Who Gets the Final Say When Athlete Safety Is on the Line?

Several recent stories in college athletics are putting renewed attention on a question Athletic Trainers deal with every day:

When athlete health and competition collide, who gets the final say?

The question has surfaced in very different circumstances.

During a recent Division II football game between Colorado School of Mines and Washburn University, play was stopped with the score tied at the end of regulation after heat conditions reached the conference's safety threshold.

The game had already been moved to a 9:05 a.m. start in an effort to avoid dangerous heat.

It's an example of a difficult decision made considerably simpler by having an established policy: conditions reached the threshold, and competition stopped.

Other recent situations have been far more complicated.

When Something Goes Wrong During Training

Arizona State hockey player Matthew Mayich suffered exertional heat stroke during an outdoor team workout in August and remains hospitalized.

According to published reports cited in a recent opinion column, the workout was attended by Arizona State coaches and Athletic Trainers but led by an individual who was not employed by the university. Arizona State and campus police have been investigating the circumstances surrounding the incident.

There are still questions about exactly what happened, and it's important not to answer them before those investigations do.

But the incident raises questions that can apply to any athletic department.

Who is authorized to lead workouts? Who reviews the workout beforehand? What authority does an Athletic Trainer have to modify or stop it? And when exertional heat stroke is suspected, is the emergency action plan ready to be put into action immediately?

Those aren't questions programs want to begin answering after an emergency occurs.

Medical Decisions Need Medical Authority

A separate controversy has raised another issue familiar to Athletic Trainers.

Six former University of Utah football players have reportedly alleged that they were pressured to play while injured during Kyle Whittingham's tenure as head coach. Whittingham and representatives of Utah and Michigan have denied the allegations.

Regardless of how that dispute is ultimately resolved, the NCAA's position on medical authority is clear.

Its sports medicine guidance calls for an administrative structure that provides independent medical care and gives primary athletics healthcare providers — including Athletic Trainers — autonomous authority over medical management and return-to-play decisions.

There's an important reason for that separation.

A coach's job is to prepare athletes to compete.

An Athletic Trainer's clinical decisions have to be based on the health and safety of the athlete.

Those priorities can coexist, but there also need to be clear boundaries when they don't.

Policies Matter. So Does the Authority to Use Them.

Heat policies, emergency action plans and return-to-play protocols are essential.

But recent events also raise another question: What happens when an Athletic Trainer needs to act on them?

Does everyone know who has the authority to stop activity?

Can an Athletic Trainer modify a workout being led by someone else?

Is the necessary emergency equipment immediately available?

And can an Athletic Trainer make a return-to-play decision without pressure from someone whose priorities may be different?

Those are questions worth answering before there's an athlete on the ground.

For Athletic Trainers, perhaps that's the larger conversation these stories should prompt.

Are your organization's policies simply written down — or does everyone understand who has the authority to act when athlete safety is at stake?