseph, the program’s project manager, said that even though there hasn’t yet been a request by a school for a telehealth consultation, the schools are excited to be a part of the program.
“These are all rural schools and they have a need for this,” she said. “They see the benefits of having the ability to connect with a board certified physician.”
When a player is suspected of having a concussion, a trained staff member (assistant coach, athletic director, school nurse, etc.) is directed to take the player to a quiet location and collect information using the Sports Concussion Assessment Tool (SCAT). The staff member then requests a consultation through an app on the tablet provided to the school. An on-call physician connects via video with the athlete and makes a diagnosis. The doctor determines that the athlete can return to play; should be removed from play and observed on the sideline; can be released to their parents/guardian; or should be taken to a hospital. The entire process is designed to take about 30 minutes.
“This program has the opportunity to change the way we address concussions,” Joseph said. “Mississippi is a leader in telehealth and that we can deliver these resources to high school athletes is huge.”
The program will run through Mississippi’s state football tournament, but Joseph said the infrastructure is in place to expand it to more sports and connect more rural athletes to qualified physicians.
“The program has started the conversation about different concussion programs statewide,” she said. “We are learning about different efforts to treat concussions. It has the capability of being a game-changer for high school athletics.”
In neighboring Arkansas, the Arkansas Activities Association is working with the University of Arkansas to determine the feasibility of providing telemedicine resources to high school athletes. R.J. Elbin is an assistant professor of exercise science of the Office for Sport Concussion Research at the University of Arkansas, who is exploring expanding his research of concussions through telemedicine.
“In many school communities, there is a shortage of certified athletic trainers and health-care providers,” Elbin said. “The infrastructure of telemedicine is there in the state and we are investigating if high school athletes with concussions can make use of that structure. Not being able to travel can’t be an excuse for not receiving treatment.”
Even in schools where athletic trainers are present, telemedicine is being used to serve their student-athletes beyond concussion treatment. In the Puget Sound Region around Seattle, dozens of high schools are utilizing telemedicine consultations to address athletes’ injuries.
Josh Waltier is the Washington Director of Sports Medicine at ATI Physical Therapy, one company that provides athletic trainers to 24 high schools in the Seattle and Tacoma area. When a state law went into effect this summer requiring telemedicine services to be covered by health plans, it opened the door to provide these services to athletes’ families.
“Physicians, physician assistants and nurse practitioners approached the athletic trainers they work with to determine if telemedicine visits would help improve the access of injured athletes to sports medicine specialists,” Waltier said.
Whereas Mississippi’s program is designed to address possible concussions of injured athletes during games, Waltier said most of the consultations in Washington’s program thus far have occurred after games, the next day or on weekends.
The first step is to set up an appointment and payment with a provider. Next, the athlete or parents download a free app on a smart phone, tablet or computer that provides a secure connection. Once they are in the virtual waiting room, a physician will join via video and to provide consultation. The app also allows doctors to share imaging results or connect multiple specialists on one call.
“Use of technology has created a cost-effective alternative to the traditional face-to-face consultative services that have proven to be much more costly to the system and the patient,” Waltier said. “One example involved an athlete using telemedicine because the father was working out of town that week and would not otherwise been able to take his son to the specialist. The specialist was able to order x-rays immediately and report the results to the parent within one day.”
So far this school year, Waltier said the program has been very successful, with physicians performing four to five telemedicine consultations per day.
“Telemedicine has allowed busy households to tend to healthcare matters remotely without taking off of work or having the student-athlete miss school,” Waltier said. “For the health of the athlete, it has proven much better to see the specialist quickly and begin the rehabilitative process the next day.”
With telemedicine’s appeal of convenience and cost-effectiveness, it is likely to expand to more states and schools, thus providing schools another valuable tool in the ongoing efforts of risk minimization.
Chris Boone is the NFHS assistant director of publications and communications.